HPV and Condoms
This New study about Condoms and HPV was released this week. And here is a link to the full study results, from the New England Journal of Medicine (it's a bit technical).

As I have now passed my 2 year mark since my LEEP surgery for cervical dysplasia (aka 'abnormal PAP smear') due to high risk HPV, and I'm still having clean PAPs and negative HPV tests (woot!).. I'm starting to consider how I start to change my approaches to new sexual opportunities. Being past the two year mark is significant, because at this point, I'm basically back to a starting place with my risk levels for future infections and dysplasia. While there's still likelyhood that the virus is still in my system, it's staying in dormancy at this point. Risk to myself is minimal, as long as I keep a healthy immune system.. and risk of spreading it to others is just about as low as it's going to get. And in a world where 80% of the population has been exposed at some time in their life to this virus, I'm considering myself pretty much re-started at a clean slate.

How I go on from here.. is up to me and my own tolerance for future risk of repeating the past 3 years. I don't really fear cervical cancer, as I get regular PAPs and early detection is key. But I do fear reduction in quality of life.

So, I'm eager to read new studies like the one I linked above, and the recent FDA approval of the vaccine.. to further make informed choices.

Since I've journaled very publicly my experience with HPV, I'll continue the process as I evaluate new information. Hopefully others will be able to benefit from being exposed to the process. Just keep in mind, these are things I ponder for myself.. and I'm in no way trying to suggest or advise people on actions they should take.


In reading this article, there are a couple of points that I want to consider.

"At the end of any given eight-month period, women who reported 100% condom use by their partners were 70% less likely to be diagnosed with HPV than those whose partners used condoms less than 5% of the time."

This is actually a better percentage that what I've been assuming. The CDC issued a report in early 2004 that compiled about 20 different condom studies. The aggregate seemed to be that condoms were effective about 40-60% of the time. The study referenced in this article is by far one of the more extensive studies over a lengthier period of time, and tracked the women every 4 months.

It does appear that many of the women had multiple partners, and new partners during the course of the study. Which is of significance in evaluating this data for relevance to non-monogamy.

But this piece of information struck out to me:

"And none of the women whose partners always used condoms developed dangerous cervical lesions during the study."

This is significant information. After all, if you have the virus and it doesn't manifest as anything.. is the virus itself really the problem? The article states that they're unsure why this is the case, that none of the women who reported condom usage had cervical lesions. There was a rather high rate of lesions in women who use condoms less than 5% of the time.. somewhere on the range of 14% (which is higher than the general averages of 9% reported by the CDC about 2 years ago.)

However, in my research of HPV, I have a hypothesis as to why this might be. In order for the HPV virus to form lesions, it has to be able to infect the basal levels cells, which are underneath the surface skin. Usually, this can only be done if there are minor cuts and nicks on the surface of the cervix... cuts and nicks that occur fairly regularly during intercourse (or any other trauma to the cervix, including things like deep fingering, fisting or dildo use.) When you use a condom, you're not usually getting direct penis-to-cervix transmission. The HPV infections that occur during condom use are going to come from uncovered skin cells (such as from the scrotum or base of the penis) making their way up into the vaginal cavity via fluids and thrusting. Whereas in unprotected intercourse, any HPV which might be living in the urethra or tip of the penis of the male can be directly transferred to the cervix... which is getting all sorts of banged up. Thus, the chances of direct basal cell infection is significantly higher during unprotected sex. In protected sex, if the virus manages to get transmitted, it's generally going to just be there on the surface of the skin, and not really able to do much harm. The body is then able to deal with the exposure without fighting basal cell infection, thus able to build immune response.

I'm encouraged by reading this study.. but it does still leave a potential risk factor within polyamory. It's quite common in polyamory for people to have at least one 'fluid bonded' relationship... ie. a relationship in which condoms are not used. Relationships outside of the fluid bonding use condoms. At first glance, you might think that as long as condoms are used in the outside relationships, all should be cool HPV wise.

But I wonder... is that really the case? Let's say that a woman has two male partners - one fluid bonded and one she's having protected intercourse with. Let's say her protected partner is infected with a high risk strain of HPV (of course, he wouldn't know this because there's no FDA-approved test for men). During the course of their relationships, the odds catch up to them and she gets the virus on the surface skin cells of her vagina somewhere. But, at this point, no big deal because they're using condoms and the basal level cells aren't getting directly impacted with the virus during intercourse.

However, when she goes home to her fluid bonded partner, he picks up the virus from her. And now, he's shedding it from his urethra. Now, when they have unprotected intercourse... he's directly pounding the virus into her basal cells.


It leads me to wonder if there's perhaps some good reason to consider not mixing and matching fluid bonded relationships with barriered contact outside. Perhaps, if you're going to use condoms.. use them for all relationships? Or at least use them with everyone for the first 6-9 months of taking on a new partner... as to give every one's immune system a chance to deal with the virus (since studies have shown that the virus becomes undetectable about 9 months after exposure in most people.)


Other interesting numbers given in this article that I haven't seen before:

- HPV appears to take at least 20 days after exposure to become detectable.
- Tests also found potentially dangerous lesions - caused by HPV - as soon as 51 days after likely infection.