Health Sex and sexual health Safe sex Safer sex for queer women and woman-aligned non-binary people By Emma Doyle Anyone can be at risk of catching and spreading STIs, regardless of how you have sex or who you’re intimate with. Whilst having penetrative sex usually carries the most risk, all forms of sex can spread STIs - especially where there is skin to skin contact. Whether you have a long term partner or you enjoy casual sex, you should know the best ways to protect yourself and others. COVID-19 and safe sex It’s important to continue following current guidelines and minimise the spread of COVID-19. The virus can be spread through close contact and contaminated surfaces, meaning meeting for sex can still put you and your partners at risk. You should check with current advice on meeting with people outside your household. Whilst restrictions are still in place you are your best sexual partner, or others in your household or support bubble. If you do decide to meet for sex, you should limit the number of partners you meet and discuss with them how you want to minimise the risks. This might include minising face to face contact, and making sure to follow good hygiene practices including handwashing. If you notice any of the symptoms of the virus (a high temperature, new continuous cough, or loss of taste or smell) do not meet with anybody, arrange for a COVID-19 test and isolate as necessary. You should also postpone any sexual health clinic appointments if you think you have coronavirus symptoms. Remember, you can still have the virus even if you do not have any symptoms, so you should remain cautious. Spotting and preventing common STIs One of the best ways to protect yourself from the risk of STIs is communication - talk with your partners about any symptoms or diagnoses, and about any protection you want to use during sex. There are a few factors that can make you more at risk of catching an STI, including: Having sex whilst menstruating: changing pH levels and the opening of the cervix can make transmission easier. Cuts or sores around your genitals, anus or your mouth can make it easier for STIs to enter the body. Not using lubrication to reduce the chance of tissue damage or small tears during sex - this is particularly important for trans woman who have had vaginoplasty and are not self lubricating. Water based lube is safe to use with latex toys, gloves and condoms. Any recent surgery or other treatment may also mean you are more susceptible to catching an STI, so it’s best to wait three months, or until fully healed, before having sex. Lots of STIs are simple to treat and keep under control, so getting regular checkups and screenings where available can help you treat them early. If you think you might have symptoms of an STI, visiting your local sexual health clinic is the best option, and will have a range of tests and treatments available. You can find out where your nearest clinic is here. Genital herpes Genital herpes is a fairly common virus that can spread through skin to skin contact. One strain of herpes includes the more common oral herpes - or cold sores, which can also be spread through oral sex. You might have genital herpes if you notice: Small, painful blisters and open sores Pain when you urinate Burning or itching sensations around your genitals A change in your normal discharge How to treat: Typically, outbreaks of genital herpes will clear up by themselves, but if symptoms persist you can be given anti-viral medication to speed up recovery time. You can also use specific creams to relieve uncomfortable symptoms. It’s also best that you avoid wearing tight clothing that may further irritate the area whilst outbreaks are clearing up. Try not to touch the area, unless applying cream, to prevent further spread of the virus. There is no cure for genital herpes, as the virus can continue to live in the body, but usually outbreaks become smaller and less severe over time. If you have an outbreak of genital herpes whilst pregnant, it’s always best to visit your GP for more advice. How to prevent: Try to avoid oral sex if you or your partner have cold soresUse dental dams, latex gloves and condoms to avoid skin to skin contactKeep sex toys clean and wash hands to prevent spread of the virusThe virus is most contagious during outbreaks, so avoid skin on skin contact with the affected area until blisters have cleared up Genital warts Genital warts are caused by a strain of the human papillomavirus (HPV), but are not linked to genital cancers, like some other strains are. Common symptoms of genital warts include: One or more growths or lumps around genitals, anus or upper thighs Lumps which are itchy, but not painful It’s also important to note that warts can grow internally, and might be harder to spot. How to treat: Again, this virus can continue to live in the body after the initial infection, however the warts themselves can be treated. This can be in the form of creams to remove the warts, or freezing or surgical treatments might be used. Make sure to visit a health professional to remove warts, as many common store-bought wart treatments are not designed for use around your genitals. Seek further advice from your GP if you have genital warts whilst pregnant. How to prevent: Minimise skin to skin contact with dental dams, latex gloves and condoms Avoid sharing toys and keep good hygiene between uses Do not have sex if you or your parter have symptoms. Even once the warts are gone, it’s good to keep the area protected as you could still pass the virus on Having the HPV vaccine can reduce the risk of genital warts HPV The human papillomavirus, or HPV, covers a number of strains of a virus that can be transmitted through sex. Some cause irritating, but less harmful conditions such as genital warts, however others can have a more serious impact, including cervical and anal cancers. HPV is the most common cause of cervical cancer. How to spot: Regularly attending any smear tests that you are eligible for is the best way to check for abnormal cells caused by HPV. Cervical smear tests are available for anyone with a vagina between the ages of 25 and 64. Some clinics also offer anal screenings too, for those having anal sex with anyone with a penis. How to treat: There is no treatment for HPV, but many strains do not cause any issue, and will be fought off by the body within a couple of yearsIf HPV causes further issues, including warts or changes to cells, speak to a health professional for potential further treatment How to prevent: The HPV vaccine can protect against the most common strains of the virus. Current programmes cover anyone aged 12-13, but anyone up to the age of 25 is eligible if you missed out The vaccine is also available to trans women that have sex with anyone with a penis, up to the age of 45Attending regular screenings can help prevent transmission Using dental dams, condoms and gloves, as well as following good hand and sex toy hygiene will also help prevent the spread of the virus Trichomoniasis Trichomoniasis, or ‘trich’, is a relatively common STI caused by a small parasite. Typical symptoms are changes to your usual discharge, including: More discharge than usual Thicker or discoloured discharge An unpleasant smell to the discharge Other symptoms include pain when passing urine, or itching and soreness around genitals and inner thighs. For people with a penis, symptoms can be harder to spot. How to treat: Trichomoniasis can clear up by itself, but it can also be treated with a course of antibiotics. Both you and any current or recent partners should seek treatment. How to prevent: Keeping good hygiene and using dental dams, latex gloves and condoms Trich cannot be passed through oral or anal sex Gonorrhoea Gonorrhoea is a bacterial infection that can infect the cervix, urethra, rectum and in more rare cases eyes and throat. Many people do not experience symptoms, meaning regular sexual health checkups are important. How to spot: Unusual discharge, often thick and green or yellow in colour Pain when passing urine Bleeding in between periods How to treat: Gonorrhoea can be treated with a course of antibiotics. It’s also recommended that you follow treatment with another test two weeks later to check the infection has cleared. It is important that you refer any recent partners to also get tested. How to prevent: Using dental dams, latex gloves and condoms Avoid sharing sex toys, and making sure to clean them and use fresh condoms between use Chlamydia Chlamydia is a common STI caused by a bacterial infection. Often people may have chlamydia without showing outward symptoms, but left untreated it could cause further health issues. How to spot: Unusual discharge Pain when passing urine Experiencing pain during sex, or bleeding after sex Pains in your abdomen and pelvis (or testicles) Chlamydia can also infect your rectum, causing discomfort and discharge How to treat: Despite often not causing noticeable or uncomfortable symptoms, if left untreated chlamydia can become more serious, and in some cases impact fertility. It can be treated with a course of antibiotics. If taken correctly and for the full course this will clear the infection in 95% of people. How to prevent: Using dental dams, latex gloves and condoms Avoid sharing sex toys, and making sure to clean them and use fresh condoms between use Avoid having sex until you have completed your treatment Regular testing, especially when meeting new partners, can help diagnose the infection early Testing can be done at a clinic, or you can request at-home test kits HIV Female to female transmission of HIV is rare, but not impossible. If you or your partners have had sex with anyone with a penis, you may be more at risk of blood-borne infections. Cases of HIV appear to be higher amongst trans women, so regular testing to know your status is important. Trans women and people on feminising hormones: Medical transitioning can have a range of effects on the body, especially when it comes to having safe sex. For instance, feminising hormones can make it harder to get and maintain an erection, meaning it can also be harder to keep condoms on during sex. Additionally, whilst hormones such as oestrogen might limit fertility, you may still be able to produce healthy sperm, meaning it’s best not to assume you won't be able to get somebody pregnant. If you’ve had gender-affirming surgery, particularly vaginoplasty, it’s also important to remember you could be at higher risk of contracting an STI. You should avoid having sex for three months after surgery, to allow the area to heal. After surgery, you should also take extra care if having sex after using dilators, as these can also cause small tears in the tissue that could become infected. Some forms of surgery may also increase the risk of contracting STIs than others, including colovaginoplasty, where the tissue is more likely to allow infections to pass into the body. People on masculinising hormones: Taking testosterone can reduce natural lubrication in the vagina and weaken tissue, making tears more likely and increasing the risk of STIs. Once again, whilst hormones will impact fertility, they cannot be guaranteed to work in place of contraception. Often hormonal contraception will not be effective whilst taking testosterone, so consult with a doctor about the best options for you. Becoming pregnant whilst on testosterone can have an impact on foetus development, so always seek further advice. If you decide to have bottom surgery, whilst no longer being able to get pregnant you will still be able to get STIs, meaning you should continue using any appropriate protection. What Next? Support services Switchboard - The UK's longest running LGBTQ+ helpline, staffed by queer volunteers. Contact on 0300 330 0630, via email at [email protected] or via webchat here. LGBT Foundation - Charity for all LGBTQ+ people based in Manchester. Offers advice, support and information via its helpline on 0345 3 30 30 30. LGBT HERO forums - Here to answer your questions about sex, sexual health, and a anything else that's on your mind. Join the forums here. THT - Information about sexual health for trans and non-binary people available via their website. CliniQ - holistic sexual health, mental health and wellbeing service for all trans people, partners and friends. Visit their site here.