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October 30, 2008

Sex, Lies, and the HPV Vaccine

The cervical-cancer vaccine is the biggest women’s-health breakthrough in years. So why did I have to talk my doctor into it — and keep the shot in the office fridge?

open refrigerator with food and medicine inside

Photo Credit: Jeff Westbrook

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“Arm or butt?” my gynecologist barked as she entered the exam room, already tearing the packaging from the prefilled syringe I’d brought to the appointment. I had been trying for almost two hours to have someone, anyone, in the practice stick me with my second dose of the cervical-cancer vaccine Gardasil, to no avail (my doctor had been tied up with an emergency labor; her associate “doesn’t do the vaccine”), and I was seriously considering injecting myself.

“Is there a reason your associate wouldn’t give me the shot?” I asked, pushing down the waistband of my skirt as the vaccine oozed into my left cheek. “Does she not believe in it? Does she think it’s not effective?”
“No, she doesn’t give it because she doesn’t want to be bothered reminding people to keep up with it,” my doctor said, referring to the three doses that must be administered over a six-month period.
“That’s why I’m telling you, schedule the third injection now. I’m not going to call you — you’re on your own.” She scribbled a few notes onto her clipboard and was gone.

My doctor and I had been sparring over Gardasil since I first mentioned it last March. I was 26 and eager for what the American Cancer Society called “one of the most important advances in women’s health” — a vaccine against cancer-causing HPV (short for human papillomavirus, the most common STD on the planet). But my physician seemed to view the inoculation as an unnecessary nuisance. Hardly anyone was getting it, she told me, and I of all people didn’t need it because I had a long-term boyfriend. “Wait and get it if you break up,” she said. “You’ve already been exposed to any HPV he has by now.” When I insisted, she rolled her eyes and handed me a prescription for all three doses. I was to fill it on my own at a specialty pharmacy for $164.95 a pop and bring the needle with me to each of the three injection appointments. “It’s an expensive vaccine, so we don’t stock it in the office,” she explained. She didn’t mention that each dose would have to be refrigerated and that I’d soon be triple-wrapping syringes in plastic bags and shoving them to the back of the office Sub-Zero disguised as my lunch.

As I ranted to friends, I learned they were facing similar hurdles. (Even the pharmacist remarked on how many women were filling prescriptions for the vaccine themselves.)

Resistant OB/GYNs rattled off arguments about billing complications, limited safety data, and diminished effectiveness in sexually active women, and many of my peers simply backed off. Sure, I’d read all about the controversy over inoculating girls as young as 9 against an STD. But now the 20-somethings, the women with the highest HPV risk, were being marginalized? It didn’t make sense. For me, no wasn’t an option, whatever the hassle. I’ve been terrified of HPV since college, when friends of mine — responsible, condom-using friends — started racking up HPV infections. The scary truth is, more than 80 percent of American women will acquire one by age 50, and the virus is the primary cause of cervical cancer. True, most infections clear up on their own without triggering any symptoms, but the sheer number of people affected and the potential complications had me swearing off sex and referring to men as “carrier monkeys.” Research indicating that the virus can be passed through oral sex and heavy petting didn’t help. Worst of all, my mother died of cervical cancer when I was 14.

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