The HPV Vaccine. Protecting Your Adult Child From Their Own Adult Decisions?

A medical news article entitled, “Increasing HPV Vaccination Coverage Needed To Decrease HPV-Associated Cancer Incidence,” caught my eye and took me back to my days at Fairview when I was on the Quality committee. The HPV (human papilloma virus) vaccine (Gardasil) had just been release. The chairman of the committee, Mike Dummer, MD, told everyone that we needed to get as many adolescent girls vaccinated as possible. In order to do that, he said, we should present the vaccine to the mothers of these youngsters as a vaccine to prevent cancer of the cervix. We were not to use the word “STD” or sexually transmitted disease when speaking of the vaccine. He feared mothers of adolescent girls would refuse to have their daughters vaccinated if we called it an STD vaccine.

I challenged him and told him I thought that approach was wrong and could violate Fairview’s diversity and tolerance policies by not being culturally sensitive to devoutly religious folks, Christians in particular. I knew some Christian women who did not want their daughters vaccinated against an STD. He shot back that I was wrong, that it was important to tell them it was a cancer vaccine. After all, we didn’t tell patients with cervix cancer or an abnormal pap smear that it was caused by an STD. I challenged him again and told him I always told my patients with an abnormal pap or cancer of the cervix that the disease was from an STD, more likely in those with early onset sexual activity and multiple life time partners. He was truly surprised, that I would honestly share that information with my patients. The conversation ended with him sticking to his guns, that we should not tell moms of young girls that the vaccine was intended to prevent an STD which caused 70% of cervix cancers.

There were probably 15 docs at that meeting. None supported me. I resigned from the committee after that. I could see I didn’t belong there.

I’ve spoken with doctors and patients who fall on both sides of the issue, but most advance the notion that young girls (and now young boys) should receive the vaccine.

Protecting children from physical harm is a parental duty and cervix cancer causes real physical harm. So, aren’t we obligated to protect our young girls from this STD and get them the vaccine? No, I don’t think so. We can give them the vaccine, of course, as many do. But we are not obligated to do so as I argue below.

A child does not catch an STD by a sneeze or a cough so I can’t place this vaccine in the same category as the vaccine for whooping-cough or measles. If I had a preadolescent or adolescent daughter at home today, I would speak to her around the time of her menarche of the availability of the vaccine, its purpose, its effectiveness and encourage her to remain chaste until marriage. Should she decide to become sexually active prior to that, she would be making an adult decision and it would be her job to make another adult decision and go to her own doctor for the vaccine if she wished to receive it or talk to me about her desire to receive the vaccine. And once she were 18, she could make up her own mind without my input.

Cervix cancer is an adult disease. Currently, the CDC doesn’t even recommend a pap test for any woman until age 21. Receiving the vaccine before exposure to the HPV virus 9,11,16 or 18 will theoretically stop 70% of cervix cancers since 70% are caused by 16 and 18. (9 and 11 cause warts.)  Fortunately, even without the vaccine, cancer of the cervix is uncommon and is treatable in its pre-cancer state. 50% of cases of cervix cancer occur in women who have never (that’s right, never) had a pap test.

And, I would contend that sexual intercourse is an adult act.

I have difficulty generating excitement about protecting my adult children from an adult act for which they are responsible.

The other side of the argument cites the irresponsibility and rebelliousness of adolescent boys and girls who may have sex. Is that really an adult act? Shouldn’t you protect her then? What if your daughter gets raped at age 14? Wouldn’t you want her protected in that event? And what about those cultures in our society in which sex at age 15 or 16 is accepted as the norm, multiple partners are the norm and marriage is rare? I’m thinking of inner city minority populations where 80% of babies are born to unmarried women. Shouldn’t they receive the vaccine at age 10 or 11? Shouldn’t you push hard to get them vaccinated, even if it involved lying to them as in, “This is a cancer vaccine, not STD vaccine?”

My own approach on this issue is to inform patients of the vaccines availability but encourage no sex until marriage and one partner for life. That’s a medical recommendation. (What? A medical recommendation?) By remaining chaste until marriage and having one partner for life, an entire plethora of disease can be avoided, including HPV, HIV, Chlamydia, gonorrhea, genital herpes, pelvic inflammatory disease, infertility, hysterectomy and on and on. That’s what I mean by encouraging no sex until marriage, then one partner for life being a medical recommendation.

Think of this. No doctor hesitates to scold a patient for smoking cigarettes and tell them to quit smoking because of the increased risk of lung cancer, heart disease and emphysema. No doctor hesitates to scold the overweight patient and tell them to start exercising and losing weight because of the increased risk of high blood pressure, diabetes and heart disease. No doctor hesitates to tell a patient to wear their seat belt, lower their cholesterol, treat their high blood pressure, get their eyes checked, and on and on and on.

Why the taboo against recommending abstinence until marriage and one partner for life to avoid the diseases which result from promiscuous sexual activity? Mainstream medicine conveys the message that adolescents will have sex like rabbits anyway, so limit disease and pregnancy. Get the vaccine, wear a condom, use birth control, have an abortion if the birth control doesn’t work, don’t ruin you life with a (gasp!) baby.

Only, that message hasn’t worked, doesn’t work and won’t ever work. Just look around. God knew what He was doing when He defined marriage as the union of one man and one woman and that sex outside of the marriage bond was sin. He defined this morality which, no surprise to me, is medically spot on.