Objective: The assumption that self-identified lesbians are at low risk for sexually transmitted diseases (STDs) and other gynecological infections may be premised upon infrequent screening, ignorance of lesbian sexual practices, and the discomfort that lesbians may feel concerning the disclosure of their sexual identity and behavior. We hypothesize that transmission between women may occur, and actual risk may depend upon the sexual behaviors as well as the number and gender of partners. Methods: In 1994, the Family Planning Council of Western Massachusetts developed a Lesbian Health Needs Assessment Survey. The Fenway Community Health Center (FCHC) supplemented the survey with a one-page STD questionnaire aimed at evaluating STD testing, diagnoses, and sexual practices among self-identified lesbian and bisexual women. Circulated only in eastern Massachusetts, 421 of the 1523 surveys, including the one-page STD supplement, that were distributed were returned. The prevalence of specific STDs among women with and without recent male sexual partners was compared and analyzed in relation to self-reported sexual behavior. Results: Among lesbians who denied having prior male sexual partners, the following gynecological infections were reported: trichomoniasis, anogenital warts, and abnormal Pap smears. The most commonly reported sexual practices were digital–vaginal penetration, oral–oral, oral–genital, and genital–genital contact. Conclusions: Probable woman-to-woman transmission of STDs and vaginitis was frequently reported. Although the true incidence of specific infections among lesbians is unknown, routine screening should be offered to sexually active lesbians.