The United States Congress designated January as Cervical Health Awareness Month. However, as a Gynecologist, I was surprised to see the month come and go without major press regarding the new approvals for the HPV vaccine. Now is a good time to talk about cervical cancer prevention and vaccination guidelines with your health care provider. The major question you should be asking yourself is, “Am I up to date with my pap smear, and have I been tested for HPV.”
The Human Papillomavirus, which is best known by its abbreviated name, HPV, is one topic that stirs up much anxiety in my office. Understandably so, the Center for Disease Control and Prevention (CDC) cited, “nearly 80 million people—about one in four—are currently infected in the United States. About 14 million people, including teens, become infected with HPV each year.” Approximately 4000 women in the United States die from cervical cancer annually. Many of the signs you will see read, “HPV causes cervical cancer” instead of “HPV may cause cervical cancer. Get Tested.” If you’ve been infected by the HPV virus don’t panic. This does not mean you have cervical cancer or you are going to get it. What it does mean is that one may need more frequent Pap smear screening on a yearly basis until the virus goes away. Also, you will likely need a colposcopy procedure which allows your gynecologist to take a closer look at your cervix with a special scope. Possible small biopsies may need to be performed in order to check for abnormal cervical cells if HPV is present. The diagnosis is super common. Bottom line is; if you are sexually active, you are at risk.
Although this fact will not make you feel any better… I tell every woman the most important action one can take is to be informed, not afraid. And even more important, talk to your gynecologist and follow your recommended treatment plan. Most HPV infections that increase one’s risk for cervical, anal, throat, and vulvar cancers, clear on their own in 1-3 years.
Most women who are diagnosed with cervical cancer in the United States have not had a pap smear within a five year period, did not follow up after having an abnormal pap smear/biopsy, or are over the age of 65. The CDC estimated in 2016 that by the time a woman reaches the age of 50, four out of five would have been infected with HPV during her lifetime.
Here are a few things you should know:
Over 150 types of HPV have been identified and affect only humans.
It is typically spread by skin-to-skin contact during sex. Sexual intercourse, which would include vaginal sex, oral sex, anal sex, and any other interaction that would involve your genital are, mouth, or hands is the most common setting in which HPV is transmitted from person to person. Touching doors, toilet seats or surfaces, will not infect you. Unfortunately, condoms do not completely protect you from the virus but they can help decrease your risk of transmission. This is because they cannot possibly cover all the parts of your body that are involved during sexual activity.
The virus can affect skin anywhere on your body but we will focus this discussion on the following common areas:
Cervix, Vagina, Vulva
Back of the Throat, Tonsils, Tongue (Oropharynx)
It has also been linked to throat, tongue, anal, vaginal, and vulvar cancers.
There are over 40 types of HPV which have been shown to increase the risk of developing cervical cancer. Years of research have allowed health care professionals to identify the types most likely to cause cervical cancer. Each type has been identified with a number. If you are diagnosed with HPV this does not mean you have cervical cancer or will develop it. Types 16 and 18 have been found to cause about 70 in 100 cervical cancers that are diagnosed.
HPV may be tested for and detected in your body by performing a Papanicolaou (pap smear). Women over the age of 30 are automatically screened for the types of HPV mostly commonly linked to causing cervical cancer. Men are not routinely screened.
If your Pap Smear is abnormal or positive for HPV we closely observe you by performing another diagnostic test called a colposcopy. This procedure allows your gynecologist to take a closer look at your cervix and possibly perform very small biopsies if necessary, if areas appear abnormal. These biopsies will be sent to a pathologist who will then be able to examine the removed tissue and determine if you actually have abnormal pre cancerous cells that need to be removed. You will likely be advised to have your Pap Smear performed more frequently for a specified time.
The overall goal initially was to protect girls and women ages 9 to 26 against cervical, vaginal, vulvar, and anal cancers and genital warts caused by HPV. On October 5, 2018 the U.S. Food and Drug Administration (FDA) approved use of the Gardasil 9 HPV vaccine in males and females ages 27-45. This expands the previous indication that covered from ages 9-26. Gardasil 9 prevents infections with the “high-risk” HPV types most commonly found in a number of cancers worldwide, including cervical cancer.
There are several vaccines approved by the FDA. All vaccines protect against a unique set of types of the HPV virus.
Gardasil-9 is the only vaccine that offers protection against 9 types of HPV: 6, 11, 16, 18, 31, 33, 45, 52, and 58. The CDC recommends vaccinating boys and girls starting at 11-12 years old. These 9 types are responsible for the majority of HPV-related cancers and diseases.
All vaccines usually involve three shots within a six-month period if given after the age of 15. The second shot should be given two months from the first, and the last shot six months from the date of the first shot.
The two shot scheduling recommends administering the second shot six-12 months apart and is the guideline for boys and girls starting at age 11.
If you have genital warts you will notice them. They can grow in many areas such as your vagina, rectum, labia, and on the skin between your vagina and rectum. They have a cauliflower-like appearance.
Genital warts can be removed by several different methods. Commonly, gynecologists use an acidic chemical or a cream to treat them. Some dermatologists use cryotherapy. Your doctor’s treatment approach will depend on the number of warts you have, where they are located, and how they have grown on your skin.
It may seem obvious, but make sure you have seen your lover’s private areas before you indulge. If your partner only wants to have sex with the lights out, you should wonder why.
Most importantly, learn the guidelines. Make sure you are up to date on your pap smear screening. And mark your calendar. Take control of your screening schedule and be proactive in making your appointments. Lastly, be sure your doctor is testing your pap smear for HPV when indicated. I find often the screening test for HPV had not been requested per our standard guidelines for cervical cancer prevention.
Gynecologists use the results of the HPV test combined with the details of one’s sexual activity and number of partners to determine how often screening is necessary.
Honor Health Vow # 5 I Choose to Be “In the Know” by Keeping Record of Important Medical Events in My Life