Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE

Pap smear rates among Australian community-attached lesbian and bisexual women: some good news but disparities persist

Catriona Douglas A B , Rachel Deacon C D and Julie Mooney-Somers E F
+ Author Affiliations
- Author Affiliations

A The School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.

B Raigmore Hospital, Old Perth Road, Inverness, Inverness-shire, IV2 3UJ, UK.

C Discipline of Addiction Medicine, University of Sydney, KGV Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.

D The Research Unit, The Langton Centre, 591–623 South Dowling Street, Surry Hills, NSW 2010, Australia.

E Centre for Values, Ethics and the Law in Medicine, University of Sydney, Medical Foundation Building, Camperdown, NSW 2006, Australia.

F Corresponding author. Email: Julie.MooneySomers@sydney.edu.au

Sexual Health 12(3) 249-256 https://doi.org/10.1071/SH14210
Submitted: 4 November 2014  Accepted: 2 February 2015   Published: 30 March 2015

Abstract

Background: Research in the US and UK shows that lesbian women are less likely than their heterosexual peers to attend for routine Pap smear tests. This study examined Pap smear test rates among community-attached lesbian, bisexual and queer (LBQ) women in New South Wales (NSW), to investigate if rates had changed between 2002 and 2012, compare rates to the general NSW population and identify predictive factors for Pap smear test attendance. Methods: Data was taken from the Sydney Women and Sexual Health (SWASH) survey, a self-completed biennial questionnaire of LBQ women’s health and wellbeing. Results: Of the 4083 respondents, 83% had ever had a Pap smear test. Recent attendance rates were similar to the general NSW population. Significant predictors for ever having attended for a Pap smear test were older age, post Year 12 education, ever having had a sexually transmissible infection test, being out about sexuality to a regular doctor and ever having had sex with men. Conclusions: Pap smear rates for LBQ women are encouraging when compared with rates from countries such as the US or UK. A significant proportion of LBQ women are never receiving Pap smear tests. Predictive factors suggest a continued perception that women who have not had sex with men are not at risk of human papillomavirus, and highlight the importance of health providers providing a safe and welcoming environment for LBQ women to openly discuss their health.


References

[1]  McNair R, Power J, Carr S. Comparing knowledge and perceived risk related to the human papilloma virus among Australian women of diverse sexual orientations. Aust NZ J Publ Health 2009; 33 87–93.
Comparing knowledge and perceived risk related to the human papilloma virus among Australian women of diverse sexual orientations.Crossref | GoogleScholarGoogle Scholar |

[2]  Tracy J, Schluterman N, Greenberg D. Understanding cervical cancer screening among lesbians: a national survey. BMC Public Health 2013; 13 442
Understanding cervical cancer screening among lesbians: a national survey.Crossref | GoogleScholarGoogle Scholar | 23642184PubMed |

[3]  National Cancer Institute. Pap and HPV Testing; 2014. Available online at: http://www.cancer.gov/cancertopics/factsheet/detection/Pap-HPV-testing [verified 15 January 2014].

[4]  Health and Social Care Information Centre. Cervical screening programme, England 2012–13. Contract No.: 22/01/2014. Leeds: Health and Social Care Information Centre; 2013.

[5]  National Cervical Screening Program. The Pap smear. Canberra: Department of Health, Commonwealth of Australia; 2013. Available online at: http://www.health.gov.au/internet/screening/publishing.nsf/Content/papsmear [verified 15 January 2014].

[6]  National Center for Health Statistics. Health, United States, 2013: with special feature on prescription drugs. Hyattsville, MD; National Center for Health Statistics; 2014. Available online at: http://www.cdc.gov/nchs/data/hus/hus13.pdf [verified 3 October 2014].

[7]  National Cervical Screening Program. Key statistics. Canberra: Department of Health, Commonwealth of Australia; 2012. Available from: http://www.health.gov.au/internet/screening/publishing. nsf/Content/facts [verified 15 January 2014].

[8]  Tracy J, Lydecker A, Ireland L. Barriers to cervical cancer screening among lesbians. J Women’s Health 2010; 19 229–37.
Barriers to cervical cancer screening among lesbians.Crossref | GoogleScholarGoogle Scholar |

[9]  Henderson H. Why lesbians should be encouraged to have regular cervical screening. J Fam Plann Reprod Health Care 2009; 35 49–52.
Why lesbians should be encouraged to have regular cervical screening.Crossref | GoogleScholarGoogle Scholar | 19126320PubMed |

[10]  Canfell K, Sitas F, Beral V. Cervical cancer in Australia and the United Kingdom: comparison of screening policy and uptake, and cancer incidence and mortality. Med J Aust 2006; 185 482–6.
| 17137451PubMed |

[11]  Fish J, Anthony D. UK National lesbians and health care survey. Women & Health 2005; 41 27–45.
UK National lesbians and health care survey.Crossref | GoogleScholarGoogle Scholar |

[12]  Cochran S, Mays V, Bowen D, Gage S, Bybee D, Roberts S, Goldstein RS, Robison A, Rankow EJ, White J. Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women. Am J Public Health 2001; 91 591–7.
Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M3ivVKhsA%3D%3D&md5=7c844fe66831b03399d533aa21adaaaaCAS | 11291371PubMed |

[13]  Bailey J, Kavanagh J, Owen C, McLean KA, Skinner C. Lesbians and cervical screening. Br J Gen Pract 2000; 50 481–2.
| 1:STN:280:DC%2BD3cvjt1Grsw%3D%3D&md5=f3e30a18c4777aa5fe07c05685d361dbCAS | 10962789PubMed |

[14]  Marrazzo J, Koutsky L, Kiviat N, Kuypers J, Stine K. Papanicolaou test screening and prevalence of genital human papillomavirus among women who have sex with women. Am J Public Health 2001; 91 947–52.
Papanicolaou test screening and prevalence of genital human papillomavirus among women who have sex with women.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MzhvVyqsA%3D%3D&md5=e7675a12c15d237f8fca7acef2a5e8f3CAS | 11392939PubMed |

[15]  Marrazzo J, Koutsky L, Stine K, Kuypers J, Grubert T, Galloway D, Kiviat NB, Handsfield HH. Genital human papillomavirus infection in women who have sex with women. J Infect Dis 1998; 178 1604–9.
Genital human papillomavirus infection in women who have sex with women.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M%2FjsVKnsQ%3D%3D&md5=06bb72b031c29858cd0f7b1ca500a28eCAS | 9815211PubMed |

[16]  Fish J. Lesbian and bisexual women: a review of the worldwide literature using systematic methods. Leicester: De Montfort University; 2009.

[17]  O’Hanlan K, Crum C. Human papillomavirus-associated cervical intraepithelial neoplasia following lesbian sex. Obstet Gynecol 1996; 88 702–3.
Human papillomavirus-associated cervical intraepithelial neoplasia following lesbian sex.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK28vjvV2htg%3D%3D&md5=7bf996f6e783681cee9a0d898885aa53CAS | 8841259PubMed |

[18]  Fethers K, Marks C, Mindel A, Estcourt C. Sexually transmitted infections and risk behaviours in women who have sex with women. Sex Transm Infect 2000; 76 345–9.
Sexually transmitted infections and risk behaviours in women who have sex with women.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M7gsVahtg%3D%3D&md5=ee67ec1094f4b9175fb2891d7c76b962CAS | 11141849PubMed |

[19]  Hall B, Howard K, McCaffery K. Do cervical cancer screening patient information leaflets meet the HPV information needs of women? Patient Educ Couns 2008; 72 78–87.
Do cervical cancer screening patient information leaflets meet the HPV information needs of women?Crossref | GoogleScholarGoogle Scholar | 18372144PubMed |

[20]  Cervical Screening NSW. Lesbians need Pap tests too. Sydney: Cervical Screening NSW; 2007.

[21]  Mooney-Somers J, Deacon R, Comfort J, Richters J, Parkhill N. Women in contact with the gay and lesbian community in Sydney: report of the Sydney Women and Sexual Health (SWASH) survey 2006, 2008, 2010 and 2012. Sydney: ACON & VELiM, University of Sydney; 2013.

[22]  Zablotska IB, Kippax S, Grulich A, Holt M, Prestage G. Behavioural surveillance among gay men in Australia: methods, findings and policy implications for the prevention of HIV and other sexually transmissible infections. Sex Health 2011; 8 272–9.
Behavioural surveillance among gay men in Australia: methods, findings and policy implications for the prevention of HIV and other sexually transmissible infections.Crossref | GoogleScholarGoogle Scholar | 21851766PubMed |

[23]  Cancer Institute NSW. Cervical cancer screening in New South Wales: annual statistical report 2009–2010. Sydney: Cancer Institute NSW; 2013.

[24]  Newell S, Girgis A, Sanson-Fisher R, Ireland M. Accuracy of patients’ recall of Pap and cholesterol screening. Am J Public Health 2000; 90 1431–5.
Accuracy of patients’ recall of Pap and cholesterol screening.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3cvktFGjsw%3D%3D&md5=267c1bff309c720a4e19d584c83679f7CAS | 10983202PubMed |

[25]  Sutton S, Rutherford C. Sociodemographic and attitudinal correlates of cervical screening uptake in a national sample of women in Britain. Soc Sci Med 2005; 61 2460–5.
Sociodemographic and attitudinal correlates of cervical screening uptake in a national sample of women in Britain.Crossref | GoogleScholarGoogle Scholar | 16102881PubMed |

[26]  Bergeron S, Senn CY. Health care utilization in a sample of Canadian lesbian women: predictors of risk and resilience. Women & Health 2003; 37 19–35.
Health care utilization in a sample of Canadian lesbian women: predictors of risk and resilience.Crossref | GoogleScholarGoogle Scholar |

[27]  Diamant AL, Schuster MA, Lever J. Receipt of preventive health care services by lesbians. Am J Prev Med 2000; 19 141–8.
Receipt of preventive health care services by lesbians.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M%2FktlOmug%3D%3D&md5=f4dc97f8dc9b80851571157a05dad9a4CAS | 11020589PubMed |

[28]  Mosack KE, Brouwer AM, Petroll AE. Sexual identity, identity disclosure, and health care experiences: is there evidence for differential homophobia in primary care practice? Women Health Iss 2013; 23 e341–6.
Sexual identity, identity disclosure, and health care experiences: is there evidence for differential homophobia in primary care practice?Crossref | GoogleScholarGoogle Scholar |

[29]  Australian Bureau of Statistics. Australian Health Survey: updated results, 2011–12, ‘ Table 2 Smoker status by age and sex – Australia, states and territories’, data cube: Excel spreadsheet, cat. no. 4364.0.55.003. Available online at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0032011-2012?OpenDocument [verified 15 October 2014].

[30]  Australian Institute of Health and Welfare [AIHW]. 2010 National drug strategy household survey report. Canberra: Australian Institute of Health and Welfare; 2011.

[31]  Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice, 8th edn. East Melbourne: Royal Australian College of General Practitioners; 2012.

[32]  Formby E. Lesbian and bisexual women’s human rights, sexual rights and sexual citizenship: negotiating sexual health in England. Cult Health Sex 2011; 13 1165–79.
Lesbian and bisexual women’s human rights, sexual rights and sexual citizenship: negotiating sexual health in England.Crossref | GoogleScholarGoogle Scholar | 21972785PubMed |

[33]  Brown R. More than just lip service - the report of the lesbian health information project. Melbourne: Royal Women’s Hospital; 2000.

[34]  Brown A, Hassard J, Fernbach M, Szabo E, Wakefield M. Lesbians’ experiences of cervical screening. Health Promot J Austr 2003; 14 128–32.

[35]  Hunt R, Fish J. Prescription for change: lesbian and bisexual women’s health check, 2008. Leicester: De Montfort University; 2008.

[36]  Moszynski P. Cervical cancer virus can be transmitted through same sex relationships, report warns. BMJ 2009; 339 b5667
Cervical cancer virus can be transmitted through same sex relationships, report warns.Crossref | GoogleScholarGoogle Scholar | 20042493PubMed |

[37]  Medical Services Advisory Committee. National cervical screening program renewal: executive summary. Canberra: Commonwealth of Australia; 2013.

[38]  Farnsworth A. Changes to cervical screening in Australia: applying lessons learnt. Med J Aust 2014; 201 245–6.
Changes to cervical screening in Australia: applying lessons learnt.Crossref | GoogleScholarGoogle Scholar | 25163361PubMed |