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It’s highly unlikely for someone to develop cervical cancer if they have never had sex.

That’s because nearly all cases of cervical cancer result from an individual having a high risk strain of human papilloma virus (HPV), which is a sexually transmitted infection (STI).

“At the end of the day, we never say never in medicine,” says Greg Marchand, MD, OB-GYN. “But it would be virtually impossible for someone to get cervical cancer unless they have had some sexual activity that could present the HPV to the vagina, which leads to the cervix.”

Got questions? Read on to better understand the relationship between HPV and cervical cancer. Plus, learn the early symptoms of cervical cancer, what you can do to prevent it, and how to get a screening for it.

Many people are taught that penis-in-vagina intercourse is the only act that falls under the sex umbrella.

Ultimately, what you qualify as sex is up to you. But it’s important to understand that people can transmit HPV via vaginal, anal, or oral sex.

That means that you can transmit HPV through sex acts such as cunnilingus, analingus, fellatio, scissoring, sword fighting, and sex toy sharing, even if you personally don’t define those acts as sex.

One great definition for sex comes from psychotherapist and sex and relationship expert Rachel Wright, LMFT, host of the podcast “The Wright Conversations: A Podcast All About Sex, Relationships, and Mental Health.”

“Sex is any meaningful act of pleasure,” says Wright.

“HPV is spread through skin-on-skin contact,” says Marchand. “So, any genital-on-genital stimulation can result in the exchange of HPV.”

That means people can transmit the virus through penis-on-penis, vulva-on-vulva, and penis-on-vulva contact.

HPV causes nearly all cervical cancers. But nearly all ≠ all.

When a person develops cervical cancer, they develop it because there is a disruption in the healthy cells in the cervix.

These cells, for one reason or another, endure a mutation in their DNA (basically, the body’s instruction manual), that tells the cells to multiply over and over.

An accumulation of atypical cells in the cervix often results in a tumor.

Here’s where it gets complicated: While certain strains of HPV link to an increased risk of cervical cancer, not everyone who tests positive for those strains of HPV will go on to develop cervical cancer.

The following HPV strains can cause several types of cancer:

  • 16, 18
  • 31, 33, 35, 39
  • 45
  • 51, 52, 56, 58, 59
  • 66, 68

According to the National Cancer Institute, HPV-16 and HPV-18 are responsible for most HPV-related cancers.

This suggests that there are additional factors that determine your likelihood of developing cervical cancer.

You may be more likely to develop cervical cancer if you:

  • do not receive or complete the HPV vaccination series
  • have a family history of cervical cancer, or have a weakened immune system
  • take immunosuppressant medications, or take oral contraceptives over an extended period of time
  • smoke cigarettes, vape nicotine, or use other tobacco products

The American College of Obstetricians and Gynecologists recommends that everyone with a cervix begin screening for cervical cancer 21 years old.

Yep, everyone. Not just those who have had sex or certain kinds of sex.

How often you get screenings after that will depend on your:

  • age
  • immune system
  • family history of cervical cancer, if any
  • engagement in sex without a condom or other barrier method

There are two ways to screen for cervical cancer: Pap smears and HPV tests.

Generally, experts suggest getting a Pap smear every 3 years between the ages of 21 and 29.

Between ages 30 and 65, you may continue to get a Pap smear every 3 years, a combined Pap smear and HPV test every 5 years, or an HPV test every 5 years.

After 65 years old, consider continuing getting screenings every 5 years if you have sex without a condom or other barrier method.

You can stop screening after 65 years old if you don’t have a personal or family history of cervical cancer AND had at least two consecutive negative co-tests, HPV test results, or at least three consecutive negative Pap smear results.

After you check in and complete any necessary paperwork, a nurse or other clinician will guide you to a private examination room. You’ll have a few moments alone to undress and outfit yourself in a paper robe.

Your clinician will knock before entering the room and help you situate yourself on the examination table. Usually, you’ll slide your bum down to the end of the table and rest your feet on the stirrups on either side.

This will help keep your legs open so that your clinician can better access your vaginal canal.

When you’re ready, your clinician will insert a lubed-up speculum into your vagina and gently open it, explains Felice Gersh, MD, OB-GYN, author of “PCOS SOS: A Gynecologist’s Lifeline To Naturally Restore Your Rhythms, Hormones, and Happiness.”

“This helps the doctor visualize your cervix, which is located at the back of your vaginal canal,” she says.

Once the speculum is in position, your clinician will insert a small brush-like tool inside the cervical canal and rotate it a few times to collect cervical cells.

“The provider will then remove the brush from your body and place it inside a little jar of preservatives, which can then be investigated under a microscope for signs of cervical cancer,” explains Gersh.

It may take up to 3 weeks to receive your Pap smear results.

Sometimes, doctors will perform an HPV test alongside a Pap smear. If you decide to get an HPV test, the clinician will insert a Q-tip-like device into your cervical canal to swap it similarly.

It usually takes 1 to 3 weeks to receive your HPV test results.

Do Pap smears hurt?

You can take comfort in the fact that a Pap test is usually a painless experience, says Marchand.

But there are a few circumstances in which it might be a bit uncomfortable. If you’ve never had a Pap smear, for example, your body may need time to adjust to the sensation.

You may also feel discomfort if you’ve never experienced vaginal penetration, which can include inserting a tampon, fingering yourself, or using a sex toy.

If you’re concerned about potential pain, let your clinician know. “While this won’t change the procedure, it will encourage them to go especially slowly and gently,” says Gersh.

Your clinician may recommend that you take an over-the-counter pain reliever beforehand or prescribe a stronger medication. They may also be able to use a smaller speculum.

A variety of other, less serious conditions cause the symptoms associated with early-stage cervical cancer, so the symptoms of the cancer can be easy to overlook.

“That’s why regular cervical screening is so important,” says Gersh. Early detection and treatment can reduce your risk of more severe complications.

Consult with a doctor or other healthcare professional if you develop:

  • persistent pelvic, abdominal, or back pain
  • changes to your menstrual cycle
  • experiences of spotting between periods
  • unusual vaginal discharge
  • occurrences of bleeding after vaginal penetration
  • pain during or after vaginal penetration

They can assess your symptoms, individual medical history, and overall risk for cervical cancer.

Getting the HPV vaccine can reduce your risk of developing cervical cancer. Gardasil-9 is currently the only HPV vaccine available in the United States.

It’s FDA-approved for people of all genders. (Yes, even men!)

The Centers for Disease Control and Prevention recommends that people get the vaccine before 26 years old. That’s because there is a perception that when you are young, you may be less likely to engage in partnered sexual activity and subsequently experience exposure to HPV.

If you’re between the ages of 27 and 45 and have not yet received the vaccine, talk with a doctor or another healthcare professional. You might benefit from getting a vaccine.

You can also reduce your risk of developing cervical cancer by:

It’s highly unlikely for someone to develop cervical cancer if they have not engaged in any kind of sexual contact or play with another person.

However, someone who has had sex before could be at risk — even if they haven’t had P-in-V intercourse.

Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Healthline, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.