We need to talk about smear tests. Because if you’re a queer woman who’s never slept with a man, there’s a solid chance someone – maybe a friend, maybe your mum, maybe an actual doctor – has told you that you don’t need one.
And look, it makes a kind of intuitive sense. Nearly all cervical cancers are caused by HPV (NHS). HPV is a sexually transmitted infection. If you’ve never had sex with a man, surely you’re not at risk?
Except that’s not how it works. And the fact that so many of us believe it is a genuine public health problem.
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Let’s sort this out.
Do lesbians need smear tests? The short answer
Yes. 100% yes! If you have a cervix and you’re between 25 and 64, you should be getting screened. Full stop. Your sexual orientation doesn’t change that.
The NHS recommends cervical screening every three years for people aged 25 to 49, and every five years for those aged 50 to 64 (and 65 and over if you have never had one). That applies to everyone with a cervix – straight, gay, bi, trans, or anywhere else on the spectrum. The same principle applies in the US and Australia, where national screening programmes recommend regular testing regardless of sexual orientation.
How HPV spreads between women
Here’s the bit that surprises a lot of people: HPV can and does spread between women.
Nearly all cervical cancer – we’re talking about 99% of cases – is caused by persistent infection with certain strains of HPV. And while penetrative sex with men is the most commonly discussed route of transmission, it’s far from the only one.
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HPV spreads through skin-to-skin contact. That means it can be passed on through oral sex, through hands and fingers touching genitals, and through sharing sex toys. Basically, if you’re having sex with women, you can be exposed to HPV. The UK Government’s own guidance on cervical screening for lesbian and bisexual women confirms this.
Research has found HPV in women who have never had sex with men. One study published by the CDC detected HPV DNA in 19% of lesbians who reported no previous male sexual partners. Another large-scale study using NHANES data found no statistically significant difference in HPV infection rates between heterosexual and lesbian or bisexual women when other risk factors were controlled for.
Studies cited by Public Health England involving lesbian and bisexual women have found HPV positivity rates ranging from 3% to 30%, depending on the study. The numbers vary, but the point doesn’t: HPV exists in our community, and it can cause real harm if it goes undetected.
It’s also worth knowing that smoking is an independent risk factor for cervical cancer, separate from HPV. Research consistently shows that lesbian and bisexual women are more likely to smoke than heterosexual women, which adds another layer of risk that has nothing to do with who you’re sleeping with.
Why queer women are skipping it – and why that’s a problem?
Around 51% of eligible women who have sex with women have never had a smear test. Let that land for a second. More than half of us have never been screened at all.
There are a few reasons for this: the myth that we don’t need it, negative experiences with healthcare providers, and the general awkwardness of the whole thing being framed around heterosexual sex. But the result is that when lesbian and bisexual women do develop cervical abnormalities, they’re more likely to be caught late.
The irony is brutal: the screening rates are lower, but the risk isn’t zero. Which means the very population that’s skipping appointments is also the one most likely to miss early warning signs.
Cervical screening isn’t a cancer test, by the way. It’s a test for HPV and for abnormal cell changes that could become cancer if left untreated. When it catches things early, treatment is straightforward and effective. In England, regular screening prevents around 70% of cervical cancer deaths. If everyone attended when invited, that number could be 83%.
“But my doctor told me I don’t need one”
Yeah, this happens. And it shouldn’t.
There are documented cases of GPs telling lesbian patients they can skip screening because they don’t have sex with men. NHS guidance was updated back in 2009 to make clear that cervical screening should be offered to everyone with a cervix, regardless of sexual orientation, but not every healthcare provider got the memo.
If this happens to you, you’re within your rights to push back. You can ask to see a different GP, or you can self-refer to a sexual health clinic for screening. You shouldn’t have to educate your doctor, but sometimes that’s where we are.
What about the HPV vaccine?
The HPV vaccine is effective at preventing infection with the strains of HPV most commonly linked to cervical cancer. If you were offered it at school and took it, great. If you weren’t, or if you missed it, it’s worth checking whether you’re still eligible – in the UK, the NHS offers the vaccine to people up to age 25.
Research suggests that HPV vaccination rates among lesbian and bisexual women are lower than among straight women. Part of this comes down to the same misconception – the assumption that if you’re not having sex with men, HPV isn’t your problem. But the vaccine protects against strains that can be transmitted between women too, so it’s worth having regardless of who you’re sleeping with.
What to expect at your appointment
If you’ve never had a smear test, or if it’s been a while, here’s the quick version:
You’ll be asked to undress from the waist down and lie on an examination bed, usually on your back with your knees bent and given a paper towel to cover yourself. The nurse or doctor will use a speculum – a smooth plastic or metal instrument – to gently open the vaginal walls, then use a small brush to collect a sample of cells from your cervix. The whole thing takes about five minutes.
It can be uncomfortable, but it shouldn’t be painful. If it hurts, tell them. They can use a smaller speculum, adjust their approach, or pause.
Your sample gets sent to a lab where it’s tested for HPV first – this is called HPV-primary screening, and it’s how the NHS has done it since 2019. If HPV is detected, the same sample is then examined for abnormal cell changes. If no HPV is found, your cells aren’t checked further because the risk of cervical abnormalities without HPV is extremely low. You’ll usually get your results within a couple of weeks.
How to make it easier
A few things that can help, especially if you’re anxious about it or you’ve had difficult experiences with healthcare before.
Tell them you’re queer. You don’t have to, obviously. But it means they won’t make assumptions about your sexual history, and they’re less likely to ask questions that feel irrelevant or uncomfortable. A good nurse will adjust their language accordingly.
Ask for a female practitioner. If that matters to you, most clinics will accommodate this. You can request it when you book.
Bring someone with you. You can have a friend, partner, or support person in the room if that helps. Just let the clinic know when you arrive.
Ask for a smaller speculum. They come in different sizes. If you’re not used to penetration or if you find it painful, a smaller one can make a significant difference.
Request a double appointment. This gives the practitioner more time, which means less rushing and more space for you to feel comfortable.
Go to a sexual health clinic instead. If your GP surgery feels too clinical or you’ve had bad experiences there, sexual health clinics often have staff who are more experienced with LGBTQ+ patients. You can usually self-refer without needing a GP appointment.
A note for trans and non-binary readers
If you’re a trans man or non-binary person who still has a cervix, this applies to you too. The tricky part is that if you’re registered as male with your GP, you won’t automatically be invited for cervical screening – the system just doesn’t send the letters. You’ll need to ask your GP to add you to the screening register, or contact a sexual health clinic directly. Public Health England’s guidance covers this in more detail. It shouldn’t be on you to navigate this, but knowing it’s an issue means you can take action.
What happens if they find something?
Try not to spiral. An HPV-positive result doesn’t mean you have cancer. Most HPV infections clear on their own – your immune system deals with them without you ever knowing they were there.
If abnormal cells are found, you’ll be referred for a colposcopy, which is a closer look at your cervix using a magnifying instrument. If the cells need treatment, there are several straightforward options. The most common is a loop excision, where the abnormal cells are removed with a thin wire loop. It sounds worse than it is.
The important thing is catching it early. And that’s literally what screening is for.
Final thoughts
The myth that lesbians don’t need smear tests has been floating around for decades, and it’s doing real damage. Queer women are dying of a cancer that’s largely preventable through routine screening, partly because they’ve been told – by friends, by family, sometimes by actual medical professionals – that they’re not at risk.
You are at risk. The risk might be lower than for women who have sex with men, but it’s not zero, and “lower risk” is not the same as “no risk.” HPV doesn’t care about your sexual orientation. It cares about skin-to-skin contact, and that happens in queer sex too.
Book your smear test. Nag your girlfriend to book hers. Nag your ex while you’re at it. This is one of those rare situations where five minutes of mild discomfort could genuinely save your life.
Where to book and find support
UK
- NHS Cervical Screening Programme – book through your GP or find a sexual health clinic near you
- Jo’s Cervical Cancer Trust – support, information, and a helpline if you have questions or concerns
- LGBT Foundation – can help you find LGBTQ+-friendly healthcare services
US
- Planned Parenthood – find a clinic near you for Pap tests, often on a sliding fee scale
- American Cancer Society – Cervical Cancer Screening Guidelines – current recommendations on when and how often to get screened
- National LGBT Cancer Network – LGBTQ+-specific cancer information and resources
Australia
- National Cervical Screening Program – information on Australia’s screening programme and how to access it
- Australian Cervical Cancer Foundation – support and resources
- ACON Health – LGBTQ+ health services, including sexual health screening
This article contains general health information and is not a substitute for professional medical advice. If you have specific concerns about your health, please speak to your GP or a qualified healthcare provider.
Nonchalant x
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This article was written by one of our creative team writers here at Nonchalant Magazine.
