No shame in learning about sexual health
The most obvious reason why abstinence-only education is terrible is the unintended pregnancies that frequently occur as a result from it. But there are actually even more serious potential consequences of denying people information about how to take care of their sexual health: When people aren’t taught how to protect themselves against easily preventable diseases, like cervical cancer, their lives are threatened, the health care system is strained, and we socially regress.
President Trump’s proposed 2018 budget includes $277 million for abstinence-only sex ed. If it passes, students will be even less likely than they already are to learn about things like their risk of contracting STIs. Instead, they’ll primarily be inundated with warnings about how dangerous and terrible sex is (spoiler: it’s not) and do it anyway—likely without protection.
I learned how little young people are educated about sexual health firsthand in January, when after my annual pelvic exam my doctor told me my pap had come back abnormal due to HPV (the human papillomavirus). I grew up in the San Francisco Bay Area, where we received comprehensive sex ed from a young age. We learned, among many other things, that if you’re sexually active, you should get a pelvic exam once a year, so at least I had been taught enough to be able to detect an STI. But I didn’t know that it was possible to have a dangerous STI without also having any symptoms.
Human papillomavirus, or HPV, is a sexually transmitted infection that most people will carry at some point in life—that is, unless we all pledge abstinence until marriage, which we’ve seen is pretty impossible. If you’re sexually active, you probably already have it; it’s been called the common cold of STIs. Many strains have no symptoms. Some cause warts. Others can lead to several types of cancer, usually in women. Men typically carry these strains without symptoms, although they can lead to cancer in some cases. They can pass HPV to other partners without ever knowing they were infected.
Cervical cancer is overwhelmingly the most common type of cancer associated with HPV. It can take years or even decades for HPV to cause precancerous cell changes and for the cell changes to turn into cancer. Pap tests can detect abnormal cells long before they become dangerous, and these abnormalities can be treated so that cancer doesn’t develop. There’s even a vaccine now, although it’s only effective if you’ve received it before you’ve been exposed to the virus.
This is a really big deal. Cervical cancer used to be the most common type of cancer death for women in the U.S., and now it’s the easiest to prevent. So the 11,000 cases of cervical cancer that still occur in this country every year shouldn’t be happening. But despite the ubiquity of HPV and the relatively straightforward nature of cervical cancer prevention, this issue is still greatly misunderstood.
Even among health professionals, there isn’t always consensus on how HPV works. One doctor told me it can only be contracted through unprotected sex, while a more experienced physician told me it can be passed through skin contact. What many people don’t realize is that the strains that cause warts and the strains that can lead to cancer are different, so you can have the more dangerous strains without any symptoms. I contracted a symptomless strain, and never had a clue that anything was wrong.
The next step after you get an abnormal pap is usually to have a colposcopy, in which your doctor uses a really powerful magnifying lens attached to a creepy-looking machine to get up close and personal with your cervix (the entrance of the uterus) to see what’s going on in there. They will likely take a biopsy, which means cutting off a small chunk of your cervix to study in a pathology lab. This will show how advanced the cell changes are and dictate what needs to happen next. My colposcopy wasn’t pleasant, but it wasn’t the worst either; it was kind of like an extra-uncomfortable pelvic exam that went on way too long. I felt crampy afterward, but it was nothing a couple ibuprofens and a pint of ice cream couldn’t fix.
I was lucky: My colposcopy found only low-risk cell changes, which meant I did not need to get any more procedures; low-grade changes often resolve on their own and just need to be monitored with regular paps. If the test had revealed more advanced changes, though, I would have needed additional treatments such as a LEEP procedure.
Perhaps most importantly, the process taught me that we live in a world where we still have to convince people, even ourselves, that women’s health matters. Since women are more likely to suffer the physical consequences of HPV, the disease and its effects are seen as a “special interest” issue. While annual physicals that include a pap are usually covered by health insurance as preventive care, the follow-up procedures necessitated by abnormal results—the procedures that actually do the preventing—aren’t always covered and women therefore often have to shoulder the expense of testing and treating it. I couldn’t help but think of the guys I’ve had sex with who may have HPV, too—who have likely continued to go about their lives as usual while I’ve been in and out of doctors’ offices and plunking down my credit card.
What’s more, since men usually don’t even know they have HPV, women also bear the brunt of the social stigma that is still associated with having an STI—even a ubiquitous one. And we internalize this stigma. I caught myself feeling ashamed and dirty knowing I was harboring high-risk HPV, despite the fact that nearly everyone has the virus, and that I’m supposedly a sex-positive feminist. If even I think this way, what’s somebody going to think who isn’t as educated or open-minded?
All of this goes to show that while high-risk HPV has the potential to get really scary, with the right education and preventive measures, it doesn’t have to be. And this doesn’t apply just to HPV and cervical cancer, but to other sexual health issues as well.
The lack of sexual health awareness in our country shows that abstinence-only education clearly doesn’t help. But we can work around this. If your school doesn’t give you the knowledge you need, you can find it online. Get your pelvic exam. If you have younger siblings, encourage your parents to get them the HPV vaccine.
Don’t just assume your friends and partners know how things work. Talk about it. The more we address sexual health issues, the less stigmatized they will become. Problems caused by lack of information are easy problems to solve. Where formal sex ed leaves off, we can keep bringing progress forward, one conversation at a time.
