Papanicolaou test screening and prevalence of genital human papillomavirus among women who have sex with women

Abstract

A B S T R A C TObjectives. The purpose of this study was to examine frequency of and attitudes toward Papanicolaou (Pap) test screening in women who have sex with women (WSW) and to determine prevalence of genital human papillomavirus (HPV).Methods. Women were eligible if they reported having engaged in sex with another woman in the preceding year. Medical and sexual histories were obtained. Cervical specimens for Pap tests and cervical and vaginal specimens for HPV DNA testing were collected.Results. HPV DNA was detected in 31 of 248 WSW (13%). Women who had never had sex with men were less likely to have undergone pelvic examinations and had fewer recent Pap tests. Reasons for not undergoing Pap tests included lack of insurance, previous adverse experiences, and belief that Pap tests were unnecessary.Conclusions.

Sex of Sexual Partners and Human Papillomavirus Vaccination Among U.S. Girls and Women

“…26 Further, it is possible that the factors potentially driving cervical cancer screening disparities between WSW and non-WSW, including heterosexism in the healthcare system 15,16,19,50 and misperceptions among women and healthcare providers that WSW are not at risk of HPV or cervical cancer, 15–17,19,51 also underlie the lower odds of HPV vaccine initiation between girls and women with only female past-year sexual partners and those with only male past-year sexual partners. Moreover, other studies have shown that healthcare providers’ and parents’ endorsement of the HPV vaccine, which may vary based on girls’ and young women's sexual orientation, 26 was positively associated with HPV vaccine initiation among young U.S. women.…”

“…However, in the meantime, healthcare facilities, schools, and public health departments and organizations can implement programs that promote knowledge of HPV and cervical cancer risk from male and female sexual partners throughout the life course among young women, caregivers, and healthcare providers 15–17,19,51 and facilitate access to opt-out HPV vaccination services among adolescent and young adult women with only female and no sexual partners.…”

“…Given low rates of Pap test use among women with only female and no past-year sexual partners, 15,19–21 these groups may be at particularly elevated risk of cervical cancer. Further, girls and young women with no lifetime sexual partners, who will likely engage in sexual activity later in life, 38 represent the ideal population for HPV vaccination, which is most effective before sexual debut.…”

“…9–18 However, despite their risk of cervical cancer, WSW are significantly less likely to have received regular Pap tests compared with women who have sex with men only. 15,19–21 Additionally, the two studies that have investigated cervical cancer screening among women with no past-year sexual partners suggest that this understudied population is also significantly less likely to receive regular Pap tests than those with only male past-year sexual partners. 20,21 However, women with no past-year sexual partners may have engaged in sexual activity earlier in life and may thus be at risk of cervical cancer from prior exposure to HPV.…”

Screening for Sexually Transmitted Infections (STIs) Among a Heterogeneous Group of WSW(M)

“…Other research has also shown WSW, particularly those who report never having had a sexual experience with a man, are less likely to receive a pap smear compared to heterosexually identified women (Marrazzo & Gorgos, 2012). Repeatedly, WSW cite the reason for not receiving a pap smear as not having had sex with men ( Bailey, Kavanagh, Owen, McLean, & Skinner, 2000; Kerker, Mostashari, & Thorpe, 2006; Marrazzo et al, 1998; Marrazzo, Koutsky, Kiviat, Kuypers, & Stine, 2001), and many have had this confirmed as unnecessary by their physicians (Marrazzo, 2004; Waterman & Voss, 2015). Marrazzo and Gorgas, among others, have called for research on patterns of seeking preventive sexual health care among WSW (Marrazzo & Gorgos, 2012).…”