When my two daughters were little girls, I would occasionally imagine them in high school, dressed in flowing, colorful gowns as they joined their dates for the prom.  Or even as brides gliding down the aisle to meet their future husbands.  But I certainly didn’t think about them having sex.  Even now, when they’re both young teens, my mind pushes out any attempts to consider their likely-near future sexual lives.

But it’s not just because I am a physician (one who focuses on cancer) married to a physician (one who focuses on children) that demands I do think about my daughters’ future sexual activity.  It is because I am a parent.  As parents, we simply must accept that our little girls and boys will engage in sex, even “experimenting” at a younger age than we did.  And not just sexual intercourse.  Oral sex.  And who knows what else?  And who knows with whom?  So as much as I don’t wish to imagine these things, as a parent whose charge includes protecting my girls from preventable future harm, I have to think about my girls having sex.

The most common sexually transmitted infection that threatens my daughters is the Human papilloma virus (HPV).  And lest you think that this little virus only causes benign disease, think again.  Because HPV is the source of approximately 99% of all cervical cancers.  That’s right:  an infection that causes cancer in women.  Cervical, vulvar, vaginal, and anal.  But wait, fathers and mothers of boys, because HPV can also generate cancers in your sons.  Penile and anal.  But wait again, parents, because HPV causes cancer in both women and men as a result of a sexual activity that many (including teens) engage in because it is believed to be “safe sex.”  That’s right.  HPV is also the leading cause of oropharyngeal cancer (the oropharynx includes the soft palate, the back and sides of the throat, and the far back of the tongue), transmissible to both girls (and women) and boys (and men) during oral sex.

Now as a dad, I’d like to believe that there is little chance my little girls will ever get a sexually transmitted disease.  No way.  They’ll have few sexual partners, all young men of good character and good intentions.  Certainly these fine young men who along with my girls will be first exploring their sexuality will be, well clean, right?

Wrong.  Virtually none of us is clean, as 80% of all sexually active people will be infected with one or more of the 100+ strains of HPV at least once in our lives.  The real fact is that for the majority of us, an HPV is or will be a reality once we become sexually active (including orally sexually active).

Fortunately, there are two very important facts about HPV that are in our favor.  First, while the vast majority of Americans have or will suffer an HPV infection (or more than one), our immune systems are incredibly efficient at eventually destroying the invading viruses.  In fact, our bodies clear about 99% of the sexually transmitted HPV infections that we suffer.  And second, only a handful of all HPV strains can cause cancer in humans.  We designate different viral strains numerically, and for HPV, it’s HPV-16 and HPV-18 that carry the big cancer risk (I’ve often wondered whether it is purely by chance that these numbers are also the ages at which humans often begin experimenting sexually…).

HPV-16 and HPV-18 infect the specialized cells lining the genital, anal, and oropharyngeal areas.  Persistent and repeated infections with these strains dramatically increases the risk of a girl or woman eventually developing cervical, vulvar, vaginal, anal, or oral cancer, and of a boy or man producing a penile, anal, or oral cancer.  The virus damages the DNA in these cells, and with further genetic mutation (from persistent and/or repeated infection), one cell can eventually transform into an immortal and invasive malignant cell.

Unfortunately, most people never even know if and when they’re infected with HPV.  And if you don’t know that you are harboring a virus, you can’t protect your sexual partner or partners.  Furthermore, if you don’t know that you’re infected, you won’t appreciate that you may be at increased risk of a future cancer and, therefore, won’t get appropriately screened to identify a cancer at an earlier, treatable stage.  That said, some people do know, as HPV infections with strains HPV-6 and HPV-11 cause the growth of benign anal and/or genital warts (they can also grow in the oropharynx).  That’s right:  genital warts are not caused by the two HPV strains associated with cancer development.  So what does it matter that between half-a-million and a million Americans suffer benign genital warts each year?  After all, the viral strains that cause these little infectious bumps are not the same as cause genital, anal, or oral cancer.  Because HPV infections are often from multiple viral strains.  That is, if you develop genital warts, you may well also be infected (or have been infected or will get infected) with other strains of the virus, including the dangerous ones that remain silent (no warts) at first, but which may trigger cancer later.  (Of course if you suspect you have genital warts, see your physician immediately and protect your sexual partners from becoming infected.)

What’s all this got to do with my daughters?  Should I lecture them on the importance of safe sex?  Should I encourage abstinence?  Should I simply lock them in their rooms until they’re thirty?  Well, maybe, yes.  But there’s something that I (and you) can do that’s much more effective (and realistic) than these and other attempts at behavioral adjustment:  vaccination.

Given that about 17,000 American women and 9,000 American men will be diagnosed with a preventable HPV-associated cancer this year, it is both surprising and disturbing that more physicians and parents aren’t partnering to prevent these malignancies.  The fact is, the U.S. Food & Drug Administration (FDA) has approved three vaccines which are highly effective at preventing infections with HPV-16 and HPV-18, the two viral strains associated with cervical, vulvar, vaginal, penile, anal, and oropharyngeal cancers.  In addition, the two Gardasil® vaccines not only protects against the two cancer-associated viral strains, they also provides protection against the strains which can cause unpleasant benign genital warts.  And these vaccines are also approved for boys and young men as well as girls and young women. The vaccines are given as three injections over a six month period (it is critical that your daughters and sons complete the entire vaccination series to receive the greatest possible protection from infection).  These vaccines are approved for use in children age nine through young adulthood (age 25 or 26, depending on the vaccine).  Thus, it makes the most sense to vaccinate our sons and daughters when they’re children, before they ever even begin to wonder about anything sexual.

It can be uncomfortable to think of (let alone discuss) your little girls’ and boys’ sexual futures.  And too many pediatricians also feel this discomfort, failing their medical responsibility to bring up HPV vaccination (the CDC describes vaccination rates as “low”).  But just as your own health is your own responsibility, so is the future health of your children.  So, parents, let’s suck up our discomfort and face the fact that our beautiful little princesses and goofy little spidermen are going to be sexually active (likely sooner than we think), and that their nearing sexual activity places them at risk for cancers in their future.  And that’s something that you can do something about, Mom and Dad.

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