Cervical Cancer, Abstinence and Pap Tests

[Piglet]

So, I admit this might be a dumb question, but it has been bugging me...

If you have never been sexually active (aka - a virgin), why do you need a Pap test? The previous post about HPV said it caused the vast majority of cervical cancer. Can you get HPV if you are not sexually active? Can you get cervical cancer if you don't have HPV? If you can, then what are the rates of cervical cancer in non-sexually active people?

I have a girlfriend that is particularly immature (we have been friends since we were in grade 5 and she hasn't grown up much since then... let's just say she would have a lot in common with the 40-year old virgin, but she is only 30). She has never had a Pap, because she has never been sexually active. I think her doctor is fine with this approach, but she asked me what I thought. Honestly, I hadn't given it much thought. I will admit that I have ever only been with DH and vice versa, so I don't see how I am a prime candidate for HPV either, but I still get regular Pap.

Any thoughts?

[o_mom]

Off the top of my head....

If she has never had sexual contact at all, then she has an extremely low chance of HPV. However, sexual contact that does not include intercourse can transmit it - think heavy petting, genital touching, etc. I don't think there is any other way to get it.

I _think_ they are pretty sure that most if not all cervical cancer is from HPV (you can never prove beyond any doubt that there is not another cause, but they can be reasonably sure). ETA: Looking this up, I can't find exact info, just that MOST are caused by this, so yes, there can be other causes.

The guidelines are something like every three years for people in monogamous relationships with no history of abnormal paps, so if she is at all concerned, she could get them very infrequently. I personally don't think they are a big deal, but know that some people do, so that could factor into her decision also.

[Piglet]

Nope, she just called me last last year and admitted that a guy had *kissed* her. She was over the moon. I know that nothing else has ever gone on. I know that Paps don't bother me now whatsoever, but the very first one scared the crap out of me. I had at least had sex by that time, whereas I would be absolutely freaked out if I was a virgin, I am sure of that.

[Karenn]

"I _think_ they are pretty sure that most if not all cervical cancer is from HPV (you can never prove beyond any doubt that there is not another cause, but they can be reasonably sure)."

I know of two people who tell me they were diagnosed with cervical cancer not caused by HPV.

[dawell0]

During a routine gyne exam, they check for other things when they do the Pap. It would be rare that she would have many problems, but they check for strange growths, fibroids, cysts, etc. I would think that she should probably still get checked, even if she isn't a prime candidate for other issues.

[tarabenet]

Definitely! Any of that stuff, you want to catch it early on and treat it quickly. Remember, it is her health and her reproductive health that are at stake here -- not something to blow off just based on modesty!

[Globetrotter]

I agree with this 100%. She might have other issues that need to be checked.

I know several 30 year old virgins :) but they are of Asian descent and it's not a big deal, culturally speaking. In fact, that's the expectation!

ETA: Not all cervical cancer is caused by HPV.

Kris

[juliasmom05]

I recall reading that 90% of all cervical cancers are associated with HPV.

Marci

[Sillygirl]

Also, and this doesn't refer to your friend in particular, people are weird about sex. You hear all sorts of things that are really impossible or extremely improbable when taken in the context of their health situation. I think in medical school I dealt with or heard about three different "immaculate" conceptions. Some folks lie, some are deluded, some are tragically misinformed. Just human nature, I guess, but you'd hate to miss HPV or other infections or problems by taking things at face value.

[o_mom]

I went and looked it up after you posted this, and all the stuff I found said that most cervical cancer is caused by HPV, but there can be other causes.

[bostonsmama]

Ouch! I can't imagine having an intact hymen and getting a pelvic exam done. Ugh. But I would also encourage her to get one done at least once as part of a general health screening. I don't know how close she is to finding Mr. Right and whether her plans include bio children, but it's always good to be proactive about making sure the flora and fauna of the vagina is in equilibrium. If nothing, the Dr. can teach her about her anatomy, yeast/bacterial infections, cervical fluids at certain times of the months (to see if she is ovulating & such). It sounds like since she's older she might want to get started ttc right away when she marries, so knowing about the overall condition of everything down there (in-tact cervix, uterus position, no polyps or growths in the canal, presence of ovaries, etc) will be nice peace of mind for when she's ready and also give her time to get things in order if they're not.

Shoot, I'm still in my 20s, but decided to get a comprehensive heart screening just to make sure it's in good health. As they say, an ounce of prevention is worth a pound of cure.

And one more thing...as to the PAP every 3 years if in a monogamous relationship....I'm still going to get one every year. It's my first line of defense in early diagnosis for a slew of conditions that affect my long-term health. I 100% trust my DH to be faithful, but there are thousands of spouses who have still picked up illness from DH's who wander. A good male friend of DH's and I just found out he has HPV...got it from his cheating wife. As my dad says: Trust but verify.

[gatorsmom]

Other cancers, not caused by having sexual contact, can be detected by a pap smear. Imagine if you have a particular gene for a cancer, you may get that cancer without ever having had sex. Always a good idea to get tested.

[maestramommy]

I was a virgin before I got married, but I still started getting regular paps and pelvic exacms at about 24? 25? I didn't know anything about HPV at the time, and it just seemed prudent because you might have a family history that is unknown, and also it's a good idea to know your OB in case something happens.

[kbudsberg]

I think every year is better than the every 3 years in a monogomous relationship. I've had one every year and when I became pregnant w/dd it came back abnormal at the moderate level. I had been in a monogous relationship for over 8 years. So if I was only doing every 3 years who knows what stage it would have been caught at. They did tell me they felt pregnancy had something do to w/it but it didn't clear after delivery which they suspected.

[vonfirmath]

My doctor wanted me to get my Pap Smear every year even before I got married (I was a virgin. they use a smaller tool for the Pap Smear for virgins, thankfully) and the pelvic exam, as a married person, is honestly no better or worse than as a virgin.

[Fairy]

Sexual activity is not the only factor in gynecological health. Just because the vagina isn't being used for sexual intercourse, or, heck, sexual anything, doesn't mean that its health is a foregone conclusion. Cervical cancer can have non-HPV-related causes. There are also other kinds of issues that can be discovered, regardless of one's sexual activity (or lack thereof) that you don't want to ignore just cuz you're a virgin or monogomous. Fibroid tumors, for instance, endometriosis, uterine and ovarian cancers, breast cancer. A yearly pap is essential for your overall healthcare, and in my opinion, it should be done by a GYN, not a general practitioner. I know others probably feel differently, but for me, if I break my leg, I'm going to the ortho. If I have a plantar's wart, I'm going to the podiatrist. And for my girl parts, I'm going to the OB-GYN.

[julieakc]

You've already heard from others that cervical cancer can be caused by things other than HPV. but here's some other information to consider...

My personal HPV story:

Several years ago I had an abnormal pap (have been going annually for years) which upon further testing turned out to be pre-cancerous....there's a few levels....and mine was the highest before actually being cancer. I had to have surgery for them to cut off the bad parts of my cervix. HPV was the presumed cause as the HPV test came back positive....but here's the thing....in just one year I went from having a normal pap (and all prior annual paps also normal) to having pre-cancer! Yes, I have had multiple partners in the past (nothing excessive....my lifetime number is 6), but this happened 4 years into my marriage, and therefore it had been almost 6 years of monogamous sex with DH (and definitely no cheating on DH's part).

My doctor told me that yes HPV is sexually transmitted, but it does occur in monogamous relationships and that even nuns have tested positive...ok...maybe they are having sex someplace, but the message I got was it's not from promiscuity. So it may be possible for a virgin to get HPV.

Apparently the vast majority of women actually carry HPV, but most of the time it resolves on it's own (remember..the V stands for virus)...it's when it doesn't resolve on it's own and starts getting into those higher, pre-cancer levels that action has to be taken.

Also, because of my experience I would definitely go for an annual pap as opposed to the every 3 year plan.

Finally, just a reminder: Paps do not screen for other cancers, such as ovarian, which is another reason for even non sexually active people to have regular GYN exams.