May 2001

From University of Washington

Lesbians' health may be threatened by lack of Pap smears

Some women who have sex with other women may be risking their health because they may not have Pap smears as often as other women, according to a University of Washington study published in the June issue of the American Journal of Public Health.

Nearly one of eight women who have sex with other women were actively shedding HPV, the human papillomavirus, the study found. HPV can cause genital warts, cervical dysplasia and, rarely, cervical cancer. HPV is detected through Pap smears. But the study found women who have sex with other women have less regular Pap smears than other women do. In part, thatís because health care providers told them that as lesbians, they were less likely to be susceptible to STDs, including HPV.

"This shows that you really canít classify women as low-risk just because they are not currently having sex with men," says Dr. Jeanne Marrazzo, an assistant professor of medicine at the UW School of Medicine. "About 90 percent of women who have sex with women have been sexually active with men at some point in their lives. That confers a risk of their acquiring the 'usual' STDs we associate with heterosexual activity. There's a faulty assumption out there: That when a woman reports being currently sexually active with another woman, the risk for any STD --even the chronic viral STDs like herpes and HPV-- is non-existent. Thatís just wrong."

Co-authors of "Pap Smear Screening and Prevalence of Genital Human Papillomavirus Infection in Women Who Have Sex with Women" include UW nurse practitioner Kathleen Stine; Dr. Laura Koutsky of the Department of Epidemiology; and Dr. Nancy Kiviat and Dr. Jane Kuypers of the Department of Pathology.

The study of nearly 300 women in the Seattle area found that 13 percent tested positive for HPV , and 4 percent had pre-cancerous changes on a Pap test. Most of these abnormalities appeared in women who reported no prior sex with men, or who last had sex with men more than a year before the test.

Women who had never had sex with men were less likely to have ever received a pelvic examination, received their first Pap smear at a later age, and had less frequent Pap smears than other women, the study found. Ten percent of the women who had never had sex with men said they never had a Pap smear, while 23 percent had not had a Pap smear in three years.

The most commonly cited reasons for not having a Pap smear were: lack of medical insurance; prior adverse experiences at a Pap smear screening; and a belief that they did not need a Pap smear because they were not sexually active with men. Nine women said that a health care provider Ė usually a physician Ė had told them they did not need to get a Pap smear because they were not sexually active with men.

"This shows that providers should take a very good sexual history based on behavior and potential for exposure, as opposed to just labeling a person as a member of what you think of as a low-risk group. And regardless of that sexual history, every woman should have routine Pap tests according to standard guidelines," Marrazzo says.

A woman should begin getting Pap smears when sexual activity starts or at age 18, whichever is earlier, according to the most commonly accepted recommendation. Once three annual Pap smears show normal results, a physician may direct the woman to get Pap smears every two years. But many women should still get annual Pap smears, depending on a variety of factors that should be discussed with a health care provider.












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