Commentary Sexual Health

Why it May Be Good That Michael Douglas Said Cunnilingus Caused His Cancer (UPDATED)

Martha Kempner

Though Douglas' announcement may have over-emphasized the dangers of oral sex, it will hopefully get more people talking about HPV and the HPV vaccine.

UPDATE, June 4, 9:20 am: A representative for Michael Douglas told Agence France-Presse Monday, “Michael did not say cunnilingus was the cause of his cancer. He certainly discussed oral sex in the article, and oral sex is a suspected cause of certain oral cancers, as the doctors in the article did point out. But he did not say this was the specific cause of his personal cancer.”

Award-winning actor Michael Douglas started a firestorm in the media recently when he told The Guardian that his oral cancer was caused by cunnilingus. Though he may have over-emphasized the risks of oral sex, he will hopefully bring much-needed attention to the human papillomavirus (HPV) and the HPV vaccine as well.

As part of the publicity tour for his new HBO movie in which is plays Liberace, Douglas spoke to The Guardian’s Xan Brooks about numerous topics, including his 2010 cancer diagnosis. Douglas explained that he had been complaining about oral pain for many months and seen a number of doctors who had prescribed antibiotics. Finally, a specialist in Montreal found a walnut-sized tumor at the back of his tongue and ultimately diagnosed him with stage four cancer. Though often terminal when caught that late, Douglas was given an 80 percent chance of survival, and after an eight-week course of intensive chemotherapy was pronounced cancer-free. This type of cancer has a high chance of recurrence, and Douglas gets check-ups every six months to ensure that it has not come back.

During this part of the interview, Brooks asked him if being diagnosed with cancer made him regret all the years of drinking and smoking, which has long been linked with cancers of the mouth and throat. Douglas replied:

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

“No. Because without wanting to get too specific, this particular cancer is caused by HPV [human papillomavirus], which actually comes about from cunnilingus.”

He went on to say:

“I did worry if the stress caused by my son’s incarceration didn’t help trigger it. But yeah, it’s a sexually transmitted disease that causes cancer. And if you have it, cunnilingus is also the best cure for it.”

The only part of that statement that is inaccurate is that cunnilingus can cure cancer, but I’m guessing that was said with a wink and a nod—as in, sex can make you feel better about anything.

The rest of it is the truth, but possibly not the whole truth.

For years, head and neck cancers were seen in older men who had spent years drinking and smoking. Over the past two decades or so, however, head and neck cancers began to be seen in younger men who did not have a past history of drinking or smoking. Interestingly, the tumors found in these men were not in the oropharynx (the back of the throat), as the older infections had been, but were instead found at the base of the tongue or on the tonsils. Researchers began attributing many of these cancers to HPV 16, the strain of the virus which also causes most cervical cancers.

A 2011 study by researchers at Ohio State University, for example, tested tumor samples from 271 patients diagnosed with certain types of throat cancer between 1984 and 2004. HPV was found in only 16 percent of the samples from the 1980s but in 72 percent of those collected after 2000. The researchers estimated that overall, throat cancers caused by the virus increased from 0.8 cases per 100,000 people in 1988 to 2.6 cases per 100,000 people in 2004. If the trend continues, they said, by 2020 the virus will cause more throat cancer than cervical cancer each year. Fortunately, oral cancers caused by HPV are easier to cure that those caused by other factors.

Michael Douglas may be right that oral sex caused his cancer—his tumor was at the back of his tongue, and it would explain why he was given such a good prognosis, despite the late diagnosis. However, as infectious disease specialist Kent Sepkowicz notes in his piece for the Daily Beast, the epidemiology of cancer is complicated, and a straight cause-and-effect relationship is hard to pin down. He cautions that we should not be too quick to blame oral sex—or only oral sex—and points to other research that has found between 8 and 40 percent of patients with oral cancer reported never having performed oral sex. In fact, the authors of that study found that “the lifetime number of sex partners conferred as much risk for oral cancer as does oral sex.”  Moreover, no research has been able to determine why men are far more likely to develop oral cancers than women. If oral sex was the only culprit, it would seem that women would become infected as well. Sepkowicz concludes:

So, yes, sexual activity of some sort is a risk, but that’s the most that can be said. It is manly, I suppose, at least in a Hollywood way—or at least interesting PR—to cop to the cunnilingus charge. But the story, like so much that touches the silver screen, is just close enough to a truth to grab a headline and just far enough away to drive experts insane.

Still, he believes, as I do, that Douglas’ pronouncement will ultimately be good for public health, and here is why: It will remind people that HPV causes cancer. And then people like me and Kent Spekowicz and many, many others will remind people that there are vaccines to prevent HPV.

The vaccines—there are two, Gardasil and Cervarix, both of which protect against the transmission of HPV 16—have been a hard sell in the United States because of a lack of understanding about how they work, and discomfort with the fact that it is important to vaccinate kids at a young age in order to ensure that they have completed the three-shot series before they become sexually active. In fact, recent research found that just 32 percent of teenage girls had been vaccinated as of 2011. Though the Centers for Disease Control and Prevention does recommend that boys be vaccinated as well as girls, that study did not look at how many boys had been vaccinated. The percentage is undoubtedly much lower than that for girls, as the vaccines were originally intended for women and have only been proven to prevent cervical cancer, not oral or anal cancers caused by HPV. Public health experts suspect that the vaccines will also provide protection against oral cancers in men, but that assertion has not yet been proven by research. Nonetheless, widespread vaccination of boys will help to bring down the overall rate of HPV in this country, which will in turn help prevent all HPV-related cancers.

As I’ve said over and over again, we now have a vaccine that can prevent cancer.  We should be dancing in the streets—all the way to the pediatrician’s office!—not quibbling over whether age 11 is too young to be thinking about STD prevention.

Michael Douglas’ announcement has made a ton of headlines (and had the host of MSNBC’s Morning Joe giggling like a schoolboy, presumably because he doesn’t get to say cunnilingus on air all that often). Hopefully, all this attention will remind people that cancer is a risk, and that will lead to more people rolling up their sleeves—or their kids’ sleeves—and getting the only cancer-preventing vaccine that we have right now.

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.

Roundups Sexuality

This Week in Sex: Why Men Fake Orgasms and How Real Ones May Help Them Avoid Prostate Cancer

Martha Kempner

Many men pretend to have orgasms to make their partners feel better—and report higher levels of sexual satisfaction, at the same time. Another study suggests that the more ejaculation, the better if men want to reduce their prostate cancer risk. And there may be more help for women with sexual arousal problems.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

When Men “Fake It,” Their Motives Are Often Altruistic 

In the pilot episode of the TV show Masters of Sex, Dr. William Masters seems shocked to learn that women might fake orgasms. When he asks his new assistant, Virginia Johnson (who becomes his research partner and later his wife), why women might do such a thing, she replies: “To get a man to climax quickly. Usually so the woman can get back to whatever it is she’d rather be doing.”

Masters and Johnson, whose real-life work and relationship was fictionalized in that Showtime series, were pioneers of sex research in the 1950s and 1960s. Those who follow in their footsteps today are still trying to answer some of the same questions.

A new study from two Canadian researchers looks not at why women fake orgasms, but why men do—and what, if any, correlation there is between faking it and relationship satisfaction.

Researchers surveyed 230 young men between ages 18 and 29 who had admitted to faking an orgasm at least once in their current relationship. Using an online survey, they asked these men at what point in their relationship they began to fake orgasms, how often they did so, and why. They also measured sexual desire and relationship satisfaction.

On average, the men began faking orgasms 14 months into the relationship. On average, the men said they faked an orgasm in about 30 percent of their sexual encounters; 71 percent of participants reported having faked an orgasm during penile-vaginal intercourse; 27 percent during oral sex; 22 percent during anal intercourse; 18 percent during manual stimulation by a partner; and 5 percent while being stimulated with a sex toy by a partner.

Many of the reasons the men gave for faking orgasm revolved around making their partners feel better—including giving their partner an ego boost, feigning simultaneous orgasms, or avoiding upsetting their partner.

Interestingly, men who faked it for these relationship reasons tended to report higher levels of sexual desire. The authors theorize, “It is possible that men feel good when giving a partner pleasure, either out of love and generosity, or because it provides indirect reassurance of their own sexual adequacy, leading them to associate this reward with sexual activity, further leading them to seek more sex (i.e., experience higher levels of sexual desire).”

Men who faked orgasms also had higher levels of relationship satisfaction, though the authors point out that pretending might not lead to relationship satisfaction; those who are already satisfied may be more likely to fake orgasms for the sake of their partner’s feelings.

While it’s reassuring to know that some men fake orgasms for altruistic reasons, we here at This Week in Sex are not big fans of the fake orgasm, regardless of the gender or the reason. Once in a while is understandable “to get back to whatever it is [you’d] rather be doing,” as Johnson said. But, for the most part, we think it’s better to talk to partners about why you didn’t have a real one this time and what could be different next time.

Is Frequent Ejaculation a Cancer Prevention Method? 

Another new study found that men who ejaculated more frequently were less likely to be diagnosed with prostate cancer. Researchers followed about 32,000 men for almost 20 years, using the national Health Professionals Follow-up Study  at the Harvard School of Public Health. The men were all in their 20s when the study started in 1992 and therefore their 40s (or close to it) when it ended in 2010. They filled out questionnaires that asked about their sexual behavior (including masturbation), and researchers also looked at the men’s medical records.

During the course of the study, about 4,000 of the men were diagnosed with prostate cancer. The researchers’ analysis showed that men who ejaculated at least 21 times a month in their 20s were 19 percent less likely to be diagnosed with prostate cancer than men who ejaculated no more than seven times a month at that age. Similarly, men who ejaculated more often in their 40s were 22 percent less likely to be diagnosed with prostate cancer diagnosis.

There are some limitations of the study, including the possible inaccuracy of self-reported data on ejaculation and the lack of diversity among participants. In addition, one urologist who spoke to Reuters questioned the fact that the relationship between ejaculation and prostate cancer applied mostly to less invasive forms of the disease. Dr. Behfar Ehdaie of the Memorial Sloan Kettering Cancer Center in New York, who was not part of the study, noted: “If ejaculation frequency was truly a causal factor for prostate cancer development, we would expect to find the association across all prostate cancer risk categories.”

And, of course, correlation does not equal causation. There could be other reasons that men who ejaculate less often are more likely to get prostate cancer. Specifically, as study co-author Dr. Jennifer Rider points out, men who ejaculate less than three times a month may be suffering from other health issues.

Still, there could be a prevention strategy in the findings. Rider told Reuters in an email: “The results of our study suggest that ejaculation and safe sexual activity throughout adulthood could be a beneficial strategy for reducing the risk of prostate cancer.”

Given that ejaculation tends to be enjoyable, it seems like a pretty good idea to try even while more research into the correlation is being conducted.

Emerging Options for Women With Sexual Arousal Issues

When the drug Addyi was under development, people referred to it as “female Viagra” because it was intended to address women’s sexual dysfunction. But the two treatments actually work very differently. While Viagra causes an erection by increasing blood flow to the penis, Addyi (or flibanserin) works on chemicals in the brain to increase sexual desire.

Now, researchers are developing a new treatment for women that is actually much more similar to Viagra. A company called Creative Medical Technologies filed a patent last week for a treatment that uses regenerative stem cells to increase blood flow to the vagina. Unlike Addyi, this treatment is designed for women who desire sex but are having trouble becoming aroused. Increasing blood flow to the vagina can cause the clitoris to become erect and the vagina to lubricate, both of which are important parts of the arousal stage of sexual response.

The treatment still needs more research and, of course, FDA approval, which was a very controversial process for Addyi’s maker. Moreover, it’s not clear how big the market is for female sexual dysfunction treatment, as prescriptions for Addyi have been low since its market release last October.