Shobha S. Krishnan, M.D., is a Staff Physician at Columbia University's Barnard College Health Services. A board certified gynecologist and family practice physician, she has also worked as a surveillance physician for the federal Centers for Disease Control and Prevention. Prior to joining Barnard, she was in private practice for 10 years. In addition, Dr. Krishnan has worked as a physician at the Institute on Aging and as Chief Resident in the Family Practice Department at St.Vincent Hospital, Indianapolis. Her new book, The HPV Vaccine Controversy: Sex, Cancer, God and Politics- A Guide for Parents, Women, Men and Teenagers (Greenwood Publications, Aug '08), presents the most up to date information about the vaccine without the influence of pharmaceutical companies or other interest groups.

Ever since the FDA approved the HPV vaccine two years ago, its introduction into the health community has been embroiled in a medical, social, cultural and political controversy. At first glance, the debut of a vaccine to fight most cervical cancers looks like an exciting advance in the history of women’s health. However, many people are unable to separate the ethics from the basic scientific facts: the virus is transmitted through sexual contact and hence the vaccine is recommended for 11 or 12-year-old girls, before they first become sexually active. The perceived possibility that administering such a vaccine to prevent a sexually transmitted disease could promote sexual promiscuity has trumped all other ethical debates, leading some people to cast its benefits aside. As a mother, I can understand why many parents are concerned about this issue and put off vaccinating their daughters. However, in addition to being a mother, I am a physician, and I therefore believe that by putting off vaccination, we effectively strip our daughters from their chances of protecting themselves from the two major cancer causing HPV types.

According to a Newsweek article from February 25, 2008, only two out of every 10 women in the U.S. in the approved age group have received the vaccine so far. In another new survey of almost 10,000 parents, only 49 percent said they would get their daughters vaccinated with the HPV vaccine at the recommended age of 9 to 12 years. Even though 68 percent planned to vaccinate their daughters at 13 to 15 years of age, and 86 percent said they would vaccinate at 16 to 18 years of age, they might be too late -- because the vaccine can only prevent and not cure HPV. The National Survey of Family Growth (NSFG), an agency that collects data on the sexual behavior of American teenagers, reports that teenage girls are already sexually active: 13 percent of them by the time they are 15, 43 percent of them by age 17, and 70 percent of them by age 19. Of the sexually active 13-21 year age group, 70 percent show evidence of HPV infections within a few to several months of when they start having sex -- most of which could easily be prevented by vaccinating preadolescent girls. In addition, many parents are uncomfortable talking to their preadolescents about sexual issues; meaning uneducated teens could make problematic sexual choices not only without realizing the consequences of their actions, but also without the protection from HPV that the vaccine provides.

Again, bear in mind that the vaccine is preventive -- it is only effective if administered prior to exposure to the virus. Therefore, the vaccine will not treat the existing infections. This is why it's so crucial to administer the vaccine when girls are young, before any chance of sexual activity, including sexual contact without intercourse. In addition, there are several other scientific reasons why the vaccine is recommended in the 11-12 year old groups. Unfortunately, it is beyond the scope of this article to discuss those facts.

But, won't vaccinating young girls against a STD cause them to become less sexually inhibited and more promiscuous by giving them a license not to worry about the consequences of sex? Won't it eliminate a deterrent to teenage sex and therefore encourage it? Highly unlikely: because teens rarely factor the possibility of getting HPV into their decisions to have sex.

Current research in adolescent sexual behavior shows that not one, but a variety of factors influence teenage sexual behavior, such as their socio-economic status, their moral and religious values, their sexual attitudes, and the influence of family, friends, and the society they live in. Therefore, it is highly unlikely that a vaccine against a single kind of STD would play a more significant role in adolescent decision making than these factors paired with their responsibility, good judgment, and the boundaries of accepted sexual behavior.

According to NSFG, the top two factors influencing teenagers who choose to remain virgins are fear of pregnancy (94 percent) and contracting HIV/AIDS (92 percent). Since knowledge and awareness of HPV in this age group is poor to begin with, teens will not view this vaccine as a reason to become sexually active at an age sooner than intended. And parents who worry about the vaccine causing promiscuity should remind themselves of the two most dangerous and important factors that influence teenagers to become sexually active and engage in high-risk behaviors: peer pressure and the use of alcohol and/or drugs.

Parents who worry about their teens becoming promiscuous can also focus on a crucial method to keep them from becoming sexually active too soon: raising their awareness. Research has shown that parental guidance is one of the most important factors in delaying teenage sexual activity -- teenagers who do not have involved parents are most likely to engage in high-risk behaviors. The HPV vaccine can actually help parents guide their teens' sexual decisions by giving them a window of opportunity to talk about the topic, and to get health care providers involved in the discussion. There is no reason why parents cannot, without any hypocrisy, inform their daughters that the vaccine is not a green light for them to immediately have sex. Rather, it is a strong message that you, their parents, care about their health, and that it’s important to take proactive steps to become a healthy adult. Think of it this way: Getting a car with an airbag, traction control and anti-lock brakes means that the car is safer in the long-run, but these features aren't a reason to drive recklessly -- accidents are still possible. No matter what, the vaccine will not, cannot and should not take the place of good, solid parental guidance.

The bottom line is we as we as parents want to do what is best for our children. We all want to teach them well while they are still in our protective cocoon so that we can trust them with their own judgment when they become independent. If they always followed our best wishes, we wouldn’t need to worry about administering the vaccine at all. However, even teens with the best judgment can face peer pressure and fall victim to bad decisions or other reasons that may cause them to engage in risky sexual behavior, and this makes the case for vaccinating all the more compelling.

©2008 Dr. Shobha S. Krishnan, M.D.

More From Shobha Krishnan--

Over 99% of Cervical Cancer Caused by HPV