The Facts About HPV Risk in Lesbians

Women who have sex with women (including lesbians) can be infected with human papillomavirus (HPV), as well as other sexually transmitted infections (STIs). HPV is known for its link to the development of cervical cancer and other cancers. HPV is also responsible for genital warts.

It's important to know that sexual minority people with vaginas often believe they are at less risk for HPV than heterosexual people with vaginas, and they may be less likely to receive preventive care such as vaccination and screening.

This article discusses HPV, how to find out if you have it, and how to protect against spreading HPV.

What is HPV?

HPV is a virus transmitted from close skin to skin contact, typically during vaginal, anal, or oral sex. It is the most common STI in the United States (US). In fact, the CDC reports that almost every sexually active person will acquire HPV at some point during their lives.

Most people with HPV do not have symptoms and never know they were infected. Out of about 200 strains of HPV, most do not cause health problems and are often called low-risk types. Only around 14 strains are known to potentially cause cancer, and often the immune system controls the infection and prevents cancer from occurring.

Diseases Caused by HPV

There are over 200 different strains of the HPV virus, 40 of which are considered the "genital type" and can be transmitted during sexual contact. The types of HPV of most concern are those that can cause genital warts and those that can lead to cancer. The strains that cause warts are different from the strains that cause cancer.

HPV 16 and 18 have been linked to 66% of all cervical cancer diagnoses. HPV 31, 33, 34, 45, 52, and 58 are also associated with cancers. Roughly 90% of genital warts outbreaks are caused by HPV 6 and 11. Between 30 and 60% of head and neck cancers are caused by HPV infection.

How HPV Is Spread 

Penile penetration is not required to spread HPV; all it takes is skin-to-skin contact with an infected person. The HPV virus can be transmitted through intimate contact, such as mutual masturbation.

HPV can be passed between two people regardless of their gender, genitals, or sexual orientation.

The sexual practices with the greatest likelihood of transmitting HPV include:

• 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.

How to Find Out if You Have HPV 

A routine Pap smear can detect cervical changes caused by the HPV virus. These early changes can sometimes 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 (dysplasia) does not mean you have cancer, or even that you will definitely get cancer. Only a handful of HPV strains are associated with cancer and even fewer cause genital warts. In many cases, HPV will resolve on its own without medical treatment.

The 2020 Guidelines from the American Cancer Society recommend that cervical cancer screening starts for all people with a cervix at age 25. HPV testing is recommended beginning at age 25 and continuing every 5 years until the age of 65. In many cases, these tests can be done at the same time.

These screening guidelines are recommended for all people with a vagina/cervix even if you have been vaccinated against HPV. If you have abnormal results, your healthcare provider may recommend additional tests or more frequent screening.

Some studies show that lesbian and bisexual women get less routine healthcare and screenings than heterosexual women. Understanding your risk factors and current screening guidelines may help you to advocate for your healthcare needs.

Protect Against HPV

For individuals between the ages of 9 and 45, immunizations can protect against some of the higher-risk HPV strains.

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

As of 2016, only Gardasil 9 is approved for HPV vaccination in the US.

It's important to know that a person can still contract an STI even if they are not engaging in intercourse.

Women who have sex with women can reduce their risk of getting or spreading HPV by:

• Using external or internal condoms on sex toys if planning to share
• Using gloves (a finger cot) when touching genitals
• Limiting the number of sexual partners or maintaining a monogamous relationship
• Using dental dams if any lesions or warts around the genitals or anus are present

Summary

HPV is a very common STI that can often spread without symptoms. However, HPV infection can cause genital warts and some kinds of cancers. It is spread through skin-to-skin contact regardless of gender or sexual identity. If you have a cervix, you should speak with your healthcare provider to ensure you get your recommended screenings.

A Word From Verywell

Sexually active lesbians are at as much risk for HPV as exclusively heterosexual people with vaginas. 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 decrease your risk of cervical cancer, as well as other HPV-related malignancies.