Early Age at First Sexual Intercourse is Associated with Higher Prevalence of High-grade Squamous Intraepithelial Lesions (HSIL)

Abstract

Objective To evaluate the association of age at first sexual intercourse with the results of the cervicovaginal cytology.

Study Design Observational analytical study about the prevalence of altered cervicovaginal cytology results in women aged between 18 and 34 years from a densely populated area in Brazil, during 10 years. The patients were stratified into 2 categories according to their age at first sexual intercourse (13–16 years and 17–24 years).

Results From the total of 2,505,154 exams, 898,921 tests were in accordance with the inclusion criteria. Considering women with 4 years or less from the first sexual intercourse as a reference, those with 5 to 9 years and 10 years or more showed a higher prevalence of high-grade squamous intraepithelial lesions (HSILs). Women with an earlier onset of sexual intercourse (13–16 years) showed higher prevalence ratios for atypical squamous cells (ASC), low-grade squamous intraepithelial lesion (LSIL) and HSIL. The prevalence ratio for HSIL adjusted by age at diagnosis and by age at first sexual intercourse was higher only for women with an earlier onset of sexual intercourse.

Conclusions The age of first sexual intercourse could be a variable that might qualify the selection among young women who are really at a higher risk for HSIL.

Resumo

Objetivo Avaliar a associação entre idade de início da atividade sexual e os resultados de citologia cervico-vaginal.

Métodos Estudo observacional sobre a prevalência dos resultados de citologia cervico-vaginal alterados em mulheres com idade entre 18 e 34 anos na região de Campinas – SP, Brasil, durante 10 anos. As pacientes foram estratificadas em dois grupos de acordo com a idade de início da atividade sexual (13 a 16 anos e 17 a 24 anos).

Resultados Do total de 2.505.154 exames, 898.921 preencheram os critérios de inclusão. Considerando mulheres com tempo desde a primeira relação sexual menor ou igual a 4 anos como grupo de referência, mulheres com intervalos de 5 a 9 anos e 10 anos ou mais entre a data do exame e a primeira relação sexual mostraram maior prevalência de lesão intraepitelial escamosa de alto grau (LIEAG). Mulheres com início da atividade sexual mais precoce (13–16 anos) mostraram altas prevalências de atipia de células escamosas, lesão intraepitelial escamosa de baixo grau e LIEAG. A razão de prevalência de LIEAG ajustada pela idade na data do exame e pela idade do início da atividade sexual foi maior somente para mulheres que apresentaram início mais precoce da atividade sexual.

Conclusão A idade de início da atividade sexual pode ser uma possível variável de seleção das mulheres com maior risco de LIEAG.

Keywords

cytology - pap smear - cervical intraepithelial neoplasia - age groups - sexual behavior

Palavras-chave

citologia - teste de Papanicolau - neoplasia intraepitelial cervical - grupos etários - comportamento sexual

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