#9: Queer Women's Sexual Health
COMMUNITY VOICE: Amanda G | HEALTHCARE EXPERTS: Michelle Forcier, MD; Anne Garment, MD | COMMUNITY REVIEWER: Fiorenza Piccorelli
SHOW NOTES
Our usual vocabulary round-up:
This episode is going to talk about queer women - but more specifically specifically on folks with vaginas having sex with other folks who have vaginas.
Our subject matter is deliberately focused. Because we’re discussing sexually transmitted infections (STIs) and the things that can cause them, we have to be precise (and consistent) about what parts are being used during sex, and what’s happening to them.
So in other words, we’re focusing on folks with vaginas because it allows us to be scientifically accurate about the risk of transmission and infection. But this is by no means a reflection of who is included within the community of queer women! For more on that subject, check our previous podcast episode.
Who’s STI and what’s she doing at this party?
“STI” stands for “sexually transmitted infection” and is the cooler, hipper, Gen Z cousin to the millennial term “STDs” or “sexually transmitted diseases”
The term “STI” has become favored within the medical community because:
There’s stigma associated with the word “disease”
Because things like gonorrhea and syphilis often have no symptoms. And so “infection” is a better word to reflect that fact
Why are we doing an episode on STIs for queer women with vaginas?
Queer women are often excluded or ignored within conversations and education about sexual health and STI risk
Why isn’t this more prominently discussed and understood?
Queer women’s sex is ~varied~ (in terms of what anatomy is involved or what’s in what hole, if any). This makes it challenging to ascribe a standard amount of “risk,” since that risk could vary drastically between two queer women.
The scientific literature on this subject isn’t doing us any favors, either. Papers that look at queer women’s STI risk use a variety of labels to define queer women, and it’s hard to find consistency or specificity.
Lastly, there’s a widespread conception out ~in the ether~ that queer women have negligible (meaning, close to zero) risk of getting/giving STIs. So, some folks believe the subject isn’t worth spending time on.
The bottom line(s)
For folks with vaginas, the risk of STIs isn’t zero
One study suggested that rates of chlamydia between queer women with vaginas are comparable to the rates in the general population
Moreover, queer women with vaginas are susceptible to the same infections that other folks are at risk for, such as:
Herpes
Hepatitis A
Trichomoniasis
Note: HIV is unlikely to spread by using fingers or toys, but queer folks with vaginas may still be at risk for HIV if they are having condomless sex with partners with penises, sharing needles, or participating in sexual or erotic blood play.
So while folks with vaginas who exclusively have sex with other folks with vaginas do have lower STI rates, there’s number of factors consider:
Number of partners (since multiple partners provides more opportunities to introduce new bacteria)
Whether there are penises present
Whether toys or fingers are being inserted
How and where folks put their mouths or tongues.
Fewer things being inserted likely means lower risk of transmission, but it’s definitely not a zero-risk situation.
This is why, at the end of the day, we always recommend having an individualized conversation with your healthcare provider about your sexual practices.
BV: the STI that isn’t an STI
BV stands for “bacterial vaginosis”. It happens when the normal (read: healthy!) bacterial environment of the vagina gets thrown off balance, and can cause symptoms like changes in discharge, changes in odor, or itchiness.
It is more common in queer folks with vaginas by a factor of 2, which is thought to be related to:
Whether a partner has BV already
Oral sex (which can bring extra-vaginal bacteria to the vagina)
Menses
What to do?
None of us recommends going out of the way to prevent BV, but cleaning any toys you share with other partners is a great thing to do in general and will likely help reduce the risk of getting BV.
If you know you have BV but don’t have symptoms (and aren't pregnant), Dr. Garment does not recommend treatment.
If you do require treatment - either because of symptoms or because you are pregnant - then a short course of antibiotics usually solves the problem for most.
HPV - the sexually transmitted…virus?
What is HPV?
HPV stands for “human papilloma virus” which is a virus that causes the overwhelming majority of cervical cancers.
Mostly, HPV can be cleared by your immune system. The problem comes if (for whatever reason) your body isn't able to get rid of that infection. In these cases, HPV hangs around for too long and over years, it can start to cause changes in the cells of your cervix which, over time, can lead to cervical cancer.
What does this have to do with queer women, again?
HPV can be transmitted in all sorts of ways – from a penis to vagina, from a mouth to any kind of genitals, from a mouth to a rectum. It can also be on toys, it can be on fingers.
Said otherwise: queer women can get HPV from sex!
In fact, when you look at HPV rates in, women who have sex with women, compared with women who identify as heterosexual, the rates are not so dissimilar in terms of the rate of HPV.
HPV prevention
On a day-to-day basis, cleaning toys between use can help reduce the risk of transmission (if you're sharing your toy with more than one partner).
You can check out if you're eligible for the Gardasil vaccine, which reduces the risk of getting HPV in the first place.
Lastly, the cornerstone of all STI prevention is testing. In the case of HPV, it's going to be testing for the changes that it causes to your cervix via a pap smear.
Cleaning toys: a brief ode to the top rack of the dishwasher
Toys made of silicone or metal can be run through the top rack of the dishwasher.
Anything with a motor can be washed down with antibacterial soap.
Toys made of porous materials (eg, hard plastic) are difficult to clean fully. In these cases, barrier protection (eg, a condom) can limit transmission.
Dental dam…to the rescue?
Things dental dams are:
Made of polyurethane
Meant to be placed over par the vagina or anus while engaging in oral sex to reduce the fluids that are being transmitted between partners (and therefore reduce the number of potential STIs)
Things dental dams aren’t:
Attractively named
Used very often
Things dental dams may or may not be:
Effective
It’s hard to find data on this, TBH
How protective they are (or aren’t) may be more a product of how consistently or correctly folks are using them
An all-encompassing form of protection
After all, queer women have many kinds of sex where barrier protection with a stretchy piece of latex won’t be helpful!
At the end of the day, this is (as always) about knowing the risk of your individual sexual practice
TRANSCRIPT
Amanda: If I were to watch straight porn, I would not be surprised to see a condom, right? Like I would see a condom wrapper. I would know exactly what it was. In queer porn there are no dental dams
[QHP THEME MUSIC]
Sam: Welcome to QHP: a podcast by queer people, for queer people, about queer health. I'm Sam. I use he/him pronouns, and you'll probably find me in a dog park because I don't have a dog.
Gaby: I'm Gaby; I use she her pronouns and you'll probably find me at a brewery because I'm a lesbian.
Richard: And I'm Richard and I also use he him pronouns and you'll probably find me reading a comic book somewhere because let's face it, I’m a comic book nerd.
Sam: We're all queer primary care doctors living in New York City.
Gaby: And you're listening to QHP episode nine: queer women, sexual health, and STIs.
Sam: At the top of this episode you heard from
Amanda: Hi, I'm Amanda. I am a 26 year old cisgender queer woman. I am a high school English teacher in the Bronx and I grew up in the city.
Gaby: Today, Amanda – along with two health experts who will introduce soon – will help us tackle the topic of queer women's sexual health.
Richard: As an FYI, this episode is part two in our series of queer women's sexual health. Our last episode covered some really important stuff: sexual satisfaction and pleasure.
Gaby: That episode dove into who our definition of queer women includes - and spoiler alert, it's inclusive. But for the purposes of this episode, we're using literature to back up our claims…and much of that literature is going to be focusing here on people with vaginas.
Sam: Because we've now talked about genitals bumping together - the scientific name was bumping lovelies - we wanted to talk about the various organisms and something that also gets bumped around, meaning STIs.
Gaby: FYI, you may be more familiar with the acronym, STDs for sexually transmitted diseases. STDs is the term that I grew up hearing in sex ed classes. But it's fallen out of favor. In part, because of the stigma associated with the term disease and in part, because things like gonorrhea and syphilis often have no symptoms. And so “infection” is a better word to reflect that fact.
Sam: We wanted to make a podcast episode about STIs because while there's a lot of information on STIs in general, there's comparably less material on the subject for queer women.
Amanda: You get typically zero discussion, obviously, about like STIs or protection. It wasn't something that my queer friends really talked about. I mean, queer male friends, yes. All the time. But not queer female friends.
Gaby: You know, Amanda's not alone in this. When we dug into the public health literature, there was plenty out there to suggest that queer women are underrepresented in discussions around their own STI risk.
Richard: And that can have an impact on who engages with care around this in one survey, less than 25% of queer women sought out any kind of STI testing. And to be clear, we're not trying to do fear-mongering or pretend that there's some epidemic of STI is among queer. Or women, but we do want to bring light to a topic that we think is really important for people to know about and to engage with their healthcare providers about.
Sam: So to that point, I guess the first question we have to tackle on this episode is why? Why is it the case that queer women, sexual health gets so little attention?
Gaby: I really wish I had a neat and tidy answer for this, but the truth is that it's complicated.
Sam: Ugh, when isn't this complicated?
Gaby: Women are complicated, Sam.
Sam: That’s not what I meant (laughter)
Gaby: But we can definitely identify by a few factors that are contributing to why this topic is so muddy. For starters, it's difficult to make sweeping generalizations about queer women and their behaviors when it comes to sex.
Richard: Exactly. Queer women have sex with a diverse array of partners, people of all genders, and have a diverse array of sexual practices, which is excellent. But when you're talking about STIs, these things matter since different partners –
Gaby: Meaning the people that you have sex with and their anatomies –
Richard: And different practices –
Gaby: Meaning what goes in, what hole –
Richard: Lead to different risks for STIs.
Gaby: In other words, different organs with different anatomies can spread different organisms differently.
Sam: Secondly, the scientific literature on STI risk for queer women is lacking. It's an understudied topic to begin with. But also, the group of individuals included in the studies is inconsistently defined. Some studies use self-reported identity labels like lesbian or bisexual.
Gaby: And while these terms are reflective of what the community uses to describe itself, they don't actually define what's happening during sex.
Dr. Forcier: So even the labeling of, you know, cis or, or queer, or all the other labels don't necessarily apply to the actual behaviors and how people live their sexual lives.
Richard: The voice you hear belongs to Dr. Michelle Forcier.
Dr. Forcier: I'm a professor of pediatrics at the Alpert School of Medicine, Brown University, Providence, Rhode Island. I'm a primary care pediatrician and have been doing sex, gender, and reproductive justice work for over 20 years now. I currently am the director of the program for gender, sex and reproductive justice, in the department of pediatrics and have the best patients in the entire universe.
Sam: Dr. Forcier makes a great point. The terms and definitions that we use in these STI studies are only important because it impacts how accurately we can study the risk of STI transmission.
Gaby: There are studies that use terms like WSW and WSMW, which are acronyms that stand for women who have sex with women or women who have sex with men and women. So these studies do focus more on sexual partners, but again, they aren't specific enough about practices, meaning what actually happens during sex.
Richard: And often terms like WSW and WSMW still presume that everyone's cisgender.
Gaby: So in summary, one of the reasons we don't talk a lot about queer women and STIs is ambiguity.
Sam: Meaning there's a variable relationship between how people identify and their behavior in bed and shocker health care providers do not do well with ambiguity.
Richard: Or sex that happens out of bed.
Sam: Whaaa?! (laughter)
Gaby: And the other big reason, probably the bigger reason in my eyes is because there's this widespread belief out there that queer women have close to zero rates of STI transmission.
Amanda: I think the first time I really talked about it was with my current partner. and I just like asked her because I didn't know. I was like, “wait, so if she had an STI and you slept with her, like, what are the chances of you getting at? And then like passing it on to me?” And her explanation was sort of like, “it can definitely happen, but it's a lot harder. Like it can be transmitted more easily through toys. And through like direct contact, but it is like much harder.”
Sam: This perspective is not an uncommon one in either the community or among healthcare providers, but it's really not the whole story.
Richard: It's really not even half of it. Lest we forget, some queer women have sex with folks with penises. In these scenarios, the STI risk is on par with the STI risk of the general population.
Sam: Meaning the clinic office waiting room pamphlets would still be applicable. Even if the pictures don't seem to do it for you.
Richard: It’s the haircuts. (Laughter)
Gaby: The crew cuts. (Laughter) Yes. The negligible transmission rate myth is really around sex between queer women who have vaginas. And for Amanda, this meant that her attitude around testing was really different depending on the genders of her partners.
Amanda: When I was sleeping with men, I was like very, very cautious. I'd had unprotected sex once in my entire life with a man who I wasn't dating and like freaked out afterwards and immediately got tested. So I think that was a conversation that I like always had. Of the women that I've slept with. I've never asked them really about their sexual history before we had sex.
Sam: Okay, but the question remains, is there any truth to this?
Richard: To some extent, yes. In some studies, queer women with vaginas who had sex with partners with vaginas had lower rates of STI as compared to other populations of women.
Sam: However, another study did suggest that the risk of STI exposure was based on the number of partners folks have had.
Richard: Now let's be really clear. Folks can have as many partners as they want. People in a monogamous relationship are going to have a lower risk of transmitting new infections to each other because they're in a monogamous relationship. But any more than two partners and you're at risk for picking up new infections.
Sam: Having risk isn't the problem. We just want everyone to be able to know their risk and act on that.
Gaby: All of that is to say that the risk of STI transmission may not be as close to zero as we think it is.
Dr. Garment: What we have learned from albeit limited data is that there are tons of STIs that women who have sex with women are in fact at risk for. It’s not entirely clear whether in certain situations they are at lower risk or higher risk. But the risk is still out there. And more concerning is that it's a conversation we don't often have. Some of the risks perhaps comes from just the fact that we're not talking about it.
Gaby: You might recognize that voice as Dr. Anne Garment, she joined us for our previous episode about queer women's sexual health and sexual satisfaction.
Dr. Garment: Pronouns are she/her. I'm a primary care provider here at Bellevue Hospital, part of the New York City public hospital system called Health and Hospitals.
Richard: Putting some numbers to what Dr. Garment said above: queer women who have sex with women have roughly comparable risk for chlamydia when compared to women who have sex with men.
Gaby: It's not just chlamydia. Queer women are at risk for a lot of the same STIs that other folks are.
Sam: Like trichomoniasis – also called trick – syphilis, hepatitis A and herpes. If you're unfamiliar with these terms or curious about the biology of these STIs, you can check out our show notes for more information.
Gaby: Okay. So there really isn't too much truth to this myth about low STI transmission. Is it all a ruse?
Sam: Like my sense of personal identity at the end of high school: this is so confusing!
Richard: Where I'll come down on this is: that we can't really know for sure. In reality risk is probably based on whether there are penises present, whether toys or fingers are being inserted and how and where folks put their mouths or tongues. Fewer things being inserted likely means lower risk of transmission, but definitely more than no risk.
Sam: For a moment of clarity amidst all the confusion: our experts. It's did seem to agree that HIV transmission is very unlikely between sexual contact of folks with vaginas.
Dr. Garment: So historically lots of organizations, including the CDC, have said that there are no documented cases of HIV being transmitted between women who have sex with women by their sexual contact with each other.
Richard: Let's demystify this a little bit. HIV is primarily spread when body fluids – like vaginal fluids, semen, or blood – come into contact with the mucous membrane – like those in the rectum or the vagina – or even directly in contact with the bloodstream.
Sam: So oral sex or penetrative sex using fingers or toys is unlikely to spread HIV from one person to another. There is one case in the scientific literature that talks about HIV transmission between two partners, with vaginas using toys, but it's literally only one case. And it was thought that vigorous use led to some skin breakdown that may have been the source of transmission. So when you're watching that House queer season reboot on Netflix now you know the plot line.
Gaby: All that being said, as Dr. Garment points out, this doesn't mean that queer women don't test positive for HIV.
Dr. Garment: There are many cases of HIV in women who have sex with women. And so the question we should really be asking ourselves is, "Well, okay. So how are these women getting HIV?”
Richard: The answer here may not include sex with other partners with vaginas, but does include the same list of things we counsel all folks on when it comes to HIV risk, like: condomless sex with partners with penises, sexual or erotic blood play, or sharing needles.
Dr. Forcier: I have a patient who. It's not at risk for any of the genital STI, but gets tested routinely for HIV because her sexual practice is to cut and share blood
Sam: Which just brings us back to the same thing: communication with your healthcare provider about your individual practices.
Dr. Garment: So it always comes back to this issue of just having an open, not judgmental conversation about who are you having sex with and what are you doing. Because just putting a patient into the category of, “This is a woman who has sex with women and therefore is at no risk of HIV” is not doing that patient justice.
[TRANSITION MUSIC]
Gaby: Now that we've covered the basics of STIs, I want to move on to talk about something that isn't an STI. I want to talk about BV.
Sam: Okay. I can't quite remember what that means, it's something like Beaver Veaver or Bothersome Vadge. I don't know. Help me out, Gaby.
Gaby: Though I wish the acronym stood for Bothersome Vadge because it's very descriptive. It actually stands for bacterial vaginosis.
Dr. Garment: In early medical school, I remember being taught that it was not considered a sexually transmitted infection, but in fact, just when there's this bacterial overgrowth. So BV is a normal bacteria that can grow a little bit out of control in certain situations. And the symptoms that you get from it, are discharged or itchiness or sometimes the discharge is a different smell than it usually is. It is not in and of itself dangerous. It can be concerning if you are pregnant, but outside of that context, BV is not a dangerous infection.
Sam: And we should add that not all folks with BV have symptoms. Some folks will test positive for it without any of the discharge or itchiness that Dr. Garment just described.
Gaby: Here's my probably predictable follow-up question: why are we talking about this on a podcast episode about queer women's sexual health?
Dr. Garment: Are women who have sex with women at higher risk of BV? The answer is “Possibly yes”.
Richard: BV is more common in women who have sex with women by a factor of two.
Dr. Garment: There's actually been a lot of studies that show concordance in partners for women who have sex with women, meaning that if you are a woman who's having sex with a female partner and you have BV, the odds that your partner has, it are much higher than not having that. Which suggests that there is a sexually transmitted element possible to it.
Richard: How BV is spread is thought to be from contact with vaginal fluid. Also, possibly around menses. There's also a possible link to oral sex, as this could introduce new bacteria into the natural local vaginal bacteria, creating an imbalance.
Gaby: And FYI, since we haven't said it yet. BV is highly treatable. A short course of antibiotics clears up the symptoms for most folks, But there are also ways to prevent BV.
Dr. Garment: So one of the things we don't know. Perhaps talk about often enough is that if you are using shared sex toys, cleaning them between partners could hypothetically reduce the risk of BV transmission as well as potentially other sexually transmitted infections.
Gaby: So toys made of different materials will need slightly different cleaning. Silicone or metal can be run through the top rack of the dishwasher. Anything with a motor can be washed down with bacterial soap. And then lastly, remember that porous materials like hard plastic are difficult to clean fully. And so using a condom or some other form of barrier protection can limit transmission. And as a plus, you can actually change these condoms between partners without jumping up to wash them or removing them from your strap-on. If that's your thing.
Sam: And speaking of barrier protection…
Dr. Garment: Hypothetically a dental dam would reduce risk of BV transmission as well. I don't want to put too much emphasis on barrier prevention because I think realistically, a lot of people aren't engaging in that.
Gaby: Dental dams are coming up soon. Don't worry.
Sam: I - I’m worried about dental dams, Gaby, but I'll hold my breath. (laughter) Dr. Garment was clear about one thing though: queer women may be at higher risk for BV, but it's also primarily about symptoms.
Dr. Garment: If it's not bothering you, it's not something to be in a panic about. So this is one of those that I would say, you know, if your partner has BV and is asymptomatic and you have it, and you're asymptomatic, you don't have to drastically change your sexual practices, just because one of you has been diagnosed with this.
[TRANSITION MUSIC]
Sam: All right, last but not least. Let's talk about HPV or human papilloma virus.
Gaby: I don't know what it is about this episode, but we are busting out all of the acronyms today. Folks have probably heard of this acronym of HPV before, but we'll let Dr. Garment define it for us just for the sake of clarity.
Dr. Garment: So the overwhelming majority of cervical cancers are caused by a virus called human papilloma virus - HPV. There are lots and lots of strains of HPV out there. In fact, there's hundreds of them, But we know that certain strains are particularly good at causing cervical cancer. So those are the ones that we call the high risk strains. And the majority of them get cleared by your immune system, where: you get this virus into your body, your immune system notices it, gets rid of it, and there's no problem. The problem comes is if for whatever reason, your body isn't able to get rid of that infection, then by HPV hanging around for too long - and this is usually on the order of years - it can start to cause changes in the cells of your cervix. Which, over time, can lead to cervical cancer.
Sam: In short HPV is a virus that is spread by skin to skin contact. On the skin, it can remain entirely without symptoms. It can also go on to cause warty growth and sometimes especially in the cervix, it can go on to cause cancerous growths.
Richard: And as you might've guessed, the reason we're talking about this on a podcast about queer women's sexual health is it can be transmitted during sex.
Dr. Garment: So my spiel for HPV transmission is that HPV can be transmitted in all sorts of ways. So HPV can be transmitted from a penis to vagina, sure. But it can be transmitted from a mouth to any kind of genitals. It can be oral-anal, it can be on toys, it can be on fingers. So this idea that only women who are having sex with men are at risk for HPV and therefore cervical cancer is not accurate. In fact, when you look at HPV rates in women who have sex with women, compared with women who identify as heterosexual, the rates are not so dissimilar in terms of the rate of HPV.
Richard: Though HPV is prevalent among queer women. There are absolutely ways to prevent it.
Sam: And more importantly, still to prevent cervical cancer.
Gaby: On a day-to-day basis, cleaning toys between use can help reduce the risk of transmission. If you're sharing your toy with more than one partner. And then from a big picture perspective, you can check out if you're eligible for the Gardasil vaccine, which reduces the risk of getting HPV in the first place.
Sam: So college Sam has a question. Let's say you find out you have HPV. What should you tell your partners?
Richard: The truth is honesty is the best policy. If you know, you have HPV telling your partner is probably the right thing to do. But HPV is so common that we assume that most people have it. If you can get vaccinated, certainly do, but it's not one of those things that people regularly call their partners about.
Gaby: And then lastly, the cornerstone of all STI prevention is testing. In the case of HPV, it's going to be testing for the changes that it causes to your cervix, the changes that might lead to cervical cancer. And we can do that screening via a pap smear, which is when a brush is placed onto the cervix to remove a few cells. And then those cells get examined under a microscope.
Dr. Garment: Because it's such a slow moving and evolving process, this gives us lots of opportunities to pick up on the fact that something's wrong either by doing a test that screens for the virus itself, or by doing a test that looks at the cells on the cervix and tells us that something is amiss. And once any of these is determined, then there are lots of steps that we can take as healthcare providers to get rid of those cells that are problematic to prevent them from becoming cervical cancer down the road. And so I would say the number one takeaway from everything I'm saying today should be: it doesn't matter who you're having sex with; if you're due for a pap smear, you're due for a pap smear.
Richard: Pap smears are something that are often easier, said than done for some folks getting a pap smear or a pelvic exam might bring up past trauma or cause feelings of dysphoria. There are absolutely healthcare providers out there who are able to make this procedure more trauma-informed and gender affirming. Also, there's still not great information about whether or how we should be screening the butts and throats of queer women who use those parts during sex. But there will likely be more information on this in the future.
Gaby: Episode 46: queer women and butts.
Sam: (Laughter) that’s really funny. (laughter)
[SIR MIX-A-LOT CLIP]
Sam: This episode has been heavy on the takeaway. So let's sum up what we've discussed so far.
Gaby: We've talked about how the sexual health for queer women and in particular, STI risk and prevention for queer women is often under-discussed in part due to the thought that folks with vaginas have a really low likelihood of passing on STIs to one another from sex.
Richard: In reality, the numbers suggest that some STIs – like chlamydia, gonorrhea. trichomoniasis – are transmissible among queer women with vaginas. How common is difficult to say because the scientific data leaves us wanting more, but at least in the case of chlamydia, perhaps as common as in the general population of sexually active women.
Sam: We also talked about two other conditions, bacterial vaginosis and human papilloma virus, both of which can be sexually transmitted. The big picture here: both are common among queer women with vaginas who are having sex. For BV, It's all about testing and treating if you have symptoms. For HPV, it's all about testing and screening before you notice any symptoms. And by testing and screening, we mean staying on top of your pap smears.
Gaby: So much nuance. Wouldn't it be nice if there was a simple way to prevent STI transmission? Like a condom, but for folks with vaginas…
Richard: Buckle up because there is the dental dam of course – silly. (laughter)
Gaby: I just want to use like the same sound effect we use for lesbian bed death.
Sam: Womp womp wooooomp.
Amanda: OK for some reason, whenever I hear the word dental dam, the first thing that comes to mind is a beaver. (laughter) It's just such an unsexy word. I'm sure maybe that's socialized, but I also, you gotta call it something different than a dental dam. Like maybe like, the lady protector, I don't know, just something like a little more empowering.
Gaby: Lady protector just sounds like a D-list superhero.
Sam: And other things on D-list of protective heroes include dental dams.
Gaby: I asked Amanda what she thought had dental dam was made out of. And here you go.
Amanda: I think it's like a barrier. Is it like a diva cup? I feel like you can make them yourself tinfoil and saran wrap those sound wrong. Like, that definitely sounds wrong (laughter)
Richard: Do not use tinfoil. Diva, cups are for something completely different. let Dr. Garment chime in here.
Dr. Garment: A dental dam is basically a piece of plastic it's know latex or, polyurethane that can be placed over the vagina and anus while you're engaging in oral sex. The idea is that it will reduce the amount of fluids that are being transmitted between partners and therefore reduce the number of potential STIs that could go back and forth between people.
Gaby: So clearly based on Amanda's response, you might expect that dental dams aren't in super wide use.
Dr. Garment: I say this not to discourage anyone from using a dental dam, but the rate of use is not particularly high.
Gaby: But the question I had for our experts was: should they be? Are they actually effective at preventing STIs?
Richard: As Dr. Garment points out, the evidence is – as per usual on this episode – not really out there.
Dr. Garment: I could not find very good, hard and fast evidence event. certain St I's, but it would, uh, significantly reduced. I mean, I can come up with all sorts of STIs where hypothetically it should reduce the transmission rate. But I am not able to give you very good numbers.
Sam: For Dr. Forcier, the effectiveness of a dental dam lies in how it's used
Dr. Forcier: There can be a misunderstanding of how maybe they're not as useful as people think they are. Mostly again, because it's a matter of do we use them appropriately? I think, you know, the big thing was all the barriers, devices, dams, or internal/external condoms is that if you don't use them each and every time, you know, you're still being exposed. Say you're with a single monogamous partner and you intermittently use a dental dam – it's really not doing you anything. Cause you're, you're also being sort of quote, unquote, exposed to potential infection from your partner all the other times, you're not using a dental dam.
Richard: Plus as Dr. Garment reminds us dental dams, don't universally protect in all the ways that queer women might have sex.
Dr. Garment: There are certain sexual practices that women might be engaging in where a dental dam has nothing to do with what they're doing. I think a big part of it is just having that open interview to begin with about who are you having sex with and what are you doing? And that really then dictates where the conversation is going and, counseling from there on out.
Gaby: So look, this is complicated and nuanced and highly individual. There's no silver bullet – or thick piece of latex – that’s going to universally prevent all STIs that queer women might come across at the end of the day, if you're a queer woman – and really, if you're anyone who is listening to this episode – good STI prevention comes from good primary care.
Richard: I couldn't agree more. And one of the great things about having a primary care provider is that not all of these conversations have to happen on the first visit. You can wait until you get to know a provider and feel comfortable with them before you lay out which body part goes, where and what needs to be screened, but that's coming on our next episode, queer women in primary care.
Sam: Until then, here's Dr. Forcier with the last word:
Dr. Forcier: There's the broad sort of public health messaging about sexually transmitted infections and preventing them versus the more intimate conversation a provider can and should be having with the patient: “Tell me about your partners. Tell me about what parts go where. Tell me about if or when and how you might use things that can potentially prevent infections". That's a different conversation than say, "Do you need HIV testing?” or, “You know, you're woman and you need birth control”. So it's really a very intimate conversation if we want to do a really good job about counseling that patient, for their unique specific sexual health needs.
[QHP THEME MUSIC]
Richard: QHP is a power-sharing project that puts community stories in conversation with healthcare expertise to expand autonomy for sexual and gender minority folks.
Sam: Thank you to our community, voice Amanda, and our experts, Dr. Michelle Forcier and Dr. Anne Garment.
Gaby: For information on the stuff we talked about in this episode, check out our website. It's www.queerhealthpod.com. It's going to have show notes, links to resources, and a lot more.
Sam: Help! Just kidding, but seriously, help this information find a larger audience by leaving a review and subscribing to our feed on Spotify or Apple.
Gaby: If you like what you heard, give us a follow on Twitter or Instagram. Our handles there are @queerhealthpod and you can let us know what experts do you want us to bring on? We're rounding out season one and we have a lot of planning to do for season two. And also I get really excited when anyone DMs us. So, feel free.
Sam: I do too, but it's kind of different. Anyway. Thank you to Lonnie Ginsburg composing the music heard throughout this episode.
Richard: As always, opinions in this podcast are own and do not represent the opinions of any of our affiliated institutions. And even though we're doctors, please don't use this podcast alone as medical advice, but instead consult with your own healthcare provider.
[QHP THEME MUSIC ENDS]
Sam: Hark! It is the dental dam! (Laughter)
Gaby: Forsooth! (Laughter)
Sam: No that’s a for-TOOTH, Gaby. (Raucous laughter)
Richard: That was good.
Gaby: My God, I'm going to have a time editing this.