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HPV, Relationships, Pregnancy and Sex

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tsunamichick89 asks:

Since I was 19 I've had an annual PAP smear done. Never, until this year, has it been abnormal. I went in January of 2011 and then held off because since then I have had an IUD put in, Gardasil, and lost my health insurance. Once I had saved up enough to get my pap test this year it was May. About a week later my doctor called to make an appointment to discuss results. I made another appointment and went in and needed a colposcopy. Another week later she called again. And then I knew then something wasn't right, I've never had a doctor call me about results.

Jenna replies:

tsunamichick's question continued:

Then a week later my doctor called me to have me come in that day and I couldn't wait 4 more days to discuss it. She told me that I had high risk HPV and she suggested a cone biopsy or LEEP procedure. I then went to see the specialist who said I had some stage 3 dysplasia. Then last week I had the LEEP procedure done since I didn't want to risk cancer by waiting. I am glad to have it over with, but I'm left confused and with some questions.

I am under the assumption that by now my husband has it as well and that there is no tests to affirm or deny this. Is it possible to get re-infected after being cleared of HPV? How common is miscarriage after this kind of procedure? How can I approach sex in a positive way without worrying about the HPV the whole time?

You are asking some great and important questions regarding the effect of HPV on your relationship and ability to have children.

Being diagnosed with HPV or any other sexually transmitted infection (STI) can be difficult to deal with for many people, especially being in a relationship. It is definitely possible to move forward and have an enjoyable, worry-free sex life with your husband post-HPV diagnosis and treatment. Because HPV can be confusing for some, let's start with some of the basics.

HPV is an extremely common sexually transmitted virus that has many different strains. The virus can cause abnormal cell growth, which either manifests itself as genital warts (low-risk) or as abnormal cervical cell growth (high-risk), which is what is detected during a pap test. HPV is incredibly common - it is estimated that 75% of all sexually active people have had or will get HPV in their lives. Some folks even refer to HPV and herpes as the "common cold" of STIs.

The way that our bodies interact with HPV is really interesting. For many young women, specifically, with HPV, the body naturally clears itself of the virus -- sheds the virus -- on its own. Because of this reason, it is now recommended that young women with normal pap results get their pap test every three years until the age of 30, rather than every year. However, your doctor/health provider will let you know if you need to be examined annually since you have had an abnormal test in the past.

HPV Testing

The current assessments for HPV include a visual examination for warts, a pap test which looks for abnormal cervical cell growth indicative of HPV but doesn't test for HPV itself, and a DNA test. The DNA test can be expensive and is usually used once cervical cell growth has been detected to identify which strains of HPV one has. Unfortunately there is no FDA-approved HPV test for men, beyond the visual examination of the penis and scrotum for genital warts. As HPV has over 40 different strains, some of those strains cause warts and other strains do not have symptoms at all. Thus, if a person with a penis does not have genital warts, that does not mean that they do not have HPV.

That means that you are correct in your assumption that there is no way to affirm or deny whether your husband has HPV or not. It is possible that the virus has shed itself from his system, but there is no way to know for sure. However, it is safe to assume that he has come in contact with the same strain of HPV that you had, and potentially still has it.

HPV Reinfection from a Partner

Because HPV is a virus, it is never really cured. The procedure that you experienced treated the disease that the virus causes (abnormal cell growth on the cervix), but does not affect the virus itself. Many people do eventually clear the virus from their system, though. Regardless of whether the HPV is been shed or is still in your system, partners with the same HPV type will not pass the virus back and forth to each other. Because your body already had a certain strain of HPV, your immune system will remember it and prevent it from creating a new infection.

However, if your husband were to have a different strain of HPV, then you would be at risk for that new strain. Therefore, it's fantastic that you have received HPV vaccinations. Gardasil is a vaccination that protects you from the two most common strains of low-risk HPV (genital warts) and two most common strains of high-risk HPV. Even if the strain of HPV that you had was one of the four strains that Gardasil protects you from, then you are still protected from the other three, which is great.

LEEP & Pregnancy

LEEP (an acronym for the loop electrosurgical excision procedure) is a very safe and effective way of removing abnormal cervical cells. There are rarely serious side effects from the procedure. Some uncommon serious side effects include heavy bleeding, pelvic infection, internal organ damage or a reaction to the local anesthesia. If you are experiencing any pain or heavy bleeding, contact your doctor.

To address your question, there is an increased chance of preterm (early) birth post-LEEP, but many women do not have any issues with this. It sounds like you would like to get pregnant in the future, so the best thing for you to do is to is talk with your doctor/healthcare provider about your individual risk. It really depends on the person and how the LEEP procedure affected your own cervix/how much tissue was removed. Getting pregnant shouldn't be affected by the LEEP, and you can work with your doctor to figure out how to have the safest pregnancy possible. There are several things that you can do when pregnant to decrease the likelihood of a preterm birth.

In addition, when you do become pregnant, you will want to let your OB/GYN know that you have had a LEEP in the past, as they will want to have more cervical examinations throughout the pregnancy. Here is more information on pregnancy after LEEP. Here is more information on preterm pregnancy and what you can do to be safe and healthy when at risk.

Sex/Relationships & HPV

Now that we have gone over the basic facts, this part gets a little trickier. There are no right or wrong ways to address HPV within your relationship, although there are some things to consider:

-Talking with your partner. From the questions that you asked, it sounds like your husband knows about your pap test and procedure. For many people, just acknowledging that they have an STI to their partner is the hardest part. I don't want to make assumptions, though, so here is a great resource for talking to your partner about HPV. Just understanding the virus, how common it is, and how it gets transmitted is extremely helpful for having a frank discussion with your partner about it.

-Avoiding the blame game. Getting caught up in the whole "who gave it to whom" often comes up in couples, but with HPV, there is no way to know. It also isn't helpful, because what would you do with that information? That type of conversation usually just stirs up unnecessary resentment and hurt. While it would certainly be an issue if either you or your husband knew that you had HPV before you became sexually involved and knowingly gave it to the other partner, that is unlikely as most people have no idea that they have HPV. However, it is important to be on the same page with your husband regarding whether you are both monogamous (are only having sex with each other), or have other sexual partners. I am not implying that either of you are having sex with other people, but some couples are in open relationships and have other sexual partners. If that is the case, it is crucial to know how to protect yourself and your partner(s) from STIs.

-Understanding what it means for your sex life now. As mentioned above, you do not need to worry about getting reinfected with this particular strain of HPV. It is recommended to hold off on having vaginal sex for the first few weeks after getting a LEEP, just to let your cervix heal. Other than that, you have done everything that you can do to have a safe and healthy sex life! By getting the LEEP, you have removed the abnormal cell growth. You have taken charge of your sexual health and wellness, and I hope that you recognize how great that is. Continue to have open communication with your husband, and voice any concerns that you have regarding your sex life, HPV-related or not. If you have not already done so, ensure that you and your husband have both been tested for other STDs. If you continue to feel concerned or worried about enjoying sex, you can also talk to a medical professional to ease your mind (see link to great docs below).

What's Next?

Depending on what your doctor/provider recommended, you will likely have a follow-up pap test in 6-12 months. Unfortunately some healthcare providers are not very sensitive when it comes to discussing sexually transmitted infectionss and their impact on your sex life or relationship, but hopefully your provider is compassionate and helpful. If not, check out Scarleteen's recommended list of doctors.

Check out these resources for more information:

written 06 Jul 2012 . updated 13 Jan 2014

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