Differences in Sexual Health, Risk Behaviors, and Substance Use Among Women by Sexual Identity

Abstract

Lesbian women may perceive themselves to be at lower risk for sexually transmitted infections (STIs) and use reproductive health care at lower rates compared with heterosexual women. Therefore, STIs in sexual minority women may go undetected. The prevalence and risk factors of urogenital STIs in women of different sexual orientations were investigated. This is a cross-sectional study of women attending the STI clinic of Howard Brown Health Center in Chicago, Illinois. Women were eligible for inclusion in this study if they reported a sexual identity and were screened for urogenital gonorrhea (GC)/chlamydia (CT) in the clinic between January 2008 and December 2011. Among the 669 women studied, the urogenital prevalence of GC was 1.5% and that of CT was 5.2%. Gonorrhea and CT were only diagnosed in women with recent male sex partners, but sexual identity was not necessarily consistent with sexual partner sex, and women of all sexual orientations were diagnosed as having STIs. Bisexual and heterosexual women had similar diagnosis and STI history rates, whereas lesbian women had a significantly lower history of STIs. Bisexual women had more sex partners than heterosexual or lesbian women, and their partners were less likely to be monogamous. Compared with heterosexual women, sexual minority women had twice the odds of drug use in the last year. Chlamydia and GC were diagnosed in sexual minority women, and several cases would have been missed if lesbian women were not tested for STIs. High rates of substance use among sexual minority women highlight the need for targeted interventions.