Risks for Bacterial Vaginosis in Lesbian and Bisexual Women

Background:
Bacterial vaginosis (BV) is a common cause of vaginitis and, for unknown reasons, is common in lesbian and bisexual women. Risks for BV in this group are not understood.

Objective:
Define risks for BV in lesbian and bisexual women with attention to detailed sexual risk history.

Method:
Women 16-35 years reporting sex with >1 woman in prior year were eligible. All underwent computer-assisted self-interview with extensive sexual and medical history at diagnosis. BV was defined by Amsel criteria and unadjusted and adjusted prevalence ratios (PR, APR) obtained via GEE to account for enrollment of both partners currently in a sexual relationship.

Result:
Of 335 participants (median age 25 y; 22% nonwhite race), 6% reported douching, 8% sex with men, and 91% any sex in prior 3 months. 96 (29%) had BV (40% symptomatic). Relative to women without BV, those with BV were more likely to report a partner with history of BV (39% vs. 12%; PR (95% CI) 2.63 (1.85-3.74); APR 2.55 (1.87-3.46)), sharing vaginal insertive sex toys in prior three months (33% vs. 21%); PR 1.54 (1.06-2.24); APR 1.46 (1.03-2.08)), or vaginal lubricant use in prior three months (77% vs. 62%); PR 1.70 (1.03-2.78); APR 1.53 (0.94-2.47)). No significant association was seen for age, race, or (previous 3 months) smoking, hormone use, douching, vaginal intercourse, receptive anal or oral sex, numbers of or new partners. Lubricant use and shared vaginal toys were correlated (Spearman 0.29) and thus not entered simultaneously in multivariate analysis.

Conclusion:
BV is associated with practices that efficiently transmit vaginal fluid and with use of vaginal lubricant; since these are correlated, assessing independent effects will require further analysis.

Implications:
More research is required to understand relationships between role of transmission of BV-associated bacteria and vaginal lubricant on BV pathogenesis.