Risks and prevention of sexually transmissible infections among women who have sex with women

Search for Healthcare and Breast/Gynecological Cancer Prevention Among Brazilian Lesbian Cisgender Women

Although breast, cervical, endometrial, and ovarian cancers account for more than 43% of new cases in 2023 in Brazilian women, no national studies were found on the incidence, risk factors, and prevention of breast and gynecological neoplasms in lesbian women, causing the health needs of non-heterosexual women to go unnoticed by professionals. This study aims to identify and analyze the search for healthcare related to the prevention of breast/gynecological cancer among Brazilian lesbian cisgender women who have not had the disease. Seven lesbian women participated in this qualitative study. Semi-structured interviews were conducted and subsequently transcribed and analyzed following the reflexive thematic analysis approach and the theoretical framework of gender studies. Two thematic axes were constructed: gynecological appointments, which includes the subthemes follow-ups, types of exams, and struggles with the healthcare system, and meeting health professionals, which includes relationships with professionals, searching for professionals, discussing sexual orientation, and (un)preparedness. The participants in this study reported visiting a gynecologist at least once and doing preventive exams, although the frequency of these appointments varied for each woman. However, they highlighted that healthcare providers are not adequately prepared to address the needs of lesbian women and to talk about sexual orientation.

Are Gender Identities and Gender Ideologies Associated with the Variety and Type of Owned Sex Toys? Evidence from a Large Italian Sample of Cisgender Individuals

Research on the use of sex toys has been primarily performed from a medical perspective, while there is still limited research from a psychosocial perspective. To bridge this gap, in this study we examined whether some psychosocial variables might be linked to sex toy ownership in a sample of 3960 Italian (cisgender men and women) sex toy buyers. More specifically, we investigated the association between gender identities and ideologies and the variety and types of sex toys owned. Based on the data, we detected two dimensions underlying the ownership of sex toys: (1) orientation to owning kinky sex toys and (2) orientation to owning clit-oriented sex toys. Results showed that benevolent sexism and gender system justification were negatively correlated with owning clit-oriented toys. Moreover, strongly gender-identified participants owned a small variety of different toys and preferred toys that were designed to stimulate the vagina or clitoris over less commonly-used toys. No significant correlation between feminist identification and sex toy type owned was found when gender identification was taken into account. These results suggest that the owning of sex toys might be associated with traditional gender ideology and the strength of gender identification.

Prevalence of Chronic Pelvic Pain by Sexual Orientation in a Large Cohort of Young Women in the United States

BACKGROUND

Sexual minority (lesbian, bisexual, mostly heterosexual) young women face many sexual and reproductive health disparities, but there is scant information on their experiences of chronic pelvic pain, including an absence of information on prevalence, treatment, and outcomes.

AIM

The purpose of this study was to describe the characteristics of chronic pelvic pain experiences of young women by sexual orientation identity and gender of sexual partners.

METHODS

The analytical sample consisted of a nationwide sample of 6,150 U.S. young women (mean age = 23 years) from the Growing Up Today Study who completed cross-sectional questionnaires from 1996 to 2007.

OUTCOMES

Age-adjusted regression analyses were used to examine groups categorized by sexual orientation identity (completely heterosexual [ref.], mostly heterosexual, bisexual, lesbian) and gender of sexual partner (only men [ref.], no partners, both men, and women). We examined differences in lifetime and past-year chronic pelvic pain symptoms, diagnosis, treatment, and quality of life outcomes. Sensitivity analyses also examined the role of pelvic/gynecologic exam history and hormonal contraceptive use as potential effect modifiers.

RESULTS

Around half of all women reported ever experiencing chronic pelvic pain, among whom nearly 90% had past-year chronic pelvic pain. Compared to completely heterosexual women, there was greater risk of lifetime chronic pelvic pain among mostly heterosexual (risk ratio [RR] = 1.30, 95% confidence interval [CI]: 1.22-1.38), bisexual (RR = 1.30, 95% CI: 1.10-1.52), and lesbian (RR = 1.23, 95% CI: 1.00-1.52) young women. Additionally, compared to young women with only past male sexual partners, young women who had both men and women as past sexual partners were more likely to report chronic pelvic pain interfered with their social activities (b = 0.63, 95% CI: 0.25-1.02), work/school (b = 0.55, 95% CI: 0.17-0.93), and sex (b = 0.53, 95% CI: 0.05-1.00).

CLINICAL IMPLICATIONS

Healthcare providers, medical education, and field-wide standards of care should be attentive to the way sexual orientation-based healthcare disparities can manifest into differential prognosis and quality of life outcomes for women with chronic pelvic pain (particularly bisexual women).

STRENGTHS & LIMITATIONS

Our study is the first to examine a variety of chronic pelvic pain outcomes in a nationwide U.S. sample across different outcomes (ie, past-year and lifetime). Though limited by sample homogeneity in terms of age, race, ethnicity, and gender, findings from this article provide foundational insights about chronic pelvic pain experiences of sexual minority young women.

CONCLUSION

Our key finding is that sexual minority women were commonly affected by chronic pelvic pain, and bisexual women face pain-related quality of life disparities. Tabaac AR, Chwa C, Sutter ME, et al. Prevalence of Chronic Pelvic Pain by Sexual Orientation in a Large Cohort of Young Women in the United States. J Sex Med 2022;19:1012-1023.

Human Papillomavirus Infection: Knowledge, Risk Perceptions and Behaviors among SMW and AFAB

Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) in the United States, and persistent HPV infection has been established as playing a major role in the development of cervical cancer. Providing HPV vaccination and regular screening tests have reduced the risk of developing cervical cancer or helped to detect the cancer at an early stage. Despite the above measures, cervical cancer still remains a major public health problem worldwide. Infection with HPV, and consequently cervical cancer, affects all people with an intact cervix, so not only heterosexual women, but also women from sexual minorities (SMW) together with people assigned female at birth (AFAB). These populations may be even more likely to develop cervical cancer, mainly because they are less likely to be aware of HPV transmission and prevention of cervical cancer. In our review, we summarized the current state of HPV knowledge, collected data assessing the orientation of this issue among SMW and AFAB, and indicated the causes of possible negligence in the prevention of cervical cancer.

Perceived HIV Invulnerability and PrEP Knowledge and Attitudes among Black Sexual Minority Women

Black women have disproportionate rates of HIV compared to women of all other racial groups. The purpose of this analysis was to investigate perceived HIV risk, HIV and STI testing behaviors, and PrEP knowledge and attitudes among Black sexual minority women (SMW) and examine differences based on their history of male sex partners. Secondary data analysis was conducted using data from the Generations Study. This analysis used a sample of N=149 participants who identified as Black cisgender women. Results showed Black SMW with a history of male sex partners reported a higher perceived risk of contracting HIV and significantly more frequent HIV and STI testing than those without a history of male sex partners. Overall, most of the sample was not familiar with PrEP, but one-third had favorable attitudes towards it, and half felt like they did not know enough about PrEP to form an opinion. Implications for culturally relevant public health campaigns and comprehensive sexuality education that integrate PrEP are included.

Development and Initial Validation of Three Culturally Sensitive Measures of Intimate Partner Violence for Sexual and Gender Minority Populations

Measures of intimate partner violence (IPV) have largely been developed and validated in heterosexual, cisgender samples, with little attention to whether these measures are culturally appropriate for sexual and gender minority (SGM) populations. However, rates of IPV are two to three times higher among SGM than heterosexual populations, highlighting the importance of culturally appropriate measures of IPV for SGM populations. In this article, after reviewing key problems with the use of existing IPV measures with SGM samples, we describe the development of a toolkit of new and adapted measures of IPV for use with SGM assigned female at birth (SGM-AFAB) populations, including an adapted version of the Conflict Tactics Scale-Revised, an adapted measure of coercive control, and the newly developed SGM-Specific IPV Tactics Measure. Using data from a sample of 352 SGM-AFAB individuals, we then test the psychometric properties of these three measures, including their factor structures, internal reliability, and convergent/divergent validity. Results provide initial evidence of the reliability and validity of each measure. Together, these three measures comprise a culturally appropriate and psychometrically validated measurement toolkit for studying a broad range of IPV tactics among SGM-AFAB that will help build a foundation for more in-depth research into IPV in SGM populations.

A Moderated Mediation Analysis of Condom Negotiation and Sexual Orientation on the Relationship Between Sexual Coercion and Condom Use in Chinese Young Women: Cross-Sectional Study

BACKGROUND

The high prevalence of sexual coercion against young women has become a significant public health issue in China and other regions around the world. Young women are also especially vulnerable to engage in inconsistent condom use because of low sexual control. Although the relationship between sexual coercion and condom use has been widely demonstrated, the mechanism of this relationship is still unclear.

OBJECTIVE

The objective of this study was to test condom negotiation as a mediator of the relationship between sexual coercion and condom use in young Chinese women and to investigate whether sexual orientation is a moderator.

METHODS

Data were collected using web-based questionnaires and a total of 402 young Chinese women were included in the analysis. Sexual coercion was measured using a subscale of the Revised Conflict Tactics Scales and condom negotiation was measured using a subscale of the UCLA Multidimensional Condom Attitudes Scale. Sexual orientation was assessed using an item adopted from a previous study and condom use was calculated by the total number of times condoms were used divided by the total number of times sexual intercourse was engaged in during the past 3 months. Moderated mediation analyses were conducted with sexual coercion as the independent variable, condom use consistency as the dependent variable, condom negotiation as the mediator variable, and sexual orientation as a moderator.

RESULTS

The moderated mediation analysis indicated that the relationship between sexual coercion and condom use was significantly mediated by condom negotiation and moderated by sexual orientation. The indirect effect of condom negotiation was significant in heterosexual women (indirect effect: -0.80, 95% boot CI -1.67 to -0.36) but not in sexual minority women (indirect effect: -0.33, 95% boot CI -0.86 to 0.31).

CONCLUSIONS

The results showed that sexual orientation meaningfully affects the relationship between sexual coercion and condom negotiation. The difference in the mechanism of the relation between sexual coercion and sexual behaviors in heterosexual and sexual minority women should be considered for future research and interventions aimed at mitigating the adverse effects of sexual coercion.

Do we need to worry about sexually transmissible infections (STIs) in older women in Australia? An investigation of STI trends between 2000 and 2018

Background This study examined trends in chlamydia, gonorrhoea and syphilis diagnosis, and chlamydia testing and positivity, among older women in Australia between 2000 and 2018.

METHODS

Using national notifiable disease data and Medicare data, diagnosis rates were calculated for each sexually transmissible infection (STI), as well as testing and positivity rates for chlamydia. Data were compared between two older groups (55-64 and 65-74 years) and two younger groups (15-24 and 25-34 years). Poisson regression examined trends for 2000-18 and 2014-18 separately.

RESULTS

Rates for all STIs increased across all age groups and were highest in the two youngest age groups. From 2014 to 2018, chlamydia rates increased the most among those aged 55-64 years [incidence rate ratio (IRR) = 1.06; 95%CI: 1.02-1.10] and declined in those aged 15-24 years (IRR = 0.99; 95%CI: 0.99-0.99). Gonorrhoea rates increased the most among those aged 65-74 years (IRR = 1.47; 95%CI: 1.23-1.77) and least in those aged 15-24 years (IRR = 1.12; 95%CI: 1.10-1.13). Syphilis rates increased the most among those aged 55-64 years (IRR = 1.58; 95%CI: 1.25-1.99) and least in those aged 15-24 years (IRR = 1.29; 95%CI: 1.23-1.35). Chlamydia test positivity declined among younger women but remained stable in older women.

CONCLUSIONS

In general, STIs are increasing among older women in Australia at a faster rate than among younger women. Although the greatest burden is among younger women, STIs need to be considered and monitored among older women.

[Literature review on studies of women who have sex with women]

Women who have sex with other women are a group that has been mostly invisible from public health policies. This category includes the group of lesbians, bisexual women, heterosexual behaviour, and homosexual practices, who have sexual relations with transsexual and transgender (trans) women and trans men who have sex with women. In the absence of a Spanish literature review of a study that addresses women who have sex with other women, a narrative bibliographic review was done using the PubMed/MEDLINE, Scopus, Dialnet, and Taylor and Francis databases. From a universe of 679 articles and after applying the inclusion criteria, 40 documents were analysed, from 1998 to 2019. Three meta-categories were identified (sexual education, the incidence of certain sexually transmitted infections, and aspects related to sexual practices), concerning prevention and risky behaviours. Women who have sex with other women are a particularly vulnerable group when it comes to sexually transmitted infections. These may include bacterial vaginitis, human papillomavirus and acquired immunodeficiency virus. Likewise, there is a lack of specific training and information in health and education professionals, as well as in women who have sex with other women.

The discursive construction of low-risk to sexually transmitted diseases between women who are sexually active with women

This paper uses a discursive analytical method to explore dominant discourses concerning the sexual health of women who have sex with women. In-depth interviews were conducted with a cross-cultural sample of women from England and Brazil. Sex between women was discursively constructed as 'safe', and women who have sex with women were seen as being at low to negligible risk of contracting/transmitting sexually transmitted infections. Analysis identified two discourses underlying these constructions: a binaries discourse which focused on dichotomies of gender, sexuality and risk; and a sexual double-standard discourse, which focused on the positioning of sex between women as safe and the use of barrier methods of protection as indicative of not engaging in or fully enjoying the sexual act.

Patient-Provider Sexually Transmitted Infection Prevention Communication among Young Adult Sexual Minority Cisgender Women and Nonbinary Assigned Female at Birth Individuals

BACKGROUND

Health care providers are an important source of sexually transmitted infection (STI) prevention information for young adult sexual minority women (SMW). However, very few studies have described patient-provider STI communication in this understudied and underserved population. We explore sexual minority women's experiences communicating with health care providers about sexual health, with particular attention to STI prevention, to inform programs and practices that address their unique needs and concerns.

METHODS

We conducted 29 in-depth interviews with sexual minority cisgender women and nonbinary assigned female at birth (AFAB) individuals aged 18-36 years. The sample included White (55%), Asian (31%), Black (17.2%), and Latina (3.4%) participants. We used thematic analysis with deductive and inductive coding to identify themes related to patient-provider STI prevention communication.

RESULTS

Heteronormative health care provider assumptions inhibited participants' willingness to disclose their sexual orientation and discuss sexual health issues with providers. Most sexual health conversations focused on pregnancy and contraception, which many felt was irrelevant to them, and limited STI prevention recommendations to condom use. Participants reported that some providers lacked medical knowledge on AFAB-to-AFAB STI transmission and were not able to provide relevant STI prevention information. Providers' bias related to gender identity and race/ethnicity furthered some participants' mistrust generated from providers' heteronormative assumptions.

CONCLUSIONS

Our study describes several barriers that AFAB sexual minorities felt inhibited their patient-provider sexual health communication. Interventions are needed to improve patient-provider STI prevention conversations with AFAB sexual minorities so they can access the sexual health information they need to effectively protect themselves from STIs.

Human Papillomavirus Risk Perceptions Among Young Adult Sexual Minority Cisgender Women and Nonbinary Individuals Assigned Female at Birth

CONTEXT

Some sexual minority women may be less likely than other women to engage in human papillomavirus (HPV) prevention behaviors. Although risk perceptions have been found to be associated with health behaviors, HPV risk perceptions among U.S. sexual minority women have not been examined.

METHODS

In 2016-2017, in-depth interviews were conducted in Boston with 29 sexual minority individuals aged 18-36 who were assigned female at birth (AFAB) and identified as women or nonbinary. Purposive sampling was used to recruit participants online, through community-based and student organizations, and by word of mouth. Thematic analysis was employed to examine participants' HPV risk perceptions.

RESULTS

Participants incorrectly linked HPV risk to the exchange of genital fluids, and a hierarchy of perceived risk emerged in relation to sexual orientation: Individuals who engage in penile-vaginal sex with partners who were assigned male at birth (AMAB) were perceived to be at highest risk, and lesbians and individuals with only AFAB partners were perceived to be at low risk. Lesbians and participants with only AFAB partners identified sex with bisexual women or AFAB individuals with AMAB partners as a risk factor for HPV infection. Risk perceptions were shaped by health care providers' linking HPV risk to sex with AMAB individuals, a lack of discussion of HPV with parents and peers, and the exclusion of information on HPV and sexual minority women from school-based sex education.

CONCLUSION

Interventions providing sexual minority AFAB individuals with comprehensive, accurate and tailored information about HPV risk are needed.

Impact of social factors and sexual behaviors on the knowledge of sexually transmitted infections among women who have sex with women/women who have sex with women and men

Although heterosexual individuals' knowledge of sexually transmitted infections (STIs) has been examined, no studies have been conducted in Poland of the STI knowledge in women who have sex with women (WSW) and women who have sex with women and men (WSWM). We enrolled a group of 146 WSW and 113 WSWM and asked them to complete a study questionnaire that contained items about socioeconomic factors, sexual behaviors, and STI knowledge. The level of STI knowledge among the studied WSW was insufficient. The frequency of correct answers was higher in WSWM. A multivariate regression model revealed that only the higher importance of sex to the respondents ( F(1) = 4.31, p = 0.04) and a higher number of same-sex sexual partners within the last 12 months ( F(1) = 14.86, p = 0.0001) influenced the level of STI knowledge. The results of the study allowed us to conclude that WSW have insufficient STI knowledge, whereas WSWM have better knowledge, and this is influenced by awareness that STI risk is not associated with the partner's gender, age, importance of sex, sexual behaviors, and openness to discussing STIs with a sexual partner.

Human Papillomavirus Vaccination Initiation Among Sexual Orientation Identity and Racial/Ethnic Subgroups of Black and White U.S. Women and Girls: An Intersectional Analysis

INTRODUCTION

Human papillomavirus (HPV) vaccination, which is recommended for U.S. women and girls aged 11-26 years, effectively prevents cervical cancer. Researchers have identified HPV vaccination disparities among groups of women and girls defined in relation to sexual orientation identity or race/ethnicity. However, no study has used an intersectional approach to ascertain HPV vaccine uptake among sexual orientation identity and racial/ethnic subgroups of U.S. women and girls.

METHODS

Using 2011-2015 National Survey of Family Growth data, we used multivariable logistic regression to estimate differences in the odds of HPV vaccination initiation (i.e., ≥ one dose) across sexual orientation identity and racial/ethnic subgroups of black and white U.S. women aged 15-24 years (N = 2,413), adjusting for demographic factors. We also assessed whether socioeconomic and health care factors helped explain observed disparities.

RESULTS

The overall prevalence of HPV vaccination initiation was 47.7%. Compared to white heterosexual women, black lesbians (odds ratio [OR] = 0.16; 95% confidence interval [95% CI]: 0.06-0.46) had the lowest adjusted odds of HPV vaccination initiation, followed by white lesbians (OR = 0.33; 95% CI: 0.13-0.82) and black heterosexual women (OR = 0.63; 0.47-0.85). Including socioeconomic factors in the model only slightly attenuated the HPV vaccination initiation odds ratios for black lesbians (OR = 0.19; 95% CI: 0.06-0.56), white lesbians (OR = 0.37; 95% CI: 0.15-0.90), and black heterosexual women (OR = 0.70; 95% CI: 0.52-0.93) compared to white heterosexual women. Adding health care factors only slightly additionally attenuated the odds ratio comparing black lesbians and white heterosexual women (OR = 0.21; 95% CI: 0.07-0.67).

CONCLUSIONS

Our findings identified black lesbians as a particularly underserved subgroup and suggest that sexual orientation identity and race/ethnicity may have a compounding effect on HPV vaccination initiation among black and white U.S. women and girls. Evidence-based interventions that are adapted to the specific needs and experiences of black lesbians and other multiply marginalized groups are needed to promote equity in HPV-related outcomes.

[Barriers to sexual health care in Argentina: perception of women who have sex with women]

Objective The objective is to describe the barriers to sexual health care of Women Who Have Sex with Women (WSW) in Argentina during 2013. Methods A cross-sectional, descriptive and quantitative study. An online survey was conducted using the Internet, in the period of April-July 2013, with homosexual and bisexual women over 18 living in Argentina, making use of the snowball methodology. Results A total of 161 women were surveyed. The results showed that 97.5 % had previously visited a doctor. The doctor did not ask about their sexual orientation in 82.8 % of cases. 93.6 % of the surveyed did not receive information about STDs; 83.8 % perceive little/no risk regarding STDs. 48.4 % are unaware of the methods of protection of STDs among women and 51.6 % obtained this information from websites and friends. 77.5 % reported not using protection methods. The main reasons were: stable partner, discomfort and the inability to acquire them. Discussion The results of this research allow for identifying the low perception among WSW regarding STDs, and the difficulty of approaching health professionals about this subject.

A cross-sectional survey of sex toy use, characteristics of sex toy use hygiene behaviours, and vulvovaginal health outcomes in Canada

Researchers' interest in the use of sex toys has increased in the past 10 years as products become more accepted in mainstream media, and incorporated into individuals' sexual scripts. Though researchers and health educators have emphasized the importance of sex toy use hygiene behaviours, few studies have addressed the extent to which individuals are sharing, cleaning and covering their sex toys. The current research examined 1) the prevalence, frequency, predictors, and types of sex toys use/used, 2) the prevalence/frequency of sex toy use hygiene behaviours (e.g., cleaning, sharing, covering) and 3) whether sex toy use hygiene behaviours were related to vulvovaginal health outcomes among a sample of Canadian participants. As part of a larger survey examining genital health and hygiene practices, 1435 participants across Canada completed an anonymous online survey. Prevalence of sex toy use was 52.3%. Sex toys users were more likely to report a bisexual, lesbian, queer or questioning identity and were more likely to report engaging in additional partnered sexual activities such as oral and anal sex. Participants used a wide variety of sex toys including vibrators, butt plugs, BDSM toys, and household items. Most participants indicated that they cleaned their sex toys regularly using soap and water and 21.7% reported sharing their sex toy(s) with a partner. Sex toy use is common among Canadian women and individuals report using a variety of sexual enhancement products. Implications for educators and medical practitioners working with sexually active clients are also discussed.

Addressing Health Care Disparities Among Sexual Minorities

There is evidence of health disparities between sexual minority and heterosexual populations. Although the focus of lesbian, gay, bisexual, and transgender health research has been human immunodeficiency virus/acquired immunodeficiency syndrome and sexually transmitted infection among men who have sex with men, there are health disparities among sexual minority women. Using the minority stress framework, these disparities may in part be caused by individual prejudice, social stigma, and discrimination. To ensure equitable health for all, there is urgent need for targeted culturally sensitive health promotion, cultural sensitivity training for health care providers, and intervention-focused research.

Girl Power or Powerless Girl? Television, Sexual Scripts, and Sexual Agency in Sexually Active Young Women

Both traditional gender roles and traditional heterosexual scripts outline sexual roles for women that center on sexual passivity, prioritizing others’ needs, and self-silencing. Acceptance of these roles is associated with diminished sexual agency. Because mainstream media are a prominent source of traditional gender portrayals, we hypothesized that media use would be associated with diminished sexual agency for women, as a consequence of the traditional sexual roles conveyed. We modeled the relations among television (TV) use, acceptance of gendered sexual scripts, and sexual agency (sexual assertiveness, condom use self-efficacy, and sexual shame) in 415 sexually active undergraduate women. As expected, both TV exposure and perceived realism of TV content were associated with greater endorsement of gendered sexual scripts, which in turn were associated with lower sexual agency. Endorsement of gendered sexual scripts fully mediated the relation between TV use and sexual agency. Results suggest that endorsement of traditional gender roles and sexual scripts may be an important predictor of college women’s sexual agency. Interventions targeting women’s sexual health should focus on encouraging media literacy and dismantling gender stereotypic heterosexual scripts. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index .

Sexual orientation and sexual health services utilization among women in the United States

Although sexual minority women are at risk of sexually transmitted infections (STIs) and cervical cancer, few nationally representative studies have assessed sexual orientation disparities in sexual health care among women. Using data from the 2011-2013 and 2013-2015 waves of the National Survey of Family Growth, which provide a national probability sample of U.S. women aged 15-44years (N=11,300), we used multivariable logistic regression to examine the associations between sexual behavior and sexual identity (modeled separately) and STI testing in the past year, Pap test use in the last 3years, lifetime HIV testing, and lifetime human papillomavirus (HPV) testing. Women with male and female lifetime sexual partners had higher adjusted odds of being tested for STIs ([odds ratio:] 1.61; [95% confidence interval:] 1.37-1.89), HIV (1.66; 1.29-2.14), and HPV (1.79; 1.41-2.25) and similar adjusted odds of obtaining a Pap test (0.98; 0.76-1.27) than women with only male lifetime sexual partners. Self-identified bisexual women had higher adjusted odds of obtaining an STI (1.43; 1.10-1.86) and HIV (1.69; 1.24-2.30) test but lower adjusted odds of obtaining a Pap test in the last 3years (0.66; 0.47-0.93) than heterosexual-identified women. Women with only female lifetime sexual partners had lower adjusted odds of receiving an STI (0.14; 0.07-0.28) and Pap (0.10; 0.03-0.27) test than women with only male lifetime sexual partners. Results comparing self-identified lesbian and heterosexual women were similar. Health care facilities should monitor and address sexual orientation disparities in women's sexual health care and ensure the provision of high-quality sexual health services to all women.

Sexual orientation identity disparities in human papillomavirus vaccination initiation and completion among young adult US women and men

PURPOSE

To examine the association between sexual orientation identity and human papillomavirus (HPV) vaccination initiation and completion among both women and men.

METHODS

Using data from the 2013 and 2014 National Health Interview Survey, we estimated logistic regression models for the association between sexual orientation identity and HPV vaccination initiation (≥1 dose) and completion (≥3 doses) among US women and men in relation to sociodemographic and healthcare factors. Analyses were restricted to individuals for whom the HPV vaccine was recommended at some point in their lives, namely women aged 18-34 years (n = 9,734) and men aged 18-31 years (n = 6,812).

RESULTS

Among all women, bisexual women had higher adjusted odds of HPV vaccination initiation [(odds ratio) 1.71; (95 % confidence interval) 1.20-2.45] and completion (1.59; 1.05-2.42) than heterosexual women. No difference was observed in the odds of HPV vaccination initiation or completion between lesbian and heterosexual women. Among women who had initiated HPV vaccination, lesbians had lower adjusted odds of completion than heterosexual women (0.41; 0.19-0.90). Among all men, gay men had higher adjusted odds of initiating (2.07; 1.17-3.52) and completing (3.90; 1.68-9.06) HPV vaccination than heterosexual men. No difference was observed in the odds of HPV vaccination initiation or completion between bisexual and heterosexual men. Among men who had initiated HPV vaccination, gay (4.36; 1.28-14.83) and bisexual (20.92; 2.34-186.73) men had higher adjusted odds of completion than heterosexual men, although these results are unreliable and should be interpreted with caution.

CONCLUSIONS

Interventions are needed to promote HPV vaccination among all US women and men, regardless of sexual orientation identity.

Sexual orientation and its impact on sexual behaviour of young people aged 15-29: a cross-sectional study

AIMS

The aim of this study was to determine whether there was a direct relation between sexual orientation and sexual practices involving penetration; to analyse whether condom use in the first sexual relation was conditioned by sexual orientation; to verify whether consistent condom use in sexual relations was determined by sexual orientation.

BACKGROUND

Recent research suggests that sexual orientation (i.e. heterosexuality, homosexuality or bisexuality) is a determining factor in high-risk sexual behaviour.

DESIGN

A cross-sectional study with purposive sampling.

METHODS

Data were collected between March 2013-April 2014 from 900 participants (524 males and 376 females). All participants were 15-29 years of age. Their mean age was 20·93 years. The participants were given a socio-demographic survey as well as a psychometric test on high-risk sexual behaviour, which had been used in previous studies.

RESULTS

There were no statistically significant differences in relation to sexual orientation and sexual practices involving penetration either in the general model for both sexes or in the models for men and women. It was also found that sexual orientation did not significantly affect condom use in the first sexual relation. Furthermore, consistent condom use had a protector effect in the general model for homosexuals and bisexuals. In the model for men, this was also true for homosexuals and in the model for women, this was the case for bisexuals.

CONCLUSION

Condom use in the first sexual relation was similar in all sexual orientations. However, the sexual orientation of the subject was found to be a determining factor in consistent condom use.

The Behavioral Definitions of "Having Sex With a Man" and "Having Sex With a Woman" Identified by Women Who Have Engaged in Sexual Activity With Both Men and Women

A sizable minority of women report lifetime sexual behavior with both men and women. In the present study, a multinational sample of women who reported genital contact with at least one man and one woman in their lifetime (N = 2,751) were asked to provide their behavioral definitions of "having sex with a woman" and "having sex with a man." Replicating previous research, participants were asked "Would you say you 'had sex' with a woman/man if the most intimate behavior you engaged in with her/him was …" followed by a list of behaviors that differed based on the hypothetical partner gender. While most participants indicated that they would consider "having had sex" if they engaged in a variety of behaviors, behaviors involving genital contact were most often included within the participants' definitions of having sex, regardless of partner gender. The percentage of behaviors included in the participants' definitions of having sex with a woman (M = 59.40%, SD = 20.77%) was higher than the percentage of behaviors included in their definition of having sex with a man (M = 37.26%, SD = 28.97%). Broadening our understanding of "having sex" for individuals with diverse sexual experiences may have important implications for clinicians and researchers.

Sex of Sexual Partners and Human Papillomavirus Vaccination Among U.S. Girls and Women

INTRODUCTION

Girls and women are at risk of human papillomavirus (HPV) infection and cervical cancer from male and female sexual partners throughout the life course. However, no study has assessed how sex of sexual partners, a dimension of sexual orientation, may relate to HPV vaccination among girls and women.

METHODS

In 2014, data from the 2006-2010 National Survey of Family Growth were used to conduct logistic regression analyses estimating the relationship between sex of lifetime and past-year sexual partners and HPV vaccine awareness and initiation among U.S. girls and women aged 15-25 years (N=3,253).

RESULTS

Among U.S. girls and women aged 15-25 years, the prevalence of HPV vaccine awareness and HPV vaccine initiation was 84.4% and 28.5%, respectively. Adjusting for sociodemographic factors, participants with only female past-year sexual partners had significantly lower odds of initiating HPV vaccination relative to those with only male past-year sexual partners (OR=0.16, 95% CI=0.05, 0.55). Similarly, respondents with no lifetime (OR=0.65, 95% CI=0.46, 0.92) or past-year (OR=0.69, 95% CI=0.50, 0.94) sexual partners had significantly lower adjusted odds of HPV vaccine initiation compared with those with only male sexual partners. No difference was apparent in the odds of initiating HPV vaccination between participants with male and female sexual partners and those with only male sexual partners.

CONCLUSIONS

Medical and public health professionals should ensure that girls and women with only female or no sexual partners are included in HPV vaccine education and promotion efforts.

SCREENING FOR SEXUALLY TRANSMITTED INFECTIONS (STIs) AMONG A HETEROGENEOUS GROUP OF WSW(M)

OBJECTIVES

This study explored predictors of STI screening among a heterogeneous group of women who have sex with women and men.

METHODS

Following bivariate analyses, a multivariate logistic regression model was conducted to assess the relationship between testing and sociodemographic, relationship characteristics.

RESULTS

The majority of participants reported not receiving STI screening in the past year. Gender expression, and not sexual orientation, was a significant predictor of screening. For each increase in masculinity, participants had lower odds of receiving an STI test.

CONCLUSIONS

More research is needed to understand how gender expression of WSW(M) relates to preventative health behaviors.

Sexual Orientation Identity Disparities in Awareness and Initiation of the Human Papillomavirus Vaccine Among U.S. Women and Girls: A National Survey

BACKGROUND

Lesbians and bisexual women are at risk for human papillomavirus (HPV) infection from female and male sexual partners.

OBJECTIVE

To examine the association between sexual orientation identity and HPV vaccination among U.S. women and girls.

DESIGN

Cross-sectional, using 2006-2010 National Survey of Family Growth data.

SETTING

U.S. civilian noninstitutionalized population.

PARTICIPANTS

The 2006-2010 National Survey of Family Growth used stratified cluster sampling to establish a national probability sample of 12,279 U.S. women and girls aged 15 to 44 years. Analyses were restricted to 3253 women and girls aged 15 to 25 years who were asked about HPV vaccination.

MEASUREMENTS

Multivariable logistic regression was used to obtain prevalence estimates of HPV vaccine awareness and initiation adjusted for sociodemographic and health care factors for each sexual orientation identity group.

RESULTS

Among U.S. women and girls aged 15 to 25 years, 84.4% reported having heard of the HPV vaccine; of these, 28.5% had initiated HPV vaccination. The adjusted prevalence of vaccine awareness was similar among heterosexual, bisexual, and lesbian respondents. After adjustment for covariates, 8.5% (P = 0.007) of lesbians and 33.2% (P = 0.33) of bisexual women and girls who had heard of the vaccine had initiated vaccination compared with 28.4% of their heterosexual counterparts.

LIMITATION

Self-reported, cross-sectional data, and findings may not be generalizable to periods after 2006 to 2010 or all U.S. lesbians aged 15 to 25 years (because of the small sample size for this group).

CONCLUSION

Adolescent and young adult lesbians may be less likely to initiate HPV vaccination than their heterosexual counterparts. Programs should facilitate access to HPV vaccination services among young lesbians.

PRIMARY FUNDING SOURCE

National Cancer Institute.

Women Who Have Sex with Women Living in Low- and Middle-Income Countries: A Systematic Review of Sexual Health and Risk Behaviors

Women who have sex with women (WSW) have long been considered at low risk of acquiring and transmitting HIV and other sexually transmitted infections (STIs). However, limited research has been conducted on WSW, especially those living in low-and middle-income countries (LMICs). We reviewed available research on sexual health and risk behaviors of WSW in LMICs. We searched CINAHL, Embase, and PubMed for studies of WSW in LMICs published between January 1, 1980, and December 31, 2013. Studies of any design and subject area that had at least two WSW participants were included. Data extraction was performed to report quantifiable WSW-specific results related to sexual health and risk behaviors, and key findings of all other studies on WSW in LMICs. Of 652 identified studies, 56 studies from 22 countries met inclusion criteria. Reported HIV prevalence among WSW ranged from 0% in East Asia and Pacific and 0%-2.9% in Latin America and the Caribbean to 7.7%-9.6% in Sub-Saharan Africa. Other regions did not report WSW HIV prevalence. Overall, many WSW reported risky sexual behaviors, including sex with men, men who have sex with men (MSM), and HIV-infected partners; transactional sex; and substance abuse. WSW are at risk for contracting HIV and STIs. While the number of research studies on WSW in LMICs continues to increase, data to address WSW sexual health needs remain limited.

Healthcare experiences of lesbian and bisexual women in Cape Town, South Africa

Understanding the health needs and experiences of South African lesbian and bisexual women is imperative for implementing effective and inclusive public health strategies. Such understanding, however, is limited due to the exclusion of these women from most existing research on healthcare access in the region. This paper bridges that gap by investigating the healthcare experiences of lesbian and bisexual women in Cape Town. Data were gathered from 22 interviews with self-identified lesbian and bisexual community members and university students in the Cape Town area. Interviews explored obstacles women face in accessing affirming services, different experiences with public and private healthcare, fear of stigma/discrimination, availability of relevant sexual health information and suggestions to improve existing programmes. Findings suggest that South African lesbians and bisexual women may have a range of both positive and negative experiences in public and private health services, that they use protective strategies when 'coming out' and that they find that sexual health information pertinent to them is largely unavailable. These discussions contribute to a more inclusive understanding of the experiences of lesbian and bisexual women accessing healthcare and other services and help to inform providers, thereby enabling them to deliver more meaningful care to lesbian, gay, bisexual and transgender persons in South Africa.

Factors associated with participation and attrition in a longitudinal study of bacterial vaginosis in Australian women who have sex with women

Objective

A number of social and sexual risk factors for bacterial vaginosis (BV) have been described. It is important to understand whether these factors are associated with non-participation or attrition of participants from longitudinal studies in order to examine potential for recruitment or attrition bias. We describe factors associated with participation and attrition in a 24-month prospective cohort study, investigating incident BV among Australian women who have sex with women.

Study Design and Setting

Participants negative for prevalent BV were offered enrolment in a longitudinal cohort study. Participants self-collected vaginal samples and completed questionnaires 3-monthly to endpoint (BV-positive/BV-negative by 24 months). Factors associated with participation in the cohort study were examined by logistic regression and factors associated with attrition from the cohort were examined by Cox regression.

Results

The cross-sectional study recruited 457 women. 334 BV-negative women were eligible for the cohort and 298 (89%, 95%CI 85, 92) enrolled. Lower educational levels (aOR 2.72, 95%CI 1.09, 6.83), smoking (aOR 2.44, 95%CI 1.13, 5.27), past BV symptoms (aOR 3.42, 95%CI 1.16, 10.10) and prior genital warts (aOR 2.71, 95%CI 1.14, 6.46) were associated with non-participation; a partner co-enrolling increased participation (aOR 3.73, 95%CI 1.43, 9.70). 248 participants (83%, 95%CI 78, 87) were retained to study endpoint (BV-negative at 24 months or BV-positive at any stage). Attrition was associated being <30 yrs (aHR 2.15, 95%CI 1.13, 4.10) and a male partner at enrolment (aHR 6.12, 95%CI 1.99, 18.82).

Conclusion

We achieved high participation and retention levels in a prospective cohort study and report factors influencing participation and retention of participants over a 24-month study period, which will assist in the design and implementation of future cohort studies in sexual health and disease.

Lesbians on Medical Encounters: Tales of Heteronormativity, Deception, and Expectations

The experiences of lesbian women in medical encounters prove particularly relevant for understanding their difficulties in their relationship with professionals and health services. We carried out semistructured interviews with 30 women aged 21 to 63 years, who define themselves as lesbian. The analysis highlights the difficulties experienced in disclosure of sexuality in medical encounters, the tendency for doctors to come across as heteronormative, and also medical practices experienced as appropriate by interviewees. Analysis of participant experiences demonstrates the need for reflection and decision making to promote the recognition of the sexual citizenship of lesbian women and their empowerment.

Sexual orientation disparities in Papanicolaou test use among US women: the role of sexual and reproductive health services

We investigated sexual orientation disparities in Papanicolaou screening among US women aged 21 to 44 years (n = 9581) in the 2006 to 2010 National Survey of Family Growth. The odds ratios for lesbian versus heterosexual women and women with no versus only male sexual partners were 0.40 and 0.32, respectively, and were attenuated after adjustment for sexual and reproductive health (SRH) care indicators. Administering Papanicolaou tests through mechanisms other than SRH services would promote cervical cancer screening among all women.

Preventive care's forgotten women: life course, sexuality, and sexual health among homosexually and bisexually active women in France

Although studies show that women who have sex with women (WSW) have poorer sexual health and more limited access to health care for gynecological problems than other women, the social processes giving rise to such health differences have not, so far, been explored. These processes may be formed in response to a dominant social norm, which assigns women to a heterosexual and monogamous sexuality. Based on data from a national random survey of sexuality (N = 6,824), enriched by qualitative interviews with WSW (n = 40), this analysis shows that bisexually active women had similar socio-demographic profiles to heterosexually active women, whereas homosexually active women appeared to be more highly educated than other women and less likely to live as couples than bisexually active women. Bisexually active women had more diversified sexual trajectories and sexual networks than other women. Chlamydia prevalence was found to be higher among bisexually active women, and homosexually active women reported fewer medical consultations for gynecological reasons. These analyses highlight the need to deconstruct the binary classification of homosexual versus heterosexual women. Because of constraint by the monogamous heterosexual norm, bisexually active women were less likely to be tested for sexually transmitted infections, and homosexually active women were less likely to have had gynecological follow-ups.

Risk reduction as an accepted framework for safer-sex promotion among women who have sex with women

BACKGROUND

Safer-sex information for women who have sex with women (WSW) is often very difficult to locate. Girl2girl.info is one of the only websites focussed on safer sex for WSW. The present article describes the predevelopment consultation and evaluation of girl2girl.info. A risk-reduction framework was used to develop the website.

METHODS

Girl2girl.info was developed in 2004 using questionnaires and focus groups with 36 consumers who were WSW, largely based in Canberra, Australia. In 2006-2007 the site was evaluated using mixed methods of questionnaires with 74 WSW and interviews with 17 health professionals around Australia.

RESULTS

This research has identified some key attitudes toward safer sex of WSW participants, in particular a misperception that the majority of WSW are at low risk for sexually transmissible infections and a consistent aversion to using latex for safer sex.

CONCLUSIONS

The article concludes that the promotion of a risk-reduction approach - including non-latex-based safer-sex practices - for WSW is both a theoretically appropriate and engaging form of health promotion for WSW.

Comparing knowledge and perceived risk related to the human papilloma virus among Australian women of diverse sexual orientations

OBJECTIVES

The study compared levels of awareness of human papilloma virus (HPV) as a sexually transmissible infection (STI) between women of different sexual orientations. It also examined self-reported risk factors for HPV infection, perceived level of personal risk, and willingness to have the HPV vaccine.

METHODS

Recruitment occurred through community sampling and data was collected using a self-completion questionnaire.

RESULTS

A convenience sample of 349 women completed the questionnaire in early 2007, 309 were sexually active; 47.6% had lifetime sexual partners of both genders, 26.9% had only male partners, and 25.5% had only female partners. Women with partners of both genders were more likely to have ever had a pap test but were also more likely to report an abnormal result (OR 3.19) than women with only male partners. Only 68% of the sample had heard of HPV and women with partners of both genders were significantly more likely to be aware than women with only male partners (OR 2.56). Forty-four per cent did not know how HPV was transmitted and less than half correctly identified HPV-associated clinical problems, with no differences according to gender of partners. The majority of women had risk factors for HPV, however, few felt personally at risk.

CONCLUSIONS

The very low personal risk perception for HPV, particularly among women who have female and male sexual partners, suggests the need for targeted education for this group regarding HPV transmission and prevention.

IMPLICATIONS

Health promotion regarding HPV should be broadened to specifically include information about HPV as an STI between women.

Absent sexual scripts: lesbian and bisexual women's knowledge, attitudes and action regarding safer sex and sexual health information

Despite recent evidence demonstrating that lesbian and bisexual women are at risk of sexually transmitted infections (STIs), there is a common perception that STIs cannot be transmitted between women. This paper reports on a study in which a self-report questionnaire, completed by over 300 lesbian and bisexual women and a comparison group of heterosexual women, was undertaken to determine lesbian and bisexual women's levels of knowledge about the human papillomavirus (HPV) and their attitudes toward the HPV vaccine and cervical smear testing. Alongside this, a series of in-depth interviews with lesbian and bisexual women explored how they perceive their level of HPV risk, the reasons why they do or do not feel at risk and how they manage their sexual health in relation to their lesbian or bisexual identity. The study concludes that lesbians generally feel at low risk for STIs because they are excluded from dominant sexual scripts that inform the negotiation of safer sex practice. Lesbians are unlikely to engage with sexual health promotion targeted toward gay men or heterosexual women, yet lesbian-specific sexual health promotion does not adequately construct an alternate discourse on safer sex that lesbians can relate to their own sexual practice.