Background: Less than 3% of lesbians develop cervical dysplasia, with increasing risk correlating with previous heterosexual activity. Because they are not currently sexually active with men, many lesbians do not perceive themselves to be at risk for developing dysplasia and do not obtain regular Papanicolaou smears. There are no standard recommendations for Papanicolaou smear intervals for lesbians.
Case: A 36-year-old, nonsmoking woman had a Papanicolaou smear history of a high-grade squamous intraepithelial lesion of the cervix, which was confirmed by biopsy and successfully treated by laser ablation. Human papillomavirus type 16 was identified in the cervical biopsy by polymerase chain reaction amplification and restriction fragment polymorphism analysis. The patient gave a clear history of having had sexual activity only with women.
Conclusion: Regular Papanicolaou testing should be recommended to all lesbians, regardless of type of sexual activity. Papanicolaou testing intervals should be determined using standards similar to those used for heterosexual women: annually after onset of sexual activity or after age 18, and possibly less often after three normal smears at her physician's discretion. An extensive number of sexual partners, current smoking, and prior dysplasia may influence the physician to advise continued yearly Papanicolaou testing for lesbians, similar to advice given to heterosexual patients.