Sex: What You Need to Know About Its Link to Cancer
By: Michael Hunter Md
Tags: Sex, Cancer, Health, Life, Lifestyle

Sex

Sex: What You Need to Know About Its Link to Cancer

Are you among the seven percent of Americans who have human papillomavirus (HPV)? Let’s talk about sex.

Photo by Alex Iby on Unsplash

For the vast majority of the patients I see for cancer of the oropharynx (the region at the back of your mouth), an infection may have heavily influenced the risk of getting cancer. Did you know that human papillomavirus (HPV) is the leading infectious cause of cancer? Or that HPV is the top sexually transmitted disease in America? How many cases of HPV-related cancers do you think we find each year?

Dozens?

Hundreds?

Thousands?

Tens of thousands?

If you answered tens of thousands, you are correct. Let’s go a step further. For those sexually active in the USA, what percentage will have human papillomavirus infection in their lifetime? Here are your choices: A) 15 percent; B) 50 percent; C) 80 percent. If you guessed 80 percent, you are on the mark. Fortunately, for most people, HPV goes away on its own.

Drawing of cervical cancer caused by HPV. https://en.wikipedia.org/wiki/Human_papillomavirus_infection

“Sex: the thing that takes up the least amount of time and causes the most amount of trouble.” — John Barrymore

HPV and cancer

Human papillomavirus (HPV) is associated with six cancers:

Cervix (women only)

Vagina (women only)

Vulva (women only)

Penis (men only)

Anus

Oropharynx (tonsils, the base of the tongue, and the back of the throat)

Globally, there are over half a million new cervical cancer cases, leading to over 310,000 deaths. The vast majority occur in low or middle-income regions. But even in the USA, we discover over 30,000 individuals found with HPV-related cervix cancer annually. Besides the cervix and the other five cancers described above, HPV can lead to warts of the skin or genitals.

Such cancers can occur years or decades after an HPV infection. Unfortunately, we cannot predict which individuals with HPV will develop cancer and which will not.

HPV in detail

A small DNA virus creates a human papillomavirus infection. Approximately 90 percent of HPV infections result in no symptoms and spontaneously resolve with a couple of years. On occasion, the human papillomavirus infection persists and can result in either warts or pre-cancer abnormalities.

If the HPV infection is in the cervix, vulva, vagina, penis, anus, or back part of the throat, cancer risk rises. Finally, some studies hint that the virus is associated with a small proportion of lung cancers.

There are over 170 types of human papillomavirus. Fully 70 percent of cervix cancer is secondary to two particular forms of HPV, known as HPV 16 and HPV18. For the other human papillomavirus-associated cancers, upwards of 60 to 90 percent may be associated with the virus. Skin (non-cancerous skin growths) or genital warts and voicebox region papilloma are often the results of HPV6 or HPV11 types.

How do we get HPV infections?

Here are some risk factors for human papillomavirus infection:

early age at first sexual intercourse

multiple sexual partners

smoking cigarettes

having a partner with HPV

immune system suppression

The virus spreads through direct skin-to-skin contact. Examples include vaginal and anal sex. It is also possible for a mom to transmit the virus to her fetus during pregnancy. While toilet seats don’t facilitate the virus transfer, one may acquire HPV types related to warts through contact with surfaces such as floors. One can have more than one type of human papillomavirus.

For those who have higher risk forms of HPV, there are variables that can make it more likely that the infection persists and become associated with cancer. Such factors included the presence of a weakened immune system, chronic inflammation, having another sexually-transmitted disease, having many children (cervix cancer), using tobacco (back part of mouth region cancer), and receiving anal sex (anal cancer).

What can we do?

Fortunately for most of us, HPV spontaneously vanishes on its own. But for those who do not clear the infection, health problems can later develop. We have no suitable means of predicting who will have future issues such as warts or cancer. So what can we do?

Vaccines. I think of HPV vaccination as one form of cancer risk-reduction

I think of HPV vaccination as one form of cancer risk-reduction Cervical cancer screenings for women

for women Safe sex

For optimal vaccine effectiveness, it should be before the first sexual activity.

HPV vaccines can reduce cancer and wart risk for both boys and girls. Photo by CDC on Unsplash

Cervix screening

For cervix screening, here are some of the updated guidelines from the US Preventive Services Task Force (USPSTF):

Women should have a first Pap smear at 21 years of age, regardless of the onset of sexual activity. Such tests can find abnormal cells in the cervix.

Women 21 to 29 years of age should have only a Pap test every three years. From ages 30–65, women should do one of the following: 1) get a Pap test every three years; 2) receive an HPV test every five years to screen for high-risk types of HPV, and 3) receive both tests together every five years.

Screening typically continues during pregnancy.

If you are under age 30, your doctor may also recommend an HPV test if your Pap results are abnormal. Selected women may need more frequent testing or a follow-up procedure, such as a colposcopy.

We do not have a US Food and Drug Administration-approved test for HPV among men. There are no routine screening tests for penis, anal, or oropharynx (back part of the mouth) regions. I have heard of using an anal Pap test for men at increased risk of anal cancer. Such men include those who receive anal sex and those with human immunodeficiency virus or HIV.

Treatment

As HPV typically vanishes on its own, there is no treatment for the infection. Instead, you may need close monitoring to see if the HPV infection persists or becomes associated with cells’ abnormal changes. We manage genital warts in various ways, including freezing with liquid nitrogen, burning with an electrical current, or with medications. These interventions target warts rather than the infection, however. Some individuals need the removal of pre-cancerous cells.