A couple of months ago, in time for Valentine’s Day, the Centers for Disease Control and Prevention announced that it would start using the term “condomless sex” instead of “unprotected sex.” The move was hailed by many HIV advocacy groups for taking into account other risk-reduction practices, such as medications that decrease the chances of HIV transmission.
Women can transmit just about any STD to one another.
However, while medications can reduce HIV risk, condoms still offer protection from both pregnancy and many other sexually transmitted diseases (STDs), such as chlamydia and gonorrhea. One reason that condoms are so valuable is that they can be placed over a penis to collect fluids before and after ejaculation — dramatically reducing risk for both pregnancy and many STDs. So, even when using anti-HIV meds, engaging in “condomless sex” can still be risky.
But what if partners are engaged in sexual activities that don’t involve penises? Not all sexual couplings involve a cisgender man, and even those that do might not utilize a penis at every encounter. When two people without penises have sex, they’re probably going to be engaging in condomless sex — though condoms can be placed over penetrative sex toys or cut along the sides to be converted into dental dams, they might not figure too prominently in this couple’s safer-sex arsenal. Lesbians protecting themselves with dental dams are technically engaged in “condomless sex,” but it’s still a far cry from being “unprotected.”
A common myth about lesbians is that they are immune to STDs. This misunderstanding probably arises from the more insidious myth that lesbian sex isn’t “real” sex — after all, with no penises at play, how can they possibly get beyond “third base”? But sports metaphors don’t always reflect the truth — and two people with vaginas can pass all kinds of pathogens back and forth, and have very satisfying sex lives. Read on to find out some of the ways — other than penis-in-vagina intercourse — that sexually transmitted pathogens can hitch a ride from one person to another. And remember that these activities aren’t exclusive to lesbians — that is, most of the below information is relevant to all sexually active people, regardless of gender.
oral-vulvovaginal contact (cunnilingus)
Cunnilingus is the act of using one’s mouth and tongue to stimulate a partner’s vulva and clitoris, and it can transmit STDs such as syphilis and herpes. Syphilis, for example, causes infectious pus-filled sores that can be found in the mouth or below the belt — meaning that cunnilingus can transmit the bacteria that cause syphilis from the mouth to the genitals, and vice versa.
Furthermore, most of us are infected with the type of herpes virus that causes cold sores, even though we usually don’t have symptoms. (One study found that about half of women who have sex with women were positive for this virus — a number that’s actually surprisingly low!) This virus can be transferred from the facial area to a partner’s genital area to cause genital herpes. To prevent the transmission of the cold sore virus to a partner’s genitals, some people use dental dams, which are rectangular pieces of latex that create a barrier between one person’s mouth and their partner’s genitals. A condom can also be converted into a (small) dental dam with a couple of scissor snips!
genital-to-genital contact (tribadism)
Two people can stimulate one another sexually simply by rubbing or grinding against one another. When this is done with clothing on, it might be called dry humping or outercourse. When it is done without clothing, risk is increased for the transmission of human papillomavirus (HPV), herpes, syphilis, and pubic lice.
HPV and the herpes viruses are both spread by skin-to-skin contact. Even people with penises can’t totally prevent their transmission with condoms, because condoms are limited by how much of the skin they cover. So, rubbing two sets of genitals together can allow these viruses to jump from one partner to the other. This includes HPV, the virus that can cause cervical cancer — meaning that Pap testing is recommended for lesbians.
Same with pubic lice — since they live in the pubic area, they can easily make the journey from one partner to another during times of intimate contact. Heck, even sharing a bed can do it — no sex required!
oral-anal contact (rimming)
Oral contact with the anal area can transmit syphilis, herpes, hepatitis A, or intestinal parasites. Intestinal parasites, as well as the virus that causes hepatitis A, are both transmitted by feces. Therefore, ingesting even a microscopic amount of your partner’s fecal matter can do the job. Dental dams can be used during oral-anal contact to reduce risk.
digital-vaginal contact (fingering or fisting the vagina)
Manual contact with a partner’s vagina and external genitalia can transmit trichomoniasis, chlamydia, gonorrhea, HPV, and herpes if cervical or vaginal secretions are shared. For instance, if you finger or fist your partner and then touch your genitals, you might make a direct deposit of your partner’s vaginal microbes into or around your own vagina. Likewise, if you touch your mouth after manual contact with your partner’s genitals, you might give yourself an oral infection. In some cases, you can even give yourself an infection by touching your eyes — yes, gonorrhea of the eye exists!
digital-anal contact (fingering or fisting the anus)
By the same mechanisms that fingering or fisting can transmit STDs from one partner to another, manual contact with the anus can transmit hepatitis A, intestinal parasites, gonorrhea, HPV, and herpes if anorectal secretions are shared.
sharing sex toys
Dildos, vibrators, beads, and other sex toys can transfer secretions between partners, which could transmit the same types of STDs that can be transmitted by digital-vaginal or digital-anal contact. When sharing penetrative sex toys, cover them with condoms, and change them between acts to prevent your partner’s fluids from contacting your genitals.
s/m (sadomasochism)
If activities involve sharing blood, hepatitis B, hepatitis C, or HIV can be transmitted from one partner to another. A case of female-to-female sexual transmission of HIV recently made headlines, and rough sex that led to bleeding is thought to be the cause.
STD risk can be reduced by practicing safer sex. To prevent sexual fluids or fecal matter from getting into your body, use dental dams over your face when making contact with your partner’s genitals or anus. Use latex gloves when making manual contact with your partner, and remove the gloves before touching yourself. Use condoms with penetrative sex toys and thoroughly wash toys between use. Avoid sharing blood.
Partners can be tested for STDs at the outset of their relationship. While some STDs can’t be definitively tested for — like HPV — and while some are so common that most people will have them — like the cold sore virus — being free of STDs at the beginning of your relationship and remaining monogamous will greatly reduce risk. Many monogamous partners whose activities don’t put them at risk for pregnancy choose to forgo barrier methods when they’ve determined their STD statuses.
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