Impact of Male Partner’s Multiple Sexual Relationships on HPV and Squamous Intraepithelial Lesion Prevalence among Women in Polygamous Marriages in Senegal – West Africa

Abstract

Background: While women’s sexual behaviors are established risk factors for HPV infection and cervical cancer, the role of male sexual behavior and marital structure remains understudied. Our study examined the association between polygamous versus monogamous marriage, including the number of co-wives, and human papillomavirus (HPV) infection, squamous intraepithelial lesions (SIL), and invasive cervical cancer (ICC) among women in Senegal. Methods: This cross-sectional study polled secondary data from three prospective studies conducted in Dakar, Senegal, between 1998 and 2010. The analytical sample included 4,891 women aged 15 years and older. The primary exposure was marital structure, categorized as polygamous versus monogamous marriage, with the number of co-wives examined as a secondary exposure. The outcomes included HPV infection types and cervical disease. The HPV infection types were determined using polymerase-chain-reaction (PCR) and all positive samples with HPV DNA were genotyped for type-specific HPV while the cervical disease status was determined through standardized cytologic screening and histologic evaluation. Generalized linear models (GLMs) were used to estimate odds ratios (ORs) and 95% confidence intervals for the association between marital structure and HPV-related outcomes. All regression models adjusted for study group, clinic, age, parity, and lifetime number of sexual partners. Results: Of the 4,891 participants, 2,124 (43.4%) were married in monogamous unions, and 2,767 (56.6%) were married in polygamous unions. Overall prevalence of any HPV was higher among women in polygamous unions compared with women in monogamous unions (30.6% vs. 25.6%; AOR = 1.28, 95% CI: 1.09-1.50). Women in polygamous unions also had higher odds of low-risk HPV infection (AOR = 1.28, 95% CI: 1.03-1.59), multiple HPV infections (AOR = 1.39, 95% CI: 1.08-1.79), and non-vaccine (HPV genotypes not covered by 9-valent vaccine) HPV type infection (AOR = 1.30, 95% CI: 1.07-1.59). Although high-risk HPV prevalence was higher among women in polygamous unions, the association was not statistically significant (AOR = 1.18, 95% CI: 0.98-1.42). No meaningful differences were observed for HPV16 or HPV18 infection. Increasing numbers of co-wives were associated with modest increases in overall HPV, low-risk HPV, and LSIL/CIN1 prevalence. As regards cervical disease, LSIL/CIN1 were slightly more frequent among women in polygamous marriages than among those in monogamous marriages (3.8% vs 2.7%), representing 38% higher odds (AOR = 1.38, 95% CI: 0.93-2.07), while no meaningful associations were observed for HSIL/CIN2-3/CIS or ICC. Conclusion: Polygamous marriage was associated with a higher burden of HPV infection and LSIL/CIN1 among married women in Senegal, particularly LR-HPV, multiple HPV infections, and non-vaccine HPV types. Although associations with advanced cervical disease were less pronounced, the findings highlight the potential role of male sexual behavior and marital structure in shaping women’s HPV risk and support strengthening HPV prevention and cervical cancer screening strategies in settings where polygamous unions are common. This supports greater inclusion of male-centered approaches in HPV prevention efforts.