Bisexual Women at Risk

B O S T O N, Oct. 24, 2000 -- Bisexual women are likely to engage in high-risk behaviors that may put them and their female partners in danger of contracting sexually transmitted diseases, a team of Australian researchers reports.

This study of more than 1,400 Australian women found many of them had a history of having sex with multiple male partners and were at a heightened risk for having caught infectious diseases, such as hepatitis C.

Researchers are unclear whether hepatitis C could be transmitted between lesbian couples, but it say it is possible with blood exposure.

Many health-care providers and lesbians have assumed that lesbians are at low risk of contracting sexually transmitted diseases, or STDs, within same-sex partnerships. But research such as the Australian study helps doctors better understand that lesbian women may have slightly different risk factors than was previously believed, and may require different preventive strategies to contain the spread of disease, public health officials say.

The findings also suggest that partners of lesbians may be at a greater risk of acquiring diseases than they assume, although experts say more research needs to be done about the transmission of STDs between female partners to know for sure.

A Down Under Study The Australian study, led by Dr. Katherine Fethers of the Alice Springs Hospital, in Alice Springs, Australia, reported their findings in the current issue of Sexually Transmitted Infections, a specialty journal published by the London-based British Medical Journal.

The study enrolled women ranging from 14 to 78 years of age who attended a public sexual health clinic in Sydney during an eight-year period beginning in 1991. Of the approximately 14,000 women who came to the inner-city clinic, around 10 percent, or 1,408 women, reported having sex with a woman. The researchers matched those up with a group of 1,400 women who reported never having had sex with a woman.

Ninety-three percent of the women who reported having sex with another woman also reporting having sex with men within the past year.

These bisexual women were found to be more likely than strictly heterosexual women to have injected drugs, had sex with homosexual or bisexual men and had more than 50 male sexual partners in their lifetime. They also were more likely to have traded sex for money.

Such behaviors are risk factors for acquiring HIV, which has a low but possible risk of passing to one’s lesbian partner.

Diagnosis: Infected The bisexual women were also at greater risk for being infected with hepatitis B and C, as well as bacterial vaginosis, a treatable bacterial imbalance in the vagina common among lesbians that can cause irritation and odor. Although researchers have found it to be present among a third of lesbian women, it is currently unclear what factors cause the disease to be transmitted between them.

Overall, 44 percent of the bisexual women in the study reported they had had a previous STD such as genital warts, compared with 32 percent of the women who’d only had sex with male partners.

However, despite their high-risk behavior, the bisexual women in this study were not more likely than the heterosexual women to be infected with AIDS, gonorrhea or chlamydia.

Although male homosexual behavior has received much attention because of the AIDS crisis, doctors are finally beginning to open the closet of lesbian sexual health, experts say.

Dr. Jeanne Marrazzo, an infectious disease expert in the department of medicine at the University of Washington in Seattle, is conducting similar research on STDs among lesbian women funded by the National Institutes of Health.

In an accompanying editorial in the journal, Marrazzo says health experts have erroneously assumed all lesbian women were at lower risk for STDs than other groups — generalizations, she writes, that are at best, “disinterested” and at worst, “homophobic and sexist.”

“The assumption is if someone says they’re a lesbian, it means they’ve never had sex with men,” she says. “Many doctors believe these women don’t need STD screening or Pap smears.”

Bisexual Bridge? But the truth, she says, is that these bisexual women may be serving as a “bridge” population, engaging in sexual activity with men who are drug users or homosexual and with exclusively lesbian women who erroneously believe they are at low risk for acquiring STDs.

For example, she says, in the Australian study, only two-thirds of the women were screened for STDs, causing her to question whether they received appropriate care.

Marrazzo recently completed a study that found that even women who partnered with women exclusively had a 19 percent chance of having the human papillomavirus (HPV), a transmissible virus which doctors believe causes the vast majority of cervical cancer. This finding strongly implies a woman can catch the virus directly from her female lover by direct skin-to-skin genital contact or by the hands.

But doctors may not suggest annual screening for the STD for a lesbian woman, even though she could go on to develop cancer if her cervix is not screened with a Pap smear, Marrazzo points out.

“It’s a very damaging misconception,” she says. “You need to take a risk history and not make any assumptions.”

Risks Unknown Dr. Kate O’Hanlan, a gynecological cancer surgeon in Palo Alto, Calif., and founder of the Lesbian Health Fund in San Francisco, says lesbian sexual health is understudied. “My sense is we need so much more research in this area,” she says. “There should be studies that investigate the transmissibility of the various STDs and what safer sex recommendations are useful in the lesbian population.”

In fact, the National Institute of Medicine published a report last year called Lesbian Health: Current Assessment and Directions for the Future, which stated that further research on lesbian health issues was necessary.

But Esther Rothblum, a psychology professor at the University of Vermont and the editor of the Journal of Lesbian Studies, says that the STD risk to lesbian women is exaggerated, and research funding should go towards studying other lesbian issues, such as aging and mental health.

“I think these studies on STDs are out of proportion,” she says, “Compared to men, lesbians are at low risk for any sexually transmitted disease.”

“There’s a sense in the lesbian community that lesbians are understudied,” she adds, “but I wish STDs weren’t what people are focusing on.”