Understanding the sexual behaviors of women that may put them at risk for HPV-related neoplasias: Are we asking the right questions? Amita Kulkarni, BA1; Christine Luis, MA2; Chris Raker, PhD2; Katina Robison, MD2 1Women’s Scholarly Concentration, AMS MD Class of 2017 2 Women and Infants Hospital of Rhode Island

Scholarly Concentration: Women’s Reproductive Health

Background The human papilloma virus (HPV) is a multifocal infection that can involve the cervix, , , anus, and oropharynx. HPV infection is related to 90% of anal cancers and has been linked to the recent rise in oropharyngeal cancers. Standard sexual history questions may not fully capture the sexual behaviors of women that might put them at increased risk for HPV-related neoplasias.

Methods We conducted a cross-sectional survey study at the Colposcopy Clinic at Women and Infants Hospital in Providence, Rhode Island beginning in July 2014. Women who presented with HPV-related cervical, vulvar, or vaginal abnormalities were eligible. All eligible women were offered enrollment. Once enrolled, each signed an informed consent and completed a self-administered sexual history questionnaire. Additional demographic information was obtained from chart reviews. The study is ongoing with a recruitment goal of 125 women.

Results As of November 2014, 34 eligible women were approached and 29 women (85.3%), 22 to 64 years of age, gave consent and enrolled in the study. Of these, 66.0% had cervical, vulvar, or vaginal dysplasia. With regards to sexual history, 69.0% reported receiving oral penetration into the vagina, 79.3% reported receiving vaginal fingering, and 100% reported participating in vaginal intercourse. The results also showed 51.7% reported participating in some type of anal-related sexual practice, including anal fingering, oral penetration on the anus, or anal intercourse. Of those participating in anal-related practices, 10.3% reported anal fingering or oral-anal penetration. And 41.4% of respondents said they used sex toys. Of the respondents, 100% indicated they used sex toys vaginally and 16% used the sex toys anally.

Conclusion Preliminary study findings show that patients are willing to report their participation in a wide range of vaginal, oral and anal sexual practices when asked. Initial results suggest that 10.3% of individuals in this study report participation in some type of sexual activity involving the anus, which might not be identified by the standard sexual history questions or a general question about anal intercourse alone. This study should begin to inform clinicians about how to better understand their patients’ sexual practices, how to counsel their patients on risky sexual behaviors, and offer effective information and education about how to best help protect against HPV and other sexually transmitted infections.

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