1. Why LBQ women don’t use
dental dams: Australian
research on LBQ women’s
sexual health
Julie Mooney-Somers
Presented at ACON’s Big Day In 9/12/2011
This work is licensed under a
Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unpor
.
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

2. Questions
1. What do we know about sexual
behaviour and sexual health in LBQ
women?
3. What are women’s perceptions of STI
risk?
5. What do these research findings mean
for health promotion?
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

3. What do we know about sexual
behaviour and sexual health in
LBQ women?
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

4. Sydney Women and Sexual
Health Survey
• SWASH run biannually since 1996
• Data collected during the Sydney Gay
and Lesbian Mardi Gras season
• Women in contact with LGBTQ
communities
• Originally sexual health now general
health and wellbeing
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

5. SWASH: sexual behaviour
• 94% ever had sex with a woman – 82%
in last 6 months
• If had sex with a woman in past 6
months, 71% had one partner and 22%
had 2-5 partners
• 63% in regular relationship with a woman
• 22% reported casual female partner in
past 6 months The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

6. SWASH: sexual practices
2006 2008 2010
n (%) n (%) n (%)
Fingers/hand on external genitals 723 (96) 751 (95) 753 (96)
Fingers/hand inside vagina 704 (94) 746 (94) 741 (94)
Fingers/hand inside anus 230 (31) 246 (31) 223 (28)
Oral sex (mouth on partner’s genitals) 640 (85) 686 (87) 693 (88)
Oral sex (mouth on respondent’s genitals) 611 (81) 668 (84) 663 (84)
Rimming (mouth on partner’s anus) 112 (15) 145 (18) 119 (15)
Rimming (mouth on respondent’s anus) 118 (16) 146 (18) 128 (16)
Sex toy used on external genitals 421 (56) 474 (60) 470 (60)
Sex toy used inside vagina 427 (57) 485 (61) 482 (61)
Sex toy used inside anus 108 (14) 138 (17) 110 (14)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

7. SWASH: N sex in past 4 wks
2008 2010
n (%) n (%)
0 100 (13) 129 (16)
1 73 (9) 82 (10)
2–5 223 (28) 244 (31)
6–10 136 (17) 139 (18)
11+ 127 (16) 107 (14)
“A few” 6 (1) 9 (1)
“Many”, “Lots” 41 (5) 31 (4)
“Too many to count” 14 (2) 2 (0.3)
“Not enough” 3 (0.4) 3 (0.4)
“Don’t know”, “Forget” 19 (2) 4 (1)
Not answered 50 (6) 38 (5)
Total 792 (100) 788 (100)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

8. SWASH: sexual practices
• 16% involved in S&M without (15%) or
with blood (4%)
• 10% engaged in any group sex in past 6
months; 83% of this sex involved a
woman
• 5% had ever done sex work. Significantly
more likely among women identifying as
queer or other (11%).
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

9. SWASH: sex with men
• 59% ever had sex with a man
• Bisexual (82%), queer/other (79%)
women more likely than lesbians (53%)
• 18% of women ever had sex with a man
they believed to be gay or bisexual
• More likely to often have unprotected sex
if sex with gay or bi man (last 6 months)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

10. Research on young SSA women
• “Writing themselves in” is a 6-yearly
survey of same-sex attracted young (14 -
21 yo) people (Hillier 1998, 2005, 2010)
• As likely to have had sex with both men
and women, as women only, and sig %
sex with men only (very different to men)
• Less likely than men to use condom at
last penetrative sex
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

11. SWASH: STI diagnosis
2010
n (%)
Genital warts 35 (4)
Chlamydia 30 (3)
Bacterial vaginosis 26 (3)
Genital herpes 25 (3)
HPV 22 (2)
Gonorrhoea 15 (2)
Lice/crabs 10 (1)
Hepatitis B 6 (1)
Syphilis 0 (0.0)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

12. STI rates higher in WSW
• Self-identified lesbian (23%), bisexuals (38%)
more likely to report STI diagnosis than
heterosexuals (17%) (ASHR 2003)
• WSW, regardless of sexual identity, more
likely to self-report ever receiving an STI
diagnosis (ASHR 2003; Mercer 2007; Tao 2008)
• Especially bacterial vaginosis (BV) (Fethers
2000) and herpes simplex virus type 2 infection
(HSV-2) (Xu 2010)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

13. Research on younger WSW/SSA
• Likelihood of reporting an STI diagnosis higher
than exclusively heterosexual women (Hillier
2008; Hillier 2005; Goodenow 2008; Smith
2002)
• 2008 Australian Secondary School Students
Survey reported 3% of sexually active young
women reported an STI diagnosis (Smith, 2009)
VS
• 9% of same-sex attracted young women in 2005
and 4% in 2010 (Hillier 2005; Hillier 2010)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

14. Young SSA women and pregnancy
• 15% reported ever being pregnant –
twice as many as hetero peers (Hillier
2010)
• 37% of ever pregnant SSA were
exclusively attracted to women (Hillier
2010)
• Findings reflected internationally
(Goodenow 2008; Saewyc 2004)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

15. SWASH: STI screening
• 54% ever had diagnostic or screening
test for STI other than HIV; 16% in past
six months
• Queer and other women (66.), followed
by bisexual women (54%) and lesbian
women (52%)
• Ever had sex with a man more likely
(63%) compared never had sex with a
man (42%)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

16. SWASH: pap smears
• 26% over due or never had pap smear
• Rates improving but:
• Never had sex with a man, three times
more likely to have never been screened
• Ever had sex with a man, 30% of
bisexual women never screened
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

17. Perceptions of STI risk in sex
between women?
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

18. SWASH: using latex barriers
• 2002 data
• Most women used latex barriers once or
never (94% dental dam; 88% gloves;
83% condoms) (Richters 2004)
• Women do not use barriers when having
sex with menstruating (Richters 2005;
Dolan 2003)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

19. Using toys
• 52-60 % do not use condoms with sex
toys (Bailey 2003; Fishman 2003)
• 12-22% don’t wash sex toys when
sharing (Diamant 2000; Bailey 2003)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

20. Barriers to risk reduction strategies
• Uncertainty about when and how to
introduce safer sex
• Reticence about using dental dams and
gloves due to a lack of experience
• Embarrassment at buying dental dams or
condoms
• Stigmatising effects of disclosing STI
diagnosis or the shame associated with
their own past sexual behaviours
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

21. Perception of risk
• Perceive the risk of STI transmission
between women to be very low (Fishman
2003)
• Lesbian = protection from STI (Dolan
2003)
• “inherent invulnerability” - lesbians don’t
have sex with men, or with women who
have sex with men
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

22. Perception of risk
• “lesbian immunity” - socially inoculated
because they can detect and avoid the
‘infected’ (Stevens 2001)
• Relies on ability to select “safe” partner,
sharing of sexual histories, trust
• But, may not know own status and hard
to talk about sexual histories and safer
sex
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

23. Perception of risk
• Assessing the prevalence of a disease in
the community is part of the risk
assessment
• “optimistic bias” – perceive prevalence of
HPV as low compared to other
communities and their own risk as lower
than other women (Eaton 2008)
• Low risk and low prevalence = low
benefit of safer sex (Fishman 2003)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

24. SSA younger women and risk
• Julie’s pilot study with 9 young SSA in
Sydney (2009-2010)
• To explore the understandings and
practices related to safer sex in same-
sex attracted young women, and identify
practical opportunities for intervention
and education around STI prevention
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

25. Translating knowledge
• I just hesitate to say just as vulnerable as
women having sex with men [pause] I suppose
‘cause I’m just thinking of the physiology of it all
and [...] well does semen actually carry these
things? That is something that I think it might
[long pause]. Like with AIDS for instance
whereas with a woman having sex with a
woman there is obviously no semen involved.
(Pandora)
• I would have thought less because there’s less
transfer of bodily fluids. (Sarah)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

26. Translating knowledge
• I would be, I would be surprised if I managed to
catch something like Chlamydia. But then, I
think it would be, for example like you know if
you’re using toys, then that would transfer it
more than if you were touching yourself and
then you touch your partner or the other way
around. But if you’re only doing one direction,
then I think it would less. (Sarah)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

27. Relative risk
• maybe if you only have sex with other women, you
might be less likely to get some things (Georgia)
• If you’ve only ever been with girls, and the girls who
you slept with have only been with girls, that you’re
at lower risk in general (Sarah)
• because in a lot of those instances there are actually
not penises involved, it will be fine. (Ange)
• maybe I do feel a bit of security because I am not
sleeping with a man (Pandora)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

28. Changing paradigms
• So I think, yeah definitely from a young girl who’s
had sex with boys and then having sex with women,
I think the likelihood to use condoms or sexual
protection is definitely greatly reduced because you
have reproduction taken out of the equation and
you’re also, you may be using products like dildos
and things that haven’t been used with other people.
You might have bought something with your
girlfriend, who you’re having a long term relationship
with. The likelihood of you feeling the great need to
use a condom in that situation is incredibly reduced
because it’s not going through the whole community
like a man’s [laughs] penis may be (Dani)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

29. Don’t know what to do
• Because there’s a broad range of sexual
activities with lesbians, I think it can be unclear
as to what is the appropriate protective
measures I can take for this activity. So there’s
the obvious, oral or digital sex, [laugh] I guess I
don’t know how to term that, fingering, but
there’s that obvious way of lesbian sex but then
there’s other forms. Some women engage in
anal sex. Some women use dildos. Some
women are doing S and M activity that involves
body fluids; all these kind of things. There’s no
specific education given as to what to do in
those situations. There’s only implied education
or implied information “ (Dani)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

30. Do know but don’t use
• With my partner, it is a bit different
because women cannot wear condoms
so... I’ve read, I’ve got a book at home on
lesbian sex, it’s a manual my friend gave
me for my birthday, very embarrassingly,
and [pause] every single thing is, “Put a
latex glove on, step one,” and I [pause]
have never done that. (Pandora)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

31. Or lack faith in strategy
• There’s a lack of stuff like condoms that accurately
work for same-sex women like dams don’t. As far as
I’m aware they don’t really work because they move
around and get turned around and what’s the point?
(Ange)
• I was sleeping with women and we weren’t using
gloves or dams or any of that stuff and I was, “I’m
tested, are you tested?” and they would say, “Yep”
but there wasn’t that trust there and they were
people that I know to have been sleeping with a
variety of other people much like myself (Ange)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

32. Or confidence in self
• I think it’s also hard to translate [...] your use of
protection when you do go from having a long term
relationship to infrequent casual relationships
because, coming from personal experience, it’s hard
to negotiate what you should do in that situation.
Like, I didn’t do it for one person, so why should I do
it in this situation? So I think that can be difficult.
(Dani)
• At the beginning of one’s relationship maybe you
should go and get tested [pause]. When I was dating
a boy that is what we were about to do [...] With my
partner now, we did not discuss that that was not an
option. It did occur to me at the beginning and I
guess I felt rude [pause] to ask that (Pandora)
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

33. Main points from pilot study
• Heterosex is reference point
• Don't know if sex between women is risky
• Don’t know how to tell if vulnerable
• Don’t know what to do if they do
• Don’t feel confident in strategies
?? how do you assess and/or address risk
is such a highly ambiguous situation?
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

34. What do these research findings
mean for health promotion?
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

35. Provocations…
1. LBQ women’s sexual health promotion
should talk about condom use for hetero
sex
2. We’ve been too eager to jump on the
STI bandwagon for LBQ women (equal
opportunities & politics)
3. If the hets are only told to use condoms,
why do we have to use dams and
gloves?
4. Skin-to-skin (herpes, warts, HPV, BV)
are most relevant but there’s no $
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

36. Paradox?
• Higher STI rates and unplanned
pregnancy, and low screening rates
• Sex with men?
• Health promotion failing this population?
• Consequences of messages about safer
sex framed by heterosexuality?
• History of same-sex-experience a marker
of sexual adventurousness?
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia

37. Contact me for references, discussion or if
you have answers/ideas/provocations!
Julie.MooneySomers@Sydney.edu.au
This work is licensed under a
Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unpo
.
ATTRIBUTION: Mooney-Somers, J. Why LBQ women
don’t use dental dams: Australian research on LBQ
women’s sexual health. ACON Big Day In, Sydney, 9
December 2011
The Centre for Values, Ethics & the Law in Medicine
The University of Sydney, Australia