The human papillomavirus (HPV) infects surface cells on the oral or genital mucous membranes and parts of the skin, such as the hands or feet.
Any contact of those areas with a person who has the virus could lead to transmission. It’s common among sexually active adults and there are many different varieties of HPV. More often than not, the body is able to fight off the virus so that it’s eliminated over a few years. However, this sometimes isn’t the case, especially if a person’s immune system is compromised, or if they smoke. When the virus persists, it can cause problems such as warts, or potentially even cancer, such as cervical cancer. This is why it’s so important to go and have regular smear tests as they’re incredibly effective at detecting pre cancerous disease, before it’s had a chance to develop and grow.
If you have an abnormal smear, please don’t panic, as it doesn’t necessarily mean there’s something wrong! Your doctor will also perform a test for HPV and if this is also positive, will refer you for a microscopic examination of your cervix, or colposcopy. Sometimes, that’s all that’s needed, or regular monitoring. But occasionally treatment is required to stop any changes already there from developing into cancer. Simply having HPV does not mean you have cancer, and there’s a huge and wide spectrum of possibility in between.
If your doctor decides that they need to remove abnormal cells, they’ll use one of the following techniques:
- cryotherapy, or freezing and eliminating the abnormal tissue
- a cone biopsy to remove part of the cervix
- a loop electrosurgical excision procedure (LEEP), which involves removing cells with a wire loop that carries an electrical charge
These procedures are very effective but may affect your ability to conceive or reach full term in a future pregnancy. This is because tissue removal from the cervix can change its structure. It may cause stenosis, or a narrowing of the opening of the cervix, which may present an obstacle to the sperm as they have to swim up the reproductive tract to reach the egg and fertilise it. Or it could present an obstruction during IUI or IVF if an embryo transfer is being attempted. The cervix may also weaken and whilst this will not cause infertility or difficulty becoming pregnant, it can lead to cervical insufficiency, which can cause your cervix to widen and thin before your pregnancy has come to term. The larger the piece of tissue removed, the greater the risk of this becomes.
If you have had treatment to your cervix, your obstetrician may need to monitor this with extra ultrasounds, and may consider performing something called cervical cerclage, which is a tie around the cervix, to reduce the chance of it opening prematurely.
But it isn’t just women who can be affected. Interestingly, some studies are finding that men who have sperm affected by HPV, could have consequences such as subfertility, by affecting the sperm and its ability to fertilize an egg, or potentially increasing the risk of miscarriage.
Having the HPV vaccine before a person has sexual exposure, but even after, is now thought to significantly help prevent the development of cervical cancer, which has a strong association with HPV, and can subsequently help to preserve fertility, in potentially both men as well as women. Barrier contraception is also important in terms of helping to prevent transmission of HPV, much like the other STDs, if you’re not trying for a baby.
However, getting the HPV vaccine doesn’t completely eliminate your risk of getting cervical cancer. The vaccine protects against two strains that cause about 70 per cent of this disease, so even if you’re vaccinated, you can still contract other types, and you still need regular screenings.
If you’ve been diagnosed with cervical cancer, there are many treatment options…
Cervical cancer treatment is very successful if you’re diagnosed in the early stages. The type of treatment used for cervical cancer depends on the stage at diagnosis. More advanced cancers usually require a combination of treatments that may involve surgery, chemo and radiotherapy.
What about preserving fertility….
Many women with cervical cancer are sadly in their reproductive years, and so preserving fertility and understanding possible consequences to any pregnancy is crucially important. There are several options for how to do this. The most important thing is to recognize the need to see a fertility specialist and to be referred on time so that the crucial opportunity is not missed to save eggs and ovarian tissue before it’s damaged or removed during any cancer treatment. Fertility preservation options include:
- egg freezing prior to treatment, but it may delay treatment and may be complicated if the cancer is hormone sensitive, meaning any drugs given to stimulate the ovaries could have an impact on the cancer.
- embryo creation and freezing prior to treatment for cancer, where eggs are collected and fertilized with sperm, there is a higher chance of success with this but again, could be affected by similar problems as the above.
- removing and freezing ovarian tissue for reimplantation later, after cancer treatment has been completed. This is a fairly novel technique that some units are offering and though successful pregnancies are beginning to be reported with this, it requires more follow up before it can become regular practice.
Despite recent advances and improving success rates with egg and embryo preservation, there are no guarantees that these methods will result in a successful pregnancy for any individual, and ultimately egg donation and surrogacy, if the woman has had her womb removed as part of treatment, may be needed.
Being diagnosed with cancer is awful and seeking help from a counselor to offer emotional support and help you to focus on a plan, is absolutely vital. Thankfully, there are also many support groups and charities out there who campaign hard to raise awareness of cervical disease and are an incredible source of help for many. They include The Lady Garden Foundation, The Eve Appeal and Jo’s Cervical Cancer Trust, all doing their bit this month to make some noise about gynaecological cancer. Being armed with some awareness on this subject will go a long way in helping you understand what you can do and help you to make empowered decisions about yourself and your future.
About the author
Dr Larisa Corda is an Obstetrician and Gynaecologist and Fertility Specialist MBBS BSc MRCOG. She qualified from Imperial College London and trained in the UK and Australia, gaining a wide understanding of womens’ health issues across an international population. She believes in a holistic approach to treatment that addresses many lifestyle factors as well as a combination of Eastern and Western principles, that underpin The Conception Plan she has devised, as seen on TV. Larisa is a passionate womens’ rights campaigner, with roles on a number of charities, and supports the use of natural and mild IVF techniques to assist conception where needed. She regularly appears in the media, and has several research interests including the effect of stress on fertility. To follow her advice and tips, including The Conception Plan, go to www.drlarisacorda.com and @drlarisacorda on Instagram.
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