Same-Sex Activity Among Women May Be a Marker for Adverse Sexual and Reproductive Health Outcomes
Five percent of British women aged 16–44 have ever had a female sexual partner, and those who have done so in the past five years are at greater risk of adverse sexual, reproductive and general health outcomes than are those who have had sex only with men.1 For example, according to findings from a national probability survey, they have significantly elevated odds of having sex with someone they have known for no more than a day and of having an STD diagnosed; they have reduced odds of rating their overall health as good or very good. Women who have had sex with women are more likely than those who have had only male partners to engage in unsafe heterosexual behavior, to consider themselves at risk for HIV, to seek care at an STD clinic and to undergo HIV testing.
The 2000 National Survey of Sexual Attitudes and Lifestyles (Natsal), from which the data were drawn, collected information through face-to-face interviews and, for sensitive topics, computer-assisted self-interviews; the sample included 6,399 women. Researchers analyzed the survey data to explore the prevalence of same-sex experience among British women and compare various behaviors and outcomes between women who have had female partners and those who have had only male partners; they categorized women by their sexual experience in the five years preceding the survey.
Overall, 5% of women reported having had sex (specifically, genital contact) with a woman; 3% said they had done so in the last five years. Because the vast majority of women reporting same-sex activity also said they had had sex with men, the analysts’ main focus was comparisons between this subgroup and women who reported only male partners. Women who had had both male and female partners were significantly younger than those who had had only male partners (27 vs. 32 years, on average). The proportion who were married was lower among those reporting partners of both genders than among those reporting exclusively male partners (14% vs. 48%), but the proportion who were living with a man to whom they were not married was higher (34% vs. 19%). Forty-one percent and 63%, respectively, had had children. On average, women who had had sex with men and women had had 11 male partners within the last five years, whereas those who had had only male partners had had two. In the year preceding the survey, 49% of the former group and 13% of the latter had had multiple male partners; 59% and 22%, respectively, had had a new male partner.
Age-adjusted analyses revealed significant differences in the sexual behavior of the two groups. Women with a history of partners of both genders who had had sex with a male in the past year were significantly more likely than women reporting only male partners to have had oral sex, anal sex or other genital contact excluding vaginal intercourse during that period (odds ratios, 2.4–3.8). They also were more likely to report that they had last had sex with someone who was not a “regular” partner (1.8) and that sex with that individual had first occurred within 24 hours of the couple’s first meeting (2.4); these associations were no longer significant, however, when the data were further adjusted for women’s number of partners. The most dramatic difference between the groups was in their likelihood of having had unsafe sex—defined as having had two or more male partners and having used condoms inconsistently—in the past four weeks. The odds of this outcome were more than seven times as high among women who had had partners of both genders as among those who had had sex only with men; adjustment for number of partners had little effect on this finding.
The survey data suggest a poorer general health profile for women who have had sex with both women and men than for those who have had exclusively male partners. The former were less likely to rate their health as good or very good (odds ratio, 0.5), and were more likely to report having had an illness of at least three months’ duration in the last five years (2.0) or having made a hospital outpatient visit in the last year (1.5). Additionally, they had elevated odds of saying that they smoked (2.6), that they drank to excess (2.0) or that they had ever used injection drugs (10.0).
Sexual and reproductive health likewise varied by women’s sexual experience. The proportion who considered themselves at substantial risk of HIV was significantly higher among women who had had partners of both genders than among those who had had only male partners (11% vs. 2%). Perhaps as a result of this difference, the former had higher odds of having visited an STD clinic and of having had an HIV test in the past five years (odds ratios, 6.3 and 3.1, respectively). They also were more likely to have had an STD (4.4). The odds of abortion were three times as high among women who had had both male and female partners as among those reporting sex only with men.
The analysts observe that although the number of women in the Natsal sample who reported same-sex activity was small, the survey’s national probability sample yields data that can be generalized to all British women aged 16–44. Thus, they conclude that for this population, “a history of sex with a woman is…a marker for increased risk of adverse sexual, reproductive, and general health outcomes.” Consequently, because women who have female sex partners often are reluctant to disclose that behavior to health professionals, or avoid seeking medical care, the findings point up “a need for practitioners to develop skills and attitudes that allow nonjudgmental sexual history-taking from female patients, without making assumptions about sexuality or sexual behavior, to facilitate discussion of risks that [women who have sex with women] may face.”—D. Hollander
1. Mercer CH et al., Women who report having sex with women: British national probability data on prevalence, sexual behaviors, and health outcomes, American Journal of Public Health, 2007, 97(6):1126–1133.