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Dear Dr. P


Dr. Pranzarone

Dear Dr. P, Just last week CBS News had an article saying that oral sex causes oral cancer.  How can this be true?  It seems to be a scare tactic invented by sexual puritans.

Dear concerned.

It is both true and scary.

I too saw the article that clearly stated that oral sex was now the main cause (64 percent) of oral cancer and that of the head and neck.  It is not smoking, “chew” or heavy drinking.

“An individual who has six or more lifetime  partners—on whom they’ve performed oral sex—has an eightfold (8x) increase in risk compared to someone who has never performed oral sex,” said researcher at Ohio University, Dr. Maura Gillison.

Yet for adolescents, recent reports indicate that oral sex is very prevalent and is considered by youth as casual, no big deal, and safer than “real” sex that involves penis in vagina coitus.  With these new findings we now have to reconsider the assumption that oral sex is both safe and inconsequential.

I had been wondering why my dentist recently began offering an oral cancer detecting mouth-wash—at additional cost—to all patients.  Swirl it around your mouth for a while and then the cancer cells would phosphoresce when a special light was shown into your mouth. Catching the cancer cells early would result in early treatment and cure.

This is now very similar to the Pap test or smear (after Greek obstetrician Dr. Georgios Papanicolaou), which is a test of the health of woman’s cervix.  The test can detect early (squamous cell dysplasia or cervical  ntraepithelial neoplasia (CIN), which are pre-cancerous changes in a woman’s cervix and uterus. This can be effectively treated before the condition in a small percentage of cases becomes cervical cancer, which if untreated, can kill you.

A variation of the test, an anal Pap smear is used to detect potential anal cancers.

All of these pre-cancerous and possibly cancerous conditions, in the mouth, the genitals (in both sexes) and anus/rectum are caused by the same family of sexually transmitted human papillomaviruses (HPVs).  There are over 200 known types of HPV which usually cause no symptoms in people who are infected.  The immune system keeps them suppressed.  Some few types of HPV cause genital warts which can be unsightly and uncomfortable.  HPV warts can be detected by the application of vinegar with a Q-tip.  The suspected area or bumps will become snow white and cauliflower-like in appearance.

Most people (that is MOST women—and men) contract HPV soon after they become sexually active. Fortunately, most people with a healthy immune system will successfully clear themselves of HPV infections (e.g., “warts”) within 18 months.  However, long-term infection with the high-risk virus types (types 16, 18, 31, and 45) can lead to cancers of the cervix/uterus, oral cavity, anus/rectum and, I believe, this high-risk HPV infection will be implicated in some male prostate gland cancers in men’s later years.

So what are we to do?  Avoid unprotected oral sex?  Latex sheet “dental dams” are available to place over potentially infected vulvas.  Condoms can be placed over potentially infected penises.  But what about kissing?  Even this activity can be a potential source of HPV infection if the oral cavity harbors the HPV virus in lesions.

The answer lies in vaccination.  The vaccination should be given to both boys and girls prior to puberty and the onset of sexual activity!

Two vaccines, Gardasil and Cervarixm, protect against HPV virus types 16 and 18 that cause 70 percent of cancers.

Guardasil also protects against HPV-6 and 11 that cause 90 percent of genital warts.  Additionally, Guardasil is shown to prevent HPV induced anal, vulvar, penile and oral cancers.

Currently state legislatures are now considering that as a requirement of school admission children must be given certain vaccinations against common infections and that these include HPV vaccines.

Needlingly yours,

Dr. P