Rethinking the Needs of Sexual Minority Women

While the AIDS crisis made gay and bisexual men a prominent focus of sexual health programs, providers largely ignored the needs of sexual minority women, who were widely deemed to have little risk of STDs. One of the first studies in Perspectives to highlight the sexual health of lesbian and bisexual women was a 2008 article in which Lisa Lindley and colleagues examined STD outcomes among nearly 30,000 young women who took part in a national survey of college students. Bisexual women and those who were unsure of their sexual orientation were more likely than heterosexual women to report having had an STD in the past year, the researchers found; although lesbians were the least likely to have had an STD, they were also by far the least likely to have had a recent gynecologic exam, raising concern that some had undiagnosed infections. Regardless of a woman’s sexual orientation, several behaviors, including binge drinking and having had multiple partners, were associated with STDs.

Three years later, Christine Kaestle and Martha Waller used data from the landmark Add Health study to examine STD prevalence and perceived risk among sexual minority women. Notably, instead of taking a simplistic view of sexual orientation, the authors examined sexual minority status from multiple angles by including measures of sexual identity, sexual attraction and sexual behavior. Women who said they were bisexual and those who reported attraction to both sexes had an elevated likelihood of having an STD; lesbians and women who had had only same-sex partners did not, but they were the most likely to underestimate their STD risk—that is, to consider their risk “very low” but nonetheless test positive for an infection. 

These and other studies have made clear that providers should focus not on young women’s sexual orientation, but on their risk behaviors, and should encourage women of all sexual orientations to obtain routine care and take safer-sex precautions.

Perspectives on Sexual and Reproductive Health and Family Planning Perspectives may be accessed through Wiley Online Library (2003–) and JSTOR (1969–2011).

Cover illustrations of Margaret Sanger © Matthew and Eve Levine