Lifetime Sexual Assault and Cervical Cytologic Abnormalities Among Military Women

Background: Little is known about the reproductive health of military women. This study sought to determine women Veterans ’ competing risk factors, including life span sexual assault (LSA) exposures, associated with recent and lifetime cervical cytologic abnormalities. Methods: This cross-sectional study of a retrospective cohort of 999 Midwestern Veterans (enrolled in the VA) included computer-assisted telephone interviews and chart reviews. Results: Over half (57%) of participants self-reported lifetime abnormal cytology. Chart review demonstrated 16 % had abnormal cytology in the preceding 5 years. Almost two thirds of participants (62%) reported LSA, and one third (32%) reported assault during military service. Women with completed LSA were more likely to self-report abnormal cytology than peers with no or attempted-only assaults (63 % vs. 51%, p < 0.01). In logistic regression models comparing competing risks for abnormal cytology, type of military service (Active Compo-nent [AC] or both AC and Reserve or National Guard) was significant even when human papillomavirus (HPV) was included. LSA was significant when well-established risk factors, except HPV, were included. Nearly all participants had health insurance (84%), and only one third (32%) used the VA for all care. Conclusions: Military type and completed LSA are significant risk factors for abnormal cervical cytology and should be routinely assessed by women’s care providers. LSA and gynecologic health risk factors are wide-spread in the female Veteran population. These findings have clinical implications for vigilant screening, gy-necologic follow-up, and behavioral health interventions. Most participants had insurance and used only some or no VA care, so findings are relevant to all women’s health providers