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Women's Health

Sexual Preference Should Not Prevent Regular Pap Smears

Women who do not have heterosexual relationships may be putting themselves at risk by not having Pap smears as often as other women, a new study has found.

Nearly one out of eight homosexual women were actively shedding HPV, the human papillomavirus, according to the University of Washington study. HPV can cause genital warts, cervical dysplasia and, rarely, cervical cancer.

HPV is detected through Pap smears; however, the study found women who have sexual relationships with other women have Pap smears less regularly than other women do. In part, that's because healthcare providers told them that, as lesbians, they were less likely to be susceptible to sexually transmitted diseases, including HPV, researchers found.

"This shows that you really can't classify women as low risk just because they are not currently having sex with men," said 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," Marrazzo said. "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. That's just wrong."

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 sexual activity with men, or 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.

In addition, nine women said that a healthcare provider -- usually a physician -- 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," said Marrazzo.

A woman should begin getting Pap smears when sexual activity starts or at age 18, whichever is earlier, according to the 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 healthcare provider, the researchers said.

Study results were published in the June 2001 issue of the "American Journal of Public Health."

© 2001 Health Resources Publishing