In my senior year of high school, I had a boyfriend I’ll call Drew.* He attended a different school, wore a pony tail, smoked pot, and was kind of goofy – all traits that were high on my list of preferred partner characteristics at the time. He became my first sexual partner.
About 6 months into the relationship, during that summer, I noticed what looked like little warts between my vagina and my anus. “What the hell? This can’t be a good thing.” I was just befuddled – could something like warts come from having sex? I was frustrated by my lack of knowledge, felt stupid by how little I knew, and angry that I had no one to talk with about it. If I’d had warts on my foot, I’d go to my mom and ask her about it. Why was sex so secretive?
I told my mom I needed to see her gynecologist for some bumps on my skin down there. She looked at me skeptically, but she didn’t ask me many questions. I think she didn’t want to know. I remember the physician telling me that the warts could be caused by having sex with someone who has them, but there were other ways one could get them too. I latched onto that second phrase and told my mom that the doctors don’t know what caused them but that they weren’t caused by having sex. Once again, the skeptical look. That was about the extent of the conversation – my mom and I were not very conversational at that time, especially about sex.
If you’ve had 3 or more sex partners, you likely have or had an infection with the human papilloma virus (HPV). HPV is the most common sexually transmitted infection (STI) in the world. Almost 80 million Americans are infected – and about 80% will never know it. It is a very, very common infection.
Of the 200 or so types of HPV, most do no harm at all, some cause genital warts, called condyloma, and others can cause cancer. Types 16 (the most common) and 18 cause cancer of the cervix (~100%), anus (~90%), vagina and vulva (~70%), penis (~60%) and throat (~65%).
Mouth and throat (oropharyngeal) cancer is on the rise — and is attributed to oral sex. Over the past half-century, the age at initiation of oral and genital sexual activity has declined leading to an increase in the lifetime number of oral sex partners.,, This factor, more than age, gender, or race/culture has been found to be responsible for the increase in HPV-positive oropharyngeal cancer. The number of cases of oropharyngeal cancer now exceeds the number of cervical cancers caused by HPV each year in the U.S.
Up until the early 1900s, warts found anywhere on the body were known to be contagious, including those on the genitals, throat, feet and fingers, and were all attributed to the “human wart virus.” But in 1901, a dermatologist identified a link between genital warts and oral condyloma. Dr. M.L. Heidingsfield reported the case of a 24-year-old ‘puella publica’ (prostitute). She presented at the clinic with ringworm on her left cheek and neck which were “promptly and efficaciously removed with a few applications of Wilkinson’s ointment.” Upon further examination, she was also found to have syphilis and a ‘peculiar warty growth’ in the center of her tongue with a few additional papules at the tip. He found similar growths on both labia majora, “though slightly more exuberant and more cauliflower-like in their appearance.”
He suspected that the patient had acquired the warts on her tongue from providing oral sex, but she denied having engaged in ‘coitus illegitimus’ which was illegal. Nevertheless, he was comfortable with his diagnosis of “condylomata acuminata linguae,” (genital warts of the tongue). However, some of Dr. Heidingsfield’s medical colleagues took exception believing the growth on the tongue to be either simple warts or syphilitic lesions. So, the following day, Dr. Heidingsfield removed some of the warts from her tongue and some from her labia “by means of curved scissors” for comparison. The similarity between the two specimens under the microscope was unmistakable. By the time he wrote up his case study for journal publication, another ‘puella publica’ appeared in the clinic with a more extensive case of oral and genital condyloma. “Coitus illegitimus was [again] strenuously denied.”
There is no test that can tell you which kind of HPV you are infected with or whether it will persist or not. The diseases that are caused by HPV (cancer, condyloma) can be treated, but we have no way to actually kill the virus itself. About 90% of HPV virus infections are spontaneously cleared from your body by your immune system within two years. But during that time, the virus can be passed to others. The other ten percent persist and lead to precancer and cancer.
As of right now, the best way to deal with HPV is to prevent HPV. Current HPV vaccines all protect against HPV types 16 and 18 and many more types as well. They will, therefore, protect against genital warts, and cancers of the mouth and throat, cervix, vagina, vulva, anus, and penis. Vaccination of boys has become as vital to men as vaccination of girls is to women.
Back in my mom’s gynecologist’s office my warts were easily treated by coating them with a stinky toxic resin called podophyllin, made from the roots of the American Mandrake plant (like something Professor Sprout would make at Hogwarts). It required a few visits to the doctor’s office but it is an easy, routine procedure that does not cause pain. It is covered by insurance.
Treatment of HPV-induced cancers, like treatment of all types of cancer, is difficult and invasive. Most are treated with surgery – excision of the affected areas – which may be followed by chemotherapy, radiation, and/or immunotherapy, especially if the cancer has spread to other areas of the body.
My Pap smears had been fine through the years, but in my 40s I developed cervical dysplasia, a disturbance of the cells on the surface of my cervix that are a marker for the potential development of cervical cancer. I had to have a colposcopy, which I remember well.
I’m lying on the usual exam room table with my feet up in the stirrups. The physician sitting between my legs puts the speculum in, which spreads the walls of my vagina apart so she can see my cervix. Then she looks through a big instrument called a colposcope. It looks like a cross between the x-ray machine in the dental office and the contraption the ophthalmologist looks through at my annual eye exams. Through the colposcope, the clinician can see a magnified view of my cervix. She can identify any areas that look suspicious or unusual. Those spots she targets for biopsy.
She takes a long metal instrument with tiny claws on the end with which she removes chunks of cells from my ectocervix (the skin on the outside of the cervix) and possibly from what she can see within the endocervix (the pathway that leads from the outside of the cervix up into the uterus) or from any other areas on the cervix or vagina that look odd. She tries to remove any suspicious-looking areas unless they are too large, in which case surgery would be the better option. Despite local anesthesia, I had to rely on my childbirth breathing training to get through the biopsies! Ouch! The pieces of tissue that were chomped off my cervix were sent to a lab to ensure that there were no cancerous or pre-cancerous cells present.
Waiting those few days for results was distressing. I was relieved when the results came back negative – none of the cells were cancerous. If they had been, I’d have had to return for a more extensive excision of areas of my cervix. I had my Pap smears repeated at six-month intervals for a while, then annually, but the results have been fine ever since. I’m pleased that I did not have to go through that again – or worse. I wish the HPV vaccine had been available when I was 11. I might have avoided those warts – and the abnormal Pap test. I’d happily trade a colposcopy for a vaccination. And I hope you will too.
* Names have been changed in respect for people’s privacy (and to protect me from lawsuits).
 Lieblong BJ, Montgomery BEE, Su LJ, and Nakagawa M. Natural history of human papillomavirus and vaccinations in men: a literature review. Health Science Report 2019;2:e18. Doi.org:/10.1002/hsr2.118
 University of California, Santa Barbara. Sex Info Online. Increasing popularity of oral sex in the United States. 16Apr2019. Accessed 7Apr2020 at https://sexinfo.soc.ucsb.edu/article/increasing-popularity-oral-sex-united-states
 Bajos N, Bozon M, Beltzer N, Laborde C, Andro A, Ferrand M, et al. Changes in sexual behaviours: from secular trends to public health policies. Aids 2010;24:1185-1191. doi: 10.1097/QAD.0b013e328336ad52
 Turner, C.F., R.D. Danella, and S.M. Rogers. (1995) Sexual behavior in the United States, 1930-1990: Trends and methodological problems. Sexually Transmitted Diseases 22(3):173-190.
 D’Souza G, Cullen K, Bowie J, Thorpe R, Fakhry C (2014) Differences in oral sexual behaviors by gender, age, and race explain observed differences in prevalence of oral human papillomavirus infection. PLoS ONE 9(1): e86023. https://doi.org/10.1371/journal.pone.0086023
 Senkomago V, Henley SJ, Thomas CC, Mix JM, Markowitz LE, Saraiya M. Human papillomavirus–attributable cancers — United States, 2012–2016. Morb Mortal Wkly Rep 2019;68:724–728. DOI: http://dx.doi.org/10.15585/mmwr.mm6833a3
 Centers for Disease Control and Prevention. STI estimates fact sheet. Available at https://www.cdc.gov/std/stats/STI-Estimates-Fact-Sheet-Feb-2013.pdf