HPV and Men: What You Might Not Know About Prevention

Pamela Merritt

More than half of sexually active men in the United States will have some form HPV at some point during their lifetime. Yet many don't know the HPV vaccine was recently approved for men.

On the last weekend of June, I volunteered with Planned Parenthood of the St. Louis Region and Southwest Missouri for a three-hour shift at their booth at Pridefest.  Pridefest is the annual two-day outdoor festival celebrating the lesbian, gay, bisexual and transgender (LGBT) community.  I’ve volunteered with Planned Parenthood at Pridefest before and have always enjoyed the positive reception, but this year was different.  Because this year the Planned Parenthood booth included a large banner announcing the availability of the HPV vaccine for males between the ages of 9 and 26 years old, prompting a lot of interest and questions.

It is important to note that the human papillomavirus (HPV) does not discriminate – people are at risk regardless of their sexual orientation or gender identity.  There are also many forms of the virus, some of which are linked to cancers and others of which are not.

For men, HPV infection can increase the risk of genital cancers and/or cause genital warts.  It is estimated that more than half of sexually active men in the United States will have some form of HPV at some point during their lifetime. Although men will often clear HPV from their system with no health problems, it is important to understand the health risks associated with the virus.

Some types of HPV in men can lead to cancer of the anus or penis, although these types of cancer are rare in men with a healthy immune system.  Other types of the HPV virus cause genital warts. It is estimated that about one percent of sexually active men in the United States have genital warts at any given time.  The types of HPV that may cause cancers rarely present symptoms, but genital warts are a symptom of the type of HPV that causes warts but not cancer. 

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Genital warts are usually diagnosed through a visual exam.  There currently is no routine test for men the types of HPV that cause cancers, although some doctors recommend anal PAP tests for gay and bisexual men who are at higher risk for anal cancer caused by HPV.  HPV may lay dormant in the human body for years without presenting any symptoms.

Condoms protect against transmission of HPV, but they are not 100 percent effective because HPV is primarily transmitted skin-to-skin.  Abstinence is the only sure way to prevent transmission of HPV. 

Planned Parenthood of the St. Louis Region and Southwest Missouri, and Planned Parenthood health care centers across the United States, now offer HPV vaccinations to males ages 9 to 26.  Planned Parenthood also offers HPV vaccines for girls beginning at 11 or 12 years old.  The three-shot regimen protects against strains of HPV and is most effective when started before sexual activity and before exposure to the HPV virus.  A Patient Assistance Program from Gardasil manufacturer Merck allows for health care centers to provide the vaccine at an affordable cost. Gardasil can protect against four types of HPV that cause warts.

Many of the young men who visited the Planned Parenthood booth at Pridefest in St. Louis said that they were interested in the vaccine to protect their future sexual partners as well as themselves.  The risk of transmission of HPV does not miraculously disappear when a person gets married or enters into a committed relationship.  Some of the men had questions about getting the vaccine even though they are over the age of 26 – all people should consult a trusted health care provider like Planned Parenthood to find information about testing, treatment and the HPV vaccine.

Throughout my volunteer shift at the Planned Parenthood booth at Pridefest 2010, I met people who wanted medically accurate information about HPV and the HPV vaccine.  A lot of folks said that they didn’t know that the HPV vaccine has been approved for males and I was grateful to be part of informing the public about an important health care opportunity.  I was impressed that so many parents came by the booth and were interested in getting more information about how the HPV vaccine could protect their sons and daughters and I was encouraged by the number of young men who visited the booth – gay, straight and bi-sexual – that were interested in taking proactive steps to protect themselves and their partners.  Knowledge is power – for more information about the HPV vaccine visit Planned Parenthood online.

Analysis Abortion

Legislators Have Introduced 445 Provisions to Restrict Abortion So Far This Year

Elizabeth Nash & Rachel Benson Gold

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. Of these, 35 percent (445 provisions) sought to restrict access to abortion services. By midyear, 17 states had passed 46 new abortion restrictions.

Including these new restrictions, states have adopted 334 abortion restrictions since 2010, constituting 30 percent of all abortion restrictions enacted by states since the U.S. Supreme Court decision in Roe v. Wade in 1973. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

Mid year state restrictions

 

Signs of Progress

The first half of the year ended on a high note, with the U.S. Supreme Court handing down the most significant abortion decision in a generation. The Court’s ruling in Whole Woman’s Health v. Hellerstedt struck down abortion restrictions in Texas requiring abortion facilities in the state to convert to the equivalent of ambulatory surgical centers and mandating that abortion providers have admitting privileges at a local hospital; these two restrictions had greatly diminished access to services throughout the state (see Lessons from Texas: Widespread Consequences of Assaults on Abortion Access). Five other states (Michigan, Missouri, Pennsylvania, Tennessee, and Virginia) have similar facility requirements, and the Texas decision makes it less likely that these laws would be able to withstand judicial scrutiny (see Targeted Regulation of Abortion Providers). Nineteen other states have abortion facility requirements that are less onerous than the ones in Texas; the fate of these laws in the wake of the Court’s decision remains unclear. 

Ten states in addition to Texas had adopted hospital admitting privileges requirements. The day after handing down the Texas decision, the Court declined to review lower court decisions that have kept such requirements in Mississippi and Wisconsin from going into effect, and Alabama Gov. Robert Bentley (R) announced that he would not enforce the state’s law. As a result of separate litigation, enforcement of admitting privileges requirements in Kansas, Louisiana, and Oklahoma is currently blocked. That leaves admitting privileges in effect in Missouri, North Dakota, Tennessee and Utah; as with facility requirements, the Texas decision will clearly make it harder for these laws to survive if challenged.

More broadly, the Court’s decision clarified the legal standard for evaluating abortion restrictions. In its 1992 decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, the Court had said that abortion restrictions could not impose an undue burden on a woman seeking to terminate her pregnancy. In Whole Woman’s Health, the Court stressed the importance of using evidence to evaluate the extent to which an abortion restriction imposes a burden on women, and made clear that a restriction’s burdens cannot outweigh its benefits, an analysis that will give the Texas decision a reach well beyond the specific restrictions at issue in the case.

As important as the Whole Woman’s Health decision is and will be going forward, it is far from the only good news so far this year. Legislators in 19 states introduced a bevy of measures aimed at expanding insurance coverage for contraceptive services. In 13 of these states, the proposed measures seek to bolster the existing federal contraceptive coverage requirement by, for example, requiring coverage of all U.S. Food and Drug Administration approved methods and banning the use of techniques such as medical management and prior authorization, through which insurers may limit coverage. But some proposals go further and plow new ground by mandating coverage of sterilization (generally for both men and women), allowing a woman to obtain an extended supply of her contraceptive method (generally up to 12 months), and/or requiring that insurance cover over-the-counter contraceptive methods. By July 1, both Maryland and Vermont had enacted comprehensive measures, and similar legislation was pending before Illinois Gov. Bruce Rauner (R). And, in early July, Hawaii Gov. David Ige (D) signed a measure into law allowing women to obtain a year’s supply of their contraceptive method.

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But the Assault Continues

Even as these positive developments unfolded, the long-standing assault on sexual and reproductive health and rights continued apace. Much of this attention focused on the release a year ago of a string of deceptively edited videos designed to discredit Planned Parenthood. The campaign these videos spawned initially focused on defunding Planned Parenthood and has grown into an effort to defund family planning providers more broadly, especially those who have any connection to abortion services. Since last July, 24 states have moved to restrict eligibility for funding in several ways:

  • Seventeen states have moved to limit family planning providers’ eligibility for reimbursement under Medicaid, the program that accounts for about three-fourths of all public dollars spent on family planning. In some cases, states have tried to exclude Planned Parenthood entirely from such funding. These attacks have come via both administrative and legislative means. For instance, the Florida legislature included a defunding provision in an omnibus abortion bill passed in March. As the controversy grew, the Centers for Medicare and Medicaid Services, the federal agency that administers Medicaid, sent a letter to state officials reiterating that federal law prohibits them from discriminating against family planning providers because they either offer abortion services or are affiliated with an abortion provider (see CMS Provides New Clarity For Family Planning Under Medicaid). Most of these state attempts have been blocked through legal challenges. However, a funding ban went into effect in Mississippi on July 1, and similar measures are awaiting implementation in three other states.
  • Fourteen states have moved to restrict family planning funds controlled by the state, with laws enacted in four states. The law in Kansas limits funding to publicly run programs, while the law in Louisiana bars funding to providers who are associated with abortion services. A law enacted in Wisconsin directs the state to apply for federal Title X funding and specifies that if this funding is obtained, it may not be distributed to family planning providers affiliated with abortion services. (In 2015, New Hampshire moved to deny Title X funds to Planned Parenthood affiliates; the state reversed the decision in 2016.) Finally, the budget adopted in Michigan reenacts a provision that bars the allocation of family planning funds to organizations associated with abortion. Notably, however, Virginia Gov. Terry McAuliffe (D) vetoed a similar measure.
  • Ten states have attempted to bar family planning providers’ eligibility for related funding, including monies for sexually transmitted infection testing and treatment, prevention of interpersonal violence, and prevention of breast and cervical cancer. In three of these states, the bans are the result of legislative action; in Utah, the ban resulted from action by the governor. Such a ban is in effect in North Carolina; the Louisiana measure is set to go into effect in August. Implementation of bans in Ohio and Utah has been blocked as a result of legal action.

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The first half of 2016 was also noteworthy for a raft of attempts to ban some or all abortions. These measures fell into four distinct categories:

  • By the end of June, four states enacted legislation to ban the most common method used to perform abortions during the second trimester. The Mississippi and West Virginia laws are in effect; the other two have been challenged in court. (Similar provisions enacted last year in Kansas and Oklahoma are also blocked pending legal action.)
  • South Carolina and North Dakota both enacted measures banning abortion at or beyond 20 weeks post-fertilization, which is equivalent to 22 weeks after the woman’s last menstrual period. This brings to 16 the number of states with these laws in effect (see State Policies on Later Abortions).
  • Indiana and Louisiana adopted provisions banning abortions under specific circumstances. The Louisiana law banned abortions at or after 20 weeks post-fertilization in cases of diagnosed genetic anomaly; the law is slated to go into effect on August 1. Indiana adopted a groundbreaking measure to ban abortion for purposes of race or sex selection, in cases of a genetic anomaly, or because of the fetus’ “color, national origin, or ancestry”; enforcement of the measure is blocked pending the outcome of a legal challenge.
  • Oklahoma Gov. Mary Fallin (R) vetoed a sweeping measure that would have banned all abortions except those necessary to protect the woman’s life.

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In addition, 14 states (Alaska, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, South Carolina, South Dakota, Tennessee and Utah) enacted other types of abortion restrictions during the first half of the year, including measures to impose or extend waiting periods, restrict access to medication abortion, and establish regulations on abortion clinics.

Zohra Ansari-Thomas, Olivia Cappello, and Lizamarie Mohammed all contributed to this analysis.

Culture & Conversation Abortion

The Burden Is Undue: What I Have Learned and Unlearned About Abortion

Madeline Gomez

For all 29 years of my life, the right to abortion has been under attack. In early March, I slept at the Supreme Court overnight, waiting for oral arguments, and had time to reflect on the experiences that have made me an advocate.

Thirteen years before I was born, the Supreme Court declared abortion a fundamental right in Roe v. Wade. Despite this, for all 29 years of my life, the right to abortion has been under attack.

In the past six years alone, states have enacted 288 provisions restricting access to abortion care. Three years ago, the Texas state legislature enacted HB 2, an omnibus anti-abortion bill. And on Monday, the Supreme Court ruled two provisions of that law are unconstitutional.

I am a Texas native, a Latina, a lawyer, and a reproductive justice advocate, so this case, Whole Woman’s Health v. Hellerstedt, naturally hits close to home.

In the years since HB 2 has passed, I have heard from friends who have waited weeks and been forced to drive hours just to get an appointment at a clinic. And, as my colleagues and I wrote in an amicus brief the National Latina Institute for Reproductive Health filed with the Supreme Court, women of color in Texas, particularly the 2.5 million Latinas of reproductive age, have been disproportionately affected by the clinic closings resulting from the expensive, onerous, and medically unnecessary standards HB 2 imposed. For example, if the law had been allowed to go into full effect, residents of my birthplace, El Paso, Texas, where 81 percent of the population is Latinx, would have to drive over 500 miles to San Antonio in order to get an abortion in the state.

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In early March, I slept at the Court overnight, waiting for oral arguments. In the 24 hours I spent outside the Court, I had time to reflect on the experiences that have made me an advocate.

***

I am 12, with my mother and her dear friend at the dinner table. As the three of us sit together, I regale them with stories of a teacher I deeply admire. She’s been telling us about how she prays the rosary and speaks to women entering abortion clinics, urging them to “choose life.” I believe this is a good act, something I want to be part of, and I’m proud of my righteousness. My mother’s friend says to me simply, “There are a lot of reasons women have abortions.” Almost 20 years later I will learn that this friend had an abortion, which makes sense statistically speaking, since one in three women do.

I am 14 and sitting in high school religion class. The male instructor tells us that pre-marital sex and contraception are forbidden by our Catholic faith. He says the risk especially isn’t worth it for women: It is, according to him, physically impossible for women to orgasm. At the time, and still, I despair for this man’s wife, and for him. Shortly after this lesson the class watches a 45-minute “documentary” about “partial-birth abortion.” This concludes my sexual health education.

I am 18 and counting 180 seconds, waiting to see whether one or two lines appear on a white stick. In a few weeks I am moving to New York to begin college. In those 180 seconds I decide with little fanfare that, regardless of the number of lines, I will not be pregnant when I go. One line appears and I move, able to begin the education I’ve dreamed of and worked for.

I am 19 and talking with a friend. We get to a question that often comes up among women: What would you do if you got pregnant? She tells me calmly and candidly that she would have an abortion. She is the first person I’ve heard say this aloud. Her certitude resonates with me. I know that I would too, and that though I always felt I should be sorry, I would not be. I feel the weight of the shame I’ve been carrying and I stop apologizing for what I know.

I am 20 and teaching sexual education classes to high school students. More than one young woman tells me that she believes she can prevent pregnancy by spraying Coca-Cola into her vagina after intercourse. We talk about safe and effective methods of contraception. Years later, I still think about the damage and danger inflicted upon young women out of fear of our sexuality and power.

I am 21 and lying naked in bed next to a man I’ve been seeing. We’re discussing monogamy. I’m on the pill and he’d like to stop using condoms. He wants me to know, though, that if I become pregnant he won’t let me have an abortion. Because I am desperate to be loved and because I don’t yet understand that love doesn’t mean conceding your autonomy, it will take another year before I leave him.

I am 22 and my friend—the first I know oftells me she is having an abortion. After the procedure I do not know the right thing to do or say or how to comfort and support her. We will lose touch. Like 95 percent of women who have abortionsshe will not regret her choice. When we reconnect years later, we will talk about her happiness and success and about how far we’ve both come.

I am 24 and reading about Congress making a budget deal contingent on “defunding” Planned Parenthood. I understand that though I now refuse to date men who believe they have a say in my reproductive choices, I’m stuck with hundreds of representatives and senators who think they do and who will use my body and health as a bargaining chip.

I am 26 and in my home state of Texas, Wendy Davis is filibustering an anti-abortion bill with two pink tennis shoes on her feet. I watch her all night, my heart swollen with pride at hundreds of women screaming in the rotunda, refusing to be ignored. Despite their efforts, Texas HB 2 will pass. Within three years, over half the abortion clinics in Texas will close.

Today I am 29 and five justices of the Supreme Court have declared the burden imposed by two provisions of HB 2 undue. Limiting abortion and lying about the effects of these laws hurts women’s health, and now the highest court in this nation has declared these actions and these laws unacceptable and unconstitutional. I am in Washington, D.C., 1,362 miles from the home where I grew up, the day the decision is announcedbut it is not just about me and it’s not just about Texas. It is about the recognition and vindication of our worth and rights as human beings. All 162 million of us.