Yes, we do. There are some things dykes don’t have to worry about in the sexual health arena – contraception springs to mind – but pap smears aren’t one of them.

Do lesbians need pap tests?

Yes, we do.

There are some things dykes don’t have to worry about in the sexual health arena – contraception springs to mind – but pap smears aren’t one of them.

Most cervical cancers develop years after exposure to sub-types of the Human Papilloma Virus. HPV is spread through genital-genital skin contact during sexual activity. So if you have ever been sexually active, with either gender, you are at risk. This risk is probably higher if you have had multiple partners, were sexually active early, and have had male partners.

There are also rare types of cervical cancer which are not linked to HPV exposure, and can occur in women who have never been sexually active.

Pap tests are designed to pick up minor changes in cervical squamous cells that, if left untreated, may develop into cervical cancer. Since regular pap testing began in Australia, detection and treatment of cervical abnormalities has led to a dramatic decrease in the incidence of cervical cancer.

Currently, pap tests are recommended twice yearly, beginning about a year after you first become sexually active (or at age 18, whichever comes later), and continuing until you are 70 (after which you get the choice of retiring – and who wouldn’t?).

They may be recommended more frequently if you have had a pre-existing abnormality, or if you have symptoms such as vaginal bleeding between your periods or after sex.

Pap tests are a screening test designed to pick up any minor abnormality in cervical squamous cells – an abnormal smear does not necessarily mean cancer, but may mean you need your next pap test earlier, or that you need referral to a specialist for further testing.

Pap tests are done using a plastic or metal speculum which is inserted into the vagina to visualise the cervix. Speculums come in different sizes and shapes, and you should still be able to have a comfortable pap test even if you have not had penetrative sex of any kind. Let the person doing the test know if this is the case.

Pap tests can be given by your GP, Women’s Health doctor, or local Sexual Health/Family Planning centre. It can help to ask around to find a lesbian-friendly practitioner. Many practitioners will also offer a breast check/pelvic exam/Sexually Transmitted Infection screen at the same time, and you can certainly ask for any of these.

It is up to you whether you choose to come out to your doctor when you go for a pap test. They will normally ask you questions about whether you are sexually active, and may assume you are heterosexual unless told otherwise. Disclosing information about your sexuality can lead to a more informed and relevant check-up.

Most health professionals are trained to provide a sensitive and respectful approach to pap tests, but there are certainly some insensitive and uninformed practitioners out there. Use your own judgement, and see what you feel comfortable with.

Although lesbians are generally regarded as being in a low-risk group in terms of contracting STIs, this is still worth thinking about. Genital herpes can be contracted via oral sex if one partner has an oral cold sore. There is some evidence that bacterial vaginosis can be passed on by using sex toys.

Blood-borne viruses (BBVs), such as HIV and hepatitis B, are rare in women who have sex only with women. They may be more likely to be contracted if a woman is menstruating during sex or if the sex involves blood or a lot of body fluids.

Bisexual women, women who have had male partners, women who have migrated from endemic areas, and women who have had tattoos, piercings, needlesticks or transfusions are at increased risk of BBVs. If you would like to find out about STI screening, ask your doctor or sexual health practitioner.

Safer sex measures such as using dental dams (available at Sexual Health centres), washing sex toys/using new condoms over them, and avoiding oral sex if cold sores are present are good ideas if you can manage them.

Sex and sexuality are wonderful things; pap tests are part of staying well so we can enjoy our sexuality at least into our lavender 70s!

© 2007 Dr Joo-Inn Chew

* Dr Chew is a Canberra-based GP and co-convenor of the Australian Lesbian Medical Association

* See PapScreen Victoria for FAQs and fact sheets about pap tests