Ask the Experts About LGBT Health
Q: Safer sex between women
I am in an open relationship and I am currently defining the rules and guidelines with my primary and secondary partners. We have all talked openly about STDs and we have been tested and will continue to get tested at least once a year for HPV, HIV, HEP C, and others.
But I would like some clarification on safety risks and concerns to consider. We are trying to decide if latex should be used in every circumstance in which bodily fluids from the genitals might come into contact with a person.
We have all agreed that there will be NO genital on genital rubbing, but is it safe to perform tribadism in which the genitals might come into contact with the thigh or other exposed flesh? In these cases, it is assumed that there is no open sore.
What should we consider as far as touching genitals with our hands? Are latex gloves the only way to go? Or would it be okay to be careful with our hands--say, keep one hand for myself and the other for my partner? Is it safer to touch my partner's genitals in the shower or wash my hands with antibacterial soap immediately before or after?
What are best practices?
A: Response from Dr. Raney
It sounds like you are being very thoughtful and vigilant about keeping you and your partners as safe as possible. Kudos to you! To help you figure out what rules and guidelines to use with your partners, we will try to explain the level of risk, from low to high, for different sexual acts. You and your partners can then decide what risks you are willing to take based on the information available.
In general, STD and HIV risk is highest when the genitals, anus, or mouth comes into contact with bodily fluids. The highest-risk activities include sharing sex toys without a barrier (e.g., condom or dam), oral sex without a barrier during menstruation, despositing vaginal secretions in the vagina or anus, rimming (mouth on anus) without a barrier, and fisting (fist in anus) without a barrier. Medium-risk activities include hand-genital and oral-genital contact without a barrier. Low-risk activities include wet (French) kissing, body-body rubbing (no fluids or skin lesions involved), sharing sex toys using a barrier and hand-genital and hand-anal contact using a barrier. (Source: The Fenway Guide to LGBT Health).
Using latex gloves while touching genitals, or using different hands for yourself and your partner as you suggest are good ways to reduce risk. Thorough and frequent handwashing is always a good idea for prevention of many common viruses and bacterial diseases, but should not be depended on exclusively.
Herpes, syphilis, and HPV can be passed through close skin-to-skin contact during sexual activity, even without direct genital contact. This is because the viruses can be shed from skin near the genitals and anus, as well as the mouth and throat. Also, the virus can be spread without any visible warts or sores (although sores and warts do make a person much more contagious, and sexual contact should be avoided until they clear up). HPV and herpes are very common in all populations and can be transmitted between women. Syphilis is less common among women who have sex with women.
Finally, "open relationships" are riskier than mutually monogamous ones, so greater caution is required when multiple partners are involved.
The website Go Ask Alice has a nice summary of the "best practices" to use for different types of sexual acts. Again, ultimately, the decision of what risks to take is up to you and your partners.
Best of health,
Pat Raney, MD
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Forum Experts
 Harvey J. Makadon, MD is Clinical Professor of Medicine at Harvard Medical School and Director of Education and Training at The Fenway Institute at Fenway Health in Boston. He is a member of the Division of General Medicine at Beth Israel Deaconess Medical Center and is the lead editor of The Fenway Guide to LGBT Health, published by the American College of Physicians in 2007. He has long been involved in developing both educational and clinical programs to serve gay, lesbian, bisexual and transgender populations.  Patricia Raney, MD, is a staff physician at Fenway Health in Boston, Massachusetts. She is a graduate of the University of Massachusetts Medical School and is Board Certified in Family Medicine. Her clinical interests include women's health and wellness, primary care, preventive care and the health concerns of lesbians, bisexual women and transgender people. On a more personal note, she is an avid stone carver. |
