Lesbian, gay, bisexual and transgender services

Lesbian, gay, bisexual and transgender (LGBT) people are welcome in all of our general clinics at the Ambrose King Centre and Barts Sexual Health Centre.

We understand that LGBT people can have specific or unique sexual health concerns, so all of our staff are trained and experienced in these sexual health matters.

Gay and bisexual men’s sexual health

Some gay and bisexual men are at higher risk of getting sexually transmitted infections, including HIV, as well as facing issues such as stigma and discrimination, and being more at risk of mental health problems.

We think it’s really important that gay men feel comfortable coming to our clinics, because regular sexual health check-ups are an essential part of looking after yourself.

Research suggests that around 1 in 7 men on the gay ‘scene’ in London is HIV positive. In addition, around 1 in 25 gay men in London attending sexual health clinics, has undiagnosed HIV (they are unaware they are carrying the virus). There is no way to tell if someone is HIV-positive by looking at them, and we also know that it is very difficult for HIV-positive men to disclose their status to partners because of the stigma and fear that they may face.

This means that it is really important to practice safe sex, and to have regular sexual health checks, including an HIV test, every 6-12 months or more regularly if you have symptoms or have been exposed to a specific risk.

Gay men are also at risk of other STIs, such as hepatitis A, B and C, chlamydia, gonorrhoea, lymphogranuloma venereum (LGV), syphilis, herpes and genital warts.

As well as comprehensive STI testing and treatment, we also offer:

Hepatitis A and B vaccination
Post-exposure prophylaxis after sexual exposure (PEPSE)
Proctoscopy – this is where we examine inside your bottom with a plastic tube, to check for problems caused by STIs. This may be necessary if you have certain symptoms.
Access to our health advisers, who are skilled in helping you disclose to your partners, and also offer ‘motivational interviewing’ to support behaviour change
Access to our sexual health psychology service.

Psychology service

We can refer you to see one of our sexual health psychologists, if we think it would be helpful. Common themes we deal with:

Issues surrounding condomless sex
Negotiating and maintaining relationships
Enhancing assertiveness and self-esteem
Managing difficult feelings
Thinking about early experiences
Solving difficulties with sexual function
Keeping safe when using alcohol or drugs

Lesbian sexual health

Lesbian and bisexual women are not immune to sexually transmitted diseases, but may not realise, or find it difficult to get tested. Sometimes lesbian women are even told that they don’t need to be tested for STIs, but this is not the case.

A recent survey by the organisation Stonewall, found that less than half of the lesbian and bisexual women surveyed had ever been tested for STIs, but that half of those who had been tested had been treated for an STI. They also found that a quarter of those who were treated for an STI had only had sex with women in the past 5 years.

Lesbian and bisexual women experience thrush and bacterial vaginosis, which may both cause vaginal discharge which is not sexually-transmitted. Lesbian and bisexual women have also been diagnosed with STIs such as genital warts, chlamydia, genital herpes, pelvic inflammatory disease, and hepatitis B and C.

Lesbian and bisexual women have both oral and penetrative sex, and can share bodily fluids by hands, mouth and sex toys.

Safer sex between women

If you're using sex toys, use a new condom for each partner or between penetration of different orifices (e.g. vagina and anus). Sex toys should be washed with soap and water between sessions
Avoid oral sex if either of you has any cuts or sores in the mouth or on the lips, or use a dental dam. A dental dam is a latex or polyurethane (very thin, soft plastic) square, of about 15cm by 15cm, which you can use to cover the anus or female genitals during oral sex. It acts as a barrier to help prevent sexually transmitted infections passing from one person to another
Some infections can be transmitted by hands, fingers and mutual vulval rubbing. Wash your hands before and after sex
Wear latex gloves and use plenty of water-based lubricant for vaginal and anal fisting

Cervical screening

Twice as many lesbian and bisexual women over the age of 25 have never had a cervical smear test, compared to women in general. Sometimes this is because they might not think they need to, or are worried about discussing their sexuality with a doctor or nurse. Or it may even be because they were told by a health professional they didn’t need one!

In the UK, data is not collected on the sexual orientation of women who are diagnosed with cervical cancer. This means that we can’t know that lesbians are not at risk. We also think that human papilloma virus (HPV), the virus that is linked to cervical cancer, could be transmitted through oral sex, or penetration with fingers or sex toys. In addition, many lesbian and bisexual women may have had sex with a man at some point in their lives.

This means that it is just as important to be part of the National Cervical Screening Program (NCSP). This is normally accessed through your GP or practice nurse (the NCSP will get your details from their register). In England, women 25 and over are called for a cervical smear once every 3 years up to the age of 49, and then every 5 years between 50-64 years.

The NCSP have produced a leaflet for lesbian and bisexual women:

http://www.cancerscreening.nhs.uk/cervical/publications/lesbian-bisexual-leaflet-sep09.pdf

We do not offer routine cervical screening at our clinics, but we may take a cervical smear in certain circumstances.

Useful web links

Elop – East London lesbian and gay mental health charity - www.elop.org
Galop – challenging homophobic and transphobic hate crime - www.galop.org.uk
Gay men’s interaction partnership – providing health training, counselling and mentorship - www.gmipartnership.org.uk
GMFA Gay men’s health charity - www.gmfa.org.uk/londonservices/index
LGBT London - www.lgbtlondon.com
London Lesbian and Gay Switchboard - www.llgs.org.uk or call: 0300 330 0630
The Metro Centre - www.metrocentreonline.org
The Naz Project – sexual health and HIV prevention and support for black and minority ethnic groups in London - www.naz.org.uk
Stonewall – the lesbian, gay and bisexual charity - http://www.stonewall.org.uk/