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Thursday, July 9, 2009

HPV, Oral Sex and Condoms

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If a woman has mild or moderate cervical dysplasia (HPV), is there any risk to her male partner if they engage in oral sex? Do condoms offer protection for the transfer of HPV?

Our understanding of Human Papillomavirus (HPV) is constantly evolving as new research is published. There are more than 100 different strains of HPV, some of which are linked to cervical cancer and some of which cause genital warts. The term "cervical dysplasia" refers to abnormal or precancerous cells on the cervix that are usually caused by HPV. During routine visits to a gynecologist or primary care provider, Pap smears are done to check for the presence of these abnormal cells.

So, if you get a Pap smear and your health care provider tells you that you have cervical dysplasia, this usually means that you have HPV. Since HPV is a sexually transmitted infection, this may leave you wondering what to do next. What should you tell your sexual partner(s)? How can your partner be protected against HPV transmission?

Thanks to relentless ads for Gardasil, a vaccine that protects against certain types of HPV, many people are aware of the link between HPV and cervical cancer. According to the National Cancer Institute, HPV is also linked to anal cancer (as I discussed in a recent SEXpress column); cancers of the penis, vagina and vulva; and yes, oral cancer. It does appear that HPV can be transmitted through oral sex and that there is a risk of developing oropharyngeal cancer for those who are infected. However, DO NOT PANIC! Oropharyngeal cancer is very rare and is far more likely to be caused by tobacco and alcohol use. The majority of HPV infections do not cause cancer and are, in fact, cleared by the body over time without any treatment.

Condoms do offer some, although not complete, protection against HPV. HPV is transmitted through skin-to-skin contact, and since condoms don't cover all areas of the genitals that touch each other during sex, they can't totally eliminate the risk. Condoms are far better than nothing, though-one 2006 study showed that women whose partners used condoms during every sexual encounter were 70% less likely to contract HPV than those whose partners didn't use condoms consistently. Other barriers can also help protect against HPV. Latex or polyurethane squares (sometimes called "dental dams") can be held against the vulva during oral sex to reduce the risk of transmission that way (use a glycerin-free flavored lube on both sides of the dam to increase pleasure for both partners).

I've counseled a number of male-female couples or male partners of women who were recently diagnosed with cervical dysplasia, and news of an HPV infection can often be extremely frustrating for men. There's no routine HPV test that's offered to men, and no treatment for men who have an HPV infection other than the strains that cause genital warts. Also, men can't get an HPV vaccine in the United States (yet! That may change in the future). Men are often seen as asymptomatic carriers of HPV who unknowingly infect their female partners, and the public health focus so far has been on vaccinating those female partners to prevent infection and on routine Pap smears to screen for precancerous cells in women. If it seems that men are left out of the equation, it's important to remember that the vast majority of HPV infections in men are harmless. Use condoms and dams to reduce risk and give yourself peace of mind, but do not let HPV ruin your sex life. Two great Web sites for more information on HPV are the American Social Health Association (www.ashastd.org) and the National Cancer Institute (www.cancer.gov).

Want Laura to answer your questions in SEXpress? Send them tolaura@shepex.com. Not all questions received will be answered in the column, and Laura cannot provide personal answers to questions that do not appear here. Questions sent to this address may be reproduced in this column, both in print and online, and may be edited for clarity and content.

Laura Anne Stuart has a master's degree in public health and has worked as a sexuality educator for more than a decade. She owns the Tool Shed, an erotic boutique on Milwaukee's East Side.