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.