Women's Bodies, Women's Wisdom (60 page)

This is one of the big questions for most women. The truth is that HPV inserts itself into the DNA of the tissue it infects, and once it does this, it may lie dormant for years. That means theoretically that a virus a woman “caught” in 2001 may not express itself in any visible way until 2012. This also means that whoever “gave” it to her may well not have known that he or she even had it. I’ve seen couples who have been monogamous for twenty or more years in which one partner has developed warts or herpes. And even though the couple has not been using condoms, the other person in the relationship may never develop the same problems. So very often it’s difficult if not impossible to assess “blame” for HPV infections. Which doesn’t stop a lot of people from pointing fingers at others, or feeling horribly guilty themselves if they develop one—especially if they are from strict, male-dominated religious backgrounds. The resulting shame, combined with the fear fueled by media stories linking HPV with cervical cancer, can be a deadly combination for the immune system. Later in this chapter, I will give some recommendations for dealing emotionally and mentally with these conditions and for boosting your immune system.

Will HPV Interfere with Pregnancy?

Vulvar warts are often stimulated to grow by the hormones associated with pregnancy. In rare instances, a woman’s warts will cause bleeding at the time of delivery, especially if an episiotomy is made through an area of the vulva that is affected by warts. In general, however, warts do not interfere with pregnancy. They often disappear without treatment once a woman has delivered. A woman with HPV can theoretically transmit it to her baby at delivery, and some babies can theoretically get vocal cord papilloma (which can be treated with surgery) from HPV. This is very rare, however; I have never seen a case of it, and it is not a reason to do a cesarean section in a woman with HPV. The immune system of the baby protects it almost every time.

Treatment

Treatment is aimed at removing the visible warts and making sure the woman doesn’t have any of the abnormal or precancerous cells that are sometimes associated with the warts. Once the bulk of a wart is removed, the immune system can deal with and remove the remainder more easily. Removal or disappearance of a wart, however, doesn’t necessarily prevent recurrence or the possibility of transmission.

I’ve seen all manner of treatments “work” for warts. Warts on the hands, for instance, are known to disappear after a variety of treatments ranging from hypnosis to applying cold potato or even duct tape.
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We just don’t know what makes warts go away, even after thousands of years of observing that warts are responsive to suggestion and folk remedies.

Even though removal of warts doesn’t really “cure” anything, it does help the body fight HPV. One reason for this is that treatment reduces the amount of virus that the warty growth sheds. Another reason is that the immune system is enhanced by the feeling that we’re “doing something.” We live in a very action-oriented culture, and Americans want to get things done. When we treat a wart and get rid of it, the patient at some level feels that it’s been “taken care of.” The immune system gets the message and continues to “take care of it.”

It is controversial as to whether it’s important for males to get treated for warts. Many doctors downplay the male role in HPV, and many men are infected without visible warts. Therefore, many men don’t know that they have HPV, and no consistent effort is made to diagnose them.
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The female cervix is a unique environment and ap pears to be more susceptible to virus-associated abnormalities than male penile or scrotal skin.

Laser Treatment

Laser treatment, very popular for warts back in the 1990s, has not lived up to the medical profession’s initial expectations, though it is still performed. If a physician is highly skilled in the use of the laser, it can be a good way to remove persistent warts, but a few studies have shown that once warts have been lasered off the cervix or the vulva, they come back faster after laser treatment than after other treatments. Perhaps this is because the laser vaporizes tissue and spreads the wart virus into the surrounding areas. HPV on the mucous membranes of the vagina and cervix can be compared with the virus that causes the common cold in the respiratory tract. We would never think of using a laser to denude the surfaces of the trachea and bronchial tree of the cold virus. But using a laser to remove warts from the genital tract is really no different—we know that ultimately we can’t eradicate the wart virus, any more than we can eradicate the common cold virus. I have not been impressed with the effectiveness of laser treatment over the long term and prefer other treatment.

Podophyllin

Podophyllin is a chemical resin derived from the mayap ple. It interferes with cell division and therefore stops genital warts from growing. It can be effective in some people, but it is for use with external warts only, because it can have toxic effects on surrounding tissues whose cell division is normal. Podophyllin is used only on the wart itself and must be washed off within several hours.

Podofilox (Condylox) is a topical 0.5 percent antiviral treatment that a woman can apply herself to external warts after an initial treatment from her health care provider. This convenient treatment may decrease the number of office visits she must make for recurrent warts. This medication is related to podophyllin and is available by prescription.
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Aldara (Imiquimod)

This is an immune response modifier that comes as a topical cream for use on HPV warts, among other things. It can take several weeks to work but is more effective than placebo. It can cause skin irritation.

Acids

Many doctors use trichloroacetic acid (TCA) to treat warts on the cervix, vagina, and vulva. This acid is very effective but doesn’t “cure” the warts— it just burns away the visible ones. This acid must be applied in minute amounts and only to the warty areas themselves because it causes painful burns to healthy tissue. (It also can burn through clothing.) Even on warty areas, it can cause immediate sting ing, followed later by ulceration of the skin. If the acid gets on any area other than the wart (and it often does), it takes from one to two weeks for the skin to heal. It also takes about that long for the ulceration of the wart to slough off. The treatment may need to be done more than once.

Cryocautery

Warts can be frozen with a cryocautery device in the office. Freezing a wart causes it to disappear over a one-to-two-week period. I have found this treatment to be time-consuming and often painful for the patient. I don’t use it.

Electrocautery

Removal of very large collections of warts is possible using electrocautery. In this treatment the wart is burned off by a heated electrical device. This procedure is usually done under anesthesia in the operating room. It is used only when all other methods haven’t worked.

LEEP

Loop electrosurgical excision procedure (LEEP), also called large loop excision of transformation zone (LLETZ), can be used to remove warts and wart-affected tissue on the vulva, cervix, and vagina. It removes warts by electrocautery, using an electrically charged wire loop. It is also used to treat cervical dysplasia. It can be very beneficial. The problem is that a LEEP procedure on the cervix doubles the risk for premature rupture of the membranes during subsequent pregnancy. This increases the risk for prematurity.
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Nutritional Approach

The effectiveness of wart removal treatment can be enhanced with dietary change and supplements. Studies have shown that foods high in antioxidants, such as vitamin C, folic acid, vitamin A, vitamin E, beta-carotene, and selenium—or supplements containing these—help heal and prevent cervical dysplasia.
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The antioxidant class known as the proanthocyanidins, found in pine bark and grape seeds, have proven to be very helpful in some cases. (See section on cervical dysplasia for dose instructions, pages 290–291, and see Resources for reliable sources.) Because of the connection between HPV, cervical dysplasia, and cervical cancer, I recommend that a woman diagnosed with HPV support her immunity by following the Master Program for Optimal Hormonal Balance and Pelvic Health in chapter 5.

Energy Medicine

Of course, none of us has complete control over whether a virus inserts itself into our DNA or whether it gets expressed once it has done that. Especially in persistent cases of warts or herpes, however, tuning in to oneself with love, forgiveness, good nutrition, and a good multivitamin can work wonders to keep the warts or herpes from showing up again. I also suggest meditating on the following affirmation from Louise Hay daily: “I rejoice in my sexuality. It is normal and natural and perfect for me. My genitals are beautiful and normal and natural and perfect for me. I am good enough and beautiful enough exactly as I am, right here and right now. I appreciate the pleasure my body gives me. It is safe for me to enjoy my body. I choose the thoughts that allow me to love and approve of myself at all times. I love and appreciate my beautiful genitals!”
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HPV Vaccine: Is It Worth the Risks?

In the summer of 2006, Merck Pharmaceuticals received FDA approval to market the first HPV vaccine, Gardasil, a genetically engi neered drug designed to prevent the most common HPV infections implicated in cervical cancer. With the unbelievably rapid approval of Gardasil, HPV and its link to cervical cancer suddenly became front-page news, with remarkably effective media ads marketing the vaccine to all young women. The CDC and many other groups quickly recommended vaccinating all women ages nine to twenty-six, and even beyond.

Overnight, women with virtually no risk for cervical cancer (the vast majority) were suddenly made to feel vulnerable (“I could be one less statistic,” says the cool teenage girl on the skateboard), thus creating a huge market for a vaccine that most healthy women and girls simply don’t need and that is dangerous for some. Although Merck continues to promise that Gardasil is safe, the National Vaccine Information Center (NVIC), an independent organization and vaccine safety group, has documented cases of seizure, stroke, cardiovascular disease, paralysis, and autoimmune diseases such as rheumatoid arthritis connected to the vaccine. According to the NVIC’s data, Gardasil causes serious side effects about thirty times more frequently than the meningitis vaccine, which is given to a similar cohort. (For more information, see the NVIC website,
www.nvic.org
.)

Reports of problems with Gardasil finally began to surface at medical meetings. At the October 2008 meeting of the American Neurological Association, researchers presented research on a fatal case of motor neuron disease that occurred after a fourteen-year-old girl received three doses of Gardasil.
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The month before, researchers presenting papers at the annual meeting of the European Committee for Treatment and Research in Multiple Sclerosis reported one case of multiple sclerosis (MS) and another of neuromyelitis optica (an autoimmune disorder in which the immune system attacks the optic nerve and spinal cord) following Gardasil immunization.
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In 2009, Australian researchers reported five cases of MS, with symptoms appearing within twenty-one days of Gardasil immunization.
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To ramp up the concern about safety even further, Spanish health authorities made headlines in 2009 when they withdrew 76,000 doses of Gardasil after two teenagers got seriously ill just hours after receiving the vaccine. In August of that year, an article in the
Journal of the American Medical Association
noted that the government had so far received more than 12,000 reports of adverse events associated with Gardasil immunizations—772 of them considered serious, including 32 deaths.
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A 2009 Medscape article pointed out that the death rate from cervical cancer in the United States (3 out of every 100,000 women) and the rate of serious adverse events from Gardasil (3.4 of 100,000 doses distributed) is roughly equal. The story quoted Diane Harper, M.D., of the University of Missouri–Kansas City School of Medicine and one of the principal investigators in the initial Gardasil trials, as saying, “This is a sobering reality. Would a parent accept such a rate of serious adverse events if the same cancer prevention can occur with continued Pap screening? Is there any acceptable level of risk of serious adverse events, including death, to prevent genital warts?”
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The vaccine may not even be fully effective, depending on the recipient’s health status. If a girl who gets Gardasil already has HPV, for example, the vaccine not only is useless against that particular strain but also won’t give her full protection against the other HPV strains. Given that the CDC data report that 25 percent of females between the ages of fifteen and nineteen and 45 percent of females between the ages of twenty and twenty-four show evidence of HPV infection, that’s not a minor point.
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And even when it is effective, we’re not sure how long the vaccine will continue to work. Clayton Young, M.D., a fellow of the American College of Obstetricians and Gynecologists (ACOG), wrote a letter of protest to ACOG’s professional journal,
Obstetrics and Gynecology,
noting that the maximum median follow-up in the studies done on Gardasil is four years, although it typically takes cancer anywhere from eight to almost thirteen years to show up. What that could mean is that preteens receiving the vaccination may unexpectedly be left unprotected when they later become sexually active and need protection the most. “Claiming this vaccine prevents cervical cancer,” Dr. Young writes, “is inappropriate.”
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