Due to the AIDS crisis and the HIV epidemic, sexual-health initiatives within LGBT communities have historically been heavily geared toward addressing men who have sex with men (MSM). Meanwhile, sex education in schools has used opposite-sex partners as its primary focus.

Unfortunately, research is revealing that several groups have been neglected in the process.

A new study led by researchers from the University of British Columbia reveals that although lesbian and female-bisexual teens face a higher risk of sexually transmitted infections (STIs) than their heterosexual counterparts, raising awareness of safe sex between women has been overlooked.

In the study, published in the Journal of Adolescent Health on December 28, 160 U.S. girls aged 14 to 18 participated in online focus groups based on whether or not they were sexually experienced.

What the researchers discovered was related to the exclusion of LGBT issues from mainstream sexual-health programs and preconceived ideas about gender.

The researchers identified four main themes as to why participants did not use latex barriers during sex.

A recurring theme was a concern about sexual pleasure or mood being reduced by awkwardness or discomfort. The study’s authors pointed out that sexual-health-promotion interventions have faced challenges in raising awareness of how pleasure can be increased by some STI–prevention methods, such as female condoms that stimulate the clitoris or lubrication on the underside of a dental dam.

Despite these issues, participants did express a willingness to use barriers in the future. Nonetheless, many participants preferred to use STI testing as a safe-sex strategy to determine whether or not they needed to use barriers. For instance, if both partners tested “clean” or “STD-free”, participants didn’t feel they needed to use barriers.

Another reason for avoiding barriers was the idea that sex with another female is low-risk due to the impossibility of impregnation. Several participants also stated that they trusted their female partners more than male partners regarding STIs.

However, the researchers pointed out that the exchange of vaginal fluid by mouth, fingers, or sex toys can transmit STIs; the human papilloma virus (HPV) can be spread by skin-to-skin contact; and genital HPV has been found on fingers, sterilized forceps, and surgical gloves (making transmission via sex toys possible).

The researchers also found that the participants often lacked awareness of safe-sex practices for sexual activity between women and lacked knowledge of the risks involved.

One 18-year-old participant said that when she started having sex, she couldn’t find any online information about safe sex for lesbians. A 15-year-old girl pointed out she had never been taught about STI transfer between female partners. Meanwhile, others were unaware of dental dams (for use during oral sex) or where to obtain them, and still others mentioned that LGBT sex was excluded from heterosexual-based sex education at school.

The researchers noted that the bias toward focusing on men as transmitters of STIs was prevalent within health-care systems, as female-to-female transmission of STIs was only considered once male-to-female transmission was ruled out.

The findings of this study recalls themes of a 2016 UBC–led research paper about transgender youth and sexual activity that pointed out similar gaps due to preconceived notions about which sexual issues are relevant to LGBT people. That study revealed—contrary to assumptions that pregnancy concerns were not relevant to transgender youth—that trans teens and their cisgender counterparts were equally at risk of being involved with pregnancy.

Consequently, such analyses highlight the need to rectify these areas of omission and oversight in both health care and education in order to achieve equality in treatment within health-care systems.