Many of you have asked my opinion about the HPV vaccine Gardasil and teen girls and boys. Here are my thoughts.
Gardasil protects against four strains of HPV: two strains cause warts and the other cause genital cancer. Recently, the American Academy of Pediatrics has added the recommendation to immunize young boys as well as young girls. This has caused a huge stir among many with religious convictions. Many parents are concerned that giving Gardasil to adolescents sends the message that it’s OK to have sex. Additionally, they worry that Gardasil may caused some nasty side effects.
The legitimate reports about the side effects of Gardasil show that the vaccine appears to be safe. When Michelle Bachman stated that Gardasil caused brain injury, she misspoke because there have been anecdotal references to such things but nothing has been verified. So, it appears as though the vaccine is safe. That said, Gardasil still has only been around for a relatively short period of time. Concerning the message that giving Gardasil to kids gives them the “green light” to be sexually active, I disagree. I think that when properly administered, the vaccine should be used to teach kids that sex is very serious stuff, that sex causes cancer when mistreated and that Gardasil doesn’t cover all HPV strains.
Here’s what I do in my office. When girls and boys are in the sixth or seventh, I begin to chat with them about what their friends are doing, specifically when it comes to sex and drugs. (The quickest way to find out what a child is doing is to find out what his/her friends are doing.) I ask if their friends are having sex and then tell them about the importance of avoiding sex. If they are open and comfortable, I talk with them about the fact that there are serious emotional and physical consequences to having sex. I ask if they know what Gardasil is and if so why doctors give it to kids. Then, I tell them what HPV is and why Gardasil (sadly) is needed in this day and age. In other words, I use Gardasil as a means to start very important conversations.
If kids are not sexually active, I tell them that I want to wait until they are older to give the vaccine (I only do this if I am convinced that they aren’t sexually active.)I also give them tools as to how to avoid sex. I have even written prescriptions to kids that they carry in their wallets that say they should not be sexually active. (This was not my idea, but was asked by a patient.) I tell them that I need to see them once a year and that we will talk about this again on the next visit. They know that they can count on me to engage them in a very candid discussion on sex.
I can honestly tell you that kids listen to me. Many really delay sexual activity. As kids mature, I tell them that HPV is prevalent in about 80% of the sexually active population. If they remain virgins until they are married, I encourage them to get vaccinated before marriage for one simple reason. The chance that they will marry a virgin is, unfortunately slim. Many teens are not told how to avoid sex and succumb to it. That means that the non-virgin may very well bring HPV into the marriage and give it to his/her spouse. That’s just the reality. I don’t want HPV to be an issue in the marriage, so I vaccinate to protect the one who has not been sexually active. Ideally, it’s great to be able to wait on the vaccine until kids are older.
Sometimes, I have kids whose parents are not supportive of them abstaining from sex and they are not coaching their kids in this direction. If I have a teen who is going to have sex at 15, regardless what I say, then I have to vaccinate. My moral obligation as a physician is to prevent disease and if I cannot later a teen’s behavior, then I have to protect them from themselves.