Dr. Brown: I'm a lesbian and only sleep with other women. Why should I get pap smears?
Like you, a lot of lesbians think that pelvic exams and pap smears are only for heterosexual women. It's a real mistake, and it can lead to cancer that could have been prevented.
A pap smear is a test doctors use to catch early stages of cervical cancer. As a screening program, it's been one of the true successes of modern medicine. Doctors have been performing pap smears since the 1950s, and from that point on, the rates of cervical cancer have come down more than 60 percent. Still, every year in the United States, more than 12,000 women are diagnosed with cervical cancer, and a fourth of those women will die.
Cervical cancer is caused by the human papilloma virus, or HPV. This virus can cause pre-cancerous changes in the cells in the cervix, and can eventually lead to cancer. A pap smear collects a sample of these cells, and when pre-cancer changes are seen, they can be destroyed before they turn to cancer.
A lot of people, and actually a lot of doctors, mistakenly believe that women only can get HPV from insertive sex with a penis, and that lesbians are not at risk. It's not true! Women can give HPV to other women, through skin-to-skin contact. One study showed 30 percent of all lesbians have HPV, and even among those that reported never having had sex with a man, one-fifth had HPV.
Lesbians get their regular pap smears less frequently than other women, partly because they feel they don't need it. Because they screen less often, lesbians have almost twice the rate of cervical cancer. We've also seen that cancer rates are higher among lesbians that smoke, those that had their first sexual experience very early in their lives, those that had multiple male partners in their past, and those with a history of genital warts.
Our current guidelines recommend that all women ages 21-65 should be screening every three to five years with a pap smear. You probably can stop screening after age 65 or after a hysterectomy.
Besides pap smears, there are other things you can do to decrease your risk of HPV. Male and female condoms dramatically decrease transferring the virus between partners. For women under 26, we now have the HPV vaccine, which helps your body clear the virus before it can affect the cervical cells.
HPV screening isn't only about cervical cancer. HPV causes many other types of cancer, including in the mouth, anus, and vagina. Some dentists have started screening for oral cancer with a modified type of oral pap smear. And we've started recommending anal pap smears for some gay men with high cancer risks. If you think it's hard to talk lesbians into getting their pap smear, you should try talking a gay man into getting one!
The bottom line is, all women—gay or straight—should get regular pap smears. It's easy, cheap, quick, and can prevent cervical cancer.
Dr. Cory Brown is a med/peds specialist, and practices at Howard Brown Health Center, a community clinic that focuses on quality care for LGBT people.
