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Dr. Sue Wilkinson is currently conducting the first national survey of lesbian health in the United Kingdom with doctoral student Julie Fish. The survey managed to contact lesbians in almost every postal district of the United Kingdom, from the southern tip of England to the islands off northern Scotland. More than 1,000 lesbians answered the questionnaire, which focused on breast cancer, mammograms, breast self-exam, cervical cancer, and pap smears.
The early results of this study focus on cervical screening. Unlike many cancers, cervical cancer has an early warning stage, with abnormal cells present. This is why women are told to have regular pap smears (or cervical smears, as they're called in the UK).
Sue and Julie found that 12 percent of lesbians eligible for cervical screening had never had a pap smear. This is higher than comparable US figures of 5 percent found by the National Lesbian Health Care Survey in the mid-1980s. However, it is lower than the 17 percent for women in the general UK population who report never having had a cervical smear. What is surprising about these low figures is that the UK has national health service. Pap smears are free, and women receive a reminder letter every five years, with two or three follow-up letters if they don't come in for the pap smear.
When Sue and Julie examined lesbians' written comments about cervical screening, they found that one reason for non-attendance was lack of time. "But apart from that, it looks as though the two main categories of response are that lesbians feel they don't need a smear and secondly, negative aspects of the procedure," said Sue. "They imagine the procedure will be painful, or embarrassing, or that they will encounter heterosexism."
Cervical cancer appears to be connected with sexual activity, particularly penetrative sex with men. This is why lesbians have traditionally been viewed as at low risk for cervical cancer. But lesbians may have had sex with men previously, and/or they may be having sex with men even while calling themselves lesbians. Cervical cancer is not well understood, so women, including lesbians, may be at risk for other reasons unrelated to sexual activity. In the UK study, about 40 percent of lesbians felt they did not need a cervical screen because they had never had intercourse. Many lesbians wrote that they had specifically been told this by a doctor or nurse. Examples: "The doctor has decided that I do not require one, as I am a lesbian and have never had a sexual relationship with a man," "The nurse informed me that it was virtually unheard of for a lesbian to get cervical cancer." Two women even reported that they were considered "virgins" by the medical profession because they had had sex with women but not with men!
But the pap smear is not a comfortable procedure for many women, and may be particularly painful, uncomfortable, unusual, or traumatizing for lesbians. Thirty-eight percent of lesbians in the U.K. study reported that they had never had a cervical smear for this reason. One lesbian reported that she viewed a speculum as "a huge metal crocodile." Others had heard horror stories from friends and partners that the procedure was aversive, humiliating, or painful.
Finally, lesbians raised questions about having a male health provider "poking around in my body," specifically, in the vagina, or they were concerned that the health care provider conducting the procedure would result in questions about their sexual activity or would assume they were heterosexual. This important study raises some questions about cervical smears. Do lesbians who have never had intercourse need pap smears at all, or need pap smears less often? How can pap smears be performed in a matter that is more positive for lesbians?
Esther Rothblum is Professor of Psychology at the University of Vermont and Editor of the Journal of Lesbian Studies. She can be reached at John Dewey Hall, University of Vermont, Burlington, VT or by email.
