A leaflet for lesbians and women who have sex with women about smear tests and lots of other important stuff

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information for lesbians

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The greatest risk factor for cervical cancer is not sex, but not being screened

(Lesbians and Cervical Screening by Fish and Wilkinson 2000)

YES - All lesbians need smear tests. This includes lesbians who have never had sex with men or who haven’t had sex with men for many years. All women aged 20 to 60 are offered a free cervical smear test by the NHS. The test is recommended every three years for all women.

Why do we need a leaflet on this?

The reason for this leaflet is that many lesbians are unsure about whether they need smear tests.

There is evidence that lesbians are being misinformed by some health care workers that they do not need smear tests. The consequence of this is that lesbians may tell each other they don’t need a test. Many of us are happy to believe this, since having a smear test may be an uncomfortable experience anyway. Some of us still do make it to our smear test appointment only to be told we don’t need one and sometimes we are even sent away. This creates a vicious circle whereby fewer and fewer lesbians come forward for a smear test and the incidence of cervical cancer is higher than it needs to be. 1

So when was your last smear test?

But do I need one?

So you do need a smear 2

Why then do lesbians and health care workers think that lesbians don’t need a smear test?

Myths and Facts

The Myths

The notion that lesbians do not need a smear test comes from two main sources: Myth 1 Lesbians have never had sex with a man

Myth 2 Women who have not had sex with a man are not at risk of cervical cancer.

The Facts

Data collected from the Audre Lorde and Bernhard Sexual Health Clinics for lesbians showed that: • 10% of lesbians had smear abnormalities; • 81% of lesbians had had penetrative sex with a man. 10.9% of this group had smear abnormalities; • 5% of the lesbians who had never had penetrative sex with a man had cervical abnormality.

What is a smear test and what is it looking for?

A cervical smear test detects abnormal cells on the cervix before these cells become cancerous. This enables these cells to be treated early and to p revent cervical cancer. 97% of smears are negative (normal).

Who does it? Usually the practice nurse at your doctor’s surgery. Sexual Health Clinics, also called GUM (Genito-Urinary Medicine) Clinics can also offer smear tests, usually as part of a general sexual health check. You can also get a smear test at a Family Planning Clinic or Well Women’s Centre. 3

What happens?

You will be asked to undress from your waist down and to lie on your back on an examination couch. You will need to have your legs apart to enable the practice nurse to insert a speculum into your vagina. A speculum is made of metal or plastic and holds open the walls of your vagina. The nurse will then put a small spatula into your vagina, which she will wipe over your cervix to pick up some cells. This is painless. The whole procedure only takes a couple of minutes. These cells will be sent to a laboratory where they will be analysed for abnormal cells. You will be told when your results will be ready and how you will receive them. If you are called back this may simply mean that your test was unclear and needs to be repeated. It may mean that there are some slight changes in the cells of your cervix which need to be looked at more closely. In both cases you will usually need to have further smear tests.

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it might help if you try some of the following: If you specifically want a woman to do the test explain this when you make the appointment. Take a friend or a partner into the room with you if it helps. Ask the nurse doing the smear to explain exactly what will happen before she begins. Raise any questions or concerns with her before she begins. Tell the nurse if you are feeling nervous or tense. If you have never seen a speculum ask to have a look at it to see how it works. If you would like to insert the speculum yourself explain this to the nurse before the test. Try to breathe slowly and to relax your body fully

Tips for handling smear tests

If you are feeling anxious or embarrassed when you go for your smear test

as this will make the procedure more comfortable. 5

Tips for handling smear tests 6

A smear test may feel uncomfortable but should not be painful. If any part of the procedure is painful, say so. If inserting the speculum hurts and you think it is too big, ask if a smaller speculum is available.

Remember that your body is yours and you have the right to stop the procedure if you are in pain or feel upset for whatever reason. A sensitive nurse will be able to listen to what you are saying if this happens. If this does happen, you may find some of the numbers at the end of this leaflet helpful if you need to talk to someone about your feelings.

A I D Y M A L CH

e h t n o e r ’ e n w a i e b l i s h e l W f o t , c h e t j l b a u e s h G l E NITAL s a e u u x s e s s i WARTS r GENITAL e h t d o e t e n HERPES wha s n a i b ? s t e u l o b do a k n i h t o t GONORRHOEA 7

Sexually transmitted infections What are they?

They are infections that can be passed on from one person to another through sex. They include chlamydia, genital warts, genital herpes, thrush, bacterial vaginosis, gonorrhoea, syphilis, trichomonas vaginalis, pubic lice, HIV and Hepatitis B.

Not all of these infections are only transmitted through sex. You can get thrush and bacterial vaginosis without having sex although they can also be passed on sexually.

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How would you know if you had one? tted i m s ran t y l l ms a e l u b x pro d, se s e u t o a tre seri n se, o u t a t e f d s i e a If l ry d n le o a t c a s y. m n c o m i n t a a l c infe regn c inf i p v l c i e p p for o , . t o c g g . e e to or h y s t i i l i w t y ons i a t c m e infer you l inf l e a r r o ef g fo n i in Ther n s e n e o r i c fect ar s l n i u g d e re us t t o i i v m b eo rans v t a y h l l a an not e v o Sexu a d en to h t f e l o b i en oss f it. p o s wom i e r wa so it a s g m to bein t u symp o ith w n tio infec

If yo u

do n otice anyt you, hing get i that t che is un c k ed o exam usua ut im ple, l for med a dif disch i ately feren arge . For t kind from of va usua abdo gina l, pa men l in in , sore burn y our l ness, ing i ower i t ching n or arou , lum nd y ps, o our v r agin a or anus . 9

Can lesbians get sexually transmitted infections? ns. o i t c e f ted in t i m s n lly tra a u x e s Infor k of s i r t mati a re a s on a n a i b s i e l bout n , s f ectio ve Ye a h exac n n s o tly h a d re pa wom on L ow n s i a r s n s e e c d i b t o an from um Clin n o h e t t l one h h t er du ea n i H l e d a ring an not r renc n Sexu e a sex i f i f i b W e s d a e e l s d o i d t n ly av s o kn g d n n o u a ow t ilabl infec fo am s. s t h e. n n a o t e i i t i t o t a c n a l e s l p f sexu and ual l x of in e ally t v e s s a b g o i r a i n e n ransm t a s and l infe he wom itted wom ction en. e s can n wh All se can b affec o x ually have e pa t ssed trans sex w oral on b mitte ith sex, e d t t w h infec ee ro on h tions ands ugh tran n wome n s and finge ferring v , through a rs an d thr ginal flui sex t ds ough oys. s h aring 10

What should you do if you think you may have an infection? al u x e t a S l. a p ck u hospita e h c et a inic at a nic i g l c n a e l c You h/GUM C to use th the d t Heal n’t have home an y ll r do You st to you and tota e to v e e near ice is fre don’t ha n’t serv al. You if you do nti e d ame i n f l n a o c r re nt to. u o y wa give

Ther e are two speci Sexu f i cally al He Glasg for le alth ow. sbian Clini ( s e leafl e s cs C i n onta et). L o n c t C d s sec heck on a for d t i o nd L n esbia etail at th n e s of an end and clinic of th G y a s ma o y t e S h witch ers t y no h are l t all boar at st ikely have d a r t up. to be lesbi Thes an st frien e a abou dly a ff bu t lesb n t the y ian h d well in form ealth ed issue s

Remember: Most sexually transmitted infections can be treated easily

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What about HIV?

The risk of HIV transmission through sex between women seems relatively low but is possible. An HIV positive woman could pass on the virus to another woman if her blood or vaginal fluid enters her partner’s bloodstream during, for example, oral sex or if sharing a sex toy. However, in the majority of cases, HIV infection in lesbians has involved penetrative sex with a man or injecting drug use. If you would like an HIV test visit a Sexual Health/GUM Clinic where they will explain more about it and discuss the issues involved. The test will be totally confidential so nobody, including your GP, will know that you have been for an HIV test.

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donor sperm you may expose yourself to HIV and other sexually transmitted infections. In order to reduce this risk to a minimum the sperm donor should have a full sexual health check including an HIV test to protect both you and the baby. Some NHS and private clinics will provide insemination - this semen will have

Is Self Insemination Safe?

If you are trying to conceive through self-insemination with

been fully screened.

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Safer Sex

If you are concerned about passing on or getting sexually transmitted infections during sex with another woman, be aware of the following safer sex advice: 14

Avoid the transfer of va ginal fluid from yourself to yo ur partner on fingers and h ands i.e. avoid touching your o wn genitals then your partn er’s and vice versa. If you use a sex toy (e.g . vibrator/dildo) wash it b efore sharing it with your part ner, or have one each. Alternati vely, if you are sharing, cover it with a condom and change the condom in between you a nd your partner.

al sex r o e k a m o t h If you wis r’s vulva e n t r a p r u o y r safer, cove al dam’ t n e ‘d a h it w s or anu re oral o f e b ) x e t la f o (square exual S / M U G l a c lo sex. Your be able y ll a u s u l il w ic Health Clin hese or t h it w u o y e id to prov get o t e r e h w n o u advise yo can u o y ly e iv t a n r e them. Alt nonr o m o d n o c p use a cut-u orous) p n o n ( le b a e v microwa cling film.

Using a w ater-based (not oil-based) lubricant on sex toys, condoms or latex is a good idea for reducing soreness or friction during penetrative sex e.g. use KY jelly and not massage oil. If blood is present during sex (e.g. during menstruation, or through sexual practice) be aware that there is a risk of HIV, Hepatitis B, Hepatitis C and syphilis transmission.

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Breast Cancer

Breast cancer is the most common cancer in women, whatever our sexuality. It is important to be aware of your breasts, and if you notice any unusual lumps or pain in your breasts or a discharge from your nipples, seek medical advice immediately. Breasts are often lumpy and tender, especially before your period, so getting to know how your breasts usually feel is a good idea. The majority of breast lumps are not cancerous but getting advice quickly is important. (For more information, advice or support on this issue contact the Breast Cancer Care Line whose number is at the back of this leaflet). 16

Coming Out to HEALTH CARE Wo r k e r s

tell a o t t o er or n h t e h out w b a e r bian. nsu s u e l e a b ay u are o y t You m a er th k r o n be w a c e r t I a c her? t o health b y r wh e d n o ays. yw a w t m n u e Yo iffer d f o e rang a n i l u usef ....... . . . . . . e l mp For exa

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Coming Out to HEALTH CARE W o r k e r s .......Why would you? t kind of a h w t u o b a s n io st e u eal with those q d to e v a h r e g n lo o • You will n rcourse. te in l a xu se d a h st la ng or when you si u re a u o y n o ti p e c contra more likely to re a u o y , h it w x se g ho you’re havin w t u o b a n e p o e b • If you can needs. For r u o y ts e e m d n a u o t is relevant to y a th re a c h lt a e h l a can pass get sexu u o y r e th e h w t u o d will be able to fin u o y , sh ru th e v a h u example, if yo or not. it on to your girlfriend blems ro p r o ip sh n o ti la re r u difficulties in yo to e u d d e ss re p e d g ation more tu si • If you are feelin r u o y in la xp e to you will be able , ily m fa to r o rk o w t coming out a ying you sa d n a s n io st e u q g years of avoidin r e ft a f lie re a e b y a fully. This m rtain way. e c a g lin e fe re a u o don’t know why y 18

• You may feel more co mfortable an d relaxed ge are able to b nerally beca e more open use you and more yo urself. • If you are bringing up children with your partner you to have it may be im this recognis portant to ed rather tha n appearing single paren t or a single to be either person witho a ut children. • You may also want he alth care pro fessionals to as next of kin recognise yo . This can be ur partner e x t re m e ly im order to ena portant durin ble your part g medical c ner to visit yo are in u at times re or to be invo served for pa lved in decis ions about y rtners our care. Ho that as the la wever, be aw w stands curr are ently, your p as your next artner is not officially rec of kin. Hope ognised fully this will c hange in the near future.

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Coming Out to HEALTH CARE W o r k e r s ..How do you decide? Obviously we all have worries about ‘coming out’ to health care workers. You may be anxious about the reaction you will receive, such as hostility or misunderstanding. You may have concerns about confidentiality. These concerns are understandable as they are, sadly, based on experiences many of us have had. It is wise, therefore, to give yourself time to make your decision. Your decision about whether to come out to your doctor or not may depend on how understanding your GP or practice nurse is generally. It may depend on how confidential you feel your GP practice is or the way you are treated when you go there. If you are very worried about confidentiality and feel you cannot come out to your GP, be aware that if you visit a GUM/Sexual Health Clinic, all the information about 20

you that is recorded by the service will remain strictly confidential. This means that it will not be passed on to any other agency including your GP. Before you come out to any health care worker you may wish to ask questions about how sexuality is recorded in patient notes. Ultimately, the decision is theirs, so find out beforehand. You have the right to view notes written about you after November 1991. For more information on this contact a local Community Health Council whose number will be in the telephone directory. If you decide not to come out to any health workers, you may be able to get lesbian health information from some of the contacts at the back of this leaflet. It may also be a good idea to think through how you can answer the awkward questions you may be asked by a health care worker, to reduce your stress as much as possible.

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Contacts

Below are two lesbian health clinics where you may be able to get information or a sexual health check up. London - The Audre Lorde Clinic, The Royal London Hospital, Ambrose King Centre, Whitechapel Road, London E1 1BB. Tel: 0207 377 7311/2. Operates sexual health sessions for lesbians. Fridays 1.45-4pm. Telephone in good time for an appointment. Open to women from outside London. Glasgow - The Centre for Women’s Health, 6 Sandyford Place, Sauchiehall Street, Glasgow, G3 7NB. Tel: 0141 211 8130 for information. Operates a lesbian health service on the 1st Tuesday of every month for women living in Glasgow only.

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Below is a list of agencies, which may be able to provide you with support, information or advice.

G R E ATER MANCHESTER The Lesbian Community Project – Manchester based project. Groups, support, events, networks. Tel: 0161 273 7128. Dorothy’s Drop In – Support and social group for lesbian and bisexual women in Bolton. Tel: 07818 046656 (answerphone) P.O. Box 314, Wigan WN5 9YD. Stockport Youth Service Young Lesbian and Bisexual Group – For more information contact Alison on 0161 477 4096 B.yoU Project - Lesbian, gay, bisexual young people’s project in Wigan and Leigh. Tel: 01942 203363 Women Out in Wigan (WOW) – Social group for lesbian and bisexual women in the Wigan area. Tel: 07812 517543 (answerphone) P.O. Box 287, Wigan WN5 9FG. Albert Kennedy Trust – Supported lodgings and befriending for young lesbian, gay, and bisexual people. Tel: 0161 228 3308 Black Health Agency. Support around sexual health for Black communities, training and resources. Tel: 0161 226 9145 e-mail: [email protected] Manchester Rape Crisis - Rape and Sexual Abuse Counselling Service – Support for any woman or girl who has been raped or sexually assaulted. Tel: 0161 273 4500 (helpline) Manchester Lesbian and Gay Foundation Helpline – Every day 6pm-10pm. Confidential advice, information and support. Tel: 0161 235 8000 Manchester Peer Support Project – Peer-led Information and support for lesbian, gay and bisexual young people aged 14-25. Tel: 0161 274 4664 or e-mail: [email protected] Lesbian and Gay Youth Manchester (LGYM) – Advice, information and activities for young lesbian, gay, bisexual people. Tel: 0161 274 4664 or email: [email protected]

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N ATIONAL

London Lesbian and Gay Switchboard – 0207 837 7324 (24 hours) London Lesbian Line – 0207 251 6911 (Monday and Friday 2pm - 10pm, Tuesday, Wednesday, Thursday 7pm - 10pm) Minicom: 0207 253 0924 Breast Cancer Care Line – A national helpline for women suffering from breast cancer. Provides support for lesbian and bisexual women and has local contacts. Tel: 0808 800 6000 Monday - Friday 10am-5pm, Saturdays 10am-2pm. Visit the website: www.breastcancercare.org.uk SOLA – Support for women who have experienced physical, emotional or sexual abuse within a same sex relationship. Tel: 0207 328 7389 10am-12am and 1.30pm-4pm or e-mail [email protected] Pink Parents - A UK-wide organisation that provides support and information to lesbian, gay and bisexual parents, parents-to-be and their children. Tel: 0117 904 4500. Helpline Thurs. 7pm-10pm Tel: 0117 377 5794 Visit the website at www.pinkparents.org.uk Gemma, BM Box 5700, London WC1N 3XX – National friendship network of disabled and non-disabled lesbians and bisexual women.

Bibliography Fish J, Wilkinson S (2000) ‘Lesbians and Cervical Screening: Preliminary results from a UK survey of lesbian health’. Psychology of Women Section Review Vol.2 (2) pp 5-15

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NOTES

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This leaflet

was written by

Melanie Ibbitson

Jayne Mugglestone

Senior Health Promotion Specialist HIV and Sexual Health Bolton Primary Care Trust

Health Promotion Adviser HIV and Sexual Health Stockport Centre for Health Promotion

01204 360053

0161 456 2596

Both departments have expertise, information and resources on lesbian sexual health.

September 2002 Leaflet design copyright Linda Green B.A. (Hons) Bolton Primary Care Trust Graphics Studio