The human papillomavirus (HPV), best known as a sexually transmitted disease and a major cause of cervical cancer, is now, thanks to oral sex, implicated as causing more cases of throat cancer in men than smoking.

Earlier this month, in the "Journal of Clinical Oncology," researchers reported that over a 20-year period ending in 2004 the percentage of oral cancer linked to HPV surged from 16% to 72%. It is estimated that these virus-linked malignancies, which thus far have been found overwhelmingly in men, will become more prevalent than cervical cancer caused by HPV. It is not clear whether the vaccine given to girls and women to prevent cervical cancer also confers protection against oral HPV. Likewise, it is not clear whether the difference between the sexes in oral cancer rates is related to differences in sexual behavior, or whether the HPV infection is of longer duration in men. The two HPV vaccines available at this time do target the HPV strain that has been associated with oral cancer.

Almost a decade ago, an article in the "Journal of Pediatric Psychology" considered the findings that 33% to 59% of high school teens (including up to 24% of virgins) had reported having given or received oral sex. The purpose of the study described in this article was to examine the following:
• Whether adolescents engage in oral sex to avoid the risks associated with other behaviors.
• If oral sex presents a health risk, the substantial number of teens engaging in this behavior raise a public health concern.
• The need to determine the number of oral sex partners, and what if any precautions are taken to prevent the spread of disease.

The subjects, of course, did consider oral sex a relatively risk-free behavior. Interestingly, however, the larger number of adolescents' reported sexual partners were associated with lower levels of popularity, and lower peer acceptance. Psychologists interested in preventative health issues should take heart: Peer culture may exert some influence on the endorsement of safer sexual behavior. Public health education can reinforce the importance of safer sexual behavior by discussing, for example, the risk of oral cancer at a relatively young age.

PT blogger Christopher Ryan, in his accessible and informative book, Sex at Dawn discusses the pitfalls of pledges of abstinence: Adolescents who made such pledges have been found to be more likely to engage in oral and anal sex than other teens; they are just as likely to contract a sexually transmitted disease. Pledges are not the answer. Until studies are done to confirm the utility of universal HPV vaccination in boys and men to prevent oral cancer, then perhaps society will just have to depend on luck, and people will just have to place further restrictions on their own behavior.

Where the proselytizing failed on the part of the self-described moral majority to control the behavior of many of us, perhaps the scientific data will succeed. It already has succeeded in terms of the role HIV as played in so many lives, reducing perhaps the numbers who engage in unprotected sex, but ironically also increasing the numbers who engage in oral sex, which itself brings an entirely new set of public health concerns.

Oral cancer is a devastating disease, with treatment involving chemotherapy, radiation therapy and surgery in many cases.  It often leaves sufferers with disfigurement, difficulty with speech, and chronic pain. Alcohol and tobacco use once were the main causes of oral cancers; much has changed. Avoiding alcohol and tobacco will not completely protect one from oral cancer any longer. 

Will men be driven back to, and forced to rejoin the battle with, that long-dormant primal archetype of the dentate vagina, a concept that has its roots in folklore found throughout the world? An ancient Chinese proverb describes a woman's genitalia as being both the gateway to immortality, and also the executioner of man. Native American folklore has extensive references to the dentate vagina. And several Egyptian deities represented the "vagina dentate."

One last thought, and perhaps one that will save the sexual revolution: What if HPV and oral cancer are transmitted through open-mouth kissing?

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