- Hello, MDJ from the Editing Feature,
and I would like to say there is pepper in my teeth
for this entire video, don't comment on it
because you'll hurt my ego, which is extremely fragile,
close your eyes and get the information
because it's important, that's all, thank you.
Hey all welcome back, Mama Doctor Jones,
OB GYN and mom to four,
today we're talking about HPV
and this will be the first in a two-video series
about human papillomavirus, the second video being
the good, the bad and the ugly about HPV vaccination.
You may have noticed that my background
is going to be frequently changing,
that's because we're on the road
and I'm just filming wherever I can,
if you didn't notice that means you're probably new here
and maybe you should hit that little subscribe button
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just learn about HPV and go along your merry way
being a little bit more knowledgeable about
a health topic in gynecology,
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(soft music)
I don't know if y'all can hear that,
but they're doing construction out
close to where we're staying and it's really loud,
so I hope that my microphone,
which is literally set up on a toilet paper roll,
hopefully it's doing a good enough job
getting that background noise away,
just listen to my beautiful voice.
So what is HPV?
HPV is human papillomavirus,
but it's not actually just one virus,
there's many, many, many types of HPV, like over 200 types.
Some of them are really what we call low risk,
they don't cause a lot of problems
or if they do cause problems,
they don't cause life-threatening problems.
Some of them cause really bad problems like cancers
or abnormal cells to start growing
in wherever the virus is living.
It can live in places like the mouth and throat,
that's the oropharyngeal HPV infections,
and it can also live on the genitals.
For the purposes of this video,
we're going to be mainly focusing on the HPV
that causes gynecologic problems,
that's the types that cause like genital warts,
abnormal pap smears, and in some cases,
cervical and vulvar cancers.
When we're talking about HPV in that sense,
it's really important to know how common this is,
about 80% of people who are sexually active
in their entire life, even with just one person
will be exposed to a HPV strand at some point,
this is because it's extremely common
and extremely easy to pass along to others
because in many cases it's not causing any symptoms.
Can be transferred by skin to skin contact,
but it can also be transferred through mouth to skin contact
like oral sex or even sex with a condom,
sometimes doesn't completely prevent HPV
because it can live on the skin of the perineum.
Even though it's super, super common,
it usually does not cause problems,
and when it does cause problems,
they're not usually life-threatening
and if they are life-threatening, we can usually catch them
before they actually threaten your life,
and you'll understand that more as we go through this video.
However, I do think it's really important
for everyone to know that almost any kind of sex
can transmit HPV, even sex that you would maybe consider
as safe sex because you're using a condom, which is great,
keep using condoms, it definitely reduces the chance
of HPV transmission, it's just not 100%.
Oral sex can transmit HPV, anal sex can transmit HPV,
anyone who is sexually active is at risk for HPV.
Now, when I was talking about this on Instagram one day,
there were a lot of questions about,
well, you said 80% of everyone,
even if you only have sex with one person,
that doesn't make sense because
if I have never had sex with anyone
and my partner has never had sex with anyone,
how would we both be at risk like 80%?
You're probably at a lot lower risk if you and your partner
have never been sexually active in any form or fashion
with anyone else, but that statistic, that 80%
is assuming that a large majority of people
are not entering into relationships
where neither partner has ever been sexually active
in any way, and again,
this does not just include vaginal intercourse,
it is any type of sex except maybe "sexting",
you're probably pretty easily avoiding STDs
if you're sexting, so no condoms required for sexting,
that was the stupidest joke I've ever made on this channel.
Okay, so what are the signs and symptoms of HPV?
How do I know that I have it?
Most of the time it's asymptomatic,
meaning you don't have any signs or symptoms,
which is really a good thing because of how common it is,
but also a bad thing because of how common it is,
that means we can easily catch it
because we don't know that we're carrying it,
that brings up another question I'm frequently asked,
which is, well then why don't we test everybody for it?
Like you can go get tested for gonorrhea and chlamydia,
why don't we test for HPV?
The answer to that is we don't test for HPV
except in certain circumstances,
which we'll get to in a minute,
because especially under the age of 30,
almost everybody at some point would be positive
and almost all of those people
would clear the virus on their own and there's no treatment,
so it doesn't help to know that you have it
if 80% of people will have it at some point
and almost all of those people will clear the virus
on their own, does that make sense?
Now, after age 30, we do start testing for this,
when you come in for a pap smear,
we run what we call co-testing, that's we do the pap smear,
which is a pelvic exam, look at the cervix,
take a small sample of cells
using kind of little spatula thing
to send off to the lab where they look at the cells
and tell us, are they normal or abnormal,
and then the HPV testing is a part of that as well.
And the reason it's over 30 only,
except in very specific scenarios under the age of 30
is because if you haven't cleared the virus
by age 30 and up, it is more likely that your body
is just not clearing it on its own for whatever reason,
and that you're in slightly increased risk
of having complications from the virus,
it doesn't mean you will,
it just means we need to know about it
so we can follow more closely.
What other symptoms can it cause?
You know, I said, it's usually asymptomatic,
so what if it's not, then what does it cause?
The two most common things that I see in gynecology
as HPV causing symptoms is either genital warts,
which are like little skin colored lesions,
they look like a wart would look on your finger
on the genital area, on the vulva, perineum,
somewhere like that.
They can be just a couple of little lesions
or it can be extremely extensive,
it's pretty unusual for it to be very extensive,
but I have seen some really severe cases
that seriously interfere with a person's quality of life.
We have a variety of treatments for general warts,
but you're better off preventing it,
which we will go into in the next video,
better ways to prevent it than just using a condom,
which is vaccination, please also use a condom
because although it's not 100%,
it does drastically decrease the risk of transmission.
Now, the other way that this can cause symptoms would be
with abnormal pap smears or other skin lesions,
this is super important to talk about
because pap smears generally don't just become abnormal
from HPV and then suddenly become cancer.
Cervical cancer is caused by HPV
in a large majority of cases,
and it's certain types of HPVs
tend to be higher risk for that,
the way that we pick up on this is by doing pap smears
because before the cervix has cells that become cancerous,
they have a pretty predictable progression
from abnormal cellular changes related to HPV
that become more and more abnormal over years and years
and eventually develop into cancer.
There are rare cervical cancers that progress very quickly
that aren't caught with routine pap smears,
but that is the minority, most of the time,
even if you have a high risk type of HPV,
your body will still clear it on its own
even if your paps becomes abnormal,
however, certain abnormalities in pap smear,
need to be treated.
How do we decide which of those need treatment
and which just need closer follow-up?
They come in a spectrum basically,
they can be low grade abnormal,
they can be kind of in the middle
or they can be high grade and then they can also be okay,
this definitely looks like cancer.
The way we manage abnormal pap smear results,
which are again by and large caused by human papillomavirus,
depends on how old you are
and what that result is on that spectrum.
Your doctor might recommend another pap smear in a year,
they might recommend continuing on the same follow-up
that you've been getting, whatever your plan was
with your doctor just get your normal pap smear
or colposcopy where you look through the microscope
at the cells of the cervix and decide
if they look abnormal or not,
and if you need to take a biopsy
or maybe you need a procedure
that removes the cells of the cervix,
where that HPV can live,
which would be called a LEEP procedure or a cone biopsy,
and I'm not gonna go into details
about this specific procedures right now,
but those are kind of ways that we treat abnormal pap smears
caused by HPV in order to try to prevent them
from becoming cervical cancer.
Just to clarify, we make all those decisions
based on your age and your specific results,
we do that using what is called ASCCP,
the American Society of Cervical Cancer
Prevention Algorithms, which are publicly accessible,
they are extensively researched HPV follow-up
and abnormal pap smear follow-up based on research
about the way HPV and abnormal pap smears progress.
There are tons of different algorithms,
they're constantly changing,
I always tell my patients just come in,
we'll look it up together,
we'll make sure we're on the right path
following the most up-to-date literature that we have.
The reason we can watch and just do close follow-up
on a lot of abnormal pap smears is because again,
your body is very good at clearing this in most cases
before it becomes cancer.
So the most important thing I tell my patients,
come in for your pap smears,
almost nobody gets HPV associated cervical cancer
if they're getting routine pap smears,
you can, it's just extremely rare
because we can usually catch it and we can usually treat
and prevent it from advancing to cancer
if we are getting our regular follow-up.
The second most important thing is
if you get your pap smear done, and it becomes abnormal,
or you get a result that's not normal,
don't disappear, come back,
you don't get an abnormal pap smear,
and then three days later it's cancer,
so don't panic if your doctor calls and says
your pap smear is abnormal.
I can usually keep that from getting worse,
and the earlier we catch it,
the better chance we have of preventing it
from advancing to cancer.
It progresses to cancer in most cases,
over many, many years, 5 to 10 years,
usually what's happened,
is someone has been lost to follow-up
or doesn't have access to care to get their pap smear done,
come back, come back, come back, don't disappear,
this is what's important here.
Okay, so what if it does progress to cervical cancer?
What are we dealing with then?
I mean, is it so bad to have cervical cancer?
Can't you just take the cervix out?
It's not often that easy,
cervical cancer is a particular kind of evil,
not that there's any cancer you would want to have,
all cancers are bad obviously, but cervical cancer
is just a really unique kind of terrible.
It tends to affect people who are relatively young,
mid 40s to 50s, and most of those people
have really young children,
and if they're on the lower end of that spectrum,
because there are people in their 20s and 30s
who get cervical cancer as well,
they often want to retain their ability to have children,
and the treatment for cervical cancer
is pretty well occlusive to having kids in the future.
If it's caught really, really early in certain situations
where somebody wants to retain the ability to have children,
then occasionally a gynecology oncologist
will do what we call a cold knife cone,
which is a really big biopsy of the cervix,
but that's kind of risky
because we still worry a lot about recurrence
in those patients.
It can be done, and I have taken care of patients
and done that procedure as well,
but if someone doesn't want to retain
the ability to have children,
then we usually go to a radical hysterectomy,
which is a very extensive hysterectomy
that has very wide margins
because we try to get all of the tissue
that cervical cancer can spread to or recur in easily.
Now, if it's really advanced,
a lot of times we can't even do that surgery
and we will have to jump straight to radiation
and chemotherapy.
Cervical cancer is not a fun way to die,
is extremely painful, and it's a slow process.
I have held the hands of many people dying
from cervical cancer, and it's absolutely heartbreaking,
I mean, anytime anyone has a terminal illness,
it's heartbreaking,
but cervical cancer is just really terrible.
I'm sorry to get heavy,
I think it's important that we discuss the realities
of what happens when cervical cancer
either can't be prevented or the right prevention steps
didn't go into place.
On that note, really good news that we have a vaccine
that can prevent a lot of these cases of HPV
and of cervical cancer.
It's not 100% and there's some controversy surrounding it
that I am thrilled to talk to you about in the next video,
I will link that here when it is available.
For now, if you missed the last,
didn't know I was pregnant reaction,
it is a very good episode
and I would highly encourage you to go watch about
vasectomy or your spouse was cheating, it's a good one,
I'll link it right here.
I hope you learned something today,
be kind to yourself, to each other, to me,
in the comments be kind, and I will see you next time.
Get your pap smears, get your pap smears,
don't be lost, follow-up,
get your pap smears,
get your pap smears please,
get your pap smears and get them on time,
your gynecologist is your friend.