Written by Emily Nagoski, Ph.D.
He explained the new guidelines for Pap smears and I told him that the Syphillis/Facebook correlation is bunkum. It was a nice time. Anyway.
For ten years, I taught young women to get annual exams starting when they were 18, whether they were sexually active or not.
Now the guideline is to start at 21 and test every three years until as long as the results are normal.
Why?
Because learning that you have HPV causes more drama than it warrants; young women in particular will clear the virus in a year or two and will never have any symptoms. Yes they may transmit it to partners, who will transmit it to their partners, but those partners and partners of partners will also have no symptoms and will clear the virus within a year or two. And the real kicker: it takes like ten years for HPV to cause cancer, apparently, so testing every two or three years will still get you an early diagnosis.
My own experience bears out the potential benefit of these guidelines. When I was diagnosed with HPV 700 years ago, I felt like someone had kicked my chair out from under me. Remember, I've been a sex educator for longer than I've been having sex, so to be diagnosed with an STI felt like both a personal and a professional failure. But it isn't. It's just a virtually inevitable consequence of having sex.
Then I had a colposcopy and a painful biopsy that put me in bed for 24 hours afterward. I got up in the middle of the night to pee, looked at myself in the mirror, and saw a white-lipped, hollow-eyed horrorshow looking back. My bloodflow, even 12 hours after the procedure, was so targeted to my cervix that I had to crawl back to bed on all fours so I didn't pass out en route. Then I lay in bed for an hour, singing the complete score of "Joseph and the Amazing Technicolor Dreamcoat" to myself whilst waiting for the ibuprophen to dull down the pain enough for me I to go back to sleep. It was a memorable night, equal parts laughable and pitiable, "like a wounded rabbit that keeps farting," as David Mitchell puts it.
I had follow-up Paps every three months for a year, then every six months for two years, and never again had an abnormal result.
If I hadn't had a Pap that year, I would never have known about it.
So I'm thoroughly convinced. I'll miss my entertaining nurse practitioner, who tells me about her son's drinking (she knows I do alcohol education on campus), but ever since the biopsy for some reason I've had an aversion to metal instruments up the vag, so see you in three years, babe.
Another issue of course is the accuracy of these tests. Herpes, for example, has a high rate of false positives and, the physician pointed out to me, the doc's not going to do anything about it anyway. With both HPV and HSV, latex is, well, partially protective, but these viruses are transmitted through skin-to-skin contact, so if you're having genital-to-genital contact it would take a LOT of coverage to ensure protection.
The realistic strategy? Just assume everyone has HPV and herpes and relax.
Which feels wrong and crazy to my students; the population I work with gets really FREAKED OUT about STIs. The idea of living calmly with an infection is utterly foreign to them.
I'm an educator. I'm not a medical professional, I'm not a counselor or therapist, I'm not even a researcher. A big chunk of my role is to serve as liaison between medical providers and the public, helping folks understand when to get tested, what to get tested for, what the results of those tests mean, and what to do about them.
I struggle each time to find a balance between caution and calm. Yes, use condoms. Yes, get tested as appropriate, but you don't actually need a full screen for everything. You don't even need to worry too much about a positive result. I worry about motivating students to protect themselves while reducing fear, stigma, moral judgments and shame that accompany Infection.
Because contrary to what most people might think, not everyone who has an affair ("concurrent partners" in public health speak) gets neurosyphillis, ya know? There is no system of crime and punishment in sex. There are just networks of people and the movement of critters through those networks.
How do I say, "Protect yourself, but don't worry"? I still don't know, after years of trying.
