Lesbians learn to play it safe; with so much talk about gay male sex and AIDS, some lesbians falsely assume that their sex life is risk-free.

Christina was volunteering at a women's health clinic when a young lesbian came in complaining of vaginal sores and pain. When told she had herpes, the woman became distraught. "She kept saying she'd been with only one person--her girlfriend--and that neither of them had herpes, so it couldn't be," Christina recalls. "Then when the doctor asked her about oral herpes--you know, cold sores--she remembered that her girlfriend had a blister on her lip. They'd had no idea that herpes on the mouth could infect a person's genitals during oral sex."

During a routine annual exam, Tracy was told by her gynecologist that she had chlamydia. "I couldn't believe it," she says. "I had no symptoms, no sign that anything was wrong. And I thought you could get that only from sex with men, but I hadn't been with a man for years. I talked to my new partner, and she got tested. Turned out, she'd probably gotten it from her old boyfriend and then infected me when we shared a dildo."

NKeesha thinks she was infected with HIV while either having sex as a prostitute or using drugs intravenously. "But one thing's for sure," she says. "Being positive and being lesbian is hard. No one believes lesbians do sex work or use needles or get HIV. Well, we do. Then when we have sex, we have to have this whole conversation, like, `Yes, we do have to use gloves and stuff so you don't get infected.' But a lot of women don't think there's anything to worry about if they're sexual only with other women."

The stories recounted by these women, who asked that their last names not be used, make the point. Statistics underscore it. By almost any reckoning the numbers are alarming. Forty million Americans are estimated to be infected with genital herpes, with about 500,000 new cases being diagnosed each year. Estimates of infection with the human papillomavirus, the virus that causes genital warts, range from 20% to 50% of all American women over the age of 18. And the Centers for Disease Control and Prevention reports that 92,242 women have been diagnosed with AIDS since 1981, with the number of women who are HIV-positive being much higher.

Add to that the prevalence of other sexually transmitted diseases like chlamydia, gonorrhea, syphilis, hepatitis, and parasites, and it becomes clear that just about anyone who is sexually active may be at some risk of exposure to an STD. That includes women who have sex with women.

Despite the illusion many lesbians have of being at very low to no risk of infection, the reality is that sexually transmitted diseases are equal-opportunity infectors. "It's what you do, not who you are or what you call yourself, that determines risk," says lesbian health educator and researcher Liza Rankow, who in March completed three years of federally funded research on lesbian health concerns. She notes that some STDs are simply a nuisance and can be easily treated and cured (body lice ["crabs"], scabies, trichomonas, and most yeast infections), while others can be much more serious.

The human papillomavirus, for example, can lead to cervical cancer, which can be deadly when not detected early. A Pap smear, a simple test used to find abnormal changes in the cells of a woman's cervix, can detect the disease. Most women should have a Pap smear every year, Rankow advises. Other diseases such as chlamydia and gonorrhea also are curable but can lead to serious problems such as pelvic inflammatory disease (leading to pain, infertility, and even death) if left untreated, according to Rankow. Still other STDs, like herpes or genital warts, have no known cure.

In her experience Rankow has found that many lesbians and bisexual women do not realize how certain STDs are transmitted. "STDs can be passed between women through contact with lesions like herpes sores or genital warts or through contact with infected blood or sexual fluids," she says. "Some STDs, like hepatitis A and intestinal parasites, can be transmitted by oralanal contact." During sex lesbians can also pass along infections that may not be considered STDs by heterosexually biased medical providers, such as vaginal yeast or bacterial vaginosis.

Nor are lesbians immune to HIV. Menstrual blood and sexual fluids can enter a woman's body through cuts, scrapes, or sores or through mucous membranes in the vagina, rectum, mouth, nose, or eyes. Risk of transmission can also be increased if mucosal tissue is irritated or inflamed from gum disease, a vaginal infection, or even recent penetration with fingers, hands, or sex toys, according to Rankow. Women who don't produce a lot of natural vaginal lubrication may be at increased risk of bleeding during penetration too. Exposure to blood and sexual fluids can also occur through sharing sex toys, particularly for penetration; grinding or humping vulva to vulva; oral sex; or penetration with cut or chapped hands.

Because of the myriad ways a woman can be exposed to STDs, health educators strongly advise the use of certain strategies to minimize the risk. Rankow emphasizes the importance of diagnosis and treatment for all sexual partners who may have been exposed to an STD. "In opposite-sex cases it's often routine practice for health care providers to treat the male partners of women with infections like trichomonas or chlamydia," Rankow says. "Unfortunately, many providers may need to be educated about offering similar treatment for female partners."

From education to prevention to diagnosis to treatment, lesbians can take steps to reduce the impact that STDs have on their lives. "It's about being concerned for and respecting yourself and your partners," Rankow says. "Too often discussions about safer sex are reduced to sound bites about latex and lube. When we talk honestly about our anger, fear, and grief and the meaning of sex in our lives, we begin to make real changes that support our health and the health of those we love."

RELATED ARTICLE: No need for lesbian sex panic

Before getting intimate...

Talk about your sexual needs and your past behavior. Safer sex begins with good communication.

Begin with the lights on. Points out sores, rashes, and sensitive areas. Let your partner know if you lubricate a little or a lot. Tell her if you have a yeast infection or other irritation. Let her know where it is OK to touch and how you like to be touched. Decide together how to protect yourselves, whether it's by using condoms on sex toys, wearing latex gloves, using barriers for oral sex, or taking other precautions.

Where to get help if you need it

General STD information and referrals: CDC National Sexually Transmitted Disease Hotline, [phone], 8 a.m. to 11 p.m. Eastern time, Monday through Friday.

Herpes information: National Herpes Hotline, [phone], 9 a.m. to 7 p.m. Eastern time, Monday through Friday. For information by mail, call [phone].

Safer-sex information: Free brochures for lesbians and bisexual women are available from the Lesbian AIDS Project at Gay Men's Health Crisis, [phone], and the National Center for Lesbian Rights, [phone].