What is Oral sex?
Oral sex, sometimes referred to as oral intercourse, is sexual activity involving the stimulation of the genitalia of a person by another person using the mouth or throat.
Ten years ago, oral cancer among women was practically unheard of. Patients were nearly always male and over 50, heavy smokers or drinkers, or both. (When actor Michael Douglas was diagnosed with the illness, the media pointed to his longtime half-a-pack-a-day habit.)
But according to the Journal of Clinical Oncology, there has been a major upswing in HPV-related oropharyngeal cancer, a deadly disease often found in the base of the tongue and the tonsils.
In fact, up to 20% of all oral cancers are now HPV-related, according to the World Health Organization (WHO), and about 25% of cases occur in women, some as young as 19, says oncologist Dr Gregory Masters.
But how could HPV be causing so many mouth problems? It’s something doctors and health experts have long feared, thanks to the rampant spread of the virus.
You’ve probably heard the stats: one in 35 women in South Africa will develop cervical cancer, predominantly caused by HPV. About 21% of SA women are estimated to harbour a cervical HPV infection at any time. What’s more, the virus – which can have zero symptoms or bloom into visible warts – will affect up to 80% of sexually active women.
In the majority of cases, the body’s immune system will clear up the HPV within two years (there is some debate over whether the same HPV infection can return to cause cervical lesions later, but research is in the early stages).
However, some infected SA women – around 6 000 per year – will not clear and may develop cervical cancer. This has prompted the WHO to recommend that girls be vaccinated for HPV by age 12.
To date, safe-sex campaigns have blamed the spread of HPV on unprotected vaginal sex. But it’s now clear that the disease can be contracted orally too. Thousands of women’s mouths were infected with HPV-16, the strain that most doctors believe is responsible for the majority of HPV-related oral cancers.
How long HPV-16 lingers in the mouth before turning into cancer is uncertain. But what is evident is that more than 14% of cases aren’t caught until the very late stages, possibly because some doctors are slow to consider the cancer in young female patients.
Since HPV-related oral cancers don’t affect the traditional group of those at risk for mouth cancer, a lot of these cases are missed or diagnosed late. Usually, the patient is healthy, exercises and eats well. She doesn’t fit the old oral cancer profile.
Healthy or not?
Lydia Miner definitely didn’t fit the profile. She had a healthy diet, worked out and didn’t smoke or drink much. But she had a strange sensation in her throat that felt like a pill, stuck midway. Or, she thought, it was skin irritated by one of the times she’d hurriedly choked down lunch during her hectic job. “I thought I was just imagining it,” says Lydia, now in her forties. But after two months, she knew better.
She got a scan, which showed something alarming. “The doctor stared at the results, then turned to me and said, ‘I think you have oral cancer,’” she recalls. Her small malignant tumour, which was surgically removed, tested positive for HPV. Lydia was incredulous. She hadn’t thought about the virus in over a decade.
In her twenties, Lydia had had a series of abnormal Pap smears, but by her thirties, her results continuously came back normal and she’d forgotten about any irregularities. But HPV is nothing if not sneaky; it can lie dormant and undetectable in the body for years, making it incredibly difficult to know if you’re infected and unknowingly passing it along to others.
This can also make it nearly impossible to pinpoint the partner responsible for giving it to you. (Meaning, that one-night stand you had in your teens or the guy you dated seriously in varsity can come back to haunt you well into your thirties and beyond.)
Though between 40 and 60% of guys have HPV at any given time, less than 1% will have visible symptoms. What all this means is that oral sex puts you at risk of picking up a cancer-causing virus, not just the host of venereal diseases such as HIV.
The most obvious HPV-related oral-cancer risk factors have to do with the kind of sex you have, how often you have it and the number of partners you’ve tangled sheets with.
According to a study in the New England Journal of Medicine, people who have had six or more sex partners are more than twice as likely to develop oral cancer. But those who’ve had six or more oral sex partners increase their chances by a whopping 340%. As such, says Dr Masters, HPV-related oropharyngeal cancer should be considered a sexually communicable disease.
“From cases I see, I get the sense that many younger people don’t think oral sex counts as sex,” he says. “But oral sex has risks too.”