Cervical cancer risk and Papanicolaou screening in a sample of lesbian and bisexual women.
BACKGROUND
Previous studies of lesbian and bisexual women have suggested that negative experiences with health care practitioners, combined with misinformation about the health needs of this diverse population, have led to an underutilization of medical services.


METHODS
This study combined focus group data (N = 44) with a self-administered questionnaire (N = 57) to explore the health concerns of lesbian women, including the prevalence of risk factors for cervical cancer, the frequency of Papanicolaou (Pap) test screening, and the barriers to obtaining care. We examined the influence of women's perceptions regarding the knowledge and sensitivity of their clinicians to lesbian issues and their experiences of discrimination in the medical setting of Pap test utilization.


RESULTS
Respondents reported risk factors for cervical cancer, including multiple past or current sexual partners (both male and female), early age at first coitus, history of sexually transmitted diseases, and cigarette smoking. One forth of respondents had not had a Pap test within the last 3 years, including 39 (7.6%) who had never had a Pap test. Women who reported that their health care providers were more knowledgeable and sensitive to lesbians issues were significantly more likely to have had a Pap test within the last year, even when controlling for age, education, income, and insurance status.


CONCLUSIONS
Lesbian women are at risk for cervical cancer and should receive routine cytologic screening according to individual risk assessment. The quality of clinician-patient interactions strongly influences care-seeking within the population sampled.
Cancer Prevention, Detection and Control Research, Duke University Medical Center, Durham, North Carolina, USA. Rankow@earthlink.net
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D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001727:Bisexuality / Q000523:psychology; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D018452:Homosexuality, Female / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D065006:Papanicolaou Test; D010817:Physician-Patient Relations; D012307:Risk Factors; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D014626:Vaginal Smears / Q000706:statistics & numerical data*