Despite what a lot of people might think, oral sex is sex — not “third base,” not “everything but” — carrying with it the potential for both pleasure and disease transmission. That includes oral transmission of human papillomavirus (HPV), which can lead to head-and-neck cancer (aka oral cancer, aka oropharyngeal cancer). Unfortunately, because so many of us have a lax attitude toward it, fewer people take precautions when engaging in oral sex, and are less likely to use condoms or dental dams.
A head-and-neck cancer epidemic is striking younger people, spurred by HPV.
Head-and-neck cancer — which can strike anywhere from the lips to the larynx, and up into the sinuses and nasal cavity — is caused by several risk factors, chief among them oral infection with HPV. When HPV causes head-and-neck cancer, it usually occurs at the base of the tongue, at the back of the throat, in the tonsils, or in the soft palate.
HPV can be spread by most sexual activities, including vaginal, anal, and oral sex, as well as by rubbing genitals together. Although HPV is most famously associated with cervical cancer, it’s actually driving more cases of head-and-neck cancer in the United States.
It’s Oral, Head, and Neck Cancer Awareness Week — a time to learn about how head-and-neck cancer has changed over the years, what consequences it can have for survivors, and how it can be prevented in the first place.
A Changing Patient Profile
In 2017, scientists reported that oral HPV infections with cancer-causing strains of the virus are five times more common in men than in women, and that, likewise, HPV-associated head-and-neck cancers are more likely to strike men. That same year, researchers also reported that, in the United States, head-and-neck cancer among men has surpassed cervical cancer among women. As the years pass by, head-and-neck cancer rates are expected to continue to skew even more heavily toward the male population.
The United States is in the midst of a head-and-neck cancer epidemic, and the patient profile has shifted from heavy drinkers and smokers to younger people whose cancers were caused by HPV. In the 1980s, only 15 percent of head-and-neck cancers were caused by HPV, but nowadays, as smoking rates decline, the virus causes 70 percent of them.
While an epidemic is bad news, the good news is that these patients have a better prognosis than their counterparts from the 1980s. On average, they’re younger and healthier, and tend not to be smokers — meaning that, after successfully completing treatment, they could have decades of life ahead of them. But, depending on the location of their tumors, they might spend those remaining decades dealing with permanent side effects.
A Dry Mouth
Most of us have experienced dry mouth. Think about the last time you got nervous, perhaps before giving a speech or having a difficult conversation — your mouth goes completely dry. But for head-and-neck cancer survivors who have completed treatment, it could be a permanent part of life, arriving hand in hand with a collection of unpleasant symptoms.
After treatment with chemotherapy and radiation, head-and-neck cancer survivors might suffer permanent loss of salivary function, potentially leading to decades of health problems and difficulties eating. Although radiation is crucial for destroying tumors in the head and neck, the salivary gland may be an innocent bystander, absorbing more and more radiation as treatment progresses. The closer it is to the tumor, the more damage it sustains, and after treatment, it might shut down completely.
Saliva contains proteins that aid the digestion process and protect our teeth and gums. It moistens our mouth and makes food easier to swallow. Head-and-neck cancer survivors with long-term or permanent dry mouth might experience worsening oral health, like increased mouth sores and cavities, and often complain that food can taste terrible and be difficult to swallow.
Although no cure exists for post-radiation dry mouth, treatments are available, including oral lubricants, saliva substitutes, and saliva stimulants. Unfortunately, they cannot fix the root cause: a damaged salivary gland. Survivors hope the future will bring improved treatments, including drugs that can help a salivary gland repair itself.
An Ounce of Prevention
A vaccine called Gardasil 9 protects recipients from seven cancer-causing strains of HPV. To be most effective, it should be given to preteens, teens, and adults who have not yet had any sexual contact — including oral sex. That will help their immune systems be ready in the future if they do encounter HPV “in the wild.”
Sexually active people can also reduce disease-transmission risk during oral sex by using condoms, dental dams, and possibly even plastic wrap. HPV is transmitted by skin-to-skin contact, which means these “barrier” methods are limited by the area of skin they cover, so they are not seen as substitutes for timely vaccination.
If you are concerned you have symptoms of head-and-neck cancer, Planned Parenthood Arizona can refer you to specialists who can evaluate your mouth and throat. You can also ask a dentist or doctor to perform a physical examination — although not all signs of cancer can be caught by a visual inspection.
You can also make an appointment at a Planned Parenthood health center to receive Gardasil 9. While the FDA has not yet approved the vaccine for prevention of head-and-neck cancer, that could change as scientists continue to collect data. Additionally, Planned Parenthood can supply you with condoms and answer all your questions about HPV and safer sex.