The Facts About HPV Risk in Lesbians

Lesbians have the lowest risk of getting human immunodeficiency virus (HIV) due in large part to the types of sexual activities they engage in (such as oral sex), which are less commonly associated with the infection.

However, that does not mean that lesbians are, in general, less susceptible to other types of sexually transmitted infections. One example is human papillomavirus (HPV), known for its link to the development of cervical cancer.

Not only do sexual minority women often believe they are at less risk for HPV than heterosexual women, but they may be less likely to receive preventive care such as vaccination and screening.

A key difference between HIV and HPV is that the risk of HIV is strongly associated with penetrative sex. Penile penetration is not required to spread HPV; all it takes is skin-to-skin contact with an infected person. The virus can be transmitted through intimate skin-to-skin contact, such as mutual masturbation (an activity that carries a negligible risk of spreading HIV).

HPV can be passed between two women as easily as between two men or a man and a woman. 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, although there is strong contention as to the reliability of the studies.

Lesbians can reduce their risk of getting or spreading HPV by:

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

Abstinence is also an option, though a person can still contract a sexually-transmitted infection even if they are not engaging in intercourse.

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 (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 most cases, HPV will resolve on its own without medical treatment.

Current guidelines from the American Cancer Society recommend that all women have their first Pap smear three years after starting sexual activity or by age 21— whichever comes first.

The HPV test is another way to detect HPV. Rather than checking for changes, the test looks for the presence of the virus in a cervical swab. The Pap and HPV tests can be performed at the same time.

According to the American College of Obstetricians and Gynecologists (ACOG), women who are 30 years of age and over should retest every three years. Women at higher risk (such as those with abnormal change on a previous test) may need to be tested more frequently.

There are over 150 different strains of the HPV virus, 40 of which are considered the "genital type" and can be spread sexually. It is believed that almost every person who is sexually active will contract at least one form of HPV in their lifetime.

The types of HPV of most concern are those that can cause genital warts and those that can lead to cancer. It's important to note that a type that can cause one may not cause the other.

HPV 16 and 18 have been linked to 70% of all cervical cancer diagnoses. HPV 16 is the most common strain associated with head and neck cancers (another 20% are linked to HPV 31, 33, 34, 45, 52, and 58). Roughly 90% of genital warts outbreaks are caused by HPV 6 and 11.

For individuals between the ages of nine and 26, immunizations are available which 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

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.