Sexually transmitted diseases: HPV

Should I be concerned about HPV and throat cancer that’s all in the news?


Well, cancers of a number of areas are linked to HPV: cervix, vagina, vulva, penis, anus, mouth and throat.  In a previous post, we discussed that HPV infections are widespread throughout the US and are transmitted sexually in 99%+ of cases.  Since this is a silent infection, most people infected with HPV do not know they have it.  Most of the time the body’s immune system will clear the high risk and low risk viruses, or they will disappear, or go into hiding, never to be seen again but in some cases the human papilloma viruses will stay and may hang around for years.

There is no way to know  who will go on to develop cancer or other health problems from the high risk human papilloma viruses.  When the high risk viruses causes changes in the cells, these cells go through a pre-cancer stage that can be detected with screening tests such as pap smears. Unfortunately, there is no specific screening test for mouth or throat cancer at this time. Biopsies of abnormal looking areas also can detect the pre-cancer stage as well.

Cancers of the vulva, vagina, penis, anus, mouth and throat are much less common than cervical cancer.  HPV is found in saliva (spit,) semen, and genital secretions.  It can be transmitted through skin to skin contact from genital warts.

It is best that you and your partner discuss your past sexual histories, realizing that most people do not know that they carry a silent infection.  You may be reluctant to even bring up the subject because you are in a special committed relationship.  Since the Head Virus does not know that this is a special person and will not tell the other viruses to stop, wait, don’t jump on this person because he/she is a nice person, Safe Sex is realistically your only protection.

Protection against HPV infections includes using condoms (male and female) and placing a barrier between you and your partner during oral sex such as a dental dam.  Vaccination against HPV would also be protective.  It would be best to be vaccinated prior to sexual activity; thus the push to vaccinate children and young people.  The HPV vaccination may be helpful even after initial sexual activity because it is unlikely a young person has been exposed to all of the 4 most common human papilloma viruses covered by the vaccine.

Birth Control Pills Safety

Are the pills safe?  Should I keep taking them?

The birth control pills, (oral contraceptives) are very safe.  They have been available for about 50 yrs and have been extensively tested.  Most contain 2 hormones, estrogen and a progestin.

The hormones in the pills work by keeping the egg from leaving the ovary and making the cervical mucus thicker.  The estrogen and progestin also make the lining of the uterus thinner and the cervical mucus thicker keeping the sperm from getting to the egg that may have already been released when the woman started the pills.

Of course, no medication will ever be 100% safe and if a woman is over 35 and smokes, she should not use the birth control pills. This woman would be at increased risks of heart attack or stroke already and if she adds birth control pills, she increases her risk.  Also women with poorly controlled hypertension, poorly controlled diabetes or who have already had a heart attack, stroke, or blood clots in legs or lungs should not use the pills.

Researchers published a study in 2012 that found that there may be an increase of 1 woman per 10,000 women younger than 50 who might have a stroke or heart attack if they use birth control pills.

A certain type of pill that contains the progestin drospirenone may also increase the risk of heart attack or stroke in susceptible women.

Taken properly, the birth control pills can be 99% effective.  The risks of an unintended pregnancy may be considerable for the mother and for the baby.

The American Congress of Obstetrics and Gynecology recently suggested that because of this, their safety and the increased number of unintended pregnancies, that birth control pills should be available without a prescription.


What is a partial hysterectomy?

The term “partial hysterectomy” is a slang phrase meaning the entire uterus has been removed and the ovaries and tubes have been left.  A simple hysterectomy is surgery that removes the top or fundus of the uterus and the bottom or the cervix.

A total abdominal hysterectomy involves making an opening in the abdomen and taking out the uterus through that opening or incision.

If the cervix is left in place, this surgery is called a subtotal or a supracervical hysterectomy.

Surgery to remove the uterus may be performed from inside the vagina, a vaginal hysterectomy.

Minimally invasive procedures have been developed that allow the entire uterus or just the upper part to be removed using 2 to 4 small band-aid size incisions in the abdomen. This is a laparoscopic hysterectomy or laparoscopic assisted hysterectomy.

Taking the ovaries and fallopian tubes is a bilateral salpingo- (the tubes) oophorectomy (the ovaries.)

Endometriosis, painful menses, pressure or pain from an enlarged uterus with benign fibroid growths, or cancer are some of the reasons for a hysterectomy.

Once the uterus has been removed, the woman will no longer be able to deliver children.  She will also no longer have regular menstrual cycles; although sometimes there may be a small amount of bleeding from the cervix if enough of the lining remains.


What exactly is Endometriosis?

Endometriosis occurs when the cells lining the inside of the womb wander around the pelvis and abdomen.  There are many theories about how this happens. The most likely is that the menstrual flow spills out the fallopian tube instead of all coming out into the vagina. That flow could spread to the ovaries, the top, front and back of the womb, the bladder, or the intestines, or the peritoneum (the lining of the abdomen.)

When they stick to other areas, those lining cells act as if they are still inside the womb and grow, shed, and bleed in response to the normal hormones of estrogen and progesterone.  The problem is there is no place for the blood and tissue to go so it sits wherever it forms and sticks to more organs and forms scar tissue, adhesions. The adhesions can be tight bands like piano wire or they can just clump tissue and organs together in hard cement-like masses.

This can be extremely painful, usually worse during the time leading up to and including the menstrual cycle.  Depending on location and how far into the organs endometriosis invades, some women may have extreme pain with a relatively small amount of endometriosis, whereas other women have wide areas involved and have relatively little discomfort.

There is a tendency for this to run in families. The only way to diagnosis endometriosis is through surgery.  Doctors can make an educated guess however, based on the woman’s symptoms, her family history, or how she responds to treatment.

Current treatment is based on changing the hormone sequence affecting the endometriosis.  Doctors use birth control pills, anti-estrogen shots such as Lupron Depot, Depo-Provera injections, and if no relief, surgery.  Endometriosis can make it difficult for a woman to become pregnant, but is she has mild disease and is successful in becoming pregnant, the pregnancy hormone changes can wipe out the endometriosis.

Ovarian Cysts

How do you treat an ovarian cyst?

Most simple cysts are just small fluid containing pockets in the ovary and given enough time, usually a few weeks, will disappear.  So usually we can wait and allow the body to heal the ovary on its own.

You can take NSAID pain meds such as Aleve, or Ibuprofen, and sometimes a pain medication with a narcotic.  Estrogen and progesterone pills, oral contraceptive pills, also can help speed the disappearance of a simple cyst.

A sonogram is useful to check on the cyst and make sure it is getting smaller or to make sure it has completely vanished.

Occasionally because the cyst is getting larger, or not disappearing, surgery may be required to remove the cyst and repair the ovary.  The doctor usually will insert a lighted tube, a laparoscope through the belly button to get a close-up look at the problem.  The doctor may be able to repair the ovary through 2 or 3 band-aid size small incisions in the abdomen.  It may be necessary to make a larger incision to go in and treat the problem.

If the cyst has debris or solid parts as well, the doctor may recommend surgery to remove it and send the specimen to the laboratory to be checked for any abnormal type of growth.