Oct. 4, 2000 — Cancer of the cervix affects the lives of thousands of American women every year. While it is mostly found in heterosexual women, it also is a problem for women who have sex with other women. In recent years, research has linked cervical cancer to a sexually transmitted infection due to human papillomavirus, or HPV. One reason lesbians may be at higher risk for developing these tumors is they do not receive adequate screening since it’s commonly believed they can’t contact HPV.
Researchers say that contrary to that notion, women can pass the virus to other women. They urge that lesbians have regular Pap smears on the same schedule recommended for heterosexual women.
Jeanne Marrazzo, MD, says she became interested in studying whether HPV could be transmitted from one woman to another when she was a research fellow at the University of Washington. At the time, she discovered that two of her friends, who were in their 30s and were lesbians, had a high-risk type of HPV.
“This meant they were at high risk to develop cervical cancer,” says Marrazzo, now an assistant professor in the university’s allergy and infectious diseases division. “I wanted to know if the recommendation for Pap smears should be different for them and whether they had contacted HPV from previous encounters with men.”
HPV is not just one disease — more than 100 different types have been discovered, according to the CDC. The most harmless types cause no problems or may possibly spawn genital warts. The more severe types can develop into cervical cancer in women, penile cancer in men, and other genital cancers.
“The link between HPV and cervical cancer is very definite; 95% of the time, a papillomavirus is found in women who develop cervical cancer,” Marrazzo tells WebMD. In addition, tests show about 75% of all Americans have at one time been exposed to HPV.
Although the virus is the most common sexually transmitted disease in the world, the majority of people who contact one will never deal with its serious effects. Doctors don’t have answers as to why some people develop the warts or why HPV progresses to cancer in a small percentage of people, but they know certain factors are at play.
Salvatore Lococo, MD, a gynecological oncologist at Harris Methodist Fort Worth Hospital in Texas, says the type of HPV, genetics, and behavior all play roles in how the disease will manifest itself in each person.
“Whether papillomavirus progresses is partially based on genetic predisposition and the type of virus,” Lococo tells WebMD. “Starting sexual activity at an early age, having multiple partners, having unprotected sex, and smoking also increases the risk.”
The disease is sneaky. It can live in the body for years with no obvious signs of infection, and it may have a very slow progression to the cancerous stage. In addition, years after contracting it, HPV can still be passed on through any type of sexual activity. This includes direct contact of genital skin, contamination of hands and fingers, and possibly even the use of sex toys, according to Marrazzo.
“We have women who have been married for 10 years and they discover they have HPV,” Lococo says. “They want to point their finger at their husband for cheating, but one of the partners may have caught it through sexual activity in their teens.” HPV could have taken that long to manifest itself.
If HPV is caught early, sometimes it can be thwarted by destroying the warts using drugs, freezing them with liquid nitrogen, or with laser treatment. But this is not a cure, nor does it prevent repeated contamination by the virus.
“If a person is being [reinfected] with the virus by a partner, there is no point in eradicating the warts,” says Norman Gant, MD, executive director of the American Board of Obstetrics and Gynecology. “It’s a difficult disease to catch without screening. Even if warts do appear on the cervix, they are difficult to see. If they are on the skin or the vulva, then they will show. But this is both the good news and the bad news: You know you have the virus.”
Gant, also a professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center at Dallas, warns that if someone has one sexually transmitted disease, then they probably have more than one. So having HPV could put you at higher risk for contracting HIV.
These facts emphasize the importance of regular physical checkups and honest communication between patients and their doctors. Marrazzo says that women who have sex with women are putting themselves at a much higher risk of HPV progressing to cancer because they don’t get regular Pap smears.
In Marrazzo’s research with lesbians, she found that more than one-third of them hadn’t had a Pap smear in more than two years.
“I was surprised because this was a highly educated group, and most of the women knew how often they should get a Pap,” Marrazzo says. “Many of them said that their medical provider told them they didn’t need to get one.”