When America heard from Michael Douglas on Monday, June 3rd that his throat cancer may have been caused by the human papillomavirus (HPV) through cunnilingus (oral sex performed on a woman), many readers must have shuddered. Some by the thought of contracting oral cancer through performing oral sex and others by the thought of not receiving it anymore. After all, in a study quoted by the Kaja Sex blog (2013), coitus made women orgasm only 25% during their sexual escapades with their partners, “but oral sex brought them to climax practically every time.”

So let’s look beyond the CNN article, go a bit deeper into what is causing these cases cancer, the strain of the virus behind it, how many cases there are each year, and how you can reduce the risk of transmission.


So what is this human papillomavirus?

To understand the meaning of a term, I like to take it apart. “Human” is pretty clear, so is “virus”. But what about this Papilloma? Actually, we have two words combined here. Papilla is a Latin word and means “nipple/swelling”, and the Greek suffix ‘-oma’, in medical context, indicates a morbid (i.e. unhealthy) growth/tumor. So, the name itself means “a virus that causes unhealthy growth of nipple/swellings with humans.”

It received that name because the virus was first classified in 1956 to cause skin warts. However, since then, over 40 different types have been found and they infect various parts of the body from cervix, anus, general pubic skin area, feet to even inside our throat. In most cases, our immune system fights these infections and no symptoms develop. However, in some cases, cancerous cells can develop over time (usually many years). The strains HPV16 and HPV18 have been identified to be the main cause of cervical and anal cancer.

CC - Annual Number of cancer cases in 2006 by type
CC – Annual Number of cancer cases in 2006 by type

These numbers look high and, in fact, HPV is the most prevalent sexually transmitted infection in the United States. In fact, it is so common, that nearly all of sexually active individuals will get HPV at one point in their lives.

Now, let us compare some numbers from general HPV infection down to HPV-induced throat cancer cases to get a better picture:

Another disadvantage when it comes to oral HPV is being a man. Men are found to be both generally more infected with oral HPV and also suffer around 4 times more cases of HPV-induced throat cancer than women. The exact reasons for this imbalance are still unclear. Some speculate that hormonal differences in women might help protect them from the virus. Others deem that oral sex on women for some reason causes a greater likelihood of transmission. I also asked a question on HealthTap and Dr. Jeff M. Livingston responded that “the current thought is that the vagina harbors HPV more frequently, therefore, so men performing oral sex are at higher risk.

Besides oral sex, it is even speculated that oral HPV can be transmitted by kissing or other means as in some studies indicate, where patients diagnosed as HPV positive never had sex or oral sex.


HPV-induced oral cancer cases on the rise

Dr. William Owen, photo from owenmed.com
Dr. William Owen, photo from owenmed.com

To get a perspective on the trend of these HPV-induced throat cancer cases, I talked to Dr. William Owen in the Davies Medical Center. He has been working with sexual health before HIV was even known and can provide a truly holistic view:

“It has been said that we are witnessing a rise in diagnoses of oropharygeal cancer attributable to HPV over recent years. This increase is definitely a phenomenon that I’ve observed over the 3.5 decades that I have been in private medical practice in San Francisco.

I think that the key to this rise is the latency, that is, the long ‘incubation period’ between the time one is infected with HPV and the time when he or she begins to develop manifestations of cancer. We see this pattern of latency with HPV-related anal and cervical cancers as well.”

And on the note that Michael Douglas might have stated that cunnilingus was also the best cure for throat cancer, Dr. Owen crushes our hope for this false remedy but thanks Michael anyway:

“I think that Michael Douglas was being a bit facetious when he was quoted as saying that cunnilingus is the best cure for throat cancer. Although the statement might seem outrageous, time and again we’ve seen that whenever a star weighs in on some serious disease, people listen. Farah Fawcett did this for anal cancer, Rock Hudson and Elizabeth Taylor for AIDS, Michael Fox for Parkinson’s, and the list goes on. The point is that these luminaries raise public awareness about these often neglected medical conditions.”


How to reduce risk of transmission of oral HPV

There are a number of options available today to prevent or greatly reduce the risk of an oral HPV transmission:

  • There is a vaccine! Gardasil is available today for men and women under 26 (Cervarix for women). It protects the body against the dangerous HPV types 16 and 18 that are related to various types of cancers, as well as type 6 and 11 which are related to genital warts. Ideally, the three shots should already be given to children at the age of 9—way before they become sexually active and are exposed to the virus. So, get vaccinated if you are under 26. Unfortunately, way too little Americans are receiving all three shots of the HPV vaccination today.
  • There is a condom for cunnilingus. It is called a dental dam, a 6×6 inch latex sheet that can be placed over the vagina or anus. Check out the Blisstree blog for more information and instructions.
  • Keep good oral hygiene and ask your dentist to include cancer screening of the posterior areas of your mouth in your annual dental exam. As with so many conditions, treatment options and success rate will be tremendously higher if the cancer can be detected early.
  • Reducing Partners: The Mount Sinai Medical Center in New York estimates that men who give oral sex to 6 or more women are 8.6 times more likely to contract HPV-induced throat cancer than those men who never had oral sex.

On the regular oral cancer screenings, Dr. Owen also states:

“The key is to be aware of your body and to see the doctor to check out any suspicious growths, whether in the mouth, on the tongue, or in the neck glands (lymph nodes). That’s because the earlier you find these cancers, the more likely it is to treat them successfully. So remember that your dentist can be a powerful ally in helping to diagnose mouth related cancers at an early stage.”

To sum it up, a huge part of our society is affected by HPV; many carry the virus orally and 1% even carries the high-risk HPV16 strain. However, as Dr. Debby Herbenick concludes in Men’s Health (2011), “most people who give or receive oral sex will not get HPV. And most people who get HPV will not go on to develop cancer.” Again, it’s our immune system that keeps the virus from developing further in most cases. So keep that immune system up and running and reduce your risk as appropriate.


Follow up action for you

Please make a list of your relatives and friends with children. Give them a quick call and ask them or their parents if the HPV Vaccination has been given. Insist that it should be given to boys as well as girls. And as Dr. Owen recommends: “Even if they missed that age 9 to 14 timeframe, do motivate them to get vaccinated against HPV as soon thereafter as practicable.

HPV Gardasil
CC – Gardasil vaccine and box by Jan Christian

This will be your good deed for today!

Modified from post on Before We Do blog on 06/04/2013.

Stefan Broda
Business Insider calls him one of the 13 most badass immigrant entrepreneurs in the Silicon Valley. That description stems most likely from his latest startup BeforeWeDo which empowers Americans to test for HIV/STDs at home. The startup is experiencing promising traction and support, having won Startup Weekend in San Francisco, been featured at SF Pride and now won the 14th Founder Showcase. Stefan's previous professional experience includes SAP consulting at IBM in China and co-founding BizSphere, an enterprise software startup in the area of sales enablement. In those years, he has established himself in a space that overlaps engineering and business, therefore organizing development, multi project management, 2nd and 3rd level support, requirement engineering, Q&A, sales support and partner management.


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