The Facts About HPV Risk in Lesbians

Lesbians are known to have the lowest risk of getting HIV due in large part to the types of sexual activities (including oral sex) less commonly associated with infection.

Some have taken this to mean that lesbians are, in general, less susceptible to other types of sexually transmitted infections such as human papillomavirus (HPV), the virus linked to the development of cervical cancer.

The difference between HIV and HPV is that the risk of HIV is strongly associated with two things: vaginal sex and anal sex. By contrast, HPV is spread through the intimate skin-to-skin contact, including mutual masturbation (an activity that carries a negligible risk of HIV).

As such, HPV can be passed between two women as easily as between two men or a man and a woman. Penile penetration is not required. Skin-to-skin contact with an infected person is all it takes.

The same susceptibility to HPV in heterosexual women exists in lesbians. In term of sexual practices, those which offer the greatest likelihood of transmission in lesbians are:

• Genital-to-genital contact
• Touching the genitals of an infected partner and then your own 
• Sharing unsanitized sex toys

Some studies have also suggested that HPV can be passed through oral-vaginal contact (cunnilingus) or by deep kissing, although there is strong contention as to the reliability of the studies. 

There are several simple ways that lesbians can reduce their risk of getting or spreading HPV:

• Using condoms on sex toys if you plan to share them
• Using gloves (a finger cot) when touching genitals
• Limiting the number of sexual partners you have
• Remaining in a monogamous relationship
• Using dental dams if you find any concerning lesions or warts around the genital or anus

Abstinence is also an option although generally unrealistic for most adults.

Women with HPV often discover they have HPV during a routine Pap smear. The Pap smear is able to detect cervical changes caused by the virus, some of which can lead to cervical cancer. In some cases, a genital wart may be present (a symptom commonly associated with certain types of HPV).

Having abnormalities in cervical tissue (known as dysplasia) does not mean you'll get cancer. Only a handful of HPV strains is associated with cancer and even fewer result with genital warts. In most case, HPV will resolve on their own without medical treatment.

Unfortunately, there is a popular misconception among some that lesbians do not need Pap smears. This is entirely false. All women need to have regular Pap screening, irrespective of sexual orientation. Current guidelines from the American Cancer Society recommend that all women begin her first Pap smear three years after starting sexual activity or by age 21, whichever comes first.

The HPV test is another means of detecting HPV. As opposed to checking for changes, this test looks for the actual presence of the virus in a cervical swab. Both the Pap and HPV test can be performed at the same time. Women 30 years of age and over are advised to retest every three years. Women at higher risk or those with dysplasia will typically need more frequent monitoring.

There are over 150 different strains of the HPV virus of which 30 or more are sexually transmitted. It is thought that almost every sexually active person — whether male or female, heterosexual or gay — will get at least one form of HPV over the course of a lifetime.

Of the types most commonly associated with cancer and genital warts:

• HPV 16 and 18 are linked to at least 70 percent of all cervical cancer diagnoses. HPV 16 is the also most common strain associated with head and neck cancers. Another 20 percent are linked to HPV 31, 33, 34, 45, 52, and 58.
• HPV 6 and 11 account for roughly 90 percent of all genital wart outbreaks.

For individuals between the ages of nine and 26, immunizations are available which can protect against some of the higher risk HPV strains. These include:

• Gardasil (approved in 2006) which protects against HPV 6, 11, 16 and 18
• Cervarix (approved in 2009) which protects against HPV 16 and 18
• Gardasil 9 (approved 2014) which protects against HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58

Lesbians are at as much risk for HPV as exclusively heterosexual women. Don't presume that non-penetrative sex puts you at less risk for HPV. Ensure that you are routinely screened for the virus and that any changes in cervical tissue are closely monitored. By doing so, you can greatly increase your risk of cervical cancer, as well as other HPV-related malignancies.