PAP test

July 8, 2008 5:48 PM

How important is getting a PAP test for a twenty-some bi/lesbian? If it is important, how do you convince someone to get one when she a) had a bad experience in the past and b) thinks she doesn't need one because she is (mostly) gay?

I've heard that both mammograms and PAP tests are mostly unnecessary - that there hasn't really been much evidence showing that early diagnosis helps. Is this true? I have also heard that since nuns don't get cervical cancer, lesbians don't need PAPs (really, I had a doctor refuse to examine me once), but what about lesbians who have had sex with men in the past?

A particular person whose life and reproductive organs are pretty important to me flat-out refuses to get a PAP test done based on the above reasons and the fact that she had the shit scared out of her with a false positive for cancer at one point. Is it worth it to try to convince her to go? How do I do so?

posted by arcticwoman to health (40 comments total)

Whoever told you lesbians don't need pap smears might have also told you sexually active people who have sex with strangers don't need condoms. It's a load of bullshit.
posted by parmanparman at 5:51 PM on July 8

Nuns don't get cervical cancer? Sounds like she's getting her sex ed from the playground.

But what's the big rush to get a mammogram and a pap test? It's not like you guys are married yet, and I don't believe she's advanced to the high-risk age bracket. Isn't it enough to get checked for STDs and let your partner take care of herself, for the time being? It just seems a little unusual to push someone to get those sorts of tests at this stage of the relaztionship.
posted by KokuRyu at 5:57 PM on July 8

Read up on Human papillomavirus (HPV). It's a VERY common STD. You could get it from a male partner or female who never had any symptoms. You might not even have symptoms yourself. But if you have it, it greatly increases your risk of cervical cancer.

I think your friend that said Nuns don't get cervical cancer was probably saying that because they haven't had sexual contact, so the risk of getting HPV is much lower.

Get a pap smear. In fact, consider getting the new HPV vaccine. It's a bit pricey but it'll virtually eliminate your risk of getting cervical cancer down the road unless you already have HPV.
posted by lockle at 6:05 PM on July 8

Just google HPV virus + lesbian. There is ample information discussing how lesbians contract it, spread it from genital contact, etc. Pap tests are important and I second the HPV vaccine.
posted by meerkatty at 6:07 PM on July 8

Birth control pills can increase the likelihood of cervical cancer, so I think your partner is basing her "facts" on the premise that lesbians don't use birth control. However, cervical cancer has many more factors, the biggest one of which is sexual activity.

Speaking from experience: I was diagnosed with cervical cancer and I was terrified. However, because I had extremely regular paps it was caught early and removed. If it is not caught it can be fatal (and in fact it kills 300,000 women world-wide each year). It is also worth noting that upon my diagnosis I was in my mid-twenties.
posted by kate blank at 6:10 PM on July 8

A woman can get HPV from another woman. HPV is the primary cause of cervical cancer.

From a U.S. government site:
A Pap test can save your life. It can find the earliest signs of cervical cancer - a common cancer in women. If caught early, the chance of curing cervical cancer is very high. Pap tests also can find infections and abnormal cervical cells that can turn into cancer cells. Treatment can prevent most cases of cervical cancer from developing.
posted by Airhen at 6:11 PM on July 8

This study calls the commonly held belief that nuns don't contract cervical cancer into question, stating "This review of previously published studies of the incidence of cervical cancer among nuns shows that the rate of death from this tumour in such women is comparable to that among other single women, and may not differ markedly from the rate in the general population."
posted by platinum at 6:16 PM on July 8

From my conversations with my doctors anyone who engages or has engaged in any kind of penetration (fingers, sex toys, penises or whatever) is at a higher risk than a woman who has never had any penetration. One of my pap tests in my early twenties caught some pre-cancerous cells which were successfully zapped away (no problems since then).

I also found this website in Australia with a bit more information.

The Health Canada report on cervical cancer is here but it is ten years old.
posted by Cuke at 6:19 PM on July 8

I'll weigh in. Yes, you need a pap smear. Find a different doctor if you had a "bad experience". Everyone above has the right reasons. FWIW, mammos ARE recommended for a certain group of women.
posted by 6:1 at 6:20 PM on July 8

HPV is a major cause of cervical cancer, but not the only cause. i don't know where the data is that nuns don't get cervical cancer--they probably have a lower incidence, as a celibate lifestyle tends to reduce one's exposure to HPV, but unless your friend is celibate, she's going to face exposure. even if she thinks HPV is only a "straight" disease, she has to acknowledge that there's a good chance at least one of the women she's slept with has had sex with a man.

the pap is important, because the exam is important. forget cervical cancer for a second--it's only a small part of why you go see a gynecologist. they can identify and treat all sorts of other STD's, plus those annoying things that just happen for no reason, like cysts, fibroids, endometriosis, yeast infections, funny smells, itches, pain, etc, as well as just reassure you that you are healthy.

if your friend has had a bad experience with a lesbian-unfriendly gynecologist, call planned parenthood or your local gay health organization to get a referral to someone who is interested in lesbian health.

about the cancer scare, she may have to seek out therapy if she is so frightened, because it's important to do these things. i can't say enough for early detection. a cousin of mine who did eventually die of breast cancer at a very early age nevertheless had many more good years of life because she was able to catch it early. she got to know and enjoy her children, who were very young when she was diagnosed, and got to travel, see her sister married, progress in her career, and do all the things a person wants to do in life. she did eventually die, but if she had not had early intervention, she would have died much sooner, and much more painfully. that's the problem with the data out there--it mostly just measures outcomes, not the quality of life between diagnosis and death (or remission).
posted by thinkingwoman at 6:21 PM on July 8

if she had a bad experience, she might consider finding a midwife to do her pap--they tend to be a better choice for those of us who've had scary/unpleasant paps before.
posted by RedEmma at 6:25 PM on July 8

I've heard that both mammograms and PAP tests are mostly unnecessary - that there hasn't really been much evidence showing that early diagnosis helps. Is this true? I have also heard that since nuns don't get cervical cancer, lesbians don't need PAPs (really, I had a doctor refuse to examine me once), but what about lesbians who have had sex with men in the past?

Some of these views are so wrong as to be almost offensive, particularly when held by someone who might claim to respect women.

1) Genital HPV is often self-inoculated. That means that women (and men) frequently get it from having touched someone else shedding the virus and then touching themselves. Chance HPV infection has very little to do with sexual preference, because it has nothing to do with the kinds of sex acts engaged in. You can get it from virus shed from other genitals, from fingers, from feet. You can get it when the shedder has no symptoms or signs. When lesbians stop touching each other's vaginas, and when they dress in hermetically sealed suits of latex, HPV may no longer be a problem for lesbians.

2) A simple PubMed search indicates that your supposition about the worthlessness of PAP smears is not only unfounded, but really dangerous. There are oodles of papers on PubMed looking at the effectiveness of PAPs for preventing invasive cervical cancers, and the evidence seems quite settled.

RESULTS: Women who had not had a Pap smear within the recommended screening interval had higher risk of cervical cancer than women who had been screened (OR = 2.52, 95% CI = 2.19 to 2.91). This risk was similarly increased for all age groups (P(homogeneity) = .96). The risk for non-squamous cell cervical cancers (OR = 1.59, 95% CI = 1.20 to 2.11) was also increased. Women who had not had a Pap smear within the recommended screening interval had a particularly high risk of advanced cancers (OR = 4.82, 95% CI = 3.61 to 6.44). Among women who had been screened within the recommended interval, those with abnormal Pap smears had a higher risk of cervical cancer than those with normal smears (OR = 7.55, 95% CI = 5.88 to 9.69) and constituted 11.5% of all women with cervical cancer. CONCLUSIONS: Nonadherence to screening intervals was the major reason for cervical cancer morbidity. The screening program was equally effective for women of all ages and was also effective against non-squamous cancers.

[emphasis added] Etc, etc.

Women have had to fight a long time to have serious and deadly medical problems taken seriously. You obviously have to keep doing it, witness the stupid doctor who said you didn't need screening. Your question reads as if your girlfriend, even aside from her bad experience, doesn't understand those struggles and instead thinks that these concerns are manufactured by "the man." The loser here is her. There are certainly disease that lesbians are very unlikely to contract from their lesbian partners (HIV), but HPV is not one of them. Anyone who doesn't understand the difference should probably reread Our Bodies Our Selves.

(And, for heaven's sake, learn how to use a search engine. Just searching Google for info on cervical cancer turns up scads of women-friendly advice suggesting that screening is effective. It's easy to do further research from there.)

(I work in an STD clinic.)
posted by OmieWise at 6:27 PM on July 8 [5 favorites]

Women who have sex with women are less likely to have HPV, but less likely does not mean unlikely. In a 2001 study, 13% of WSW were positive for HPV (article here). In an earlier study (2000), the point prevalence was found to be 30% (here). Women who also have sex with men or who have sex with women who have sex with men are at a higher risk.

The statement about pap smears being unnecessary is patently, irresponsibly false. The pap smear has been one of the greatest success stories of modern medicine, reducing the rate of mortality due to cervical cancer by 70% in the US. Cervical cancer is one of the most important cancers to catch early, as it generally does not cause symptoms until it is very late stage. It is trivially easy to cure in its pre-malignant and early cancer stages, and it has high mortality in its late stages.
posted by LittleMissCranky at 6:28 PM on July 8 [1 favorite]

As for the second part of your question, from a logical perspective, a false-positive pap smear is a heck of a lot less scary than a diagnosis of late-stage cancer, which would be the next thing that she would hear if, god forbid, things went that way. I am actually slightly concerned that she heard "false positive" when she really had some dysplasia that didn't show up on colposcopy, in which case she should be screened diligently. Not that that's what happened or that she necessarily made a mistake or anything...just that it's a VERY common misconception

Could you make an appointment for both of you to go in together? Would it make a difference if she went on a once every two-to-three year schedule (better than nothing)? Promise a lollipop (or your choice of inducements) for good behavior? Finding a gay-friendly gynecologist might also help...do you know of a good one?
posted by LittleMissCranky at 6:50 PM on July 8

Thanks for all the help and advice, everyone. I found the article that I was referring to when I mentioned the perhaps less-than-usefulness of PAP tests. Here is the quote that Wikipedia uses:

"A nurse performing 200 tests each year would prevent a death once in 38 years. During this time she or he would care for over 152 women with abnormal results, over 79 women would be referred for investigation, over 53 would have abnormal biopsy results, and over 17 would have persisting abnormalities for more than two years. At least one woman during the 38 years would die from cervical cancer despite being screened."

Raffle AE, Alden B, Quinn M, Babb PJ, Brett MT (2003). "Outcomes of screening to prevent cancer: analysis of cumulative incidence of cervical abnormality and modelling of cases and deaths prevented". BMJ 326 (7395): 901. doi:10.1136/bmj.326.7395.901. PMID 12714468.

Does anyone know if this finding is generally accepted? It sounds like it means the test is pretty ineffective, but that can't be true, right? How do I argue against this?
posted by arcticwoman at 6:59 PM on July 8

Arcticwoman - all of these things can be true at once. Check out this page from the National Cancer Institute. There are about 11,000 new cases of cervical cancer each year in the USA, which has around 300 million people, for an incidence rate of around one case per 30,000 people (which works out to one per 15,000 women). So it is a pretty rare disease over all, at least in this country (I guess it's 4-5 times worse in some parts of the world). I'll admit I don't know exactly how to map the statistics you just gave onto this incidence rate, but it seems realistic.

So, I guess the woman in question could tell herself that she only has a 1-in-15,000 chance of getting cervical cancer in any given year, and call it a day. But it's also true that it's a very serious disease, the Pap test is very good for detection, and early treatment is very helpful in reducing mortality from cervical cancer. What your friend should ask herself is, in light of all of these facts, is it a wise, considered decision to skip the tests? Or is it an unreasonable acceptance of risk, not only on herself but also on her loved ones, due to a single bad experience?
posted by rkent at 7:32 PM on July 8

Oh, I forgot to pull my argument together to actually answer your question: whether that article means the test isn't very good. It doesn't mean that AT ALL. The rarity of saving a life is simply due to the fact that there are so few cases of cancer in the first place.
posted by rkent at 7:36 PM on July 8

Debating the effect of regular screening on a population is an important area of inquiry, but population studies and cancer prevention are not such simple problems than any study provides "the answer." It's not a matter of this finding being accepted, true or false. This study does not mean that the test is ineffective -- it means that the author is attempting to show, by running the numbers, that mass screening may not be the most effective and economical way to reduce the number of cervical cancer deaths overall in England. Yeah, it's somewhat about money. Surprise. And about statistics. Use caution when applying statistics to an individual cervix.

Part of the debate regarding screening is that the population getting screened is highly self-selected, with those getting the most testing being the those most likely to already be getting excellent health care. Yearly paps are regularly received by women who can take time off from work to go for yearly check-ups, who have higher trust in doctors, who have more education, whose diet may be better, who are less likely to engage in highly risky behaviors. Meanwhile, many, many women die of cervical cancer who hadn't time for the relative luxury of preventative heath care.

If your girlfriend is interested in joining the latter group, she's certainly got a lot of company. Cervical cancer is the second most common cancer in the developing world, but seventh in wealthier countries. Some stats from 2002 here.

Also, what OmieWise said.

I work for an organization dedicated to cancer research.
posted by desuetude at 7:49 PM on July 8

Oh, and bad experiences? Look, I sympathize. I even had an AskMe regarding a former gyn. Just get a new doc.
posted by desuetude at 7:57 PM on July 8

If you go to the BMJ site and search for the lead author on that study, you'll find many other results that will add to the debate. (This editorial by Raffle goes further in talking about PAP guidelines.) In general, I tend to agree with her central premise, which is that the important number to consider when evaluating the benefit of medical treatments (especially epidemiologically) is Number Needed to Treat (here's a pretty good explanation from Slate).

Basically, all of the data that I cited before on PubMed are from case studies, studies which start from the cancer and work backward into the testing history. Those studies do show what they claim to show, which is that women who come down with cervical cancer, especially the more invasive types, tend to have poor screening histories. What those studies do not show is how many women who did not get cancer needed to be screened in order to catch those who did get cancer and got caught early. As your girlfriend has undoubtedly pointed out, there is a cost to screening, which is emotional and physical as well as monetary, and that cost is even greater if a false positive is found somewhere in the screening process. (Of course, as Raffles' study doesn't mention, there is a substantial emotional and physical cost to the families and friends of those women who might have been prevented from dying had they gotten regular treatment.)

So, the NNT is a crucial number, because it allows us to actually make cost-benefit analyses that are closer to how we think about those things than are risk reduction analyses. (When you think about reducing your risk of Cervical cancer 30%, you rarely think of that 30% as a factor of the already low percentage of risk for developing cancer in the first place, but that's what it is.) The thing is, even with the high NNT, cervical cancer screenings are still saving women's lives. This slide compares historical trends in cancer deaths, and you'll notice that Uterine (which includes cervical) was the leading death causing cancer in women in 1930 (at about 30/100k, and is now the second from least death causing cancer (at about 5/100k). (The slide is from this paper 2001 Cancer Statistics.) Cervical Cancer Successes and Failures, notes:

In the US, the situation is considerably better, with deaths from cervical cancer declining rapidly since the introduction and widespread use of the Pap test for screening in the 1930’s and 1940’s, to an estimated 4,400 deaths in the year 2001.2 Currently, the age-adjusted death rate from cervical cancer per 100,000 population in the US is reported as 2.4. In contrast, rates in countries such as Mexico (14.0), Venezuela (10.8), and Romania (10.5) are markedly higher.3

The paper provides citations. It seems that you need to perform a lot of PAPs to catch the cancers that you can treat, but cervical cancer isn't something you want to get and not catch.

Despite how strident I was in my earlier answer, as with all health situations like this, deciding what to do is a personal decision. Many people (most?) who smoke know the health consequences, but choose to smoke anyway for all kinds of reasons that are good enough to obviate arguments for quitting, at least for a time. There are legitimate questions to ask about whether, and how much, it benefits society to increase screening requirements, but that argument is a lot less persuasive on the individual level for many people. For men, PSA tests are thought, perhaps, to be epidemiologically unnecessary, but I sure want my dad to get one. The best you can do is argue from the available facts, honestly assess the pros and cons, and do it in such a way that your girlfriend will be willing to revisit the conversation if she makes the decision to forgo screening.
posted by OmieWise at 8:00 PM on July 8

Wow, that wikipedia article is terrible. The information and the writing.

Just for context, prior to the pap smear, cervical cancer was the leading cause of cancer death in American women. More deaths than breast cancer or lung cancer in women. Now there are about 3500 deaths/year in the US, overwhelmingly due to cancer that was only discovered in a late stage. This change is pretty much entirely due to the use of the pap smear.

Briefly looking at the study that you mentioned, I would say that there is one thing that bothered me: They use cervical cancer rates from pre-1930s cohorts to model the predicted mortality without screening. I find that problematic due to the increased prevalence of HPV now versus the earlier part of the last century.

More importantly, there's a difference between having a high number-needed-to-treat and having an ineffective test, especially on an individual level. The test is effective, but fortunately, relatively few patients get cervical cancer...about 11,000/year in the US with screening, with an incidence up to three times higher in less developed countries, probably significantly (but not wholly) due to lack of screening. This means that, thank god, most women who get pap smears are not going to have cervical cancer, and therefore you are going to need to do a lot of paps to save a life. We screen everybody, so that works out fine. The thing is, if you are one of the 11,000 with cancer, or one of the 4-5% of women with abnormal (but still pre-cancerous) pap smears, it is really, really in your best interest to catch it early, since stage I cervical cancer has about a 92% 5-year survival rate, while stage IV has about a 15% 5-year survival rate with maximal therapy, including chemotherapy and radiation.

Believe me when I say that you do NOT want to have to have the radiation for cervical cancer.
posted by LittleMissCranky at 8:10 PM on July 8

My girlfriend had cervical cancer when she was twenty years old, and a virgin. It was detected by a pap smear. Fortunately it was found early, and following a complete hysterectomy, she has now lived an additional 30 years.
posted by netbros at 8:29 PM on July 8

Woah, I read the first few responses and was blown away by how much I disagree.

HPV is the primary cause of cervical cancer. Cervical cancer from other causes is extremely rare. It's true that your friend's identity doesn't effect her risk of HPV, her behavior does.

If your friend has had intercourse with a penis or shared sex toys during penetrative sex, she could have gotten HPV. Theoretically she could also get it from some vigorous pussy/pussy rubbing. Otherwise, it's pretty darned unlikely that she has gotten HPV. If she doesn't have HPV, there's no need for regular paps.

But keep in mind - HPV is very common and the Pap has a very low sensitivity - there are lots of false negatives. So if your friend had intercourse with some dude 10 years ago, its quite possible she's been carrying HPV around all that time even if she's had a pap since then.

My personal choice has been not to have paps. I had one right before I got pregnant 6 years ago or so actually, but basically since I haven't had intercourse with men in over 10 years, I always used condoms when I did, and I had a few negative paps in the intervening years, I think my risk for cervical cancer is low to nil.

I also think a lot of the commenters here just don't "get" the fact that many dykes won't go to doctors. If you haven't had to deal with the "are you sexually active" question from a lesbian point of view, you probably don't understand why a queer woman wouldn't want to go to the doctor. I'm not directing that point at you arcticwoman, since I assume you can sympathize with that part of it, but I do think this is important and valid from a mental health point of view.
posted by serazin at 8:36 PM on July 8

Wait, wait, wait - I just re-read your post more closely. What exactly was the "false positive for cancer"? Did she have an abnormal pap that was incorrectly labeled as cancer? Because if she had an abnormal pap in the past - even if it wasn't cancerous - she should have follow up paps for a few years.
posted by serazin at 8:40 PM on July 8

serazin, i doubt i'm the only queer woman responding in this thread.
posted by desuetude at 9:09 PM on July 8

Yeah, good reminder that I'm not the only homo, but you gotta assume that there are some straight people commenting here too.
posted by serazin at 9:29 PM on July 8

I'm bi, but in a straight relationship at the moment. The last time I had a smear test, I asked the nurse if I had a period of "celibacy" (meaning anything but, of course) if I would need to keep getting tested regularly, and she told me yes. Which I think means that basically if your friend has had sex with a man, ever, she needs to be tested regularly.

Strangely, we were told that nuns don't get cervical cancer in our sex-ed class. Love that all-girl school thing.
posted by featherboa at 3:40 AM on July 9

Is it worth it to try to convince her to go?

It's not worth trying to convince someone if it puts a strain on your relationship. Cervical cancer is rare, and participation in the screening program can be stressful and/or uncomfortable. Your partner is an adult, she gets to weigh the evidence and decide if she wants to take part in screening. If everyone agreed to screening, the number of cancers in the whole population would be cut, but that doesn't mean that screening is right for everyone at a personal level. Maybe the best thing you could do is help your partner find a sympathetic (maybe female) gynaecologist who can help her make a fully informed decision.
posted by roofus at 4:32 AM on July 9

The nun thing is this: the discovery of HPV as a cause of cervical cancer was incredibly, crazily controversial. It was previously thought a viral cause for cancer was highly improbable. That nuns, who are fairly reliably celibate (unlike the rest of the self-reported population) have lower rates of cervical cancer was an aha! in figuring out this unexpected environmental (meaning: not inherited) risk factor of the incredibly-common, frequently-otherwise-benign HPV, for cancer.

Woman-to-woman transmitted HPV is common, though. While both nuns and lesbians don't have sex with men, a major point of departure is that lesbians, unlike nuns, are indeed having sex with humans. Thus, a risk of HPV. Thus, a risk of cervical cancer.

She doesn't need a yearly pap. Once every three years (unless there are suspicious results) will suffice. Since I (and others) fussed at you for citing Wikipedia, here's another stat quoted in Wikipedia Iin human papillomavirius) for ya, "Since the Pap test was developed there has been a 70% decrease in cervical cancer deaths over the last 50 years. Pap smear testing has proven to be one of the most successful screening tests in the history of medicine. A study published in April 2007 suggests that the act of performing a Pap smear produces an inflammatory cytokine response, which may initiate immunologic clearance of HPV, therefore reducing the risk of cervical cancer. Women who had even a single Pap smear in their history had a lower incidence of cancer. "A statistically significant decline in the HPV positivity rate correlated with the lifetime number of Pap smears received."
posted by desuetude at 6:20 AM on July 9

Many medical tests have been designed to have a higher rate of false positives rather than a higher rate of false negatives. The pap fits in this category, thus abnormal pap smears are often followed up with a second pap smear. The probability of having an abnormal pap smear is much higher than the probability of having a cancer that will be detected in this way, but the consequences of cancer are very serious. If you have cancer, and don´t get a pap smear, and it is not detected, your lack of knowledge will in no way prevent the cancer from spreading.

Some people would rather not know though. Sometimes they change their mind about taking care of their health and getting preventative screenings when someone they know dies. This person you know will probably go through that experience at some point in their life, and at that point they might be more open to getting a pap smear done.
posted by yohko at 6:54 AM on July 9

female here who has had sex with both men and women and checks of the "homo" box on new patient intake forms....

are you fucking kidding me? i have to deal with the bullshit "if you've had sex with men, why did you check 'gay'?" questions umpteen times over the past several years and it never ceases to amaze and bother and upset me. BUT IT DOESN'T STOP ME FROM GOING TO THE DOCTOR.

we've all had bad experiences with doctors. and more than one of us have had cancer/other-terrible-disease scares. but that doesn't stop us from being responsible and going to the doctor and getting preventitive care that can save our lives and save us tons of money in treatment costs and can save our loved ones from having to deal with our care-taking and our death.

the fact is, she's had sex with men, so she's at higher risk for hpv than if she'd never done it with a man. HOWEVER, i know from personal experience, that women who have never ever had sex with a man, or even thought about it, CAN get hpv. plus, there are other things that the box doc looks for when doing a "well-woman" exam, it's not just about scraping the cervix.

if cost is a factor, there are places like planned parenthood or community clinics that can do a yearly or every other year pelvic exam for free or at low cost.

if nervousness/fear is a factor, offer to go with her to her next appointment; into the exam room and everything.
posted by misanthropicsarah at 7:54 AM on July 9

One thing to consider that I don't think has been mentioned: even if you currently have nothing wrong with you, and nothing about you or your behavior puts you in a high-risk category for anything more serious than a yeast infection, by getting these tests now, when you are young and healthy, you are establishing a normal baseline for you for the future.

Sometimes what a doctor sees in a pap smear, breast exam, pelvic exam or mammogram is not Some Obvious THING, but a slight change from the last test you had, something that isn't normal for YOU. And that change is what is worth investigating further.

Remember that pap smears are done as part of a pelvic exam, and a pelvic exam can reveal much more than just STDs.
posted by SuperSquirrel at 8:33 AM on July 9

Your girl needs to go get the undercarriage checked out. Find a gay-friendly doc (local lgbt papers, ask other friends where they go), and cut a deal with the doc that she check in once every 3 years as a compromise. I am a big fat hypocrite as I have yet to follow my own advice, but will be making an appointment any day now, especially since the other half just left an ovary and change at the hospital in part due to not going in for regular maintenance. Tell yer mate I will if she will :D
posted by Iteki at 10:23 AM on July 9

Woman-to-woman transmitted HPV is common

Prove it. There are very few studies on sexual health in lesbians, period. There is some evidence that women have passed trich and BV (not exactly an STI, but it is caused by bacteria) during sex. Other STIs are both difficult to pass through the ways that many women have sex with each other (oral, digital, toys) and are uncommon within the communties of people who are sharing cooties.

Sure, it's theoretically possible for a woman to pass HPV to another woman. But I don't know of any evidence that it is "common" or likely.
posted by serazin at 11:37 AM on July 9

Sometimes what a doctor sees in a pap smear, breast exam, pelvic exam or mammogram is not Some Obvious THING, but a slight change from the last test you had, something that isn't normal for YOU. And that change is what is worth investigating further.

Do you really think your doctor remembers the feel of your boobies when they do the next boobie check three years later? Doctors aren’t some special magic people, and there’s nothing particularly magic about a pap or pelvic exam. Here’s what they’re for:

-The pap checks for signs of cervical cancer
-Separate from a pap, the clinician can also do a swab to check for certain STIs: chlamydia, gonorrhea.
-A bimanual exam, when the clinician has a couple fingers in the vag and another hand on your belly, helps diagnose abnormal growths in the uterus or ovaries which could indicate fibroids (generally benign though sometimes painful) or cancer (quite life-threatening, if rare). If you had PID, usually caused by an untreated STI, you’d also probably notice that during the bimanual because it is quite painful.
-There are a few other odds and ends a very thorough clinician might look for – enlarged glands, hemorrhoids, stuff that you would probably notice yourself first.

What it comes down to is that, like any other part of your body, your ladyparts can have problems. The pelvic and the pap are the (limited) tools we have to find those problems. If your friend is concerned about any of those problems, she should use the tools we’ve got. Otherwise she shouldn’t. It’s up to her.
posted by serazin at 11:51 AM on July 9

Fine, serazin. Common enough. To warrant at least an occasional pap if one has had multiple partners.

And no, doctors aren't magical creatures, but they do take notes. My gyn is certainly aware before she gets to the examining that normal for me includes fairly dense breast tissue, that my one of ovaries sometimes feels a little bigger than the other, and what factors elevate my yeast levels (lots of sex.)
posted by desuetude at 12:22 PM on July 9

desuetude, sorry if I was overly confrontational. I'm letting the internet carry me away. And I"m glad to hear your doc takes good notes and reads them before each exam. Many don't - even if they wanted to there's little time - and many people don't have regular docs that they always see anyway. I guess where I'm coming from is a concern that we invest too much faith in doctors and medicine. And I don't think the person in question really needs paps very often, unless she wants them, and actually, I think many doctors would agree.
posted by serazin at 12:39 PM on July 9

this thread has kind of turned into a debate about lesbians and their risk for hpv. a valid debate, but still not what the poster was really asking about.

OP, i think the consensus is that your friend should go in for a pelvic exam every few years. i agree with that.

for anyone looking for more info about lesbians and hpv, check out Perceived prevalence and risks for human papillomavirus (HPV) infection among women who have sex with women and Lesbians and cervical screening. there are also some sexual health sites out there that address the issue.

serazin is right: lesbian sexual health is pretty under-studied. i'm sure we could also get into a debate about why that is. BUT, i think now that hpv is a "hot topic" and people are learning more about it (through tv commercials and glamour ads if not in health class) some misconceptions (like that lesbians can't get it) will start to go away.
posted by misanthropicsarah at 5:04 PM on July 9

I guess where I'm coming from is a concern that we invest too much faith in doctors and medicine. And I don't think the person in question really needs paps very often, unless she wants them, and actually, I think many doctors would agree.

Hey, I think that modern medicine still has a lot to answer for in terms of womens health. I'm no blind acolyte to docs. But proving that HPV causes cervical cancer was a really long, tough 34-year-long road, partially because of gender bias in medical practice (also because the particulars of a viral cause were unexpected...I'm not a conspiracy-theorist, either.) Hell, you still can't hardly get a doctor to give a shit that a man may have HPV, because it's usually basically asymptomatic in men -- it's the woman's problem. I'm not saying that a lesbian necessarily needs the yearly Pap, but every three years during prime risk years is more than reasonable, especially since the lesbian in question has had sex with men.
posted by desuetude at 6:38 PM on July 9 [1 favorite]

Woman-to-woman transmitted HPV is common

Prove it.

4.7% of exclusively lesbian women have cervical cytological abnormalities consistent with HPV, and that is an under-estimate of true prevalence because smear testing does not diagnose all HPV infections.

The data is pretty clear. Exclusively lesbian women, (i.e. never having had sex with a man), are actually pretty safe. They have less than half the risk of any cervical abnormality, and in this study none of the 121 sampled had any serious abnormality at all. Lesbian women who have ever had sex with a man should consider themselves as being at the same risk as straight women though.
posted by roofus at 8:21 AM on July 10