Inclusion and exclusion in mid-life lesbians' experiences of the Pap test.

Lesbians are said to feel excluded by sexual health messages that presume heterosexuality, a finding linked to lower levels of Papanicolaou (Pap) testing. This paper discusses a small, focused qualitative study based in Calgary, Canada that illuminated mid-life lesbians' experiences and perceptions of Pap testing and health. Participants indicated that they felt compelled and invited to access Pap testing by an inclusive discourse - that of 'mid-life', a period associated with an increased need for body surveillance. They also reflected upon aging as an experience of liberation, increased confidence and a time when they could 'catch up' on health and sexuality issues denied them in their younger days. On the other hand, there was significant uncertainty about Pap testing, human papillomavirus (HPV), cervical cancer and what kind of sexual healthcare is necessary for lesbians, which was reinforced by physician messages suggesting a reduced need for Pap testing when lesbian sexual identity was disclosed. In approaching mid-life lesbian healthcare, we suggest that greater analytical attention should be paid to the ways in which lesbian women are included, as much as excluded, in dominant sexual health scripts particularly by health providers who need to attend to women's diverse experiences and needs.