June is Pride Month, an opportunity for the LGBTQ+ community and its allies to celebrate the influence and contributions of LGBTQ+ people in our society. However, it is also a chance to reflect on the significant discrimination they continue to face and the adverse impact this has on their health.
The sexual and reproductive health inequalities faced by gay, bisexual and other men who have sex with men (GBMSM) are well documented. However, a population whose sexual and reproductive health needs are poorly understood and frequently overlooked are women who have sex with women (WSW). Research into the sexual health of WSW is limited and this group has frequently been perceived as low risk for sexually transmitted infections (STIs).
However, newly released data from the UK Health Security Agency shows that rates of chlamydia diagnoses have increased from 90.6 per 100,000 in 2018 to 221.8 per 100,000 in 2022. Over the same period, similar patterns are seen for gonorrhoea and herpes, rising from 51.2 to 174.6 per 100,000 and 45.7 to 124.1 per 100,000 respectively. Despite evidence that bisexual women are twice as likely to develop cervical cancer, WSW have typically not been the focus of cervical screening initiatives.
There are a number of factors that are likely to be contributing to increasing rates of STI diagnoses, poor outcomes in other aspects of sexual and reproductive health, and limited understanding of the needs of WSW. These include:
- Misinformation – a parliamentary enquiry into health and social care and the LGBT community was told that many women who exclusively have sex with women had been told incorrectly by healthcare professionals that they do not need to be screened for cervical cancer.
- Lack of perceived risk – women themselves, as well as the healthcare professionals looking after them, may perceive their risk of contracting STIs as low
- Poor access to services – lesbian and bisexual women have been found to be much less likely to go for cervical screening than heterosexual women. This may in part be related to having been told that they do not need to be screened.
- Heteronormative attitudes towards health promotion – despite WSW, including those who exclusively have sex with other women, being at risk of STIs, primary prevention initiatives focus on the use of condoms, with little reference to dental dams.
- Discrimination – a parliamentary enquiry heard evidence that a large proportion of frontline workers in health and social care did not consider a person’s sexual orientation to be relevant to their needs.
It is clear that more needs to be done to understand and adequately address the sexual and reproductive health needs of WSW. This should include:
- Improved training for healthcare staff to increase their understanding of the sexual and reproductive health needs of WSW and reduce misinformation.
- More health promotion initiatives focused on the sexual and reproductive health needs of WSW and incorporation of specific messaging into broader campaigns on women’s and LGBTQ+ sexual and reproductive health.
- Better representation of WSW in sexual and reproductive health research.
- Ensuring that healthcare services are LGBTQ+ inclusive, with the specific needs of WSW explicitly addressed.
The Faculty of Public Health’s Sexual and Reproductive Health Special Interest Group will continue to take advantage of opportunities to raise awareness of these issues and seeks to work with partners to address them.
