Lesbians and Sexual Abuse: Implications for STD Risk and Pregnancy Outcomes

Background:
Little information is available regarding young lesbian women, especially those reporting sexual abuse histories, and behaviors that put them at risk for acquiring STDs.

Objective:
Evaluate relationships between sexual abuse history in lesbians and sexual risk behaviors that have implications for STD acquisition and unwanted pregnancy.

Method:
Women 16-35 years who reported sex with >1 woman in the previous year were eligible. All underwent computer-assisted self-interview at baseline. Comparisons were made using Mann-Whitney U test, or Fisher's exact test, where appropriate.

Result:
Of 335 subjects (median age, 25 years), 103 (31%) reported a history of sexual abuse. These women reported earlier age of sexual initiation (14 vs. 16 years, P=0.001), higher lifetime number of female (10 vs. 7, P=0.002) and male sex (11 vs. 6, P=0.001) partners relative to women without abuse history. They were also more likely to report any pregnancy (31% vs. 10%, P=<0.001), and younger age at first pregnancy (17.7 vs. 20 years, P=0.025), 63% vs. 49% (P=0.41), of which resulted in abortion, as well as lifetime cocaine (50% vs. 41%, P=0.002), methamphetamine use (34% vs. 18%, P=0.004) and mental health treatment for PTSD (18% vs. 5%, P=<0.001), and less likely to report Pap smear in prior 3 years (12% vs. 6%, P=0.055). No association was seen for current alcohol use, binge drinking, or ever having Pap smear.

Conclusion:
Sexual abuse is associated with increased risk of health concerns including sexual risk behaviors, mental health disorders and drug abuse. Lack of health care access may make lesbians especially vulnerable to high-risk behaviors and outcomes associated with past sexual abuse.

Implications:
Clinicians and health care educators should be aware of risk behaviors among lesbians, and of the vulnerabilities specific to those with sexual abuse histories, in order to assess and counsel them appropriately.