Truly safe sex: one doctor's case for abstinence

There probably isn't a college student in America who has not heard at least two or more lectures on "safe sex." But before rolling your eyes and saying to yourself, "Uh oh, here comes another one," let me say at the outset: This is not your grandmother's sex lecture. My credentials: I am an Internal Medicine physician, BA from Haverford College and MD from the University of Buffalo. My current work involves lecturing on sexually transmitted diseases (STDs) nationally and internationally. And I am nobody's grandma. Students reading this article have to pay the bill for the cavalier ways of the sexual revolution. Fewer than 10 years ago, a study of women who first became sexually active in college found that one in four contracted Human Papilloma Virus (HPV) within the first year, even though the women averaged only two male partners. Now, at some colleges the rate of HPV infection stands at 20 percent, or one in five young women. Two decades of "safe sex" education and condom distribution programs has resulted in more than 65 million Americans over age 12 having an incurable STD, according to the Centers for Disease Control. I shall limit my remarks to HPV since it is (1) the most prevalent STD, (2) very high numbers of college students are infected and (3) it can lead to cervical cancer in a minority of cases. But it must be emphasized here that nearly all cervical cancer is caused by HPV. Moreover, in the United States, more women die from cervical cancer than die from AIDS! College women frequently suffer along the lines of the following two scenarios. A young woman may acquire HPV and develop cervical changes discovered on a Pap smear. When cells are rapidly mutating toward cancer, her gynecologist may recommend surgery to remove a large portion of the cervix. Later this leads to more difficulty in conceiving and then, more difficulty maintaining a pregnancy. Alternatively, she may need cervical freezing (cryosurgery) and frequent reevaluation. If this doesn't work, and invasive cancer develops, she may need a hysterectomy or chemotherapy. A more common scenario is that she doesn't know she has been infected with HPV until an abnormal Pap smear arises five to 20 years later. The Student Health Center nurse is gone; the boyfriends have faded. Then, the same medical offerings may await her. In both cases, unless she has had sex with only one man, it is impossible to pinpoint by whom she was infected. Was it the first, second or third steady boyfriend or was it one of many 'hook-ups'? The most dangerous misinformation surrounding HPV today is the unmerited assertion that prophylactics will protect women. "Condoms, condoms, condoms," cry university health centers. Incredibly, condoms are offered up like sacrifices to the pleasure god to ward off ugly HPV. Scientifically, condoms have been shown to be ineffective in significantly reducing the rate of HPV transmission. Major public health entities have been loath to admit this because there is no effective alternative. They are left to sigh, shrug and recommend condoms. The National Institutes of Health (NIH) say: "For HPV, the Panel concluded that there was no epidemiologic evidence that condom use reduced the risk of HPV infection, but study results did suggest that condom use might afford some protection in reducing the risk of HPV-associated diseases, including warts in men and cervical neoplasia [cancer or precancer] in women." Notice that the NIH says condoms "might afford some protection" And not "do provide protection." The research on condoms fails to show significant protection. If the world's biggest medical research organization cannot say 'they work,' should you really rely on condoms to protect you from genital warts and cervical cancer? HPV is still contagious whether warts are visible or not. Only about 2 percent of infected persons have visible genital warts; 98 percent of infected persons have no symptoms. Pap smears diagnose women with HPV. How many men do you know that have ever had a Pap smear? There is no commercially available test to diagnose men with HPV (outside of having visible warts). This puts men in the pitiable position of being ignorant that they are a vector for the Big C: cancer. Men, how will you react when you future wife has an abnormal Pap smear because of her college behavior? In the case of HPV, like many STDs, both males and females are infected but women bear a higher burden; don't bother filing a discrimination complaint - HPV is not an equal opportunity offender. Because: there is no cure for HPV, men cannot be tested, most infected people have no symptoms and condoms do not stop transmission - students need to make other choices. Maybe you've read of students who have had sex only one time and yet contracted HPV. Sadly, they have paid the price of a culture that endorses multiple partners - including "serial monogamy" - which truly are the greatest risk factor for STDs. Before you resort to the latest faddish alternative, know that HPV and many other STDs can also be spread by other sexual non-intercourse practices. If you want to avoid HPV, the only truly effective strategy is to avoid sexual activity until you have found Neo, "the one", and pledge "til death do we part."