Stephanie A. Naas: Take Charge Of Cervical Health – September 14, 2011
In March 2011, the Institute of Medicine (IOM)* published a report for the National Institutes of Health (NIH) that humbly showed many primary healthcare providers, as well as lesbian and bisexual women, what most of us already knew: there are considerable and profound health disparities present among LGBT (lesbian, gay, bisexual, transgender) people, as evidenced by scouring through more than 100 individual studies over the past two decades.
Primary healthcare providers have a responsibility to read research to keep up to speed on current issues and treatment options. But what happens when the research itself is lacking? Our patients become “health disparity statistics” and we unintentionally deliver sub-standard care. This is not a combination that anyone wants.
Approach any group of women and, odds are, most will know what a “pap” is. It’s considered a health screening exam, a preventive exam, to test for cervical cancer. A number of different variables dictate how frequently these exams need to be done on a woman throughout her lifespan, but sexual orientation is not one of those variables.
Cervical cancer is caused by HPV (humanpapillomavirus) and it’s mistakenly considered a sexually transmitted virus that is passed from male to female and vice versa.
As has been shown unanimously across the board with alarming consistency in all high-quality research, lesbian and bisexual women are not getting pap smears done appropriately, if at all.
Women stating no previous sex with men were less likely to have ever received a pelvic examination, more likely to have had their first pap smear at an older age, and more likely to have had pap smears less frequency than women who reported previous sex with men.
What’s the concern with this? Well, all studies show that lesbians and bisexual women can and do test positive for HPV. Lesbian and bisexual women in monogamous relationships (sex with only their partner) can test positive for HPV. Furthermore, lesbian and bisexual women who reported no previous sex with men (ever) also can and do test positive for HPV.
So, what’s the best way to deal with an issue that involves both patient and primary healthcare provider?
1) First of all, you as the patient need to be your own healthcare advocate. If you are seeing a primary healthcare provider whom you are not comfortable with or you feel doesn’t respect or acknowledge your sexual orientation, go find another provider.
2) Secondly, once you find a healthcare provider you like and trust, be honest with him or her. We can only provide you the best care if you are open with us. We will be open with you in return. Some questions might be sensitive or make you feel a little hesitant to answer, but we’re asking them because they are important for us to know. We want you to be healthy.
Sexual health is incredibly important and the need to follow consistent guidelines for screening and prevention has proven to be true regardless of sexual orientation. If you are a lesbian or bisexual woman and never had a pap and pelvic exam, please make an appointment with your primary healthcare provider to have this done.
If you can’t remember the last time you had one done (more than two or three years), it’s also time to get it done.
Of course, all women need to be vigilant about their reproductive health. All women are at risk and should request and receive preventive screenings.
So, here’s a little rundown of the basics of when to go in for your first pap smear and pelvic exam:
1) If you’ve never had sex with a woman or a man, you still need to have your first pap smear and pelvic exam at age 21. Even if you are a virgin, you need to get tested by age 21.
2) If you have had sex with a man or woman, you need to get your first pap smear and pelvic exam three years after you first have sex. So, if you lost your virginity at age 15, you need one by the time you’re 18.
Once you’ve had your first one, your primary healthcare provider will talk to you about when to get the next one done. Cervical cancer truly is a silent killer and taking charge and control of your sexual health is one thing we should be empowered and proud to do!
* The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decisionmakers and the public.
Stephanie A. Naas, FNP-C, is a primary care provider at the Eureka Community Health Center, a clinic of Open Door Community Health Centers.