Guidance

Cervical screening for lesbian and bisexual women

Updated 19 January 2021

Cervical screening is not just for heterosexual women

If you want to be screened, then you should be. Cervical screening is for women and anyone with a cervix.

Sometimes health workers have advised lesbian women they do not need screening because they do not have sex with men. Or you may have been told by other lesbians that you do not need to be screened. However all individuals aged 25 to 64 who have a cervix should consider having cervical screening, regardless of their sexual orientation.

What screening does

Cervical screening is not a test for cancer. It is a test to look for the human papillomavirus (HPV) and abnormal cell changes on the cervix (the neck of the womb). These cell changes may turn into cancer over time if left untreated.

In England, cervical screening currently prevents 70% of cervical cancer deaths. If everyone attended screening regularly, 83% could be prevented.

The NHS offers cervical screening every 3 years to women aged 25 to 49, and every 5 years to women aged 50 to 64.

You will get information about cervical screening with your invitation. This tells you all about the screening process and what the possible results are. The information is to help you decide whether or not you would like to have screening.

Where to go for screening

Usually, cervical screening is carried out at your GP practice by the practice nurse. Screening is sometimes available at a local sexual health clinic, but not all clinics offer this service.

The cause of cervical cancer

Nearly all cases of cervical cancer are associated with HPV, which is passed on by skin-to-skin contact through any type of sexual activity. This includes sexual activity between women. The virus causes changes in the cells of the cervix, which can go on to develop into cancer over time if left untreated.

Someone can have HPV for a number of years without them ever knowing about it.

For every 100 people that have cervical screening, 13 (13%) are found to have HPV (an ‘HPV positive’ result). Studies involving lesbian and bisexual women found between 3% and 30% of the women in the study groups tested positive for HPV.

Woman who do not have sex with men can get cervical cancer. Research suggests that although HPV is more easily passed on through heterosexual intercourse, it can also be transmitted through lesbian intercourse. As with other sexually transmitted infections, HPV is passed on through body fluids. This means that oral sex, transferring vaginal fluids on hands and fingers, or sharing sex toys, can all be ways of being exposed to HPV.

As well as sexual behaviour, smoking is also a risk factor for cervical cancer.

How often to have cervical screening

The NHS offers cervical screening every 3 years from ages 25 to 49, and every 5 years from ages 50 to 64. This is because most cervical cancers develop between these ages.

Research on cervical screening in lesbian and bisexual women suggests that lesbian women may be less likely to go for regular screening at the recommended intervals. Lesbian and bisexual women are also more likely to have never been screened than heterosexual women.

If you are told you do not need to be screened

Only women who have never engaged in any sexual activity at all (with men or women) may be advised that the risk of them developing cervical cancer is extremely low. Even then, a woman should not be refused screening if she is due for an appointment. We can only say someone is at low risk, we cannot say they are at no risk.

As long as you are aged 25 to 64 and you have a cervix, then you are eligible for screening every 3 or 5 years (depending on your age).

Questions about your sexual orientation during screening

It is unlikely you will be asked about this during your appointment. But some women may find they get asked sexual health questions more appropriate for heterosexual women. You may wish to mention your sexual orientation so that the information you are asked for or given is more appropriate.

Remember that:

• all individuals aged 25 to 64 who have a cervix are eligible for cervical screening
• nearly all cases of cervical cancer are associated with HPV, which is a sexually transmitted virus
• HPV can be passed on during sex between women, although the risk of infection through heterosexual intercourse is thought to be higher
• regular cervical screening prevents 70% of cervical cancer deaths

Cervical cancer symptoms

Cervical cancer can start to develop between screening tests. It is important to look out for anything that is unusual for you, especially:

• bleeding between your periods, during or after sex, or after the menopause
• changes to vaginal discharge

If you have any of these changes, do not wait for your next cervical screening appointment. Speak to your GP for advice.

Find out more about cervical screening at NHS.UK

You can read information on screening available to transgender and non-binary people.

About this guidance

Public Health England created this information on behalf of the NHS.

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