Can HPV really lead to cervical cancer?

Human papilloma virus, or HPV, affects nearly all sexually active men and women at some point in their lives. Many people “clear” or fight off their infections without ever knowing that they had an infection at all. However, a percentage of people with the virus do not clear their infections and may develop genital warts, cervical cancer, or other types of cancer.

We spoke to Dr. Terez Yonan, an adolescent medicine specialist at CHOC Children’s, to get the facts on HPV and how it can indeed lead to cervical cancer.

terez-yonan-do
Dr. Terez Yonan, an adolescent medicine specialist at CHOC Children’s.

How common is HPV?

There are nearly 80 million people currently infected with HPV in the United States, according to the Centers for Disease Control, and nearly 14 million people, including teenagers, become infected with HPV each year.

How does HPV lead to cervical cancer?

The most common way to contract HPV is through sexual contact, from a direct transmission from one person’s genitals to the other. When transmitted vaginally, the HPV cells will integrate into cells of the vaginal wall and cervix. This changes the composition of the normal, healthy cells and you end up with dysplasia, also known as abnormal and pre-cancerous cells. This can worsen and turn into cervical cancer.

For people with a normal immune system, it could take years for HPV to turn into cervical cancer, but for someone who is immune-compromised, that process could take just a few months.

HPV does not always lead to cervical cancer. There are what we call high-grade infections and low-grade infections. Low-grade infections are easily cleared by the body on its own. It takes about two years for a healthy person to clear HPV. High-grade infections can last longer in the body and put you at risk for cervical cancer or genital warts. Although not considered dangerous, genital warts are unsightly and can cause irritation depending on where they are. If not treated, warts can grow into different types of cancer, including oral and anal and penile cancer.

What are the warning signs of cervical cancer?

Most of the time, people don’t know they have HPV because there are no warning signs. In some cases, genital warts may appear. Abnormal vaginal bleeding can be a sign of cervical cancer. If you notice abnormal bleeding, consult your primary care provider, gynecologist, or adolescent medicine specialist.

Can I get tested for HPV?

A Pap smear, also called a Pap test, is a pelvic exam designed to test for cervical cancer in women. An HPV test can be done using the same sample of cells collected during a Pap smear.

When should I get my first Pap smear?

A Pap smear is intended for healthy, sexually-active people. They are generally not recommended before 21 years of age. For people who are immunocompromised, Pap smears are recommended when you become sexually active regardless of age because of the increased risk for picking up infections , and for those infections to more quickly develop into cancer.

How often should I get a Pap smear?

Someone who is immunocompromised needs two Pap smears within the first year of becoming sexually active. If those are normal, the exam can be done annually. Healthy women in their 20s need a Pap smear every three years. Beginning at age 30, Pap smears can usually be done every five years.

Who can do my Pap smear?

You can get a Pap smear from your adolescent medicine specialist, family medicine provider, internal medicine provider, or gynecologist. Nurse practitioners and physician assistants  in each of these offices can perform the exam as well.

What does an abnormal Pap smear mean?

If your results are abnormal, you will undergo more frequent Pap smears for monitoring, until your results are in the normal range. The frequency of these Pap smears will be determined by your doctor, but it could range from every three months to every year. Since many people’s bodies clear HPV on their own, when the results are clear again, you will return to an every three- or five-year schedule for Pap smears, depending on your age.

Your doctor may suggest a colposcopy, another type of cervical cancer test. This gives them a better view of your cervix. If they identify cells that may be abnormal, they will perform a biopsy and remove a tiny sample of tissue from either the inside or outside of your cervix. If the biopsy confirms the presence of abnormal cells, your doctor will discuss specific treatment options.

How can I prevent cervical cancer?

Receiving the HPV vaccine is the only way to protect against cervical cancer. Each year in the U.S., 13,200 women are diagnosed with cervical cancer. This number has decreased since the introduction of the HPV vaccine.

What happens if I get cervical cancer?

If you are diagnosed with cervical cancer, you will be referred to a gynecologic oncologist—a doctor who specializes in cancers of the female reproductive system. Most cases require chemotherapy, and some require radiation as well. Surgery may be a treatment option.

Get more facts about HPV

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Does my child need the HPV vaccine?

Human papilloma virus, or HPV, affects nearly all sexually
active men and women at some point in their lives. Many people “clear” or fight
off their infections without ever knowing that they had an infection at all. However,
a percentage of people with the virus do not clear their infections and may
develop genital warts, cervical cancer, head and neck cancers, and penile
cancers.

We spoke to Dr. Marisa Turner, a CHOC Children’s pediatrician, on the most common myths she hears from parents regarding the HPV vaccine.

dr-marisa-turner-choc-childrens-pediatrician
Dr. Marisa Turner, a CHOC Children’s pediatrician, addresses the most common myths about the HPV vaccine.

Myth 1: My child is
too young. They don’t need the vaccine yet.

Some parents decline the HPV vaccine because they think
since they have years until their child is sexually active. However, many
parents don’t realize the vaccine is more effective the earlier it is given.
The immune response to the vaccine is better when given younger, therefore only
two doses are needed if the series is started prior to the 15th birthday.

The
number of recommended doses depends on the child’s age when they receive their
first dose.
A two-dose series is given for children starting the
series before their 15th birthday. Children who start the series on
or after their 15th birthday will receive a three-dose series.

Myth 2: You can only
get HPV if you’re sexually active.

Although sexual intercourse is the most common way to get HPV, it is
not the only way to get it. It could take just one encounter to catch the
virus, and most people who carry the virus have no symptoms and don’t realize
they even have it. Even for those that are having protected intercourse, you
can still catch HPV despite using a condom.

Myth 3: Giving my
child the HPV vaccine will make them become sexually active.

Multiple studies have shown that giving this vaccine doesn’t
increase rates of sexual activity in those patients compared to those who don’t
receive it.

It’s important for adolescents to take a part in their own health
and begin to realize that decisions they make now can affect them later in life
and their future health.

Myth 4: Getting the
vaccine will guarantee my child does not contract HPV.

Most adults are likely to get HPV at some point in their
lives. Some people clear it on their own, but others do not. If your child is
vaccinated against HPV and later contracts HPV, it’s s likely to be a strain
you can clear on your own.

The HPV vaccine prevents against the nine strains of HPV
most likely to lead to cancer. About half of all new infections are in people 15-24-year-olds,
the peak age at which one should receive the HPV vaccine.

Myth 5: HPV only affects females, so my son does not need the HPV vaccine.

The HPV vaccine has benefits for males too. It prevents oral,
anal and penile cancer, and genital warts. Getting vaccinated will also help
prevent them from passing it on to other partners, which can happen even in the
absence of visible symptoms of HPV.

Myth 6: This vaccine
is new, so it must not be safe enough to give my child.

The HPV vaccine was first administered in 2006. Prior to
coming to market, it was studied for many years. Ongoing studies have tracked
patients for years after receiving the vaccine, and they have not shown any
adverse effects. The HPV vaccine is administered and studied all over the
world.

Each year in the U.S., 13,200 women are diagnosed with
cervical cancer. This number has decreased since the introduction of the HPV
vaccine.

Myth 7: My child
doesn’t need the HPV vaccine. If they contract HPV, we’ll just treat it.

There is no good treatment for HPV. Some strains clear on
their own, but others do not. It’s better to get vaccinated and lower your risk
of getting HPV in the first place.

Myth 8: Getting the
HPV vaccine will affect my child’s fertility later in life.

Receiving the HPV vaccine will not affect fertility. However, having HPV can cause changes in the cervix which can later affect fertility.

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Ask a CHOC Doc: How can I safely gain weight?

Question: I am underweight, and don’t feel like eating sometimes. I am tired of not being able to gain weight. I tried talking to my doctor about it, but she didn’t give me a chance to explain; all she said was to eat more. When I was diagnosed with depression I wouldn’t eat as much and a part of that stayed with me I suppose. I don’t get hungry even when I want to eat. There is this supplement called Apetemin that helps people gain weight by making you feel hungry and slowing down your metabolism. Would you recommend it? -Anonymous

Answer:

Identifying and maintaining a healthy weight is an important discussion, and a common one I have with teen patients. Here’s what I usually discuss with my patients:

  1. How to determine a healthy weight

To determine whether someone is medically underweight, doctors use a tool called Body Mass Index, or BMI. This is a calculation that uses height and weight to estimate how much body fat someone has. Doctors use it to determine how appropriate a someone’s weight is for a certain height and age. There are online tools to help you calculate your BMI at home.

BMI is the most common measure about what weight is appropriate for someone’s height—but there are exceptions to this guideline. BMI is not always the best measurement for everyone. To determine a healthy weight for you, have a conservation with your doctor. Work with them to identify a healthy weight.

  1. How to know when skipping meals is a cause for concern

It’s ok if you skip a meal every now and then because you’re stressed or sick. That’s normal. Some days our bodies are hungrier than others, and that’s ok. If skipping meals becomes a regular thing, or if you’re unable to complete meals on a regular basis, talk to your doctor. If you’re also experiencing stomach problems like vomiting or diarrhea, see your doctor.

  1. How appetite plays into mental health

If this feeling of not being able to eat accompanies sadness, worry or sadness, speak to your doctor. You can also speak to a trusted adult like a school counselor who can help you find a psychologist or other mental health professional. Depression and anxiety are common problems that can cause changes in appetite and eating. These are chronic problems that can have times where they’re pretty severe, and other times where symptoms are not present, but they can still affect your appetite or mood. It’s important to have an ongoing conversation with your physician about your mental health. They can help you find the resources you need, including a psychologist.

  1. Be cautious with supplements

If you are underweight and having trouble eating, your doctor may recommend seeing a nutritionist for recommendations on food and supplements. Always discuss supplements with a provider, as they are not well regulated and need to be taken under the supervision of a doctor or nutritionist.

Appetite stimulants may be prescribed, but can come with adverse effects, including abnormal changes to the immune system, nausea, stomach problems and fatigue.

terez-yonan-do

-Dr. Terez Yonan, adolescent medicine specialist at CHOC Children’s

Explore adolescent medicine services at CHOC

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  • The female athlete triad: What you need to know
    By Dr. Amanda Schafenacker, pediatric resident at CHOC Children’s The female athlete triad, commonly called “the triad,” is a significant phenomenon being seen more and more in middle school and high ...

The female athlete triad: What you need to know

By Dr. Amanda Schafenacker, pediatric resident at CHOC Children’s

The female athlete triad, commonly called “the triad,” is a significant phenomenon being seen more and more in middle school and high school female athletes. The triad consists of three health concerns: disordered eating, low bone density (osteoporosis), and loss of periods (amenorrhea). While we always encourage children and adolescents to exercise, the triad can be seen in females involved in sports.

The triad occurs when the calories a female athlete is consuming doesn’t compensate for how much exercise girls she’s doing. To make it simpler, the amount the teen is eating is not enough to support the energy needs for daily life plus exercise. This has adverse effects on reproductive, bone and cardiovascular health.

The full triad occurs in 1 percent of all high school girls and 16 percent of all female athletes—but many adolescents may only exhibit one or two of the components, which can still have adverse effects on health. This also means a higher percentage are at risk for the full triad over time if their nutritional habits do not improve.

Disordered Eating

While some athletes may be obsessively counting calories, or practicing other unhealthy weight loss techniques such as unnecessarily restricting food items or entire groups, vomiting, diuretic or laxative use, some athletes may simply be unaware they are not consuming enough calories to support their active lifestyles. When the calorie intake does not equal the calories consumed by the body, the body starts to break itself down, which can lead to problems in different organ systems.

Potential triggers for disordered eating includes prolonged periods of dieting; weight fluctuations; coaching changes; injury; and casual comments about weight from coaches, parents, or friends. Many athletes falsely believe that losing weight will improve their athletic ability and that thinner means faster or more agile, but this is not true. This is dangerous. These ideas are common among dancers, gymnasts and swimmers, but can also be seen among runners, soccer players, and in wrestlers or boxers as athletes fluctuate through periods of “cutting weight” and gaining weight.

Loss of muscle mass happens quickly after you begin restricting food intake. This leads to decreased speed, decreased agility, decreased coordination, and increased risk of injury of muscles or bones.  Parents should be vigilant if they notice significant weight loss, their children restricting food, or purging habits (like inducing vomiting or laxative use), and bring their child to the doctor.

It is important for any athlete to remember, if a coach or family member feels it is necessary for the teen to gain or lose weight, to do so safely with the help of a doctor.

If you or your teen have questions about how much food the body needs to keep up with natural metabolism and athletic activities, talk to your doctor or a pediatric nutritionist to get more information.

Bone Disorders

As teens continue to grow, this is a critical time for bone mass creation. Without enough energy for daily function and exercise, bone growth and strength (also known as bone mineralization) can diminish. Decreased bone mineralization leads to muscle and ligament injuries, or even as bone fractures. Bone growth during the teen years is critical to prevent osteoporosis (weak bones) in adulthood. Peak bone mass usually occurs between ages 20 and 30, but up to 90 percent of bone mass is obtained by the time teens finish high school.

Periods

After the first menstrual period, adolescents’ periods should become regular within one to two years. Going without a period for more than three months is called amenorrhea. There are many causes of amenorrhea in teens, but considering low or inadequate caloric intake is necessary in all female athletes. Without enough calories to support the hormones that cause periods, female athletes may stop having their periods or start having irregular periods. Studies have shown that athletes with period irregularities can be three times as likely to have bone injuries and other muscle or ligament injuries than those athletes who maintain normal periods. The usual treatment for regulating periods is increasing nutritional intake (eating more) or decreasing vigorous activity, or a combination of both.

What should I do if I suspect this is me?

Talk with your doctor! At any sports physical, your doctor should be evaluating you for all of the above. At your visit, you can expect to have your vital signs taken (things like blood pressure, heart rate, weight and height) and have a thorough physical exam performed. Your doctor may ask you to have some blood tests done, especially if you are not having regular periods. In extreme cases, your doctor may have a bone scan done to see how your bones are growing.

What happens if I’m diagnosed with female athlete triad?

The ultimate goals are to restore normal periods and weight safely. Overall, you need to start increasing the amount of healthy calories you consume to get the energy your body needs on a daily basis. Treatment plans often include decreasing exercise while increasing calories in meals. To restore bone density and growth, your doctor may encourage vitamin supplements including vitamin D and calcium. You may be referred to a multi-disciplinary team where a doctor, a dietitian, and a mental health professional can help set appropriate nutrition and exercise goals.

Explore adolescent medicine services at CHOC

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Heavy Periods (Dysmenorrhea): Should You Be Worried?

By Dr. Arpine Davtyan, pediatric resident at CHOC Children’s

Heavy periods, also known as dysmenorrhea, can be painful, and is one of the most common medical problems teen girls face. More than 60 percent of teenage girls report painful periods. Periods usually become painful within the first few years after you begin menstruating, and they become less common with age. Dysmenorrhea is split into two major categories.

  • Primary dysmenorrhea occurs when there is pain with menses, typically crampy and located in the lower abdomen or lower back, without the presence of any diseases that could possibly be causing the pain. The pain typically begins as soon as menstrual bleeding occurs, or right before the start of bleeding and lasts one to three days.
  • Secondary dysmenorrhea is when you have the same symptoms listed above, but along with a diagnosis like endometriosis which could be causing the pain. Secondary dysmenorrhea is more common in older women.

During menstruation, the lining of the uterus produces hormones called prostaglandins, which cause the muscle cells that make up the uterus to contract. The contractions lead to painful cramps that characterizes dysmenorrhea. These prostaglandins are also responsible for nausea and diarrhea during menses.

How is dysmenorrhea diagnosed?

Dysmenorrhea is usually diagnosed by your doctor with a history and physical examination. Additional testing, such as an ultrasound of the pelvis, may be performed to look for conditions like endometriosis or fibroids which could be causing the pain. Laboratory testing or imaging is usually not required.

How is dysmenorrhea treated?

First, let’s talk about non-pharmacologic treatments―treatments that do not require medication. Herbal treatments, dietary and vitamin supplements have been studied on a small scale, but we do not have enough information about safety or effectiveness. Therefore, we don’t recommend any supplements for the treatment of dysmenorrhea. There have also been studies showing that yoga or acupuncture may help with dysmenorrhea and while this association needs to be further studied, these activities are not harmful and may be effective.

Studies have shown that exercise can lead to a decrease in menstrual pain. Since exercise also has many other benefits (decreased anxiety, depression, stress, diabetes, cancer, cardiovascular disease, in addition to improved cognitive functioning and more), we recommend regular exercise for those with dysmenorrhea. A heating pad, hot water bottle or a heating patch can also help decrease menstrual pain and can be used as often as necessary. Ensure that the temperature of the heating method you use is not higher than 104 degrees Fahrenheit to avoid burns.

There are a variety of medical treatments available for heavy periods or dysmenorrhea. Over-the-counter medications such as ibuprofen (Advil or Motrin) are the most commonly-used medication to treat dysmenorrhea. These medications provide pain relief in patients with heavy periods or dysmenorrhea by decreasing production of prostaglandins, the hormone which causes the cramps in the abdominal or lower back pain These non-steroidal anti-inflammatory drugs (NSAIDs) work best when taken right before or as soon as bleeding begins, and then taken regularly for two to three days. Talk to your doctor to be sure it is safe for you to use this readily available medication.

Hormonal birth control― including the pill, patch, vaginal ring, injection, implant, IUD― have been shown to be effective in controlling menstrual pain. These treatments thin the lining of the uterus, which means less of the prostaglandin hormone is produced, leading to less contraction of the muscle cells of the uterus that causes cramps. Patients taking hormonal birth control in the form of the pill, patch or ring normally take them in a way that allows them to have monthly periods. Patients with severe dysmenorrhea can choose to take these treatments continuously and NOT have monthly bleeding; talk to your doctor to see how to use birth control for this added benefit. These treatments are usually effective for most women. If these treatments fail, then a detailed discussion with your doctor is necessary to determine what further testing or alternative medications may be necessary.

Explore adolescent medicine services at CHOC

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