The effect of non-heterosexual factors on the vaginal flora has been studied. Ninety-one lesbians attending a specialist genitourinary medicine service for lesbians were studied. Bacterial vaginosis (BV) was diagnosed in 51.6% of them. While most of the women had previously had a male sexual partner, the presence of BV was not associated with a male sexual partner in the previous 12 months. A detailed analysis of lesbian sexual practices in the group did not relate BV to any sexual practice which would have the propensity to pass vaginal secretions from one to the other.
Bacterial vaginosis (BV) was studied in lesbians in an attempt to look at non-heterosexual in¯uences on vaginal¯ora. The women attended a clinic which provides a specialist genitourinary medicine service for lesbians and the majority of them were not complaining of a genital-tract infection but were merely requesting a check-up. BV was identi® ed in 47 (51.6%) of 91 women examined. This was a proportion larger than recorded in two other recent studies 1,2 , although in these it was also noted to be large. Fifteen (16%) of the women in our study were exclusively lesbian, of whom 6 (40%) had BV compared with 42 (55%) of the remaining 76 women who were not exclusively lesbian. BV was not related to the number of female sexual partners in the previous 12 months, nor with the frequency of sexual activity, but was associated with an increasing number of lifetime female sexual partners. Thus, 25% of those who had had 1 or 2 partners had BV compared with 54% of those who had had 3 or more partners. BV did not occur more frequently in women who had had a male partner in the previous 12 months and was not associated with an increasing number of male partners. Some women had been pregnant. Of 10 women who had had a pregnancy that had carried into the third trimester, 5 (50%) had BV. This was a proportion similar to that (45%) of the 69 women who had never been pregnant. However, of 12 women who had previously had a termination of pregnancy, 11 (92%) had BV.Of various sexual practices examined, including oral sexual activity, none could be related to the occurrence of BV; evidence for sexual transmission as a cause was not apparent. Further studies of lesbian couples and their sexual practices are required because the reason for the high prevalence of BV in this population remains an enigma. In addition, the existence of a high prevalence of BV in lesbians will complicate the provision of gynaecological and obstetric care for this group. It may be prudent to screen for BV as soon as a pregnancy is con® rmed, so that early treatment can be initiated.
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