Sexual health for LGBTQ+ people

Having sex only with women does not rule out sexually transmitted infections, or remove the need for cervical screening if you have a cervix. Your care needs to reflect your body and the sexual contact you have.

For trans and non-binary people, CDC guidance also says care needs to take account of your current anatomy, the sex you have, and any hormone treatment or surgery. You can ask the clinician to use your preferred words and pronouns while discussing those details.

STI testing follows the contact involved

STIs can pass during sex between women, non-binary people and trans men. Some infections cause no symptoms, so you may need testing even if you feel well. Tell the clinician about the contact you have had and any symptoms, and ask which tests are appropriate.

Depending on the tests, a clinic may use a urine sample, a blood sample or swabs. CDC guidance for trans people takes account of where contact happened, including oral, anal and vaginal contact. Describing the contact in more detail than “sex” helps the clinician choose the right samples.

If you share sex toys, NHS Wales advises washing them between sessions and using a new condom for each partner. Change the condom when moving between vaginal and anal use. Barriers for oral sex, such as dental dams, can help reduce transmission; ask a sexual health service about options that suit the sex you have.

Cervical screening depends on having a cervix

Women who have sex with women can acquire HPV, the virus linked to cervical cancer. Trans men and non-binary people with a cervix also need screening according to the relevant programme. Having had the HPV vaccine does not remove the need for screening.

In England, invitations may not arrive automatically if you are registered with your GP as something other than female. Contact your GP surgery, sexual health service or transgender health clinic to ask about invitations. If you do not have a cervix but receive an invitation, ask the service to check its records.

If an examination feels difficult, discuss it before the appointment. The NHS suggests asking about a smaller speculum, a different position or bringing someone for support. You can ask to stop during cervical screening. You could tell the clinician: “Please explain each step before doing it, and use these words for my body.”

Testosterone is not a contraceptive method

Testosterone cannot be relied on to prevent pregnancy. Ovulation may continue during testosterone treatment in people who retain a womb and ovaries. CDC recommends offering contraception counselling and services to people using testosterone who could become pregnant and do not want to.

If the sex you have could lead to pregnancy, ask a clinician about contraception that fits your needs. Include your hormone treatment in that conversation. You can ask whether pregnancy is possible without making plans for a future pregnancy or changing prescribed treatment yourself.

Asking for care that fits your needs

Anyone can attend an NHS sexual health clinic, including people without symptoms. In the US, CDC asks providers to create welcoming environments and use gender-inclusive care. When contacting a service, you can ask about its experience with LGBTQ+ patients, examination options and the language staff will use.

Ask how results will be sent and which contact details to use. NHS clinic guidance says staff ask about your preferred way to receive results. If privacy is a concern, raise it before giving a phone number or agreeing to a message.

Contact a sexual health clinic or A&E now (UK), an emergency department (US), or a local urgent medical service elsewhere if you think you may have been exposed to HIV in the last 72 hours. Ask immediately about post-exposure prophylaxis (PEP); do not wait for symptoms or a routine test.

Contact a GP or sexual health clinic in the UK, or your doctor or sexual health service in the US or elsewhere, if you have symptoms or are worried about an STI. You can also book for contraception advice while using testosterone. You can start the conversation with what you need help with today.