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Sexual health education to help reduce risk of cervical cancer

Cervical cancer is one of the most common cancers affecting women. The most significant risk factor is considered to be a sexually transmitted virus (human papillomavirus). The greater number of sexual partners a woman has without the use of condoms, the greater her risk of coming into contact with this virus and of later developing cervical cancer. This review aims to determine the effectiveness of education to promote safer sexual behaviour.

Bottom line

This review highlights the need to include the prevention of cervical cancer in sexual health education.

Reference

J Shepherd et al. Cervical cancer and sexual lifestyle: a systematic review of health education interventions targeted at women. Health Education Research 2000 15: 681-694.

Search

A comprehensive literature search was conducted, which included searching several databases (e.g. MEDLINE, PsycLIT), systematic reviews, recent issues of relevant journals and references of identified papers. Studies were included if they evaluated educational interventions, targeting women, and measured their impact on either a behavioural outcome (e.g. condom use) or a clinical outcome (e.g. incidence of a sexually transmitted disease). Thirty studies met these criteria, but twenty were excluded after their methodological quality was assessed, primarily because the comparison and intervention groups were not equivalent (e.g. in terms of socio-economic status).

Of the ten remaining studies, eight were randomised controlled trials, with a total of 5,089 women, aged between 11 and 54 years. In all but one study women were of low socio-economic status and eight studies (conducted in the US) targeted African-American women.

The primary aim of all studies was the prevention of HIV and other sexually transmitted diseases (none aimed to prevent cervical cancer). All interventions provided information on transmission and prevention of sexually transmitted diseases and eight studies taught safer sex negotiation skills (e.g. practising correct condom use). The interventions differed in other ways, including format (e.g. discussion groups, role play); length (one day to three years); setting (e.g. prison, health clinic); follow-up (one to six months); and outcomes (e.g. self-reported condom use, intention to use condoms).

Results

All studies observed a positive intervention effect. Nine studies reported an increase in the use of condoms.

Comment

There is no doubt about the importance of sexual health education, but investigating the efficacy of interventions is tricky. For example in this research:

Furthermore, sexual health education needs to be relevant and sensitive to its target audience. It is therefore difficult to be specific about its content and delivery. Nevertheless, this paper does offer some insights into the promotion of safer sexual behaviour.

Sexual behaviour that increases a woman’s risk of becoming infected with the human papillomavirus (HPV) include intercourse at an early age, having many sexual partners and having unprotected sex at any age. Reducing the risk of HPV infection and consequently cervical cancer could easily be incorporated into sexual health education/campaigns. Other opportunities include visits by women to a health care provider concerning contraceptive use or other sex related issues and routine visits for a Pap test.