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When you go to your provider regarding reproductive health -- to have a Pap smear, address a gynecological concern, or get an HIV test -- usually the provider first asks you if you are sexually active. If you are sexually active they usually then ask if you use protection. "That's a funky question for lesbian and bisexual women," says Kathleen M. Morrow, Ph.D., Brown University School of Medicine in Providence, Rhode Island. Often the answer is: "Yes, I have sex with women -- that's my protection."

Yet women who have sex with women (WSW) are at risk for sexually transmitted diseases, and many are unaware of their risks, according to new research conducted by Dr. Morrow and her colleague Jenifer E. Allsworth, A.B. "A lot of WSW are not getting educated by providers," Dr. Morrow says. Some women are scared to tell their providers about their sexual orientation, and physicians sometimes lack knowledge or are uncomfortable with WSW. These factors are largely to blame for the absence of education, says Dr. Morrow.

Both lesbian and bisexual women reported that they'd engaged in behaviors that potentially lead to the transmission of HIV and other STDs, according to the 504 self-administered surveys that were returned. About 85 percent of the women reported an average of one or more episodes per month of unprotected sex with a woman. Eight percent reported one or more episodes of unprotected oral sex per month with a man -- of those, six percent reported unprotected vaginal-penile sex. Twenty percent reported possible exposure to blood with a female partner, either from menstrual cycle or S&M.

More than 2000 questionnaires were distributed mostly at three music festivals during the summer of 1993, and the results of the research were published in the December issue of the Journal of the Gay and Lesbian Medical Association.

While the study exposed what risk behaviors some lesbians are participating in, it also uncovered a lack of awareness about what behaviors are risky. A total of 84 percent of the women believed they were at zero risk for HIV or STD infection. Meanwhile, 26 percent reported that they had been infected with at least one STD in their lifetime. The most common STDs reported were crabs (9 percent), genital warts (6 percent), chlamydia (6 percent) and herpes (5 percent).

Lesbians were more likely than bisexual women to have a single sexual partner, and bisexual women were more likely to report a history of STDs. Women with multiple partners considered themselves at greater risk. However, having unprotected sex or male partners was not associated with increased risk perception. "Lesbian and bisexual women are engaging in sexual behaviors that may increase their risk for HIV or STD infection. Culturally sensitive prevention programs are needed," according to the GLMA the article.

Researchers are not certain about how risky woman-to-woman sex is -- more research is urgently needed to determine this. "Even if the risk is lower, once HIV is in our community it is in our community," says Dr. Morrow.

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Educating Women and Providers
Over 60 percent of the study participants reported getting sexual health information from friends and sexual partners, says Dr. Morrow. It turns into a game of 'telephone' gone awry, and women just trade and pass along false information. "If WSW are not getting educated properly, then we are just perpetuating the same myths and misinformation," she says.

It is very difficult to track down women to participate in surveys and clinical trials. "It's really hard to access the WSW population. This research was of women willing to go to events, with the money to go, women who are part of the community," she says. As a result, most of the women who filled out the questionnaire were white, well-educated, and had an average age of 35. Dr. Morrow is concerned about reaching -- and educating -- women who are not part of this community. "Providers are the best people to reach these women."

Just how to reach women and educate providers is the challenge at hand. "We really need to educate providers about what women who have sex with women do, and which sexually transmitted infections (STIs) can be transmitted by fluid or blood," says Dr. Morrow. Many providers don't know how to talk about sex with patients. "If they are very old school, they might not even think woman-to-woman sex is sex," says Dr. Morrow. "They blow it off."