Preventive Care's Forgotten Women: Life Course, Sexuality, and Sexual Health among Homosexually and Bisexually Active Women in France

Abstract

Although studies show that women who have sex with women (WSW) have poorer sexual health and more limited access to health care for gynecological problems than other women, the social processes giving rise to such health differences have not, so far, been explored. These processes may be formed in response to a dominant social norm, which assigns women to a heterosexual and monogamous sexuality. Based on data from a national random survey of sexuality (N = 6,824), enriched by qualitative interviews with WSW (n = 40), this analysis shows that bisexually active women had similar socio-demographic profiles to heterosexually active women, whereas homosexually active women appeared to be more highly educated than other women and less likely to live as couples than bisexually active women. Bisexually active women had more diversified sexual trajectories and sexual networks than other women. Chlamydia prevalence was found to be higher among bisexually active women, and homosexually active women reported fewer medical consultations for gynecological reasons. These analyses highlight the need to deconstruct the binary classification of homosexual versus heterosexual women. Because of constraint by the monogamous heterosexual norm, bisexually active women were less likely to be tested for sexually transmitted infections, and homosexually active women were less likely to have had gynecological follow-ups.

Acknowledgments

This research was funded by the French National Agency on AIDS Research, The Ministry of Social Affairs, The Foundation of France, and the National Institute for Health Education.

Notes

¹Percentages presented throughout the text are based on quantitative data only.

Note. WSM = women who have sex with men; WSWM = women who have sex with men and women; WSW = women who have sex with women; CI = 95% confidence interval.

^a Means and confidence intervals (not percentages).

Note. WSM = women who have sex with men; WSWM = women who have sex with men and women; WSW = women who have sex with women; CI = 95% confidence interval.

^a Among women who have had several lifetime partners.

^b Among women who have had at least 1 lifetime partner.

^c Among those who participated.

Note. WSM = women who have sex with men; WSWM = women who have sex with men and women; WSW = women who have sex with women; CI = 95% confidence interval; OR = odds ratio; STI = sexually transmitted infection; GP = general practitioner.

^a ORs adjusted for age (18–34 and 35–69), education, and reported number of lifetime partners (under 3, 3–5, and 6 or more).

^b ORs adjusted for age (18–34 and 35–69), education, and reported number of partners in the past 12 months (1 partner and 2 or more partners).

²The test was offered to all women under the age of 26 and to all those aged 26 to 44 who had a new partner, or at least two partners, during the year (Goulet et al., 2010). A total of 1,445 women agreed to participate in chlamydia testing.