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Lesbians Urged to Get Pap Smears

Sexual preference no shield against cancer-causing virus

FRIDAY, June 1, 2001 (HealthDayNews) -- Many lesbians believe that their sexual preference leaves them less vulnerable to sexually transmitted diseases, so they don't bother with Pap smears, a new study says.

That mistaken impression, the study suggests, could cost them their health.

Researchers found that almost one in eight gay women were actively shedding the human papilloma virus (HPV), which has been implicated as a chief cause of cervical cancer.

"This work supports our previous findings that HPV occurs in women who never had sex with men, as well as in women who have had sex with men in their remote past," says lead author Dr. Jeanne Marrazzo, an assistant professor of medicine at the University of Washington in Seattle. "The same holds true for Pap smear abnormalities, including precancerous changes in the cervix."

Marrazzo studied 248 women in the Seattle area who had sex with other women and found that 13 percent of them tested positive for HPV. In addition, 4 percent had precancerous changes on their Pap test. Most of these abnormal Pap smears appeared in women who reported no prior sex with men, or who last had sex with men more than a year before the test.

"I think it's highly likely that women who have stopped having sex with men have the ability to pass on HPV to women who have never had sex with men," Marrazzo says.

Women who have never had sex with men were less likely to have ever undergone a pelvic examination, the study says. Those women get their first Pap smear at a later age and have less frequent Pap smears than others. Of the women who never had sex with men, 10 percent said they never had a Pap smear, while 23 percent had not had a Pap smear in three years.

The women cited a lack of medical insurance, unpleasant experiences during a previous Pap smear, and a belief that they did not need a Pap smear because they were not sexually active with men as reasons they did not have the procedure. Nine of the 250 women said that a health care provider -- usually a physician -- had told them they did not need a Pap smear because they were not sexually active with men.

The findings appear in the June issue of the American Journal of Public Health.

"These women clearly have the perception because they were no longer having sex with men, they don't believe they are at risk for STDs or the attendant problems, such as cervical cancer," Marrazzo says. "And about 98 percent of cases of cervical cancer can be related to HPV."

The Pap smear, which allows for the microscopic examination of a specially treated sample of cervical cells, was introduced in the early 1940s and was in widespread use a decade later. The procedure is largely responsible for cutting cervical-cancer deaths by 74 percent between 1955 and 1992, according to the American Cancer Society.

"This study 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," Marrazzo says. "And regardless of that sexual history, every woman should have routine Pap test according to standard guidelines."

The vast majority of American women diagnosed with cervical cancer -- about 12,000 will be diagnosed this year, and 4,400 will die -- hadn't had a Pap smear in the previous five years.

"This is something we've seen in other studies," says Kathleen DeBold, executive director of The Mautner Project for Lesbians with Cancer in Washington, D.C. "And one of the reasons is that lesbians, in general, are less likely to get regular physical examinations of any kind because of fear of discrimination, fear of being outed, or being treated poorly. Lots of lesbians have experienced that kind of treatment."

The solution is twofold, DeBold says. "We need to educate health care providers about the needs and concerns of women who partner with women, so that we feel more comfortable going to the doctor. And we need to educate women on the need for regular gynecological examinations."

"'You're here, you're queer; now get a Pap smear' is our favorite gay-pride parade chant," she adds.

What To Do

Every woman should have an annual Pap smear as part of a complete pelvic examination as soon as she becomes sexually active or turns 18, and that should continue for the rest of her life, experts say. The frequency of the test is often lengthened if the results are negative for three consecutive years.

To learn more about HPV, visit the University of Iowa. And for more on Pap smears, visit the The American Society of Clinical Pathologists.

Read other HealthDay stories about Pap smears.

SOURCES: Interviews with Jeanne Marrazzo, M.D., assistant professor of medicine, University of Washington, Seattle; Kathleen DeBold, executive director, The Mautner Project for Lesbians with Cancer, Washington, D.C.; June, 2001, American Journal of Public Health
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