Online Exclusive Article

Lesbian Women and Knowledge About Human Papillomavirus

Carolee Polek

Thomas L. Hardie

papillomavirus, lesbian
ONF 2010, 37(3), E191-E197. DOI: 10.1188/10.ONF.E191-E197

Purpose/Objectives: To explore the association between lesbians' knowledge of human papillomavirus (HPV) cancer risk with age, education, and openness with a woman's healthcare provider; and to explore the relationship between lesbians' knowledge of female-to-female HPV transmission with age, education, and openness with one's physician.

Design: A descriptive correlational survey.

Setting: Surveys were distributed at lesbian and gay community events such as Bingo A-Go-Go; Rainbow Support Group meetings; Lesbian, Gay, and Bisexual Student Union of the University of Delaware meetings; and the Second Annual Women's Conference of the Women's Project of CAMP (Create a More Positive) Rehoboth.

Sample: 96 women who self-identified as lesbian, bisexual, or transgender and lived in the state of Delaware.

Methods: A 35-question survey, modified from an existing survey from the Delaware Breast Cancer Coalition and Centers for Disease Control and Prevention National Health Interview Survey.

Main Research Variables: Knowledge of HPV transmission, age, education, openness about sexual preference with physician, sexual preference, and knowledge of the relationship between HPV and development of cancer.

Findings: Twenty-nine women (30%) either did not know or did not believe that HPV could be spread by female-to-female sexual contact. Similarly, 29 (30%) of the women did not identify HPV as a cancer risk.

Conclusions: Lack of HPV knowledge was prevalent in this population of women.

Implications for Nursing: Cultural awareness by nurses is essential when discussing cancer prevention and early detection for this vulnerable population. Every woman, regardless of sexual orientation, needs to be informed about routine health screenings, vaccinations, and relative risk for the development of diseases. Culturally competent interventions are essential and are a priority for health professionals who screen and educate women about their healthcare needs.

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    Aaron, D. J., Markovic, N., Danielson, M. E., Honnold, J. A., Janosky, J. E., & Schmidt, N. J. (2001). Behavioral risk factors for disease and preventive health practices among lesbians. American Journal of Public Health, 91, 972-975. Retrieved from…
    American Cancer Society. (2007). Breast cancer. Retrieved from
    American Cancer Society. (2008). American Cancer Society recommendations for human papillomavirus (HPV) vaccine use to prevent cervical cancer and pre-cancers. Retrieved from
    Bailey, J. V., Farquhar, C., Owen, C., & Whittaker, D. (2003). Sexual behavior of lesbians and bisexual women. Sexually Transmitted Infections, 79(2), 147-150.
    Case, P., Austin, S. B., Hunter, D. J., Manson, J. E., Malspeis, S., Willett, W. C., & Spiegelman, D. (2004). Sexual orientation, health risk factors, and physical functioning in the Nurses' Health Study II. Journal of Women's Health, 13, 1033-1047. doi: 10.1089/jwh.2004.13.1033
    Clark, M. A., Bonacore, L., Wright, S. J., Armstrong, G., & Rakowski, W. (2003). The cancer screening project for women: Experiences of women who partner with women and women who partner with men. Women and Health, 38(2), 19-33.
    Cochran, S. D., Mays, V. M., Bowen, D., Gage, S., Bybee, D., Roberts, S. J., … White, J. (2001). Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women. American Journal of Public Health, 91, 591-597. Retrieved from…
    Diamant, A. L., Wold, C., Spritzer, K., & Gelberg, L. (2000). Health behaviors, health status, and access to and use of health care: A population-based study of lesbian, bisexual, and heterosexual women. Archives of Family Medicine, 9, 1043-1051. Retrieved from
    Dibble, S. L., Roberts, S. A., & Nussey, B. (2004). Comparing breast cancer risk between lesbians and their heterosexual sisters. Women's Health Issues, 14, 60-68. doi: 10.1016/j.whi.2004.03.004
    Dibble, S. L., Roberts, S. A., Robertson, P. A., & Paul, S. M. (2002). Risk factors for ovarian cancer: Lesbian and heterosexual women [Online exclusive]. Oncology Nursing Forum, 29, E1-E7. doi: 10.1188/02.ONF. E1-E7
    Fethers, K., Marks, C., Mindel, A., & Estcourt, C. S. (2000). Sexually transmitted infections and risk behaviours in women who have sex with women. Sexually Transmitted Infections, 76, 345-349.
    Fields, J. M., & Clark, C. L. (1999). Unbinding the ties: Edit effects of marital status on same gender couples. Retrieved from
    Gay and Lesbian Medical Association. (2001). Gay and Lesbian Medical Association and Lesbian, Gay, Bisexual, and Transgender (LGBT) health experts. Healthy People 2010 companion document for lesbian, gay, bisexual, and transgender (LGBT) health. San Francisco, CA: Author.
    Gay and Lesbian Medical Association. (2002). Ten things lesbians should discuss with their healthcare providers. Retrieved from
    Hughes, C., & Evans, A. (2003). Health needs of women who have sex with women. BMJ, 327, 939-940. doi: 10.1136/bmj.327.7421.939
    Institute of Medicine. (1999). Lesbian health: Current assessment and directions for the future. Washington DC: Author.
    Khan, A., Plummer, D., Hussain, R., & Minichiello, V. (2008). Does physician bias affect the quality of care they deliver? Evidence in the care of sexually transmitted infections. Sexually Transmitted Infections, 84, 150-151. doi: 10.1136/sti.2007.028050
    Koh, A. S. (2000). Use of preventive health behaviors by lesbian, bisexual, and heterosexual women: Questionnaire survey. Western Journal of Medicine, 172, 379-384.
    Lauver, D. R., Karon, S. L., Egan, J., Jacobson, M., Nugent, J., Settersten, L., … Shaw, V. (1999). Understanding lesbians' mammography utilization. Women's Health Issues, 9(5), 264-274.
    Marrazzo, J. M., Stine, K., & Koutsky, L. A. (2000). Genital human papillomavirus infection in women who have sex with women: A review. American Journal of Obstetrics and Gynecology, 183, 770-774. doi: 10.1067/mob.2000.106681
    Mathieson, C. M., Bailey, N., & Gurevich, M. (2002). Health care services for lesbian and bisexual women: Some Canadian data. Health Care for Women International, 23, 185-196.
    McGregor, B. A., Carver, C. S., Antoni, S. W., Yount, S. E., & Ironson, G. (2001). Distress and internalized homophobia among lesbian women treated for early stage breast cancer. Psychology of Women Quarterly, 25, 1-9. Retrieved from…
    McNair, R. (2003a). Lesbian health inequalities: A cultural minority issue for health professionals. Medical Journal of Australia, 178, 643-645. Retrieved from
    McNair, R. (2003b). Outing lesbian health in medical education. Women and Health, 37(4), 89-103.
    National Center for Immunization and Respiratory Diseases. (2008). HPV vaccination. Retrieved from
    National Lesbian Health Organization. (2005). Mautner Project. Retrieved from
    National Women's Health Information Center. (2005). Lesbian health. Frequently asked questions. Retrieved from
    O'Hanlan, K. A., Dibble, S. L., Hagan, H. J., & Davids, R. (2004). Advocacy for women's health should include lesbian health. Journal of Women's Health, 13, 227-234. doi: 10.1089/154099904322966218
    Polek, C. A., Hardie, T. L., & Crowley, E. M. (2008). Lesbians' disclosure of sexual orientation and satisfaction with care. Journal of Transcultural Nursing, 19, 243-249. doi: 10.1177/1043659608317446
    Purnell, L. (2003). Cultural diversity for older Americans. Cultural competence for the physical therapist working with clients with alternative lifestyles [Monograph]. American Physical Therapy Association.
    Purnell, L., & Paulanka, B. (2003). Transcultural health care (2nd ed.). Philadelphia, PA: F. A. Davis.
    Rankow, E. J., & Tessaro, I. (1998a). Cervical cancer risk and Papanicolaou screening in a sample of lesbian and bisexual women. Journal of Family Practice, 47, 139-143.
    Rankow, E. J., & Tessaro, I. (1998b). Mammography and risk factors for breast cancer in lesbian and bisexual women. American Journal of Health Behavior, 22, 403-410.
    Roberts, S. J., Patsdaughter, C. A., Grindel, C. G., & Tarmina, M. S. (2004). Health related behaviors and cancer screening of lesbians: Results of the Boston Lesbian Health Project II. Women and Health, 39(4), 41-55.
    Roberts, S. J., & Sorensen, L. (1999). Health related behaviors and cancer screening of lesbians: Results from the Boston Lesbian Health Project. Women and Health, 28(4), 1-12.
    Rosenberg, J. (2001). Lesbians are more likely than U. S. women overall to have risk factors for gynecologic and breast cancer. Family Planning Perspectives, 33(4), 183-184. Retrieved from
    Ryan, H., Wortley, P. M., Easton, A., Pederson, L., & Greenwood, G. (2001). Smoking among lesbians, gays, and bisexuals: A review of the literature. American Journal of Preventive Medicine, 21(2), 142-149.
    Sell, R. L., & Becker, J. B. (2001). Sexual orientation data collection and progress toward Healthy People 2010. American Journal of Public Health, 91, 876-882. Retrieved from…
    Simmons, T., & O'Connell, M. (2003). Married-couple and unmarried-partner households: 2000. Washington, DC: U. S. Census Bureau. Retrieved from
    Spinks, V. S., Andrews, J., & Boyle, J. S. (2000). Providing health care for lesbian clients. Journal of Transcultural Nursing, 11, 137-143. doi: 10.1177/104365960001100208
    Stine, K. (2005). Lesbian health: Getting the care you deserve. Retrieved from
    U. S. Department of Health and Human Services. (1991). Healthy People 2000: National health promotion and disease prevention objectives. Washington, DC: Author.
    Valanis, B. G., Bowen, D. J., Bassford, T., Whitlock, E., Charney, P., & Carter, R. A. (2000). Sexual orientation and health: Comparisons in the women's health initiative sample. Archives of Family Medicine, 9, 843-853. Retrieved from
    Yancey, A. K., Cochran, S. D., Corliss, H. L., & Mays, V. M. (2003). Correlates of overweight and obesity among lesbian and bisexual women. Preventive Medicine, 36, 676-683. doi: 10.1016/S0091-7435(03)00020-3