Protect Yourself Against Cervical Cancer

"Dear KnowYourV, how can I protect myself and reduce my chances of getting cervical cancer?"

With the rise of HPV infections & lesions showing up in places like the tongue, throat and anal and labial areas, everyone is becoming concerned. HPV (Human Papilloma Virus), is in the condyloma (genital wart) family. But unlike other genital warts, HPV warts are flat and cannot be detected without placing a special solution on the area. The solution reacts in such a way that the HPV lesions turn a whitish color, and this helps in diagnosis and treatment.

Since HPV is transmitted sexually, the best way to protect yourself from infection is to ensure safe sexual practices. Condoms are the best way to prevent most STD's, but it is thought that the HPV virus is so small that it can escape through a condom’s tiny pores. The addition of spermicidal foams and jellies can help.

The biggest breakthrough in the past few years has been the introduction of a vaccine initially approved for females age 8 to 27. Now the vaccines approval has been extended to males of the same age. This will hopefully be the #1 way to prevent transmission.

Women are typically at higher risk for acquiring these types of STDs as we are the semen recepors. Men, on the other hand, are depositors. Because we are the receptors of the semen, if the semen is infected, we serve as little incubators.

That is why it is so nice to use the WaterWorks cleansing system. WaterWorks can be used immediately after sex to rinse out semen quicklyreducing the time HPV can sit in vagina. Not only does WaterWorks function to reduce vaginal odors, it can also be used for daily feminine cleansing.

If you have not spoken to your healthcare provider about getting the HPV vaccine, it is a good idea to at least get information to read about it.

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What is Desquamative Inflammatory Vaginitis?

Desquamative Inflammatory Vaginitis is a vaginal syndrome that is very rare, usually seen in women in their late 30's & 40's, and is thought to be associated with estrogen imbalance and lack of the normal vaginal flora, especially Lactobacillus.

The good thing is that it is treatable. It affects the inside of the vagina and the area called the "vestibule" which is the very opening around the vagina. It typically causes a watery, grey-whitish or even a yellow-green discharge.

We have discussed how the vagina is like a self-cleaning oven. But with this Vaginitis, the vagina loses the ability to self-clean because it does not produce the normal amounts of Lactobacillus needed to keep the pH low (acidic). When this happens, vaginal estrogen is also thrown off balance. Estrogen is important for maintaining tissue integrity and healing.

Desquamative Inflammatory Vaginitis means the mucosa and skin around the vagina continues to slough off and become inflamed. This makes the opening and inside of the vagina raw and irritated, which in turn can make sex painful and using tampons impossible. It also creates a continuous discharge, as the vagina tries to heal itself.

Luckily, doctors can provide treatment with topical Clindamycin, an antibiotic, that along with hydrocortisone (or Clobetasol, a stronger steroid cream), function as anti-inflammatories. This, along with avoiding douching can help restore the natural vaginal flora and Lactobacillus. If there is no bacteria, virus or other organism associated with this, the Clindamycin is for healing & inflammation only. Estrogen Vaginal cream can also be helpful, as directed by your physician.

Note, if you are worried or concerned that your partner may not be faithful and that it may be somehow linked to an STD, then be reassured that Desquamative Inflammatory Vaginitis is not associated with past or present STDs. It is also not a precursor to cancer. But there has been some question as to whether Estrogen may be a trigger in setting it off or that it may be linked to Autoimmune disorders. You should always talk to your doctor to discuss screening for these.

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Can PID (Pelvic Inflammatory Disease) Occur Without a Partner Bringing an STD?

A woman recently asked me whether PID can occur from causes other than their partners bringing an STD to them.

The answer is, yes, it is absolutely possible to get PID without our sexual partners cheating and bringing an STD to us.

But, it is true that, many times, PID can be caused from our partners giving us Chlamydia or gonorrhea. If this goes undetected and untreated it can become a super infection called PID and move into our uterus, tubes, ovaries, abdomen and pelvis.

If couples have oral sex this can even put women at risk for Chlamydia or gonorrhea pneumonia or meningitis. The same is true for couples that have anal intercourse and may be transferring bacteria from the anal area to the vaginal region. This is why using WaterWorks immediately after sex can really help avoid these types of infections by helping us clear out the semen and abnormal bacteria.

Women may often show positive blood cultures for bacteria. Because there are many strains of bacteria naturally in the vagina, and if a woman has even a slight shift of the bacterial flora causing a leaning towards bacterial vaginosis, these abnormal bacteria can cause PID.

This is a serious illness that usually requires hospitalization for IV antibiotics. Women can become so sick that they can experience fevers, chills, vomiting, vaginal bleeding and discharge.

Remember, unless your PID was definitely caused by Chlamydia or gonorrhea, which would show up on the cultures that were done, then he may not have cheated on you. Okay?

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What You Need to Know About Human Papillomavirus (HPV)

Human papillomavirus (HPV) seems to be one of those infections women get that has a lot of rumors and misinformation associated with it. Some patients come in saying, "I have HPV and my doctor told me I have pre-cancer." Others come in worried because you have an abnormal pap smear and HPV infection and have been told that you have cervical cancer. HPV can, indeed, cause cervical, anal and oral cancer. It is also the cause of genital warts, but just having an abnormal pap smear and an HPV infection does not mean you have cancer or that you will ever get cancer.

HPV is the most common sexually transmitted infection in the United States. An estimated 20 million people are currently infected, and an estimated 6.2 million new HPV infections occur annually. HPV infection is common among adolescents and young adults. Prevalence among adolescent girls is as high as 64%. Up to 75% of new infections occur among persons 15–24 years of age. It is estimated that more than 80% of sexually active women will have been infected by age 50.

About 11,070 new cases of cervical cancer will be diagnosed in the United States a year, and, of those, approximately 3,870 women will die as a result of cervical cancer. HPV is believed to be responsible for nearly all of these cases of cervical cancer. HPV types 16 and 18 are associated with 70% of these cancers.

HPV is classified as either high- or low-risk types. The low-risk types do not carry a risk of cancer, but can cause genital warts, and, for some women, an increase in discharge, negative culture results and no treatment. Low- and high-risk HPV infections can just come and go, and even spontaneously resolve. High-risk types, if persistent, are the ones tested for on pap smears and will cause cancer if they do not resolve. The high risk types are: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 69, 73 and 82.

In addition to cervical cancer, HPV is believed to be responsible for 90% of anal cancers, 40% of vulvar, vaginal, or penile cancers, and 12% of oral and pharyngeal cancers. Population-based estimates, primarily from clinics treating persons with sexually transmitted infections, indicate that about 1% of the sexually active adolescent and adult population in the United States have clinically apparent genital warts. More than 90% of cases of anogenital warts are associated with the low-risk HPV types 6 and 11.

HPV is transmitted by direct contact, usually sexual, with an infected person. Transmission occurs most frequently with sexual intercourse but can occur following nonpenetrative sexual activity. Studies of newly acquired HPV infection demonstrate that infection occurs soon after onset of sexual activity. HPV transmission can be reduced, but not eliminated, through the use of condoms and recent studies demonstrated a significant reduction in HPV infection among young women after initiation of sexual activity when their partners used condoms consistently and correctly. Abstaining from sexual activity is the surest way to prevent genital HPV infection. For those who choose to be sexually active, a monogamous relationship with an uninfected partner is the only sure way to ever prevent HPV infection.

The reason I bring this up is because there is so much conversation that HPV is only caused by risky behavior, when the truth is, if you are virgin and marry or have your first sexual experience with someone who has HPV you can get it that fast just like getting any other sexually transmitted disease.

We've heard it said that Risk factors for HPV infection are related to sexual behavior, including the number of sex partners, lifetime history of sex partners, and the partners’ sexual history. Most studies
suggest that young age (less than 25 years) is a risk factor for infection.
Most cases and deaths from cervical cancer can be prevented through regular Pap tests at your gynecologist.

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Can I Get Pregnant or Contract an STD in the Hot Tub?

For some reason, many women have been told, or somehow believe, that if they have sex in water, it will somehow work to prevent pregnancy - like a natural contraceptive. But, water will not prevent a pregnancy from possibly happening (even if the man pulls out before ejaculating) once any sperm have been released into the vagina.

Of course, some women also worry that, if a man even ejaculates into the water, a woman would be at risk for getting pregnant. There are many explanations as to why women cannot get pregnant just by swimming in a pool or Jacuzzi where sperm may be present. If ejaculation takes place in hot water (like a hot tub or Jacuzzi), or water filled with pool chemicals like chlorine, sperm would not be able to survive for more than a few seconds.

Also, the water in a regular pool is too cold for sperm to live, and sperm could last for only a few minutes if a man ejaculates in warm water even with no chemicals (like a bath tub). It would also be so difficult for sperm to swim through the water in a bath tub, pool or Jacuzzi and find the vagina open enough to even get in.

Sexually transmitted infections, HIV, and additional bacterial infections can still be spread while having sex in a pool, ocean, lake or in a hot tub. This means that it is important to use birth control during water sex that can provide STD protection. Although hormonal methods may protect against pregnancy, they do not provide any defense against STDs, like using condoms does.

Even though condoms are effective at preventing pregnancy and STDs, they may be somewhat risky to use during underwater sex. They can possibly rupture from decreased lubrication and possibly deteriorate from heat, chlorine, or oil-based substances in the water like tanning lotion, sun screen and bubble bath. There is also the added threat that the condom can slip off if water gets into it, and a man may be unaware of this happening.

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Should I be Tested For an STD?

For many of us this may be an uncomfortable and embarrassing question. I know many of my patients will tell the staff they are coming in for a different reason, and only when they are finally in the exam room with me they are comfortable enough to share their concerns about possible STDs. 

Some of them have just discovered that their partner has been cheating on them, and are emotionally devastated. Maybe you or someone close to you has recently experienced this and can understand how scary it can be not knowing if you might have contracted something serious from an unfaithful partner. Even if you are single and dating and are careful to use condoms everytime, the worry is still there as condoms don’t protect from all STDs. 

Testing for STDs should begin when you become sexually active or have symptoms that make you worry that something may be wrong. Symptoms like vaginal bumps, blisters or open sores should be shared with your OB/Gyn.

So should vaginal discharge that is odorous, itchy, bloody, or higher volume than normal. If the infection gets to your kidneys or fallopian tubes and into the pelvis, it can cause fevers, severe pain and possibly PID (pelvic inflammatory disease). PID can cause scarring of the fallopian tubes and eventually infertility. I would never want to think that any of you or my patients would suffer from this and try to self- treat because they were too embarrassed to see their doctor. We are here to help you and want to see you get better. 

The home tests that you can get from the drug store can be used, but will often read positive when no infection is present at all. So a follow-up with your doctor is still a good idea. 

The best time to screen for STDs & STIs is during your annual exam. It is also a good time to ask questions and get information on prevention.

Some STDs (like HIV, Hep B, & Herpes or syphilis) may not show up right away on initial testing and take a few months to pick up on a blood test, so follow-up in 6 months to confirm that tests are truly negative.

I hope this helps. I know a lot of my patients ask me if douching helps get rid STDs and I have told them that it can actually force the infection up further through the cervix and into the uterus and fallopian tubes. This in itself can cause PID as discussed above.

A much better way to clean out your vagina is to use the WaterWorks Vaginal Cleansing system. It will rinse out excess discharge and infection-causing bacteria. [Note: this will not cure any STD or prevent an STD]. WaterWorks uses only fresh water (no chemicals!) and is FDA cleared. It does not use a shooting action so will not push the infection further up into the uterus or fallopian tubes. It may help you heal faster along with taking the prescribed medications. Don't share your WaterWorks with anyone else!

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What is the Difference Between an STD and STI and How Can You Prevent Them?

Essentially, they represent almost the same thing. STD is an abbreviation for a Sexually Transmitted Disease and STI is an abbreviation for a Sexually Transmitted Infection. The best way to describe the difference between an STI and an STD is that you can have an infection without having any symptoms; however once symptoms appear, it becomes an STD.

STIs, like many infections,can be passed from one person to another, even when there are no symptoms. Examples include Herpes, HIV, HPV and Hepatitis. A mother can pass these to her infant through childbirth and breastfeeding when she is unaware of being infected. Other infections such as the flu, common cold and mononucleosis, can also be transmitted during sex from oral contact and kissing, but would not be considered to be 'sexually transmitted infections'.

It’s important to know that just having sex won't necessarily give you an STD or an STI. You have to have sexual relations with another person who is infected in order to receive the infection. Also, if a person is treated for a STD/STI and returns to the same sexual partner they can become re-infected if their partner has not been treated. So if you get an STD/STI it is important that your partner be checked and treated as well.

So how do you protect yourself from contracting an STD/STI?

Prevention through avoiding exposure is the best strategy for controlling the spread of STIs. We know that protected vaginal and anal intercourse carries the highest risks for the most dangerous sexually transmitted infections. Abstaining from sex is the only way to be 100% confident of avoiding Sexually Transmitted Infections but let's get real! If abstinence is not an option, then condoms, used properly, can reduce your risk  significantly. Condoms be used with each act of sexual intercourse. But even this practice not completely eliminate the risk of transmission of STIs. Condoms can fail, slip off, be punctured, or break down from spermacides or lubricants. In the best conditions, they provide great protection against HIV and Gonorrhea, but are less effective against Genital Herpes and Chlamydia. They provide no protection from HPV.

Nearly everyone has taken risks sexually, but please beware of the potential consequences which can impact your health and the course of your life. Many STDs can last a lifetime, put stress on relationships, cause sterility or birth defects and even lead to major illness and death. Know the risks! Sexually Transmitted Infections are not all transmitted the same way.

Unprotected Vaginal and Anal sex can lead to the transmission of:
-trichamonas
-gonorrhea
-chlamydia
-syphylis
-pubic lice, Hep B, HPV,HSV,HIV

Unprotected oral sex can lead to the transmission of:
-gonorrhea
-chamydia
-syphilis
-Hep B, HSV, HPV

Even sexual play without intercourse can lead to the transmission of:
-HSV,HPV
-pubic lice
-gonorrhea
-chlamydia
-trichamonas

The most important thing to remember is to take care of yourself, and if you feel that something isn't right, make an appointment with your doctor.

Always be safe when it comes to your health.

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