Girls, Sex and HPV

Q: At our last pediatric appointment, I just about fell off the exam room chair when the doctor brought up vaccinating my daughter for HPV, a sexually transmitted disease. She’s just turning 12. Who does the doctor think she is?

A: It is hard not to react with anxiety and concern when a pediatrician starts to talk about protecting your daughter from a sexually transmitted disease. Rest assured that even though your doctor wants to vaccinate for HPV (human papillomavirus) now, sex is still something most girls will not engage in until they are much older.


The reason HPV vaccine (also known as Gardasil) is recommended for girls 11 to 12 years old is that, like all vaccines, it will only work if given before a child is exposed to the virus. A 2003 study found that 7.4 percent of girls are sexually active by age 13. Therefore, it is best to vaccinate all girls at this early age to be on the safe side.


Q: What if getting the vaccine makes my daughter think it is OK to have sex?

A: Researchers have found no link between getting the vaccine and early sexual activity. If you are concerned, use this as an opportunity to have an important talk with your daughter about the realities and risks of early sexual activity.


Q: What should I tell my daughter about HPV?

A: I would explain that HPV is the most common sexually transmitted infection in the United States, but it is not the only one. There are many other sexually transmitted diseases that the vaccine will not protect her from catching. 


Studies have shown that women and men in their late teens to early 20s are at greatest risk for an HPV infection. In fact, 40 percent of HPV infections occur in people who have only been sexually active for two years. In sexually active men and women, 50 percent will get HPV in their lifetime.


HPV is transmitted through direct skin-to-skin contact and is strongly associated with cervical cancer and genital warts. There are approximately 40 HPV strains that can infect the genital tissues of both men and women. Most individuals do not have symptoms from this virus and thus are unaware they have it.


Two vaccinations are currently available for HPV, Gardasil and Cervarix. Both are approximately 70 percent protective against cervical cancer. Gardasil is 90 percent protective against genital warts. Cervarix does not offer protection from genital warts. Neither vaccination can treat an HPV strain already present in an individual. 


Q: If males can also get HPV, shouldn’t boys be vaccinated too?

A: Boys can carry and transmit the HPV virus. Although they do not get cervical cancer, they can get genital warts. Gardasil was recently approved for use in males ages 9 to 26 years for the prevention of 90 percent of genital warts.


Q: Is the HPV vaccination safe?

A: Thus far, there are no known major complications to either Gardasil or Cervarix. Both have been reported to have temporary mild side effects in some patients. Neither vaccine is recommended in pregnancy.


Q: Do schools require HPV vaccination just like they do for other diseases?

A: There has been some discussion regarding mandatory vaccination. However, the California school system currently does not require it.


Q: If my daughter is vaccinated, will she be able to skip Pap smear screening? 

A: No, she will still need screening throughout her adulthood because the vaccination does not protect against all HPV strains nor other types of non-HPV related cervical cancer.


Women should start Pap smear screening at the age of 21 and repeat this test every other year until 30 years of age. After 30, the timing of Pap smear screening may change based on each individual.


Q: Will our family health insurance plan cover my daughter’s vaccination?

A: Nearly all private insurance plans cover the HPV vaccination. In addition, there are federally funded vaccination programs for children covered by Medicaid, uninsured children and other underserved populations. However, as a rule of thumb, it is always a good idea to check with your insurance prior to getting vaccinated.

Mary Parman, D.O., is a physician at the Palo Alto Medical Foundation’s Palo Alto Center Department of Obstetrics and Gynecology.

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