My Doctor Said Lesbians Don’t Need Pap Smears, but She’s Wrong

I’m 25 years old and since my friend group is obsessive about health care, I was pressured into finally getting my first pap smear. Peer pressure, amiright?

I expressed my nervousness to my primary care physician because I had never had PIV sex before. She was shocked. “You’re 25 and you’ve never had sex?” Annoyed, I told her that I was sexually active, just not with anyone with a penis. She paused for a few moments until she realized what I meant. “I had a lesbian patient once,” she told me. “She didn’t have her first pap smear until she was 45 and she was just fine.” She then proceeded to tell me several times how weird it was that I was 25 and had never had PIV sex. I said nothing about her transphobia or about her sex shaming attitude and gritted my teeth as I thought about my girlfriend waiting for me in the lobby. I was grateful she didn’t have to hear the doctor shame me for my sexual experiences.

I’m a lesbian in conservative Southwest Missouri whose insurance requires me to go to a Catholic hospital, though, and I’d been expecting as much. What I hadn’t expected, however, was the ignorance of what she would tell me next. My doctor, who I trusted even less now, then explained that if I wasn’t having PIV sex then there was a less than a 1% chance that I could get cervical cancer — and since I was gay, I didn’t need a pap smear at all. Ever. Or at least until I was middle-aged. Although this seemed wrong, I believed her. Determined to advocate for myself though I asked to get the HPV shot I’d never gotten as a teen. Since I wasn’t getting a pap smear, this would surely protect me in some way, right?

After leaving the doctor’s office, I realized I didn’t know a single thing about HPV or pap smears. I also realized that my doctor had given me false information – the internet told me that everyone with a cervix, regardless of who they’re having sex with, should get pap smears regularly. Although I knew that for LGBTQ people, accessing quality healthcare can be a challenge, I’d never experienced it myself. I felt cheated out of the money I’d just paid for the visit. I felt guilty for not better advocating for myself and I was angry that a supposed expert had so irresponsibly told me I never needed a pap smear. Just like the first time I ever held hands with a woman in public and received dirty looks, being shamed and misled by my doctor felt like a simultaneously inevitable and painful part of being queer.

The whole experience felt awful.

It turns out though that I’m not alone. A 2012 study by the University of Maryland School of Medicine showed that nearly 38 percent of lesbians polled in a national U.S. survey were not routinely screened for cervical cancer.

I decided to talk to Kecia Gaither, MD, MPH, FACOG about my experiences. I’d recently read an article that featured Dr. Gaither in which she discussed how hard accessing quality healthcare can be for LGBTQ people. As Director of Maternal Fetal Medicine/Perinatal Services at Lincoln Medical and Mental Health Center, NYC Health + Hospitals, in the Bronx, I knew Dr. Gaither would be LGBTQ-affirming and a knowledgeable source.

Right off the bat, Dr. Gaither told me that my doctor was wrong. “To say that because you are a lesbian [you] can’t catch HPV, that is erroneous,” Dr. Gaither said. “HPV can be transmitted if the person has HPV and you’re engaging in closeness in the genital region. You can catch it by using infected HPV toys. You certainly can catch it if you have oral intercourse with someone who is infected with the virus. You need to go and have a pap smear.”

Another crucial point that my primary care physician failed to address was the fact that although I hadn’t had PIV sex, many cis lesbians do have sex with penis-having people. Cis lesbians date trans women and non-binary people; cis lesbians even sometimes have sex with men. To assume that just because I’m a lesbian, I’ll never have PIV sex is naive and erases the existence and realities of trans women, non-binary people, and their partners.

There’s another misconception that if you’ve had the HPV vaccination, pap smears aren’t necessary. This is also false. “Gardasil was invented to serve as a methodology to prevent you from even acquiring the HPV virus,” Dr. Gaither said. “However, there are multiple strains of the HPV virus, and Gardasil does not protect you against all of them. It’s supposed to protect you against some of the more virulent strains that are associated with the development of each virus.”

Dr. Gaither pointed out too that HPV is only one of several viruses that can cause cervical cancer. Getting a pap smear is a way to ensure that you don’t have any of those viruses. “There are certain virus strains that are more prominent as far as causing the disease,” she explained. “When you have a pap smear, not only are they looking at the cells of your cervix, they’re also screening to see whether or not you carry one of those strains that have been implicated in the development of cervical cancer.”

While my primary care physician told me I didn’t need to get a pap smear for another few decades, Dr. Gaither recommends that all people with vulvas and cervixes get pap smears just as regularly as straight cis women, even if they’re exclusively having sex with other people with vulvas. The American College of Obstetrics and Gynecology (ACOG) advises cervix having people aged 21–29 years to have a pap test every three years. For cervix having people aged 30–65 years, ACOG recommends having a pap test every five years.

Dr. Gaither says that cervical cancer is one of the most preventable types of cancer because it is slow growing. “The emergence of the pap smear has saved millions of lives because it screens you and it catches cervical cancer or cervical dysplasia or precancerous conditions early. Cervical cancer is a cancer that [no one] should be dying from.”

According to the National Cervical Cancer Coalition, “more than 13,000 women in the United States will be diagnosed with cervical cancer each year, and more than 4,000 of women will die.” My doctor telling me not to get a pap smear is ignorant at best. At worst, it is irresponsible and dangerous.

I asked Dr. Gaither advice on how to better advocate for ourselves as LGBTQ people. “I think that it’s important for you to do your research,” she said. “To look at those medical facilities that are LGBTQ friendly. Look at the providers and what institutions they’re affiliated with.”

In a perfect world, LGBTQ people would be afforded the same quality of healthcare as cisgender straight people. For now though, this is a fantasy. As this experience taught me, being educated about my body and advocating for myself is crucial.

While I felt helpless as I sat in the doctor’s office a few months ago, I now feel empowered and able to fully advocate for myself in the future. Dr. Gaither urged me to find a new doctor and to get a pap smear ASAP.

I’m getting my first pap smear next month.

Hannah Brashers is a Missouri-based freelance writer with bylines in Allure Magazine, Refinery29, Teen Vogue, Glamour Magazine, and elsewhere. She covers politics, religion, sexuality, and anything Cate Blanchett related. Find her at hannahbrashers.com or tweeting about being gay @hannahbrashers.

Hannah has written 2 articles for us.

30 Comments

  1. Thank you for an important article!
    In the spirit of encouraging everyone to advocate for themselves, and letting people know about the range of options:

    I’m in the UK and when I went for my first smear, it hurt too much and the nurse said I was low enough risk because of my sexual history that it wasn’t worth pursuing. I mentioned being worried about this to my GP, and was referred to the local colposcopy clinic where they had a wider range of speculums, and I was able to have it done. If you’re having trouble with a smear, this is an option! Have a word with your GP and they can refer you.

    • They have to use a pediatric speculum for me. I’m grateful my doctor actually looked at that as an option.

      I just had a hysterectomy because of pre-cancer cells that were found. I’m actually fine, they didn’t find anymore. But the fact that if I had a different doctor I could have developed cervical cancer in the future just because I’m a lesbian is scary.

  2. What a coincidence I recently made my appointment for my yearly Pap smear! I’m a big advocate for them I tell all my cervix having friends to get Pap smears. It really was irresponsible for your doctor to say that. Hopefully future doctors will be more informed.

    Thanks Hannah and Autostraddle for publishing this piece. This is the kind of content I love from this community!

  3. Not to mention that lesbians often date bi women who may have had sex with men in the past! To my knowledge you can’t test a penis for hpv and, like herpes, it can be transmittable even if you use a condom.. so even if a man/person with a penis you’re sleeping with has “been tested” there’s no way of knowing if they have hpv unless they have a strain with visible warts or they just happen to know a former partner had a bad pap smear. It seems like it would be best practice to just give pap smears to all vaginas regularly, but they’re trying to cut costs?

    Also, anyone know why it jumps to every five years after you’re 30? People don’t have less sex in their thirties.. is this because they assume everyone will be in monogamous marriages by this point, or that most people will already have been exposed..? I insisted on having a pap smear recently because I’m poly and felt like my personal risk factors warranted it, but my insurance company disagreed and I ended up paying $300 because it was too close to my last one (about two years prior).

    • Cervical cancer, what a pap smear tests for, develops really slowly, often 10-15 years. It is also most common in people from age 30-60. Over here (the Netherlands) we are offered free testing from age 30, every 5 years. If suspicious cells are found you will be tested more often. I have no clue why in the US you are tested more often before 30. Maybe it’s capitalism since you have to pay so much for healthcare?

      Then again, in the Netherlands acces to healthcare is much better, healthcare insurance is mandatory and highly subsidized for low incomes. So maybe we are more likely to visit a doctor with symptoms?

    • Oh, I found an answer! I can’t edit my last answer, so here it is.

      Dutch organisation for healthcare, RIVM, says the following: (I translated and paraphrased.)

      “Women under 30 are at greater risk to are HPV positive and have minimal abnormal cells in their pap smear. Nearly always this is cleared by the body. A large group of women would be unnececarly worried or treated.”

      We startscreening at 30, as stated in my other reply.

      Source (Dutch): https://www.rivm.nl/bevolkingsonderzoek-baarmoederhalskanker/veelgestelde-vragen/veelgestelde-vragen-uitnodiging-bevolkingsonderzoek#uitnodiging2

    • I worked as a medical assistant in a sexual and reproductive health clinic and can share what I was told about the recommendations! It’s a bit long and complicated… Previously in the U.S. pap smears were recommended yearly as part of a person’s regular preventative check-up. This is why some people still call a pap the “annual exam” and why some people might feel nervous about spacing them further apart than one year – that’s what they got used to.
      Then, the recommendations changed to every 3 years because of the new scientific understanding that cervical cancer actually takes many years to develop (usually 10+) and large-scale studies showed no health benefit to yearly paps vs. every 3 years. Another way of putting it is that people don’t go from zero to cervical cancer in 3 years, so 3 years is plenty of time to identify abnormal pre-cancerous cervical cells, intervene, and hopefully avoid cancer entirely. This is why people with many partners get told they don’t need to do paps more frequently than anyone else.
      Then, HPV testing technology was developed and the recommendations were changed yet again to say that if you have a pap with HPV testing (called co-testing) and get normal results for both, spacing co-testing every 5 years apart is perfectly safe. The pap test is when someone looks at the cervical cells under a microscope to see if they are growing normally or abnormally. When that’s all we do, we might not know there’s an HPV infection that could cause abnormal cell growth to start in the next few years (you can’t see the virus under a microscope). But a negative HPV test lets us know abnormal cell growth is not at all likely to happen anytime soon, so you can safely wait 5 years to do it again.
      Finally, the difference in recommendations for people under 30 vs over is based on what Yasmin found: HPV is statistically much more common in people under 30 and most of the time the body fights it off, so doing routine HPV testing in that age group would lead to too many false alarms and unnecessary treatments that carry some health risks. Yes, health insurance does a LOT of problematic shit because of capitalism… But the recommendations are more based on potential harm to patients, and come from medical organizations, not the insurance companies. So in the U.S. they say to get a pap without HPV testing every 3 years from age 21-29, then a pap with HPV testing every 5 years starting at age 30.
      TL;DR recommendations change over time as we learn more from research and try to weigh risk versus benefit

  4. Hey, something extremely relevant to my work! Everyone with a cervix should absolutely get a pap smear and everyone should get the Gardasil shot if they’re able to! The FDA just approved Gardasil 9 for use up to age 45, so talk to your doctor if you never got it before!

    I’m constantly frustrated by how poorly physicians are educated on LGBT issues in med school. The Fenway Institute has the National LGBT Health Education Center (https://www.lgbthealtheducation.org/) which puts out a lot of resources to educate healthcare providers. Would also recommend forwarding this ACOG Committee Opinion to any doctor who thinks lesbians don’t require STI testing and cervical cancer screening (https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Health-Care-for-Lesbians-and-Bisexual-Women?IsMobileSet=false).

  5. Thanks for sharing your experiences! I’m glad you came out of this empowered.

    Honest question though: as an 26- year old asexual lesbian, who’s never had sex and is currently in no rush to change that, is there any reason for me to get a pap smear?
    (I do have insurance and think I could probably find a gynocologist rather easily (living in a big city in europe and all), but so far I’ve never really seen a reason to do that…)

    • I’ve been looking for an answer but haven’t found one yet. As I said in another reply, in the Netherlands we only start testing at 30, because chances of having cervical cancer before that are very low. We also only test every 5 years, if there are no abnormalities found.

      So you could possibly wait until then to make a choice. In case you change your mind or experiment once: if you have had any sexual contact I’d certainly recommend getting a pap smear every 5 years. Any contact includes frottage without clothes.

      In case you are at 30 still happy ace and never want to have any sexual contact – I haven’t found a definitive recommendation. As far as I can remember, there are types of cervical cancer not caused by HPV. So chances are slim, but it’s not impossible. Maybe you can contact a general practioner or gynocologist and ask for advice?

    • In addition to the other answers to your comment, I’d say the only other reason to consider seeing a gynecologist would be if you’d like to have established care with one in case of pelvic health concerns in the future. A GP can usually manage these kinds of concerns, but if you’d feel better seeing a specialist it might be worth finding one you are comfortable with. In my experience in the US medical system, the gynecologist is also the only provider that routinely screens for breast health concerns as well.

  6. This is somewhat timely for me. I’m 29 and just had my first pap smear last month. I’m also not physically sexually active (LDR situation), and have never had physical sexual contact with another person. The doctor I went to said it was good to get screened regularly starting at age 21 regardless of sexual activity as good preventative medicine. Mileage may vary on that advice though, I don’t know.

    My GP just retired and I actually used getting a pap smear as a test for another medical clinic in my town. It’s also a Catholic healthcare situation, but they’re more affordable and upfront about self-pay costs than some of the other options. I was extremely nervous going in that they would be homophobic since it was a religious health care center and in rural East Texas, but everything went really, really well!

    She even brought up the HPV vaccination options with me unprompted, and we discussed my options since I had previously been vaccinated during a time frame where they didn’t protect against as many HPV strains as the vaccines do now. I felt very lucky that My experience went so well, and I’m sorry yours went so poorly!

  7. I’m asexual and have never had sex. When I was turning 21, I visited a gynecologist because I’d been struggling with irregular periods over the last few months, hoped for an official diagnosis for the vaginismus I’d suspected for years and tips for making penetration easier, and I’d also heard the guidance that people should start getting pap smears at 21 regardless of sexual history.

    I’d scheduled the appointment online and mentioned multiple times in the form that I’d never had sex. Clearly, the doctor never read what I’d shared. She was shocked that I’d make an appointment without having had sex. She refused to examine me. She dismissed all my questions about my body. When I brought up my suspected vaginismus, she used that against me, saying that, see, she couldn’t examine me if it was going to be painful. She told me repeatedly to come back after I’d had sex and clearly meant only P-I-V sex (never mind the catch-22 of her not allowing me to have vaginismus, a condition that potentially makes penetrative sex impossible, diagnosed or treated until I’ve already had that kind of sex.)

    She made me feel like I wasn’t allowed to have questions or concerns about my own body until a cis man had been inside me. I left the appointment in tears and did not get my copay returned.

    Surprise surprise, I have not made any attempts to visit a gynecologist since.

    • That was irresponsible if not un fucking professional of her.

      Endometriosis and variety of things can occur without any penile assistance and with irregular periods as an indicator.
      She deserves to be reported to a regulatory board.

      If you ever decide to try braving another gyno appointment bring a close friend you’ve informed of this history with you to act as an advocate and emotional support.

    • This is terrible and I’m so sorry :( In my country it’s common to have your first visit as a teenager, mainly so they can tell you to “start taking birth control pills to get better skin” but then at least you would have had a chance to bring up your problems and questions. Ugh, it really sucks that you had to go through that.

  8. Ugh I’m so sorry that your doctor treated you this way. Stories like this make me wish my fiancée went into OB/GYN instead of ortho. At least up in the twin cities I’ve experienced more lgbt+ knowledgeable doctors but I know even there it’s inconsistent and it should be everywhere.

  9. „In a perfect world, LGBTQ people would be afforded the same quality of healthcare as cisgender straight people. For now though, this is a fantasy.“

    No, it‘s not. It is the law. There are, of course flaws and socioeconomic fails, but your doctor would have gotten her license suspended in Germany for denying you care due to discrimination.
    Look, I don’t mean to be all „It’s better somewhere else“ but I do think it is important to point out that this is not the norm and this version of it is not acceptable.

    On a lighter note, the Pap smear is named after George N. Papanicolaou a Greek doctor who only went into (research) medicine after not becoming a violinist, working in oceanography, delving somewhat deeply into philosophy and finally working as a journalist (with his wife) in New York after emigrating there in WWI before starting at New York Hospital as a pathologist and researcher.
    If you‘re in that stage of life where you feel guilty for not having it together, switching majors, or not knowing what to do in your life, well, there’s still time to become a hero of sorts, save countless lives and get your face printed onto a bill of money one day.

  10. I was told the exact same thing by a nurse here in the UK… her exact words, etched onto my memory forever, were “oh, ok, great – you don’t need one as you’re so low risk! Make sure you wash your sex toys properly though.” Not embarrassing at all.

    An easy response I guess, without getting into too many specifics, is to point out that low risk isn’t no risk, let’s check this out anyway!

  11. I’m really late to this article but gosh I hope the writer and commenters see this comment.

    I’m seeing an erroneous (but common) assumption throughout that HPV is a necessary prerequisite for cervical cancer. It is not!!!! HPV is associated with 60-70% of cervical cancers, but that means at least 1/4 of cervical cancers are not. I have a 30 year old friend with cervical cancer who does not have HPV, who had the HPV vaccine, and has had minimal sexual partners.

    PIV SEX OR SEX OF ANY KIND, AND HPV, ARE NOT PREREQUISITES FOR CERVICAL CANCER. GET YOUR PAP SMEARS.

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