Oct 122015
 
Human Papilloma Virus

Human Papilloma Virus

Little is known about reproductive cancer risks among cisgender lesbian and bisexual women. Cancer registries generally don’t ask about sexual orientation. Studies suggest so far that lesbian and bisexual women are less likely to get a pelvic exam and pap smear when it’s recommended. Pap smears help to detect cancer in its earlier, most easily treated and cured stages. Logically, lesbian and bisexual women may be at risk for having more developed (and potentially incurable) cancers. The data confirming that aren’t in yet, but it seems likely.

And now we have HPV vaccines. The human papilloma virus is a major cause of cervical cancer, along with anal cancer, penile cancer, and mouth/throat cancers. Human papilloma virus spreads by skin-to-skin sexual contact regardless of biological sex or gender. Along with pap smears, the HPV vaccine has been a great tool for preventing advanced cervical cancers.

This week I looked at a study of survey data from 15-25 year old women from the National Survey of Family Growth, from 2006-2010. They asked the questions: “Have you heard of the HPV vaccine?” and “Have you received the HPV vaccine?”

The results were rather spectacular. Lesbian, bisexual, and straight women had heard of the HPV vaccine. There was no difference there. However, 28% of straight women, 33% of bisexual women and 8.5% of lesbian women received the HPV vaccine.

That’s 8.5% of lesbians vs 28-33% of non-lesbian women.

Why?? Lesbians are at risk for HPV infection too!

Before looking at what the authors thought, I have some thoughts of my own.

2006, the earliest year this study had data on, isn’t too far off from when I graduated high school. I remember the sex ed class we had. We were lucky to have sex ed at all. It was a one-day class focused on the effectiveness of birth control options, how to put a condom on a banana (or maybe it was a cucumber?), and sexually transmitted diseases that can be passed between men and women in penis-in-vagina sex. There was no discussion of sexually transmitted diseases that are passed between men who have sex with men or women who have sex with women. I remember walking out of the class feeling confused and alone — what STDs were passable between women, and how can women protect themselves and their partners? Were there diseases that women could spread? Was protection warranted? I had no idea.

The study authors discuss similar problems and attributed the difference between lesbian HPV vaccine and bisexual/heterosexual HPV vaccine to misinformation. The idea that lesbian women who have never had sexual contact with men don’t need pap smears or HPV vaccines is old and incorrect, but still persists. I remember when pap smears were recommended starting at first sexual contact with men — if a woman never had sexual contact with a man then she didn’t ever need a pap, right? Wrong!

But it takes time to correct misinformation. As the authors correctly point out, important changes have happened since 2010. HPV vaccine is now recommended for all young people regardless of sex, sexual activity, sexual orientation, or gender identity. It’s not just a vaccine for a sexually transmitted disease — it’s a vaccine against some forms of cancer. Pap smears are now recommended for everyone with a cervix every 3-5 years or so.

So can you be part of the change? Help spread the word about HPV vaccine for *all* people, and pap smears for people cervixes!

The study was published in the Annals of Internal Medicine. The abstract is publicly available.

Oct 192012
 

Data from a University of Maryland School of Medicine survey were just released showing that nearly four out of ten lesbians do not get regular pap smears. Pap smears screen for cervical cancer, among other things. Cervical cancer is usually caused by the human papilloma virus (HPV). HPV can be spread by skin-to-skin contact, so lesbians are just as much at risk for getting HPV as bisexual or heterosexual women. Screening is important to detect precancerous changes and cancer in their earliest stages so that treatment can be done when it’s most effective, preventing deaths.

Why do so few lesbians get their screenings? The primary reasons cited in the survey were: a) not having a physician referral, and b) not having a physician. Together, these two reasons account for 34.8% of study participants. We already know that lack of access to care is a big problem in gender and sexual minority communities. This just helps to confirm it. The survey authors note that lesbians who were open with their physicians about their sexual orientation were more likely to be screened than those who weren’t open.

There has been a recent change to pap smear recommendations. Pap smears are no longer recommended every year for most people. Screening starts at 3 years after first sexual activity, or age 21, whichever is first. From age 21-30, screen every 3 years, then from age 30-65, screen and do an HPV test every 5 years. After 65, no screening is recommended. If a pap smear is abnormal, screenings become more frequent. I should also note that these guidelines apply to everyone with a cervix, regardless of gender identity.

I, personally, think it’s highly advisable for everyone to know their HPV status and get vaccinated if possible, in addition to regular pap smears. HPV vaccines are not a replacement for pap smears because they don’t vaccinate for all HPV strains which cause cervical cancer. However, vaccines do protect against some.

EDIT (10/21/2012): I should also note that during a pap smear, a physician can do other screenings. This includes gonorrhea/chlamydia screening, looking for signs of other STDs or vaginal cancer, and checking the ovaries for lumps.

Aug 152011
 

Felching is the act of sucking semen out of an anus or vagina. It can be accompanied by “snowballing”, where the semen is shared between people orally. Felching can be done by both straight and gay partners. Felching is also relatively common in the gay male barebacking community. A recent study found roughly one in sex men who bareback also do felching.

There is relatively little information about felching in the academic literature. The greatest risk with felching or snowballing is the potential to spread STDs, including HIV and hepatitis. These diseases are spread most often from the inserting partner to the receptive partner. There is also a risk of spreading intestinal parasites, if the receptive partner has one. For that reason, it’s considered a “high risk sexual behavior”.

There is no way to use barriers to reduce risk with felching. The best way to protect oneself is to get all potential sexual partners STD tested before felching. Keep in mind that HIV can take up to three months to show up on an HIV test, so you may wish to wait until a test at three months is clean.

Resources:

Jul 232011
 

News has come out recently that gonorrhea is showing resistance to the antibiotics used to treat it. Gonorrhea is an infection caused by a bacterium, Neisseria gonorrhoeae. Like many bacteria, it loves dark, damp places. In both men and women, it can infect the urethra, anus, mouth and throat. In women it can also infect the ladybits.

How does a bacterium like gonorrhea become antibiotic resistant? It’s evolution. All bacteria are slightly different because of random mutations in their genes. Antibiotics don’t always kill all the bacteria in an infection. Some of them are naturally resistant to the antibiotic. Those bacteria then can reproduce. Over time and repeated applications, the resistant bacteria become the common kind. And then we have a problem.

Gonorrhea can cause some really nasty long-term damage. It can cause sterility for both sexes (through either pelvic inflammatory disease or inflammation of the epididymis). It can also spread to infect joints, causing arthritis, or into the blood, which could be fatal. Gonorrhea can also be transmitted to newborns in the process of a vaginal birth. In newborns, it can cause blindness. All gonorrhea infections should be treated.

Since all infections should be treated, the best way to deal with the rise in antibiotic resistance to gonorrhea is to prevent infections.

What are the symptoms of gonorrhea? First, it’s important to know that it’s possible to have gonorrhea without symptoms. Around 90% of women and 10% of men with gonorrhea don’t have symptoms. Symptoms of a genital infection include a) a burning feeling while peeing, b) white, yellow, or green discharge from a penis and c) bleeding between periods. An anal infection may itch or burn, cause painful bowl movements, or create a discharge. Throat infections generally only cause a sore throat. Symptoms can appear up to two weeks after the infection starts.

Gonorrhea spreads by fluid contact, so vaginal, oral, and anal sex can all spread it. A simple skin-to-skin contact won’t spread it, unlike HPV. Like all STDs, the only way to 100% prevent it is to never have sexual contact with other people. That’s usually not possible. The next best thing? a) use barriers (like condoms, latex or nitrile gloves, or dental dams) correctly and consistently with all toys and body parts that come in contact with genitals, b) get yourself and your partner(s) regularly tested, especially before having sexual contact with a new person, c) restrict the number of people you choose to have unprotected sex with.

Need to know more?: