This week in Comprehensive Women’s Health, we covered cervical cytology, which of course includes a long discussion about HPV, one of my favorite party topics. Since I had my own personal cervical dysplasia debacle several years ago, I’ve gotten a little uppity about the subject, wondering loudly why HPV isn’t one of the standard STI tests, and why there isn’t a test at all for men. Perhaps you’ll recall that a provider told me that it’s “too prevalent and too uninteresting,” and that someone else likened cervical cancer to skin cancer, in that you can’t really help putting yourself at risk.
ACOG’s recommendations for Pap smears have recently changed, and the new protocol is to start Pap’ing women at age 21, regardless of the age of what my professor refers to as “sexual debut,” then Pap every 2 years until age 30, and every 3 years after that, assuming everything’s normal. (“Sexual debut” always makes me think of the Diana Ross song, “I’m Coming Out.” One friend asked if she also used the term “sexual sophomore slump.”)
ANYWAY. The understanding these days is that pretty much every girl has HPV on her cervix soon after she becomes sexually active, and that pretty much all of these girls’ immune systems get rid of HPV within three years. According to ACOG’s December 2009 practice bulletin on the subject, 91% percent of HPV infections in young women are gone by the time three years have passed. This is a big reason why there’s much more of a wait-and-see approach to dysplasia treatment these days.
I also learned that a lady’s cervix changes as she gets older, making it less susceptible to HPV infection! The area that is most likely to harbor precancerous lesions is called the transformation zone. This is just inside the cervical opening, where there is a transition between endocervix (inside the cervical canal that leads to the uterus) and ectocervix (the exposed part at the top of the vagina). Ecto- and endocervix are made of two different kinds of cells. In younger women, this area is closer to the outside of the cervix, but as we get older, it retracts further inside the cervical canal, making it less accessible to cooties. But even though younger women are more vulnerable to infection, their immune systems usually take care of it, like a cold. It’s the infections that stick around until you’re in your mid-twenties and beyond that require further monitoring and treatment, because those are the persistent strains that are more likely to develop into something bad.
Ass-kicking immune systems and structural changes are two physiological reasons that I can get behind for chilling out about HPV infection until women are a little older. The cellular changes caused by HPV also develop extremely slowly, so it makes sense to do Pap smears less frequently.
But still, ladies, I implore you: get yer junk checked on some kind of schedule. Cervical cancer is usually pretty easy to nip in the bud…as it were.
