Although we are unsure about the agent that causes precancerous changes to cells of the cervix, we do know that women who have been exposed to multiple sexual partners or who started intercourse during their teens are at increased risk of cervical cancer unless they protect themselves with condoms. Because your cervical cells are changing during your teens, you are more at risk if you have intercourse at that time. If you start having intercourse at age 22, most of these changes will have already happened, so you are at lower risk. In this sense, sex can give you cancer; it does matter how many different sex partners you have had and how young you were when you began having intercourse. Early child-bearing seems to be a risk factor, but if you have children when you are 20, obviously you have been having sex early. Some factor in childbirth itself seems to increase risk, so that women who have had many children are at higher risk than women who have had only one or two.

Thus, a woman who had intercourse first at age 24 with her husband, who remained her only sexual partner for the rest of her life, is a low-risk candidate — unless her husband has had multiple partners. If that is the case, he increases his wife’s risk for cervical cancer.

table Classification of Pap Test Results

Papanicolaou Classification System Old System Bethesda System
Class I Normal Within normal limits
Class II Atypical Benign cellular changes (or) Atypical squamous cells of undetermined significance (ASCUS)
Class III Dysplasia Squamous epithelial cell abnormality
Mild Low-grade squamous intraepithelial lesion (SIL)
Moderate High-grade SIL
Severe High-grade SIL
Class IV Carcinoma in situ High-grade SIL
Class V Invasive squamous cell carcinoma Squamous cell carcinoma
Adenocarcinoma Adenocarcinoma

Women whose mothers took diethylstilbestrol during pregnancy are at slightly increased risk of cervical cancer. This synthetic estrogen was given during pregnancy to prevent miscarriage and other complications, though there was never convincing evidence that it did so. The Food and Drug Administration advised against its use during pregnancy in 1971 and banned its use as a growth hormone for livestock in 1979.


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