Bye, Bye, Bystander! It’s on Us

The following guest post comes to us via Kate Thomas, community sexuality educator for Planned Parenthood Arizona. Kate has her master’s degree in public health from the University of Arizona and a passion for ensuring that people of all ages have access to the information, resources, and support they need to be sexually healthy.

it is on usIn October, the It’s on Us campaign launched a PSA about stopping sexual assault. In it, a guy at a party gets up to help when a girl who has been drinking is being harassed and grabbed by a male party-goer. The voiceover (provided by the amazing Jon Hamm) says, “This isn’t a PSA about a sexual assault. It’s about being the guy who stops it.”

You may have heard a lot about “bystander interventions” in the media coverage about how to prevent sexual assault. But not everyone knows what this term means. A bystander is someone who just stands by as something happens. They see something bad is happening, but do nothing to stop it. However, “bystander interventions” encourage individuals to intervene in situations instead of standing idly by.

Most of the time, it’s easy to intervene and prevent sexual assault. But not everyone takes that intervention in the best way. You could be told to back off, get called mean names, or even be threatened. That’s why it’s important to have others help you intervene if it isn’t safe to intervene on your own.

I have a lot of personal experience with bystander interventions.  Continue reading

Is Pap Testing Better Than HPV Vaccination?

Good news: The decision to be vaccinated for HPV or receive regular Pap testing isn't either/or. Image: Andy Newson

Good news: The decision to be vaccinated for HPV or receive regular Pap testing isn’t either/or. Image: Andy Newson

It’s January, which means that it’s Cervical Health Awareness Month! If you have a cervix, there are two big things you can do to protect its health: get vaccinated against human papillomavirus (HPV) before becoming sexually active, and receive regular Pap testing after becoming sexually active. When you take both of these steps, you can maximize what modern medicine has to offer. However, some people think you can just do one and ignore the other. Are they right?

You’ve probably heard of HPV, which causes genital warts and certain cancers. This virus has the dubious honor of being the most common sexually transmitted pathogen — some call it “the common cold of STDs.” According to the Centers for Disease Control and Prevention, “HPV is so common that nearly all sexually-active men and women get it at some point in their lives. This is true even for people who only have sex with one person in their lifetime.”


HPV isn’t just the “cervical cancer virus” — it’s a jack of all trades that can trigger cellular abnormalities all over the body.


One of the cancers most commonly caused by HPV is cervical cancer. In fact, when Gardasil, the most popular HPV vaccine in the United States, made its debut, it was marketed as a “cervical cancer vaccine,” despite the fact that HPV can cause other types of cancer. Nevertheless, a vaccine that could protect against such a common and potentially dangerous virus was good news indeed. However, some critics were quick to point out that cervical cancer is rare in the United States, thanks to widespread access to Pap testing, an effective screening procedure that can catch cellular abnormalities when they are still in their “precancerous” stages, allowing them to be treated before progressing to cancer.

For those of us planning to receive regular Pap testing, is vaccination really necessary? Likewise, if we’ve been vaccinated against HPV, do we really need regular Pap tests? Let’s examine both questions separately. Continue reading

Are Pap Tests Accurate?

If you follow health news, you might have noticed some controversy over certain cancer-screening methods: Does the evidence support mammograms as a tool to reduce breast cancer deaths? Are PSA tests effective in saving lives from prostate cancer? These are questions that we are beginning to answer as more and more evidence comes in. But don’t let these questions dissuade you from all cancer screening.


With regular Pap testing, cervical cancer is almost 100 percent preventable.


In fact, although we’re reevaluating data for other cancer-screening methods, we have mountains of solid evidence that the Pap test is one of the best cancer-screening methods out there. Because it detects signature mutations that mark cells as headed toward becoming cancerous, Pap testing detects “pre” cancer while other cancer-screening techniques, like mammography, only detect cancer.

Cervical cancer used to be a top killer in developed nations — and it remains a major cause of death in countries without widespread health-care access — but in the last 50 years, cervical cancer deaths fell by 70 percent in the United States, transforming cervical cancer from the leading cause of cancer death among American women to a less common, nearly preventable cancer. Despite this, you might hear people complain that the Pap test isn’t accurate, citing the possibility of receiving “false positive” or “false negative” results.

A Pap test looks for abnormalities in cervical cells, and you can receive one of these four results:

True Positive: Cellular abnormalities are detected, and they are in fact present. True Negative: Cellular abnormalities are not detected, and in fact the cells are normal.
False Positive: Cellular abnormalities are detected, but the cells are actually normal. False Negative: Cellular abnormalities are not detected, but are actually present.

When we receive a true positive result, we can receive treatment for precancerous lesions that in fact might otherwise lead to cancer. Likewise, when we receive a true negative result, no further treatment is needed. Continue reading

How Does HIV Cause AIDS?

diagram of a human immunodeficiency virus

Last week, we gave a general background of human immunodeficiency virus (HIV), the virus that causes AIDS by destroying the immune system. But how is HIV able to disable our immune systems so effectively, anyway? The answer lies in its structure.

HIV, just like any other virus, is made up of a tiny capsule with a small piece of genetic code inside. While most viruses we’re familiar with store their genes on a molecule called DNA, HIV contains two pieces of RNA, which is another type of gene-storing molecule. The HIV capsules also contain an enzyme called transcriptase, which “translates” the RNA into a strand of DNA that our cells can read. Our cells are then tricked into reading this DNA and producing more copies of the virus — which are then released from the host cell, at which point they are free to infect other cells. In this manner, an HIV infection slowly grows.


HIV targets our immune systems, the very mechanism that evolved to keep us safe from pathogens.


When a virus is introduced into a host’s body, immune cells pick it up and carry it to the lymphoid organs — which are a sort of meeting place for other types of immune cells, including CD4+ T helper cells (also called helper T cells). Helper T cells enlist the help of other immune cells, called killer T cells, which destroy cells infected with viruses. Helper T cells also activate the production of antibodies, molecules that are specialized to attach to a specific pathogen so that it can be destroyed. Normally, this is where the virus meets its end. Unfortunately, HIV is different from run-of-the-mill viruses in that it is specialized to invade helper T cells. Now, instead of coordinating an attack against HIV, the helper T cells have been hijacked — converted into factories for the production of yet more HIV. Continue reading

STD Awareness: HIV and AIDS

Our immune systems are beautiful things, refined through millions of years of evolution. The immune system’s complexity is testament to the “arms race” that has been taking place between our species and the harmful pathogens that surround us. Last century, a virus called human immunodeficiency virus (HIV) emerged, and it found a weak spot in our immune system’s armor. HIV has been exploiting this weakness ever since, and an HIV infection can eventually progress to a disease called AIDS, or acquired immune deficiency syndrome. AIDS is a condition that disables our immune system’s ability to function properly, rendering us vulnerable to a host of opportunistic infections and cancers.


Even if you don’t think you’ve been exposed, HIV testing can be a good idea.


HIV is transmitted via bodily fluids: blood, semen, pre-seminal fluid (which can be present without ejaculation), breast milk, vaginal fluids, and rectal mucus. (It can also be present in bodily fluids like amniotic fluid, cerebrospinal fluid, and synovial fluid, to which health-care workers might be exposed.) The virus is not transmitted by fluids like snot, saliva, sweat, tears, and urine — unless blood is present.

Activities that can bring you into contact with HIV-infected bodily fluids include injection drug use and sexual activities like anal, vaginal, or oral sex. It can also be transmitted to a fetus or baby during pregnancy, childbirth, or breastfeeding. In the early days of HIV, many infections occurred as a result of blood transfusions or organ transplants — though nowadays this is a rarity thanks to tissue screening. Lastly, health-care workers might be exposed to HIV through accidents involving needlesticks or cuts. Continue reading

Interpreting Abnormal Pap Tests

Because a Pap test screens for abnormal cervical cells and because those cell changes can be associated with cervical cancer, being on the receiving end of an abnormal Pap test result can be frightening, intimidating, and confusing.

On the “frightening” aspect: Some people assume that an abnormal Pap means that cervical cancer is imminent. On the contrary, the National Cancer Institute not only states that cervical cancer, when it develops, takes “many years” to do so, but also that “[t]he majority of infections with high-risk HPVs [human papillomaviruses] clear up on their own.” This is not to suggest that regular screenings aren’t important — but rather, that they do their job and detect cervical changes in plenty of time to prevent cancer from developing in the first place.


Remember that if you’re confused about your Pap test results, part of your health care provider’s job is to answer your questions and keep you informed.


On the “confusing”: It’s true. There are a lot of different letter codes. Though some of them look awfully similar, they each mean a different thing. Moreover, the clinical recommendations for how to follow up with an abnormal Pap can depend not only on the code — in other words, the specific abnormal result — but also on one’s age and medical history.

Ready to sort them out?

Most labs in the United States use a classification system called the Bethesda System in order to have some standard terminology when reporting results. The Bethesda System uses the term squamous intraepithelial lesion to describe changes on the surface of the cervix. It categorizes those changes in these ways: Continue reading

How Often Do I Need a Pap Test?

Almost 80 years ago, Dr. George Papanicolaou developed a simple test, the Pap test (also called the Pap smear), done in a doctor’s office to check for cervical cancer. During a pelvic exam, a doctor swabs a small sample of cervical tissue and looks for abnormal cells. If these precancerous cells are detected, it will lead to more tests or other more invasive treatments such as a colposcopy (in which actual tissue may be removed). In the 1930s, when Papanicolaou was developing his test, cervical cancer was more lethal than breast cancer. But since the development of this test, the number of women dying from cervical cancer has dropped dramatically. In 2009, of the 4,000 women in the United States who died of cervical cancer, most had never been screened or had not been screened in the 10 years before their diagnosis.


This year, the U.S. Preventive Services Task Force recommended less frequent Pap testing.


Cervical cancer is most common in women between ages 35 and 55, and usually develops from a human papillomavirus or HPV infection. Not all HPV infections lead to cervical cancer, and it can take decades for a persistent infection with a high-risk type of HPV to become cancer. High-risk HPV types are sexually transmitted and can lead to cervical cancer and also anal, penile, and oral cancers.

There are two types of screening: Pap tests and HPV tests. While they both require a pelvic exam in which cells are taken from the cervix, Pap tests look for abnormal or precancerous cells, and HPV tests look for DNA or RNA from high-risk HPV types in cervical cells. Both tests are used to try to catch cervical cancer in its earliest stages so that it can be successfully treated. Continue reading