HUMAN PAPILLOMA VIRUS-ASSOCIATED CERVICAL INTRAEPITHELIAL NEOPLASIA FOLLOWING LESBIAN SEX

Background: Less than 3% of lesbians develop cervical dysplasia, with increasing risk correlating with previous heterosexual activity. Becau se they are not currently sexually active with men, many lesbians do n ot perceive themselves to be at risk for developing dysplasia and do n ot obtain regular Papanicolaou smears. There are no standard recommend ations for Papanicolaou smear intervals for lesbians. Case: A 36-year- old, nonsmoking woman had a Papanicolaou smear history of a high-grade squamous intraepithelial lesion of the cervix, which was confirmed by biopsy and successfully treated by laser ablation. Human papillomavir us type 16 was identified in the cervical biopsy by polymerase chain r eaction amplification and restriction fragment polymorphism analysis. The patient gave a clear history of having had sexual activity only wi th women. Conclusion: Regular Papanicolaou testing should be recommend ed to all lesbians, regardless of type of sexual activity. Papanicolao u testing intervals should be determined using standards similar to th ose used for heterosexual women: annually after onset of sexual activi ty or after age 18, and possibly less often after three normal smears at her physician's discretion. An extensive number of sexual partners, current smoking, and prior dysplasia may influence the physician to a dvise continued yearly Papanicolaou testing for lesbians, similar to a dvice given to heterosexual patients.