Cervical cancer screening guidelines for lesbian, gay, bisexual and queer women

Lesbian, gay, bisexual and queer women, and other women who have sex with women (WSW) age 21 and over and who are or have ever been sexually active need to be screened for cervical cancer by having a Pap test every three years.

Tips for providing Pap tests to lesbian, gay, bisexual and queer women

Many WSW (and trans men) are told or believe — incorrectly — that they don’t need a Pap test if they don’t have sex with non-trans men. Studies have also shown that WSW do not necessarily believe that health promotion messages for “all women” include them.^[1] These facts may contribute to the fact that some WSW have lower rates of cervical screening than heterosexual women.

Here are some things that you as a healthcare provider can do to make Pap tests more accessible and easier for WSW:

Let your client know they can bring a friend or advocate to the exam: Many clients appreciate having someone next to them to hold hands or to provide distraction techniques. 

Don’t assume that your client’s sexual behavior correlates with her sexual identity:  Many women who identify as lesbian, gay, bisexual or queer have had sexual relationships with men (trans and non-trans). It’s important to have frank and open discussions about sex and birth control. You might ask:

• Do you have a sexual partner or partners?
• What are the genders of your partners?
• Is there a possibility that any of your partners could get you pregnant? If so, are you using birth control?

Don’t assume that a client who identifies as lesbian, gay, bisexual or queer:

• doesn’t have sex with men
• doesn’t have children
• doesn’t plan to have children
• has a female partner (she may have a non-trans or trans male partner, or no partner)
• has only one partner

Gauge comfort with the actual exam: Ask your client if she has had a Pap test before, or whether she has had vaginal penetrative/frontal sex. If your client has no experience with penetration, it may be helpful to know this in advance and to suggest that she try penetration at home first, using a small toy, fingers or a speculum.

Make sure that your client understands clearly what will happen during the Pap test and pelvic exam: Ask if she wants to play with or see the speculum, see pictures of what a Pap test will look like, or have you use a mirror so that she can see the test and her internal structures. Let your client know that the test is relatively short and that you can stop at any time.

Ask your client if she would like you to explain what’s happening as you conduct the Pap test and internal exam: Some clients will appreciate knowing what’s going on at each stage, while others will prefer silence.

Use a water-based lubricant and warm the speculum: Note on the lab requisition that you used a water-based lubricant.