Tagged Sex

How Our Sex Habits May Affect Our HPV and Cancer Risk

How Our Sex Habits May Affect Our HPV and Cancer Risk

Certain sex practices, at certain ages, increased the risk of throat cancers related to human papillomavirus.

Credit…Getty Images
Nicholas Bakalar

  • Jan. 12, 2021, 5:00 a.m. ET

Human papillomavirus, or HPV, is a leading cause of throat cancer, and it is sexually transmitted. But how the timing, number and types of sexual behaviors affect the risk, and why some people develop cancer and others don’t, are still open questions. Researchers are beginning to suggest some possible answers.

HPV causes about 70 percent of oropharyngeal cancers — tumors of the back of the throat, the base of the tongue and the tonsils. According to the Centers for Disease Control and Prevention, there are about 3,500 new cases of HPV-associated oropharyngeal cancers diagnosed in women and 16,200 in men every year in the United States. These cancers are more common among white people than among African-Americans, Asian-Americans, Hispanics, or American Indians and Native Alaskans.

There are many types of HPV, only some of which cause cancer. In addition to throat cancer, HPV is a cause of cervical, vaginal, vulvar, penile and anal cancers. It can take years, even decades, after infection for cancer to develop.

To try to sort out the risk factors for HPV-associated throat cancer, researchers compared 163 patients with cancer with 345 cancer-free controls. Patients and controls ranged in age from 18 to 89, but more than 95 percent of them were over 40. At the start of the study, all of the participants provided a blood sample, and the scientists obtained tumor samples from the patients with cancer. None of the participants had had the HPV vaccine, which was introduced in the United States in 2006 and recommended primarily for preadolescents, teenagers and young adults.

Using a self-interview administered on a computer, the participants also answered detailed questions on lifetime and recent sexual behavior, including number of partners, age of sexual initiation, types of sexual acts, extramarital sex and the use of alcohol and recreational drugs during sex. The scientists also had data on income, education, sexual orientation, and any history of sexually transmitted and other diseases. The study is in the journal Cancer.

Taken together, the various cancers caused by HPV are slightly more common in women, but HPV-associated oropharyngeal cancers are almost five times as common in men. Exactly why is unclear.

“There is some evidence that cunnilingus is more infective than fellatio,” said the senior author, Gypsyamber D’Souza, a professor of epidemiology at Johns Hopkins. “But that’s a surrogate for more nuanced behavior. Many patients have not engaged in high-risk sex behavior and are unlucky enough to still get this. It’s not just sexual partners, but the timing, the kind of practice, the nature of the partners and other factors, plus aspects of our own immunological response that are all involved in this.”

The cancer patients in the study were about 80 percent more likely than those without cancer to have ever performed oral sex on a partner. They were also younger when they first did so — 37 percent of patients were younger than 18 the first time they performed oral sex, compared with 23 percent of controls — and they were more likely to have performed oral sex at their sexual debut.

Why having oral sex at a first sexual encounter would raise the risk is unknown. Is there a different immune response if a person has had other forms of sex before having oral sex? Does the initial site of exposure affect your risk? “We don’t have good answers yet,” Dr. D’Souza said.

Almost 45 percent of patients had had more than 10 sexual partners during their lifetimes, compared with 19 percent of the cancer-free controls. People under 23 who had a sexual partner at least 10 years older were more likely to be infected, possibly because older people have had longer exposure to the virus.

Deep kissing was also associated with increased risk. Those who had 10 or more deep-kissing partners were more than twice as likely to have an HPV-related cancer as those who had none or one.

People who reported that their partners had extramarital affairs, and those who even suspected that their partners had had affairs, also had an increased risk of HPV-associated throat cancer. There was no association of HPV-related throat cancer with smoking, alcohol consumption or substance use.

The study had limitations. It depended on self-reports, which are not always reliable, and because more than 95 percent of the participants described themselves as heterosexual, there was not enough data to draw conclusions about the effects of sexual orientation on HPV and cancer risk. But the analysis had carefully matched controls, HPV tumor data, and a confidential questionnaire, all of which contribute to its strengths.

Dr. Jason D. Wright, an associate professor of gynecologic oncology at Columbia who was not involved in the research, believes the work could be useful in clinical practice. “This is one of the first studies to provide in-depth details for patients about how specific practices influence your long-term risk,” he said. “A higher exposure, more partners, oral sex early on — these are all risk factors. These are important things to think about in talking to patients.”

The lead author, Dr. Virginia E. Drake, a resident physician at Johns Hopkins, said that explaining the infection to patients can be difficult. “If people get this infection, they’re going to ask, ‘Why me?’” she said. “How this information will change things clinically, we don’t know. But we can give patients a better understanding of the disease process and how someone gets it.”

Still, she said, “It’s complex, more complex that just the number of sexual partners. We don’t have the exact answers on this, and we’re still figuring out the complete picture.”

Turn Your Sex Life Around

Take Back Your Sex Life

With all its stress and uncertainty, this year hasn’t exactly been a banner year for intimacy. But that can change.

Credit…Rose Wong
Meaghan O’Connell

  • Dec. 26, 2020, 10:57 p.m. ET

Melissa Petro is a 40-year-old writer who lives in New York with her husband of four years and two children. She and her husband switch off between working and kid duty. According to Ms. Petro, the always-on nature of parenting a 12-month-old and a 3-year old in a pandemic has been “relentless, exhausting and not sexy.” Recently her husband has been sleeping on the family room couch.

“It’s not that I don’t want to,” she said, “It’s just that there’s so many things to do besides have sex with my partner, who I do hypothetically find attractive and theoretically want to have sex with. It feels pretty — at times — hopeless, our sex life.”

Ms. Petro is not alone. A Kinsey Institute study on the impact of Covid-19 on marital quality found that 24 percent of married people reported having less frequent sex than they did before the pandemic, and 17 percent of women reported a decrease in both sexual and emotional satisfaction since the pandemic began. Another study from the spring suggested that a third of couples were experiencing pandemic-related conflict and that many of their sex lives were suffering.

“We are missing out on many parts of our former lives,” Maya Luetke, a researcher at the Center for Sexual Health Promotion at Indiana University who led the study, wrote in an email. “Just as this is the lost year in other ways, it may also be the lost year in terms of sex.”

Likewise, Emily Nagoski was not surprised by the data. A sex educator, researcher and author of “Come as You Are: The Surprising New Science That Will Transform Your Sex Life,” Dr. Nagoski describes sexual desire and inhibition like the accelerator and brake in a car. And while right now there are more factors in couples’ lives hitting their brakes than their accelerators, all hope is not lost. There is still a lot you can do to take your foot off the brake and hit the sexuality accelerator.

Shift your perspective.

Self-criticism and judgment of your partner are classic ways to dampen sexual desire. More than half of women report that stress, depression and anxiety decrease their interest in sex, as well as their sexual arousal and ability to orgasm. Dr. Nagoski said it’s normal to feel less desire during a crisis, like a pandemic. “You feel like the entire world, literally the air you breathe, is a potential threat to yourself and your family. That’s going to hit the brake.”

The first step to improving your sex life might be a shift in attitude rather than behavior. “If you have sex because you have to or you feel like you’re supposed to, you won’t have much sex and you probably won’t enjoy it,” Dr. Nagoski wrote in her book. “Don’t just decide to have sex, try on the identity of a person who loves sex.”

Make a plan.

Ms. Petro said she and her husband still make time for sex, even if it’s just, say, every third Sunday. “I shove thoughts of chores undone out of my mind and just try to relax into my body and be present for my partner,” she said. Afterward, they take each other less seriously. “We’re lighter.”

“People get very wrapped up in the idea of spontaneously desiring sex,” Dr. Nagoski said, but, especially in women, it’s fairly rare. Based on a wide body of research on gender and sexual desire, Dr. Nagoski estimates that roughly 15 percent of women experience spontaneous desire, whereas most experience responsive desire — wanting sex when something erotic is happening.

“When we study people who have great sex over the long-term in a relationship, they do not describe spontaneous desire as a characteristic,” she said.

So what do they describe? When the clinical psychologists Peggy Kleinplatz and A. Dana Menard conducted a study for their book “Magnificent Sex: Lessons from Extraordinary Lovers,” they found that the components of great sex were consistent across gender, sexuality and a host of other descriptors and tastes. They included things like communication, empathy, vulnerability, connection and being present in the moment. They stressed ignoring notions of romantic spontaneity and, instead, embracing deliberateness and making a plan.

Great sex, they found, doesn’t just happen. It requires intentionality. Don’t be afraid to put it in your calendar if you have to. Because while you can’t plan on great sex, you can, as Dr. Kleinplatz and Dr. Menard put it in their book, “intentionally create the conditions in which the magic might occur.”

Pursue novelty.

While experiencing low sexual desire during a pandemic might be normal and understandable, there are things you can do to increase desire in a relationship. One thing that science says increases arousal is a novel experience. Not just the sexual kind, but anything to get your heart rate up.

This might be a good time for people to “open a dialogue with their partner(s) about their relationship overall as well as their personal desires, fantasies, needs, etc.,” Dr. Luetke, who studies the link between conflict and sexual intimacy at Indiana University, wrote in an email. If these conversations are awkward for you, she recommended engaging a therapist specializing in sex.

Or find another way to raise your heart rate. You might not be able to ride a roller coaster or dance at a crowded concert, but you could still do a YouTube workout, go for a hike with your partner or watch a scary movie together after the kids are in bed. Some research suggests that being excited around your partner makes that person seem more novel and thus more sexually attractive, by association.

Complete the stress cycle.

When your brain senses a threat (a lion, say, chasing you), your body activates the sympathetic nervous system, which sends chemicals like adrenaline and cortisol to help you run faster or fight harder. Once the threat is gone (you ran away; you killed the lion), the parasympathetic nervous system kicks in, taking you out of fight-or-flight mode and returning your body to a calm state.

That calm state activated by the parasympathetic nervous system is also responsible for sexual arousal. In other words, your brain knows that when the lion is chasing you, you won’t want sex.

Modern-day stressors, however, are more ambiguous than a lion. It’s less clear to your brain when the threat has passed — when your paycheck has been deposited or your child’s remote school day is over. So Dr. Nagoski recommended “completing the stress cycle,” or doing things that will signal to the body that the danger has passed. When you go for a run after a long day of work, you’re moving through fight-or-flight mode by jogging away from the figurative lion, and telling your body that the stress is over, at least until tomorrow.

And even if you still don’t feel safe enough to experience desire, you can still touch your partner and intimately connect. Lying in the dark watching a movie with your partner, going for a walk, exercising, practicing self-acceptance — these things all have their own benefits, even when they don’t lead to sex.

Meaghan O’Connell is a freelance writer and the author of “And Now We Have Everything: On Motherhood Before I Was Ready.”

Most Women Prefer to Go Bare, Citing Hygiene (and Baffling Doctors)


Rachel Dratch, as customer, Nia Vardalos as spa technician during “Bikini Wax” skit on November 9, 2002. Sixty-two percent of a nationally representative sample of 3,316 women said they opted for complete removal of their pubic hair; 84 percent reported some grooming.

Rachel Dratch, as customer, Nia Vardalos as spa technician during “Bikini Wax” skit on November 9, 2002. Sixty-two percent of a nationally representative sample of 3,316 women said they opted for complete removal of their pubic hair; 84 percent reported some grooming.Credit Dana Edelson/NBC, via Getty Images)

For years, gynecologists have had a bird’s-eye view on a phenomenon that is now so popular as to be almost commonplace: female genitalia, bereft of hair.

Sometimes called “grooming,” the practice of shearing off pubic hair — parodied on Saturday Night Live, celebrated as a girl-bonding ritual by various “Real Housewives” — has prompted sexual health experts to ask what motivates women to do it.

A new study published in the journal JAMA Dermatology on Wednesday confirmed just how widespread the practice is. Sixty-two percent of a nationally representative sample of 3,316 women said they opted for complete removal of their pubic hair; 84 percent reported some grooming.

But while previous research showed that women groom to facilitate sexual activity, this survey found the overwhelming majority said they did so for hygiene.

That perception troubled researchers. “Many women think they are dirty and unclean if they haven’t groomed,” said Dr. Tami S. Rowen, an obstetrician-gynecologist and the lead author of the study.

The study found that the practice crossed all ages and races. But the women most inclined to groom are younger, between the ages of 18 and 34. They were more likely to be white, with at least some college education. The researchers did not find associations between grooming and income or marital status.

Anecdotally, gynecologists say they are seeing girls as young as 13 take up grooming, when they have only recently come into puberty. The teenagers, doctors said, are influenced by locker room jeers, social media chatter, and even internet pornography, where female genitalia is often displayed as hairless and almost prepubescent.

“At least once a week I hear from a young woman that she thinks it’s wrong to have pubic hair, that it’s meant to be removed,” said Dr. Jennifer Gunter, who specializes in pelvic pain and vulvovaginal disorders for Kaiser Permanente Northern California. “Grooming has become so common that people think that’s the norm.”

Pubic hair functions as a protective cushion for sensitive skin, and has its own hygienic purpose, trapping bacteria from entering the vaginal opening. ”Prepubertal girls have a higher incidence of irritation because they don’t have that protection,” Dr. Gunter said.

Dr. Rowen, an assistant professor at the University of California San Francisco School of Medicine, is concerned about grooming’s prevalence both because of a spate of health problems linked to it, and because of what it may suggest about women’s self-image.

She and other doctors have seen grooming-related cases of folliculitis, abscesses, lacerations, allergic reactions to waxing burns, as well as vulvar and vaginal infections. One study has noted that 3 percent of ER visits for genitourinary trauma are a result of grooming.

Although some researchers speculate that micro-abrasions and nicks from grooming may facilitate the spread of sexually transmitted infections, no large studies have definitively made that connection. A paper from one clinic did note, however, the rise in the number of so-called Brazilian waxes among patients (men as well as women) and a concurrent decline in pubic hair lice.

But it was this study’s finding that women associate grooming with health and hygiene — many said they groomed before a visit to a health care provider — that disturbs many gynecologists. Women were self-conscious even in private, medical settings.

“I’ve had women say, ‘I’m sorry I didn’t get a chance to clean up down there,’” said Dr. Cheryl B. Iglesia, a professor of obstetrics-gynecology and urology at Georgetown University School of Medicine.

Emphasizing that pubic hair patterns vary widely, according to women’s stages of development, ethnicity and individuality, Dr. Iglesia eschewed the popularity of the narrow standard of what she calls “the Barbie doll look.”

The results of this study are part of a larger project looking at grooming by men as well as women, exploring demographics, motivation, perceptions, sexual behavior and health habits.

Women were more likely to groom if their partner expressed a preference for it, the study found. But while earlier smaller studies had shown a link between grooming and sexual activity, particularly oral sex, this study found that while some women groomed for that purpose, it was not the primary reason: For example, 22 percent of the women reported grooming around the area of the anus, but only 10 percent had partaken in anally-related sexual activity in the prior year.

Instead, the researchers said, providers of health care and aesthetic treatments should become attuned to the diversity of reasons that women groom. The women also said they did so for vacation and because they see their own genitalia as more attractive when groomed.

“If it is something you do for you and makes you feel better, awesome,” Dr. Gunter said.

But noting that 59 percent of the survey’s responders said they groomed for hygienic reasons, she added, “But don’t tell yourself it’s healthy or better from a medical standpoint.”

Advice on Boys and Sex, From the Author of ‘Girls and Sex’


Peggy Orenstein

Peggy OrensteinCredit Michael Todd


Credit Harper, via Associated Press

“Girls and Sex: Navigating the Complicated New Landscape” is a book for both young women and their parents — but primarily their parents — about what’s changed for girls with respect to sex. The author, Peggy Orenstein, looks at every aspect of that evolving world in the hope of helping girls learn to develop satisfying intimate relationships, and helping their families offer guidance.

Last week in the Well Family weekly newsletter, I invited readers to submit questions to Ms. Orenstein. Amid all the questions about our daughters — how do we talk to them, how do we teach them, how do we protect them — were a flurry of questions about our sons. Ms. Orenstein understood. “Obviously you’re only having half the conversation if you only talk about girls,” she said. “Boys absolutely need to learn the same things.” Here are your questions and Ms. Orenstein’s answers, edited and condensed.


Will this book help me talk to my son about sex?


So much of it is the same — boys need to know about consent and alcohol and how it affects your judgment, and both boys and girls need to learn what the sex educator Charis Denison talks about toward the end of the book, about making decisions that end in joy rather than regret.

All of this is trying to inculcate ideas about respect, ethics, reciprocity. I ended the book in a co-ed classroom because I wanted to see boys and girls working these things out together. At one point, they’re talking about the baseball metaphor for sex — first base, home run, all that — and one of the boys says, “I never thought about it before, but in baseball one of the teams is supposed to be the winner and one is supposed to be the loser. Who’s supposed to be the loser in sex?” And I just thought, bingo. He will walk into his sexual encounters seeing his partner as a partner, not as an adversary, and that’ s really meaningful.


How can I talk to my son about consent, and what do you think we’re missing in that conversation?


Boys need to learn about the differences between consent and coercion and assault and particularly, I think, about these issues with respect to oral sex. So much of what kids are doing is not intercourse, it’s oral sex, and when we ignore that, we set up a situation in which they think that’s not sex and since it’s not sex it’s not subject to the same rules about consent and reciprocity and respect. Boys need to know that it’s not O.K. to push in oral sex either.


Do you have any suggestions for resources for boys?


I’m on the lookout. I love that TED talk by Tony Porter, “A Call to Men,” on how falling for our culture’s idea of “manly” can lead boys toward disrespect and violence. And I really like Al Vernacchio’s TED talk, too, “Sex Needs a New Metaphor.” That’s the one about talking about sex as a pizza instead of a game of baseball, which has only one set of goals and one winner. Sex is supposed to be an experience you share, and maybe there’s a negotiation process about what you both want.


How can I talk to my children — boys and girls — about porn?


It’s such a tough one, because they will see it. First of all, I think we have to put it out there that porn is not real sex. It’s about as real as pro wrestling. Boys, especially, need to know how much it affects their perspective even if they don’t think it does. A lot of the entitlement and the idea that sex is something that girls do for boys is a porn thing. We don’t want to demonize a child for curiosity, but we do want them to know that it is not how people behave — and that TV sex isn’t real, either. People don’t rip off their clothes and be done in 10 minutes. Kids need to know that that’s like, TV and movie shorthand for sex. It’s not what it’s like.


I have this illusion that my middle-school aged daughter isn’t hearing much about sex at school yet. What might I be missing?


It’s a time to start talking about images of women in the culture and about the idea of what’s “hot” and how that’s sold to girls. If they’re on social media they’re going to start being pressured to present themselves in a certain way. Every girl knows you get more likes with a picture in a bikini than in a parka.

It’s also really important to start talking about sexting. Girls are twice as likely to be coerced into sexting as boys, and interestingly, being coerced into sexting seems to cause more anxiety than being coerced into real sex. Boys will just badger and badger and badger by text, where it’s easier to say things like this, until girls give in and send the picture. Which makes this a good time to talk about assertiveness versus aggressiveness versus passiveness. I heard over and over again that girls just “don’t want to hurt a boy’s feelings.” They just can’t be rude. They need to know when it’s O.K. to just say, “knock it off.”

Kids at that age also need to hear that what they’re going through — puberty — so much of it is the same for everyone, boys and girls. Everybody gets hair in new places. Everybody’s genitals get bigger. Everyone starts to stink.


If I find it hard to talk to my children about sex, any ideas?


All of us need help with that. Try to think about talking to your kids about sex as an opportunity, rather than looking at it as something scary. It’s a chance to create a closer relationship. And if they ask something and you’re not ready, it’s O.K. to say so. You can say, that’s a good question, let’s talk about it after we’re done with dinner, or let’s look it up together, or let me think about it and get back to you.


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