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Misconceptions About the Safety of Oral Sex Worries Doctors

New York (Dec 1, 2011)

Much has been publicized about vaccines that target cancer-causing strains of the human papilloma virus (HPV) and their effectiveness for preventing HPV-associated cervical cancer. But there's a growing trend in the incidence of another type of cancer related to HPV: that of the oropharynx (the area at the back of the mouth and base of the tongue).

In fact, a recent study published in the Journal of Clinical Oncology in November reported a 225-percent increase in the incidence of HPV-associated oropharyngeal cancers between 1988 and 2004 (and a corresponding 50-percent decline in HPV-negative cancers). The authors concluded, "If recent incidence trends continue, the annual number of HPV-positive oropharyngeal cancers is expected to surpass the annual number of cervical cancers by the year 2020." HPV-16 is the strain linked to oropharyngeal cancers.

John S. Santelli, M.D., M.P.H.
John S. Santelli, M.D.,

The International Agency for Research Against Cancer has acknowledged HPV as a risk factor for oropharyngeal cancers. And a report issued in November 2010 by the U.S. Centers from Disease Control and Prevention (CDC) suggested that "we are encountering a slow epidemic of mainly sexually transmitted HPV-induced oral squamous cell carcinoma" – the most common cell type of oral cancer. (The vaccines that target cancer-causing HPV strains could lessen that burden, but to date they are not approved for preventing oropharyngeal cancer.)

With a diagnosis of oropharyngeal cancer may come a long and often grueling course of treatment that typically includes radiation therapy, chemotherapy, and sometimes surgery. Treatment lasts months and may significantly decrease a patient's quality of life by hampering appetite, swallowing, and nutritional intake.

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Oral sex is the major route of transmission for oral HPV. But there's a belief among many adolescents that oral sex is safe sex. "While it's true that having oral instead of vaginal sex prevents pregnancy and reduces the risk of transmitting HIV, there is still a risk of contracting other sexually transmitted diseases (STDs) – including HPV, syphilis, and herpes," explained John S. Santelli, M.D., M.P.H.

While data is limited on changes over time in the prevalence of oral sex, comparisons of behavioral data from the early 1990s and 2002 suggest little change in the rates of oral sex among young people. (National data on oral sex among teens are not available before 1990.) A 2002 CDC report found that the practice of oral sex among teenagers is slightly more common than vaginal intercourse; however, adolescents typically initiate oral sex about the same time that they initiate vaginal sex.

Gail M. Saltz, M.D.
Gail M. Saltz, M.D.

Many teens who engage in oral sexual behaviors believe they can do so because technically they are still "virgins." "There's less 'taboo.' Kids get hung up on labels," said Gail M. Saltz, M.D. "They may think that having just oral sex means you're still a virgin, but these kinds of labels are harmful and fudge reality."

"Teenagers may view oral sex as less physically intimate," added Dr. Santelli. They tend to divorce the emotional feeling from the physical act.

Moreover, the teen brain is biologically wired to take risks. "To tell a teen that he or she might develop oropharyngeal cancer in ten years after having oral sex...they're not programmed to fully process and retain that yet," added Dr. Saltz. "They may also feel that having oral sex makes them popular, but we have to ask them: Is this the kind of popular you want to be?"

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Both Drs. Santelli and Saltz encourage parents to begin speaking about sex with their children early and often. By age 12 or 13, most adolescents are already hearing about oral sex from their friends. If the child does not want to discuss it, parents can tell them they are there for them when they have questions.

"We encourage parents to talk about sex in the context of other family values," said Dr. Santelli. "Explain the risks of all sexual behaviors, including the potential for contracting STDs. If you start talking about it early" – even before adolescence – "then it will be easier later on."

Dr. Saltz noted that parents can tell their children that having a healthy sex life is okay, but encourage them to reserve it for someone they care for. They can advocate condom use not only to prevent pregnancy and STDs during vaginal intercourse, but during oral sex as well. And they can talk with teens about other nonsexual ways to be intimate.

"Any contact with someone else's genitals is an intimate act," concluded Dr. Saltz. "Teens may tell you it's no big deal, but it is, and it changes a person. Parents have to take the lead in talking to them about these issues, for both their emotional and physical health."

Contributing faculty for this article:

John S. Santelli, M.D., M.P.H., is Chair of the Heilbrunn Population and Family Health Department and Professor of Clinical Population and Family Health at the Columbia University Mailman School of Public Health, and also Professor of Clinical Pediatrics at Columbia University College of Physicians and Surgeons.

Gail M. Saltz, M.D., is Clinical Associate Professor of Psychiatry at Weill Cornell Medical College.

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