Why talking about HPV (and other STIs) matters

‘Much of what we are taught about sex is through a shame-based model’ (Picture: Getty Images)

While STI stigma is not limited to HPV, when you think about the fact that most people will get HPV in their lifetimes, it’s a bit odd that we so rarely hear it brought up.

Indeed, even though most of us have heard of HPV, many people don’t really know what it is, despite the fact there are school-age vaccinations against it, and around 80% of us will have it at some point.

But, in answering why we should be talking about HPV more, we need to look at the facts.

Suneela Vegunta, M.D., a women’s health physician at Mayo Clinic in Phoenix, Arizona, tells us: ‘There are millions of people who have experienced this infection.

‘There are about 200 different types of HPV and only 15 of them can cause precancerous and cancerous lesions.

‘Other HPV types can cause benign infections such as warts and are spread by skin contact. Certain types of HPV can cause benign genital warts.

‘In addition, many individuals who get the infection will clear this infection within 12 to 24 months.

‘HPV infection is mostly transient and they come and go without the infected individuals being aware of having it. Most HPV types do not cause any symptoms, unlike other STIs.’

Dr. Suneela adds that, while most people will clear the infection without any medical intervention, some cases of HPV can persist and turn into cancers, including cervical, vulvar, vaginal, and anal cancers, as well as cancer of the penis and oral cancer.

‘HPV is a virus that likes lymphoid tissue,’ professor Mark McGurk, co-founder of the Head & Neck Cancer Foundation says.

‘The back of the mouth is protected by a thick ring of lymphoid tissue i.e. tonsils and base of the tongue.

‘The role of this ring of tissue is to guard the entrance to the gastric tract from adverse agents taken via mouth. The viruses can cause some genetic abnormalities that make cancer development more likely.’

Mark is keen to stress that most HPV infections, like HPV18 and 16, which have a link to cancer both in the cervix and the mouth, will clear up on their own.

But it’s also important to keep in mind that, according to the NHS, ‘high risk’ forms of HPV are found in more than 99% of cervical cancers.

Stats like this are why HPV vaccines are offered to all students aged 12 to 13 in England – even though most cases clear up on their own, any protection we can get against catching it is still very much worthwhile.

Zoya Ali, a reproductive health scientist and sexual health educator, tells us: ‘In the current UK vaccination programme, the HPV vaccine is available to all young
people aged 12-13, usually through school.

Most of us got close to no sex education in school

‘Last year, research by Cancer Research UK found that cervical cancer rates in those vaccinated between the ages of 12 and 13 were 87% lower than in an unvaccinated population.

‘Although it is recommended to get the vaccine at a younger age before you are sexually active. If you have missed it, it is beneficial to get it even after you have started being sexually active. If you are eligible and missed the vaccine, you can get it free on the NHS until your 25th birthday.

‘People assigned male at birth who have sex with men aged up to 45 are also eligible for free HPV vaccines from sexual health and HIV clinics.’

So with all that very important information in mind, why don’t we talk about HPV?

Well first off, unfortunately, it’s not uncommon for there to be big gaps in our sexual health knowledge because the sex education many (if not all) of us got when we were young has left a lot to be desired.

Zoya says: ‘The fact that most of us got close to no sex education in school affects the amount of information we have regarding our sexual health and how proactive we are with it.’

Dr Susanna Unsworth, the in-house doctor for intimate wellbeing brand, INTIMINA, doesn’t believe the infection’s link to certain types of cancer is talked about as much as another potential outcome of HPV.

Things we need to remember about HPV

Even if you have been vaccinated, there are still things Zoya says you should be keeping in mind.

She explains: ‘You should practice safer sex. Using barrier protection like a condom can reduce the risk of transmission of HPV.

‘However, since they do not cover the whole genital and anal areas, it is possible for transmission through skin-to-skin contact. Don’t forget to attend your routine cervical screening.

‘STIs are more common than you realise, and there is a lot of unnecessary shame and stigma around them. Most STIs, HPV included, don’t always show symptoms, and someone might be unaware they have one unless they get tested.

‘It is important that you and your partner(s) get an STI test done regularly.’

Though keep in mind, HPV doesn’t show up in a standard sexual health screening.

‘I think when most people talk about HPV infection,’ she tells us, ‘they often think about it in relation to genital warts. This is actually the most common viral sexually transmitted infection in the UK.’

She adds: ‘Although its link with cervical cancer is becoming more well known, likely as a consequence of the changes in the cervical screening program, I do not feel its link with other cancers is so widely spoken about.’

Dr Susanna says: ‘Hopefully, the vaccination program will significantly reduce the frequency of the cancers mentioned.

‘However, HPV infection can often coincide with other sexually transmitted infections, so it remains important to still practice safe sex.’

Kate Moyle, the in-house sex and relationship expert for Lelo, says part of why people don’t often talk about HPV (along with other STIs) full stop is down to shame.

She explains: ‘Even the language that we use around STIs and sexual health, such as using terminology like “clean” to describe being STI-free creates further stigma and shame around the topic as it infers that the alternative is in some way “dirty”.

‘This can create avoidance around the topic and general, and even more so when talking about it. This contributes to STIs like HPV not being discussed, even though they are very common.

‘Much of what we are taught about sex is through a shame-based model, and this is particularly relevant when we talk about sexual health which is a stigma that just doesn’t exist to the same extent in other areas of our lives.’

Using terminology like ‘clean’ to describe being STI-free creates further stigma and shame around the topic as it infers that the alternative is in some way ‘dirty’

Meanwhile Counselling Directory member Jan Hall says it could also be down to STIs being associated with ‘promiscuity’, even though the fact is that anybody can catch something from a sexual encounter whether it’s their first or their 100th time.

Sadly, Jan tells us this stigma can ‘lead one to feel alone and abnormal.’

‘Shame begins to recede as soon as people discover the facts, that they are not alone’, she says, adding: ‘If we could talk about HPV in the same non-judgmental way we talk about, say, cold sores, there would be a lot of very relieved people around: those who have, or have had, a diagnosis, and those who may in the future. 

‘And the better informed we are, the more calmly and usefully we can support people close to us when they need us. 

‘It’s scary to broach the subject, so the best way to feel able to do so is to make sure you’re confident of the facts beforehand and choose a time and place where you won’t be interrupted or overheard. 

‘Talk calmly rather than making a huge deal out of it. People take their cues from one another, and as matter-of-fact as possible is the best way – if you can manage it.’

When you think about it, even reading articles like this and making sure you’re familiar with the facts about HPV and why it’s nothing to be ashamed of is helping to destigmatise and demystify it.

Like Jan says: ‘Every person who knows the actual facts about HPV is one more ally in the fight against stigma.’

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