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Lesbians, bisexual women need to have screenings.
If your practice includes care of lesbian and bisexual women, and most practices do, don't dismiss taking their reproductive histories. New research indicates that previous pregnancy, induced abortion, and hormonal contraceptive use are common among women who report sex with women, regardless of whether they identify themselves as lesbian. (1)
Why is it so important for clinicians to perform Pap smears and sexually transmitted disease (STD) screens for lesbian and bisexual women? According to the researchers involved with the new study, parity and hormonal contraceptives modify the risk of reproductive cancers and cardiovascular disease; however, clinicians may not obtain reproductive histories from patients who self-identify as lesbian. (1)
"Pap smears are important because our work, and case studies from some other authors, (2) have shown that oncogenic strains of human papillomavirus [HPV] occur at the cervix in many lesbians, including those who report no prior sex with men," states Jeanne Marrazzo, MD, MPH, assistant professor of medicine at the University of Washington in Seattle.
The Seattle scientists have detected not only oncogenic HPV types at cervix, vagina, and vulva sites in this group, but also demonstrated a high prevalence of serum antibody to HPV-16 and HPV-6 in earlier research, (3) she notes.
According to Marrazzo, most women who self-identify as lesbians have had sex with men, which places them at some risk for chronic viral STD infection such as HPV and herpes. Nonetheless, research indicates that lesbians may not seek Pap smears because they don't believe they are at risk for cervical cancer, and providers may mistakenly tell them they are not needed, she explains.
Women who have sex with women are at the same risk for STDs as heterosexual women; findings from a 2000 study indicate that women who had sex with women had a higher prevalence of bacterial vaginosis (BV), hepatitis C, and HIV risk behaviors than heterosexual women. (4)
While the reasons are unclear, lesbians have a higher prevalence of bacterial vaginosis, (5) says Marrazzo. Since BV has been strongly associated with adverse outcomes of pregnancy, lesbians planning pregnancy may consider being screened for this condition, she notes.
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