Q : My most recent pap smear came back abnormal. I had a colposcopy and my doctor said that it looked like I had only mild cervical changes. He checked for warts but did not find any. Can I still have sex with my boyfriend (vaginal and oral)? What safer sex practices should we use, and for how long?
A: Many women feel worried when they receive news about an abnormal Pap test result. Most abnormal tests are caused by infection with the human papillomavirus (HPV) and the resulting changes in cervical cells. Nearly half of Americans are infected with HPV and many never know it – especially men, since routine HPV testing for men is still not available. In other words, your boyfriend may have HPV but neither of you would know it unless he had visible warts diagnosed by a healthcare provider. It is even possible that you got HPV from him, but there is no way to know.
There are more than 100 strains of HPV. Some are linked to genital warts; others may cause cervical changes that would show up on a Pap test. Most people’s bodies appear to “get over” their HPV infection without it ever causing symptoms like warts or cervical changes, even if the virus remains in one’s body.
Most females who have an abnormal Pap test result have a normal Pap test result again within one year. It is wise to follow your healthcare provider’s recommendations regarding follow-up testing. Good for you for doing so!
This May Be A HPV Situation …
It is a personal choice to have sex after a sexually transmissible infection diagnosis so we cannot advise you on what to do. Since you have been together for a year and have likely been sexually active together for a while, it is possible that your boyfriend already has HPV. Again, this is whether you gave it to him or he gave it to you, or whether you both already had HPV from previous partners.
As HPV is transmitted skin-to-skin, condoms (which do not cover all of one’s genital skin) cannot eliminate the risk of HPV transmission. However, some research suggests that correct and consistent condom use may reduce the risk of HPV. HPV can be transmitted during oral sex, vaginal sex, and anal sex.
But This May Not Be A Wart Situation
An HPV diagnosis does not mean that you will get warts. You may not have a wart-related strain. Even if you do, you may never get warts or you may only get a few warts from time to time. Treatments are available for warts should you ever get them, though some healthcare providers recommend a “wait and see” approach rather than active treatment. Again, if you develop warts or have other questions about STIs, we recommend that you speak with your healthcare provider for personal information about your health.
Both you and your boyfriend can examine your genitals for changes in appearance, keeping in mind that there are many normal lumps and bumps on one’s genitals that have nothing to do with HPV. You can learn more about HPV, abnormal Paps, warts, and normal lumps and bumps in The V Book: A Doctor’s Guide to Complete Vulvovaginal Health.
If you smoke cigarettes, quitting smoking is a major step toward improving your cervical health. A great deal of research has connected cigarette smoking with HPV-related problems including cervical changes and appearance of genital warts. Smoking cessation classes are available through many campus health centers and community groups. In addition, anything that enhances your immune system (e.g., good sleep, relaxation, healthy lifestyle) may be helpful.
You can learn more about HPV from the Centers for Disease Control website (www.cdc.gov) and more about abnormal Pap test results from the American College of Obstetricians and Gynecologists. At the CDC site you can read detailed information about HPV vaccines, which are available to both women and men. Some healthcare providers will still offer the HPV vaccine to women who have already been diagnosed with one or more strains of HPV, since the vaccines offer protection from multiple HPV strains. Ask your healthcare provider for more information.