You're Teaching My Child What? (17 page)

Gardasil is good news, but it's important to remember that it doesn't solve everything. There is much we don't know, and won't know, for decades. How long does protection last? Will the vaccine affect girls' natural immunity against HPV? We also don't know how it will affect pre-adolescent girls—or how it will affect screening practices. Will the vaccine give girls a false sense of security? One Youtube account tells of a pre-teen telling her friends on the playground, “Hey,
I just got that safer sex shot.” Will vaccinated girls and women be less likely to go in for Pap tests? There are about 17 other cancer-causing HPV types, so even vaccinated women must continue to be regularly screened. And we don't know if, as a result of the suppression of two of the strains by the vaccine, the other dangerous strains could become more common, or new ones will emerge.

So what's the bottom line? While the vaccine is a welcome development, the most effective way for a girl to avoid cervical cancer is by making smart decisions and delaying sexual activity.

It may not be politically correct. But it's true.

In May 2007, a group of surgeons and cancer specialists reported on the increasing incidence of oral cancers in young adults.
³³
Oral tumors used to be considered diseases of people in their 50s and 60s who smoked and drank heavily; young people were at very low risk.
³⁴
But surgeons have been seeing younger patients
³⁵
who are neither smokers nor drinkers.

The risk of oral cancer in these patients was related to their sexual behavior: having more than five oral-sex partners in their lifetime increased their risk a whopping 250 percent. Evidence that the throat cancers—a type found at the base of the tongue and in the tonsils—were caused by HPV was called “compelling.” So here's one more way this virus does harm—by traveling from genitals to mouth, and quietly causing deadly cancers in the throat.

This finding is particularly relevant to sex educators, because by ninth grade, that's age 14 or 15, 20 percent of students have had oral sex.
³⁶
Online “sexperts” inundate kids with detailed and graphic information about this activity, portraying it as safe and normal. More than a year after the report,
gURL.com
's
³⁷
newsletter (delivered right to
your daughter's email account) read: “Martina's not afraid of a little man juice”
³⁸
(“. . .
ewww
. . .
it's so sticky. . . and a little salty
....
”)
But no mention here of HPV-related oral cancer.

Do teens use protection for oral sex? “Never happened, never will,” says Lisa, 15. The NCHS [National Center for Health Statistics] study found the same—only nine percent of the teens surveyed reported using condoms for oral sex.

What's the problem here? Why so much unsafe behavior? It's due to abstinence education, says Teen Talk. “Since abstinence-only education doesn't teach about safer sex, many teens may not be aware of how to reduce their risk of infection during oral sex.”
³⁹

What a blunder. I'd say Planned Parenthood, which runs Teen Talk, missed an opportunity here. Instead of trashing the enemy, they need to sound an alarm:
Having oral sex with multiple partners is associated with throat cancer. Don't do it!

Planned Parenthood is not the only group guilty of ignoring this critical finding: I find no mention of it by SIECUS, on Columbia University's GoAskAlice, or any other of the dozen websites kids are directed to for “medically accurate” sexual health information.

Where are the red flags alerting kids that oral sex can be hazardous? Where are Scarleteen's and Sexetc's activist campaigns urging them to stop? As of this writing, almost two years after the report, they have yet to be seen.

Chlamydia is the most common bacterial STD in the United StatesIn 2006, reported infections hit an all-time high—a million new cases, up 5.6 percent from 2005.
⁴⁰
Usually asymptomatic, chlamydia is notorious for the damage it causes to the female reproductive system: pelvic pain, ectopic pregnancy, and infertility. Girls are
instructed
: If you get an annual check-up, chlamydia can be caught. If you take antibiotics, you'll be cured.

My patient Delia was reassured in that way. She was a graduate student whom I saw while working in UCLA's student counseling center, and I told her story in my 2006 book,
Unprotected.
⁴¹
Delia had chlamydia years before I met her, during her wild freshman year. She and her boyfriend took antibiotics as instructed, and were declared cured. I explained in the book why this was inaccurate and misleading, and I want to explain it again here. Young people, especially women and girls, deserve to know how chlamydia can evade detection and cause persistent problems—even with yearly exams and antibiotic treatment.

Chlamydia's mission is to travel all the way up the genital tract: from the vagina, through the narrow cervical opening, to the uterus, and finally, to enter the fallopian tubes. It might succeed in reaching its destination by hitching a ride on some sperm. In the tubes, the bacteria settle in. The immune system responds to the invasion, and there's probably some swelling and pus. It may cause fever and pain, or it may not.

But the dangerous part isn't the tubal infection, it's what's left when it heals: a scar. The fallopian tubes, where fertilization occurs, are only about one millimeter in diameter. A tiny scar here can cause infertility, or worse.

A fertilized egg—which is much larger than sperm—that's moving toward the uterus can be trapped when its path is narrowed by the scar. Unable to proceed, it will grow in the tube, causing what's called an ectopic pregnancy. Unless discovered at an early stage, the tube will eventually burst, causing sudden, enormous pain and bleeding: a medical emergency.

In
Unprotected
, I wrote:

Chlamydia infection is perilous because it can cause serious damage without noticeable symptoms: no appreciable pain, fever, or discharge. A woman may be unaware of the infection until years later, when she tries to conceive. But her delicate fallopian tubes are scarred and narrowed—sometimes completely blocked. The intricate process of transporting the egg at the right time to the right place is now impossible. She's sterile, the doctor tells her, because of this bug she acquired in her care-free youth.

There's more here. Chlamydia infection may lead to fertility problems even when Delia's tubes are wide open and clean as a whistle. Amazing creatures that they are, when white cells recognize Chlamydia as a foreign invader, they memorize the bug's structure, especially that of a protein called hsp. Based on the contours of hsp, the white cells produce weapons to combat it: antibodies. White cells are like mobsters who never forget—they store the memory of Chlamydia HSP, adding it to their hit list, should they cross paths again. And the memory is passed down, to all future generations.

Fast forward ten years: an embryo is growing safely in Delia's uterus. She's finally pregnant. Time to celebrate? Not so fast. The embryo makes a protein, one that happens to be a type of HSP. That's
not good. Delia's white cells are unable to tell the difference between the earlier HSP, and the new one. Her defense system concludes: the enemy—Chlamydia—is back. Antibodies are released, and the “invader,” the embryo, is destroyed... a miscarriage.

Bottom line: Chlamydia infection is a complex issue, about which there are more questions than answers. Following current guidelines is important, of course, but it's not a guarantee that one is out of the woods.

So why tell girls that there's a certain cure for Chlamydia? I've been asking that question ever since I discovered the real dangers of this ravaging bug. I dug up 1994 copies of
American Journal of Obstetrics and Gynecology
⁵⁰
and learned how the HSP reaction causes early pregnancy loss and decreased
in vitro
fertilization success years after antibiotic treatment. In a 1997 volume of the medical journal
Human Reproduction
⁵¹
I learned that even after treatment, Chlamydia DNA can be detected in the fallopian tubes, evidence that an earlier infection may not have been cured.

But as of this writing, “comprehensive” sex ed reassures our daughters: just come in for testing, take these tablets, and you'll be fine.

Well, maybe. Hopefully. But maybe not.

With ten million new STIs every year in young people,
⁵²
no wonder they're fed platitudes:
They're so common. Most people have one at some point.
Telling the truth, sharing stories like learn2luv's or all_alone23's might shake up students. We certainly wouldn't want to frighten them into changing their behavior; that would be what SIECUS and Planned Parenthood call
fear-based
sex education. Scare tactics, of course, have no place in health education.

Or do they?

Think about how other health topics are presented, like alcohol, illicit drugs, tanning beds, trans fats, and—of course—smoking. Subtlety is not the preferred mode of communication.

Consider an ad campaign in New York City called “Nothing Will Ever Be the Same.” “Smoking gave me throat cancer at 39,” says a poster showing a man named Ronaldo Martinez holding a metal device against his neck. “Now I breathe through a hole in my throat and need this machine to speak.”

The TV ad is more disturbing. Kids swim underwater in slow motion and happily splash about in a pool to the sound of a guitar. Mr. Martinez strolls nearby, fully clothed. An eerie, synthesized voice tells us, “I was born on an island where swimming was a way of life. I never thought that anything could keep me from the water. Then I got cancer from smoking cigarettes and lost my voice and have to speak through a hole in my throat. If water gets inside, it will drown me. I used to love swimming.”

Scare tactics? You bet. But as a result, says
The New York Times
, thousands of New Yorkers have quit the habit. The campaign, created in Massachusetts, was praised by public health officials in both states. The implication? The ends justify the means.

Educators especially love to warn kids about the dangers of lighting up. Just look at
Sexetc.org
, a site recommended by Advocates for Youth: