A little intro first:

Focus on the Family and other conservatives have claimed that mandatory implementation of the new HPV vaccine is a bad idea. Once again they’re thinking they can stop people (including impulsive teens) from having sex by making sure they’ll be unnecessarily exposed to a deadly disease if they do have sex—the deadly disease in this case being cervical cancer.

As someone who has HPV, I found this hit too close to home. So with inspiration from Dan Savage’s call to straight people to stand up for their sexual rights, I took a cue from AIDS activists and spoke up about how HPV is playing out in my life.

The published version of this essay appeared in the Chicago Tribune on July 5, 2006, and was called “A Shot that Could Save Thousands of Lives in the U.S.” I happen to think the pre-editing version is much better, so here it is:

“A Shot that Could Save Thousands of Lives”

I haven’t got cervical cancer…yet. What I’ve got is HPV (the virus that causes it), roughly half a cervix, and an enormous sense of relief that, in spite of some opposition, a federal panel just voted to recommend that all girls and women aged 11 to 26 be given the new vaccine against cervical cancer.

Yet as a historian of medicine, I’ve also got a persistent sense of confusion. I look back at the patients’ rights movements around HIV/AIDS and breast cancer, and see all of those people who were personally affected and who stood up to make absolutely sure that the maximum possible resources of medical science and public health would be thrown at these horrific diseases. Why have women like me been mostly silent in the public discussions about the cervical cancer vaccine?

Imagine if there were a vaccine that could prevent HIV or breast cancer. Imagine too—as in the case of the new HPV vaccine—some people hoped to prevent full implementation of the vaccine because of a naive notion that they could thereby control the sexual behavior of others. (The logic goes like this: If we give girls this vaccine, maybe they won’t abstain from sex like they otherwise would.) The HIV/AIDS and breast cancer (or prostate cancer or whatever) advocates would be shouting from the highest hills. They would be saying what is absolutely true: your sexual politics should not determine whether or not women like me have to live with or die from this disease.

So where are the women like me who have lived (and who risk dying) from HPV? Why are we being so quiet?

I think I know. In fact, I know I know. Because as I thought about writing this, I kept thinking one thing: My parents are going to read this. My neighbors are going to read this. My colleagues are going to read this.

And like a lot of women in this country, I’ve gotten the clear message that I’m not supposed to be honest about the fact that I’ve had sex with anyone other than the guy I eventually married. I’m supposed to be ashamed of my sexual history. And obviously I am. Why else would I have been silent this long about my cervix?

So let me allow the HPV vaccine to out me, just as HIV/AIDS caused so many gay men to be outed.

I was seventeen when I started having sex. My first sexual partner was a trusted high school teacher of mine who took advantage of my emotional vulnerability. I went on the pill, so he didn’t use a condom.

I have no idea whether he was the man who passed HPV onto me. It could have been another man I slept with. When I was twenty-three, my annual pap smear showed up positive. I had cells that were pre-cancerous, because by then, somewhere in my sexual chain, I had picked up HPV.

I suppose I counted as lucky that we caught it early. After the positive pap, I made an appointment with my gynecologist so that he could use a freezing technique to kill and remove a conical section of my cervix, in the hopes that this would remove my risk for cancer. I remember that the doctor made sure I was the last patient of the day, because he wanted to be slow and careful. My boyfriend at the time—a very nice guy—came with me and held my hand. The doctor did the procedure. I tried to ask him about what this meant for my future—was I going to get cancer? Could I have a baby someday? But he didn’t want to talk about all that. He just told me in a rather grandfatherly voice we’d deal with all that when it was time.

I went home and for the next several days watched my cervix melt into menstrual pads. I developed a persistent nightmare that I had a wire hairbrush growing out of the small of my back. Sometimes in my dreams the hairbrush turned into prickly pinecones.

Twelve years ago, when I was twenty-eight, I fell in love with the guy I knew I would marry. Before we started having sex without condoms (I had finally gotten smart, like a lot of people do as they age), I got tested for every sexual transmitted disease I could, and came up clean. Everyone except HPV, which I knew I probably still had, and which maybe he didn’t. The guy who became my husband knew this, too. He knows that if he goes on to have another sexual partner in his life, he puts her at risk of cancer.

The guy I married happens to be a doctor—an internist. Whether he’s got HPV, we don’t know. But what he lives with for sure is me worrying intensely every few months when I’ve got unexplained vaginal bleeding or a vague pain in my lower gut. Last year I finally got up the nerve to ask him, as we were making breakfast together, what if one of my paps comes up positive? What if I do get cervical cancer?

“Hysterectomy,” he said.

“Hysterectomy!” I shouted. “I don’t want a hysterectomy!” I knew from my work on the history of gynecology what hysterectomy can do to women. “Aren’t there any other options besides hysterectomy?”

“Yeah,” he said, smearing peanut butter on toast. “Death.”

When the first news of the HPV vaccine came out, he emailed it to me from work. When he came home that night, I had lots more questions for him. If I get the vaccine, would that help me? Can he get the vaccine? He said he didn’t know yet. He’d have to do more reading.

But I asked him three questions he could answer: “If it turns out this vaccine works in boys and men, we can get this vaccine for our son before he becomes sexually active, right? And we will do that, right? And that could, theoretically at least, prevent him from ever becoming a transmitter of the virus?”

And my husband said yes, to all three.

I take solace and action from statistics. I know it is unlikely, if I get a yearly pap, that I’ll die of cervical cancer. I know it is unlikely my husband will kill another woman with the virus I may have given him. I know my son is likely to grow up to have sex with multiple women, and like most people, he’s likely to be inconsistent about condom use, but if the vaccine works in boys and men, I know that he won’t give his sexual partners HPV. But unless the vaccine is provided to all girls as is now the plan, some may grow up to go through what I have been through anyway, completely unnecessarily.