I think it’s safe to say that no new vaccine has ever generated quite as many questions from parents or quite as much discussion on the media as the Human Papillomavirus Vaccine. That’s not surprising. It’s a vaccine designed to prevent the recipient from a sexually transmitted infection, and from the cancer that can result from infection. For best effectiveness it should be given several years before the onset of sexual activity. We usually target our 11- and 12-year olds for this vaccine, although it can be given at a younger age. The combination of talking about an STI and middle-schoolers in the same breath is bound to make any parent uncomfortable.
But we at Childhood Health Associates of Salem — and other pediatricians around the country — believe passionately in this vaccine. While the vaccine for hepatiis B vaccine does help prevent cases of liver cancer caused by the effects of the hepatitis B virus, this is the first time we’ve had a vaccine whose primary purpose is to save young people from a deadly cancer. Cervical cancer in young women can result in painful tests and procedures, loss of fertility, the need for hysterectomy at a terribly young age, and death. The same strains of HPV are also responsible for many cases of oral cancer in both sexes. We can prevent this, and can also prevent the corresponding disfiguring and infectious genital warts in both females and males, by a simple three-dose vaccine.
When I talk with parents about this vaccine, I get a variety of responses. Many want their children to have it ASAP, and don’t even have questions. Others have questions about efficacy (it works, the cervical cancer rates are already decreasing nationally) and safety (after-market research continues, as it does on every vaccine, and safety data continues to show no increased incidence of adverse events). Some want their adolescents to have the vaccine but want to wait a year or two more. Others tell me that they don’t want their young people to have the vaccine, because they believe that it isn’t necessary for their children or that it will somehow encourage their children to become sexually active at a young age. I want to gently suggest some reasons why that isn’t true.
- The odds are against you. Most teens experiment with some kind sexual activity during their school years. We know this from anonymous surveys, from experts who study adolescent sexual behavior, and from teen pregnancy rates. My own very conservative high school church youth group saw (in the 1-3 years after high school graduation, back in the 80’s) at least five unintended pregnancies amongst those who were about my age or a little older. None were still in high school, but none of those pregnancies were intended. If these young people, (all of whom had publicly and earnestly embraced the concept of chastity) were having sex, then you’d better believe that today’s teens are doing so. The average age of first sexual intercourse in this country is age 16.9. That’s just the average, so for every teen who is waiting until 18 or 19 there is one becoming active at 14 or 15… or younger.
- You can’t foresee the future. The girl or boy who follows their parents’ rules at age 12 and shows little interest in their developing sexuality may present a completely different picture at 16. Or 18. Or 22. You don’t know who they will meet, when they will leave home, where and if they will attend college, and what pitfalls they will encounter. Maybe they will travel, maybe they will join the military, maybe they will have friends who are a great influence, maybe they will have friends who terrify you. You can’t predict exactly what kind of person they will be over the coming years, and what part of your careful parental instructions will ‘stick’. And you will be unlikely to be able to drag that 18 year old or that 20 year old in for a vaccine, which will now be less effective than if it had been given earlier.
- There may be special risks that you don’t yet realize. The adolescent with ADHD, for example, will always be more prone to impulsive actions. In elementary school that may be limited to building catapults out of their desk supplies or jumping off of the garage roof, but as they get older, these impulsive actions may take the form of sexual risk-taking. Children with developmental disabiities are also at risk; they may head into their teenage years with a rapidly maturing body but a mind that isn’t ready to cope with sexual attraction and that can’t discern good intentions from seduction and predation. Mental illnesses such as schizophrenia and bipolar disorder typically present during the teen and young adult years, often with no signs during childhood, and those young people can place themselves at considerable risk with unwise sexual behaviors before their illness is recognized and controlled.
- Not all adolescent sexual contact is consensual, especially the first time. Date rape is an ugly thing, yet it happens every day to someone. Your teen may have every intention of saying ‘no’, but may find themselves either physically or emotionally overpowered or given substances to ensure their cooperation.
- Not everyone tells the truth to their eventual spouse, and many don’t know they are infected. Even if you’ve got one of those rare young people who can delay gratification and can pick their way through the minefield of teenage sexuality unscathed, they still aren’t safe from HPV. They can still get infected by that one special man or woman with whom they have chosen to spend their life. Maybe that person isn’t honest with them, or maybe they simply don’t realize that those illicit moments behind the bleachers in the 9th grade with their ‘crush’ gave them an invisible STD.
These are all sobering thoughts. Our goal is to help your adolescent get through these difficult years and end up happy and healthy at the end of them. Even if you consider your youngster to be relatively low-risk for HPV, we’d recommend that you have them receive this vaccine, for all of the reasons listed above. They can get this vaccine at any office visit or you can make a ‘nurse visit only’ appointment for shots. And if after reading this, you still have questions, please ask any of our nurses or providers.