A 22-year-old woman comes to the office for an annual physical examination. The patient, who has no concerns at the visit, has regular, monthly menses with 3-4 days of light bleeding, and no palpable breast masses, abnormal vaginal discharge, dysuria, or changes in bowel function. She has no chronic medical conditions or previous surgeries. The patient has engaged in sexual activities only with women and has had 3 lifetime partners. Sexually transmitted infection testing a year ago was negative. She has not received a human papillomavirus vaccination. The patient does not use tobacco, alcohol, or illicit drugs. She is finishing her last year of college and plans to attend graduate school. Vitals signs are stable. BMI is 26 kg/m². Physical examination is unremarkable. She asks for counseling for herself and her partner regarding the health risks of their sexual orientation. Which of the following is the most appropriate statement regarding general health-related issues for this patient?

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Explanation: 11ec2b69_bf1a_3923_8f63_f3f3f9ed25ab_MD0005_00 Health care for women who have sex with women (WSW) includes counseling regarding mental health, cancer screening, and risks for sexually transmitted infections. As in the heterosexual population, screening for sexually transmitted infections in WSW is based on risk factors (eg, multiple sex partners, history of intravenous drug use) or testing based on symptom development. Sexually transmitted infections in WSW can spread via vaginal secretions on hands or sex toys, as well as via skin contact. Although bacterial vaginosis (BV) is not technically a sexually transmitted infection, it is passed through the exchange of vaginal secretions and therefore is more common in WSW. Both partners in a monogamous relationship typically demonstrate the presence or absence of bacterial vaginosis. However, screening is not recommended. Patients with symptomatic infection (eg, thin, malodorous discharge) are evaluated and treated with metronidazole or clindamycin. (Choices A and B) The majority of cases of syphilis and HIV are diagnosed in men, with a much higher proportion occurring in men who have sex with men. WSW are not at an increased risk of syphilis or HIV compared with heterosexual women and therefore do not require more frequent screening. (Choices C and E) WSW have lower rates of vaccination against human papillomavirus (HPV) than women who have sex with men. However, because HPV can be transmitted through skin-to-skin contact, the vaccine is recommended for all girls and women age 9-26 regardless of sexual orientation. WSW have an increased risk of cervical cancer from HPV infection compared with heterosexual women, likely due to lower rates of HPV vaccination, lower rates of screening, and higher rates of smoking and obesity. WSW are also at higher risk of ovarian and breast cancer due to higher rates of smoking and obesity, less frequent screening, lower parity, and less hormone contraceptive use. Educational objective: Women who have sex with women are at increased risk of bacterial vaginosis and cervical cancer. This increased risk likely arises from lower rates of human papillomavirus vaccination and cervical cancer screening. The risk of bacterial vaginosis is increased due to the exchange of vaginal secretions. References: Sexual orientation identity disparities in awareness and initiation of the human papillomavirus vaccine among U.S. women and girls: a national survey. (http://www.ncbi.nlm.nih.gov/pubmed/25961737) Lesbian and bisexual women's gynaecological conditions: a systematic review and exploratory meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/27862853) Preventive health care for women who have sex with women. (http://www.ncbi.nlm.nih.gov/pubmed/28290645)

A 22-Year-Old Woman Comes to the Office for an Annual