Intimate partner violence and cervical neoplasia

Intimate partner violence (IPV) is associated with a range of adverse physi cal health outcomes, including chronic and infectious diseases. An emerging literature suggests that partner violence and specifically sexual violence may be associated with an increased risk of cervical neoplasia. To assess the risk of preinvasive and invasive cervical cancer in a cross-sectional s tudy of women screened for IPV by type, frequency and duration, 1152 women ages 18-65 were recruited from family practice clinics in 1997-1998. They w ere screened for IPV during a brief in-clinic interview, and health history and current status were assessed in a follow-up interview. Of 1152 women s urveyed, 14 (1.2%) reported cervical cancer, and 20.3% (n = 234) reported t reatment for cervical neoplasia. Ever experiencing IPV was associated with an increased risk of invasive cervical cancer (adjusted relative risk [aRR] = 4.28; 95% CI 1.94, 18.39) and with preinvasive cervical neoplasia (aRR = 1.47; 95% CI 1.16, 1.82). This association was stronger for women experien cing physical or sexual IPV than for women experiencing psychological IPV. Women with cervical cancer reported being in violent relationships longer a nd experiencing more frequent physical and sexual assaults and more IPV-ass ociated injuries than did controls. This exploratory study suggests that IP V may increase a woman's risk of cervical neoplasia. The mechanism by which IPV effects cervical neoplasia may be indirect through psychosocial stress or negative coping behaviors or direct through sexual assaults and transmi ssion of human papillomavirus (HPV).