Safe sexual health practices are a key part of health and wellness. Unfortunately, many LGBT people are erased from mainstream conversations about safe sex. As young people, many of us never received proper sex ed that was LGBTQIA+ inclusive. Plus, many of our healthcare providers might not fully understand how to provide the best sexual health services for our community. This means that many lesbian, gay, queer, as well as transgender and nonbinary people have to rely on guesswork when it comes to practicing safe(r) sex and making the right decisions for our health, bodies, and sex lives.
What types of conversations should you have with a partner before having sex? Is there a risk of pregnancy on hormone replacement therapy (HRT)? Can you get an STI from using a sex toy? At FOLX Health, we want you to have the tools you need to practice gender-affirming safe(r) sex, no matter what kind of sex you’re having. LGBTQ+ people deserve access to clear and concise sexual health information. Read on to learn more.
What is LGBTQ+ safe(r) sex?
What is the difference between safe sex and safer sex? Some people use the term “safe sex” to talk about sexual health practices that reduce the risk of sexually transmitted infections (STIs) or unwanted pregnancy, but no kind of sex with another person can ever be guaranteed to be 100 percent safe. Many people with sexually transmitted infections experience no symptoms, so are often unaware that they have them. That’s why “safer sex” is a more accurate term to describe anything that we do to lower our risk and our partners’ risk of STIs, including HIV.
STIs can affect anyone (queer or straight). They’re passed from all types of sex with all types of body parts and/or sex toys. Most STIs can be passed through bodily fluids, including ejaculate, pre-ejaculate, vaginal fluids, discharge, and blood. Some STIs can also be passed from saliva or skin-to-skin contact. Some common safer sex practices to avoid STIs include using latex or internal condoms for vaginal or anal intercourse, using latex condoms for oral sex, or having oral sex instead of unprotected vaginal or anal sex.
What are the most common STIs?
In this guide, we’ll cover three types of common STIs: viral, bacterial, and parasitic STIs.
Viral STIs
There are two viruses that cause herpes: HSV-1 and HSV-2. Although HSV-1 tends to be associated with oral herpes (cold sores) and HSV-2 tends to be associated with genital herpes, it’s possible to have either virus affect either location. Genital sores can look a lot different than oral herpes sores, so it’s important to know what to look out for. The primary symptoms of genital herpes have a lot to do with the location of the sore. If a sore is near your urethral opening, you might experience some pain when you pee from urine getting on the sore. Similarly, you might have difficulty peeing if the sore is in or near your urethra. Itching on and around the sore is also a common symptom.
Hepatitis is an inflammation of the liver, which can be caused by a virus. Hepatitis has different strains, such as hepatitis A, hepatitis B, and hepatitis C. Each can be passed on through sexual contact with someone who has it, and each strain has its own symptoms, but they can be hard to notice and can go away for periods of time.
The symptoms of hepatitis A typically develop a few weeks after a person is infected, but not everyone will experience them. The symptoms may include fatigue, joint/muscle pain, fever, loss of appetite, nausea, vomiting, abdominal pain or discomfort (especially in the area of your liver on your right side beneath your lower ribs), yellowing of the skin and eyes called jaundice, dark urine, pale bowel movements, and/or itchy skin. Hepatitis A can take two to seven weeks from infection to show in tests.
The symptoms of hepatitis B typically develop a few weeks after a person is infected, but not everyone will experience them. The symptoms may include abdominal pain, fever, joint pain, loss of appetite, nausea, vomiting, weakness, and fatigue, yellowing of the skin and eyes (jaundice), dark urine, and pale bowel movements. Hepatitis B can take up to six weeks from infection to show in tests.
There are two stages of hepatitis C: acute and chronic. Symptoms of acute hepatitis C typically include jaundice, abdominal pain, loss of appetite, nausea, and fatigue.
After six months, hepatitis C is said to be in the chronic stage, the virus is still active, although some people don’t have symptoms. Signs and symptoms of the chronic stage include extreme fatigue, depression, memory/concentration problems, mood swings, digestive problems, joint and muscle aches/pains, headaches, flu-like symptoms, liver pain, stomach pains, and itching. Hepatitis C can take eight to nine weeks from infection to show in tests.
HIV can be spread through exposure and contact with bodily fluids from an infected person. These bodily fluids include anal mucus, blood, semen, pre-cum, vaginal fluid, and human milk. Early/acute signs of HIV infection look a lot like the flu: headaches, fever, rash, fatigue, and swollen lymph nodes. These are all common symptoms seen in folks with an acute HIV infection. PrEP (pre-exposure prophylaxis) is a useful preventative medication that can reduce the transmission of HIV. Despite popular belief, PrEP is not just for gay cisgender men; learn if PrEP might be right for the types of sex you’re having.
Genital warts are caused by human papillomavirus (HPV). They’re small bumps that appear around the genitals or anus. While genital warts can be treated, there isn’t a cure for HPV, so warts may appear again in the future. Most people have HPV at some point and are asymptomatic—just know that you’re most likely going to clear it! However, some strains of HPV can progress to more serious infections, so it’s important to get STI screenings done regularly and talk to your provider about HPV vaccines. HPV is transmitted by skin-to-skin contact, particularly through vaginal and anal sex, and genital contact without penetration. HPV can also be passed on by sharing sex toys, and less commonly, through oral sex. Genital warts may be found on the vulva or labia (vaginal lips), in the vagina, on the cervix, on the penis, scrotum (balls), and urethra (pee tube), on the anus or buttocks, or upper thighs.
Bacterial STIs
Bacterial Vaginosis (BV) is a condition that happens when there is too much of certain bacteria in the vagina, which changes the normal balance of bacteria in the vagina. Symptoms include itchy and/or painful in and around your groin area; burning while peeing; strong odor, especially after sex; and front hole/vaginal discharge. In some cases, there aren’t any symptoms. Treatment can include prescription cream, gel, or medication.
Chlamydia is one of the most common STIs. Fortunately, it can be easily cured with antibiotics. Most people who have chlamydia often don’t realize it because the symptoms tend to be either very mild or not present at all. The symptoms to look out for are yellowish front hole discharge with a strong odor, painful front hole penetration, painful peeing, and peeing more often. Chlamydia tends to affect the cervix most commonly, so those who’ve had their cervix removed have a greater likelihood of not having symptoms.
Gonorrhea is the second most common STI behind chlamydia. It’s commonly passed on through sexual contact with someone who has it. Most people will have symptoms, but it’s also possible to have gonorrhea and not feel any different. Symptoms of gonorrhea can begin within a few days of infection; however, it’s common not to have symptoms of infection, especially if you have a vagina. Common symptoms of gonorrhea include: unusual discharge from the vagina (thin or watery with a yellow or green color) or from the tip of the penis (white, yellow or green); pain or burning when peeing; and/or swollen or inflamed foreskin. Rarer symptoms can involve pain in the testes, or in the lower stomach area, and also heavier periods and bleeding after sex. Gonorrhea in the throat typically doesn’t have symptoms.
Syphilis is divided into stages. The first two stages show symptoms for the most part. The first sign of a syphilis infection tends to be a chancre, or a sore that develops in the same spot where syphilis entered your body. That means that even if a chancre does develop, it could be inside the body and difficult or impossible to see. One of the key symptoms of secondary syphilis is a rash that’s typically on the palms of the hands and soles of the feet. Syphilis is treatable at every stage, though the effects of tertiary syphilis can be permanent, so it’s better to test regularly and get treatment if you test positive.
Parasitic STIs
Crabs or pubic lice are parasites that live on coarse human hair like pubic hair. They can also live in leg and armpit hair. They’re most commonly passed on through sexual contact. The main symptom of crabs is itching, which gets worse at night when the lice become more active. Other symptoms also include inflammation or irritation caused by scratching, black powder in your underwear, blue spots, or small spots of blood on your skin in your groin, caused by lice bites.
Trichomonas vaginalis or trich is a common STI caused by a parasite. The parasite is carried in sexual fluids, like semen, pre-cum, and vaginal fluids. Trich can also infect your urethra. Symptoms include irritation and itching, smelly discharge, painful or frequent peeing, and/or vaginitis.
What are some queer safer sex practices?
LGBTQ+ sex can look different than heterosexual cisgender sex. While all types of bodies can have all types of sex, the concept of queer sex isn’t based on the standard PIV (penis in vagina) penetrative sex. While some LGBTQ+ might be having this type of sex, others will practice anal sex, oral sex, fingering, and/or penetration or stimulation with sex toys more frequently.
Anal and vaginal/front hole sex
This type of sex has the highest risk of contracting an STI or HIV. If you’re having anal sex or vaginal/front hole sex, it’s important to use internal condoms or external condoms and water-based or silicone-based lube. Make sure that you use a different condom with each partner or when a penis or dildo/sex toy is moved between the vagina/front hole and anus. Infections such as herpes, genital warts, syphilis, and monkeypox can be transmitted through regular skin-to-skin contact. Barrier methods such as condoms, dental dams, or latex gloves can reduce your risk of contracting these infections, but will only cover the protected area.
Oral sex
Oral sex is when someone uses their mouth to stimulate the genitals of another person. has a low risk of STI transmission and a very low risk of HIV transmission, but it’s still possible to get STIs such as herpes, syphilis, HPV, or gonorrhea. Using an external condom on a penis during oral sex can help contain body fluids such as semen, ejaculate, and pre-ejaculate and reduce the risk of STI transmission. Condoms can also be used on a sex toy/dildo, especially if it was used with multiple partners without proper cleaning.
If you recently got bottom surgery, avoid receiving oral sex until you are fully healed. Also avoid oral sex if you have bleeding gums, mouth ulcers, a sore throat, or have gotten dental work done recently.
Rimming
Rimming (analingus or a rim job) is when someone licks, sucks, kisses, or penetrates someone’s anus with their tongue. This can function as a way to prepare for anal sex and/or as a fun, pleasurable sexual activity in its own right. Rimming has an extremely low risk for HIV, but it’s possible to get hepatitis A or bacterial infections like gonorrhea. Practicing good personal hygiene greatly reduces risk, but you might also want to use a barrier method like a dental dam if you or your partner haven’t had a recent anal STI check.
Fingering
Fingering is when someone uses their hand, finger, or multiple fingers to stimulate and penetrate their partner’s vagina/front hole and/or anus. Fingering is considered low-risk since there’s only a small chance of spreading an STI. There is a small chance that STIs can spread through fingering if you have any cuts on your hands or fingers, or if there are internal tears in the anus or vaginal/front hole tissues. Practice good hygiene and wash your hands with soap and water, especially if you’re fingering multiple partners. You can also use latex gloves or finger condoms to cover your fingers.
While this guide didn’t go into depth about birth control in regards to HRT, we also encourage you to read our related Library article, HRT and Birth Control: What You Need to Know.
If you’re a queer and/or trans person having sex, it’s important to know how to have sex safely, so you can protect yourself and others. Safer sex not only ensures that you’re happy and comfortable with sex, but also that you’re looking after your and your partner’s physical health. We recommend getting tested regularly to know your STI status as well as using barrier methods alongside lube as often as you can. You’re entitled to have enjoyable and safe sex no matter what.
If you have additional questions about STI signs or symptoms, you can schedule a virtual primary consultation here. FOLX members with questions about their sexual health are encouraged to contact their clinician. For questions about starting a FOLX membership, including our sexual health offerings, visit the FOLX Help Center to connect with our friendly Member Navigators, who are here to answer any questions you may have.
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FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include virtual primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), mental health care, sexual and reproductive health care, preventive care, and fertility consultations. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more. Whether you’re lesbian, gay, bisexual, transgender, queer, gender non-conforming, or nonbinary, you can find LGBTQIA+-specialized health care that helps you meet your wellness goals. FOLX Health is health care that's queer all year. Get all the benefits of becoming a FOLX member and sign up today!
