Fridae

Women who have sex with women (WSW) are often not adequately screened for human papillomavirus (HPV), a sexually transmitted disease (STD) that can lead to cervical cancer, according to a study published in the June 2001 issue of the American Journal of Public Health.

HPV is particularly worrisome for lesbians and bisexual women because it is "so ubiquitous, and it causes cancer," Jeanne M. Marrazzo, M.D., M.P.H., the study's lead author, told GayHealth.com. "And it is the first proven transmittable STD among women who've never had sex with men."

In February of 1998, Dr Marrazzo and colleagues from the University of Washington in Seattle, WA recruited 248 women who reported having had sex with other women within the prior year. All participants volunteered their medical and sexual histories, and gave cervical and vaginal specimens for analysis. Eighty percent of participants reported having had sex with men at least once, and 23 percent reported having had sex with men within the prior year. Participants' median age was 32, and 88 percent were Caucasian -- not as young or ethnically diverse a group as the researchers had hoped, due to a lack of funding for recruitment, Dr Marrazzo noted.

The study uncovered disturbing news. Pap tests -- which can detect cervical cancer in its early stages -- were performed less often and later in life among WSW who had not had sex with men. Reasons for not getting regular Pap tests included lack of health insurance, a belief that the tests were unnecessary and prior adverse experiences. "We didn't ask specifically about the adverse experiences. A description line has been added to the study," said Dr Marrazzo. It would be an interesting study to look only at what types of negative experiences WSW have had with Pap exams, she says. Dr Marrazzo has heard reports from patients about providers treating them differently after they disclose that they are gay or bisexual.

In addition, nine percent of WSW who hadn't had a Pap test in over two years said their doctors told them -- erroneously -- that they didn't need the test if they weren't sexually active with men. This incorrect medical advice put the health of these women at risk. "There is a huge need for education" about cervical cancer and Pap tests, said Dr Marrazzo, who added that many providers operate "without specific guidelines" for gynecological care of WSWs, which adds a further stumbling block to proper care.

Next, the researchers analyzed the women's specimens. They detected HPV DNA in 13 percent of participants, of whom 74 percent had cancer-causing strains. Overall, 25 participants (10 percent) had abnormal Pap tests, four participants had high-grade pre-cancerous lesions and seven participants had low-grade pre-cancerous lesions. Most of the abnormalities occurred in WSW who reported never having had sex with men, or who had had sex with men a year or more prior to the study. "The population we studied was not very sexually active," noted Dr Marrazzo.

To counter the dangerous notion that woman-on-woman sex carries no risk of STDs, the study authors called for efforts to educate providers and WSW patients about gynecological health. The authors also recommended that all women -- regardless of sexual history -- get routine Pap tests according to standard guidelines.

In the US, cervical cancer is the second most common form of cancer in women, and the most common in younger women. It used to be one of the deadliest cancers, but with the advent of the Pap test, there has been a 74 percent drop in cervical cancer deaths from 1955 to 1992. When detected at an early stage, invasive cervical cancer is one of the most successfully treatable cancers, according to the American Cancer Society.