Uterine Cancer

Can early sexual initiation lead to cervical cancer?

Cervical cancer is the third most frequent in the female population in Brazil and is responsible for more than 6,000 deaths per year in the country. In almost 100% of cases, traces of the Human Papilloma Virus (HPV) are identified, which makes this microorganism the main cause of the disease. HPV is a sexually transmitted virus and is present in about 75% of sexually active adults. Most of those infected are asymptomatic and most often do not know they are carriers, which facilitates the perpetuation of transmission. There are more than 100 viral lineages; however, only 13 are considered oncogenic and the main ones are types 16 and 18, which together are responsible for 70% of cancer cases.

Based on this, it is understandable that certain sexual behaviors increase the chances of contracting the virus, which is actually the main risk factor related to the disease. The early onset of sexual life is listed as a risk factor for two reasons: first, because the probability of a woman having more partners increases, increasing the chances of transmission. Then, because if a woman contracts the virus in adolescence with her first partner, even if he is the only one in her life, the HPV may act for a longer time in the body, increasing the chances of malignant transformation of the epithelium.

Currently, we have the HPV vaccine, which is shown to be quite safe and effective in preventing the disease, and everyone who has access should be encouraged to get vaccinated. In addition, it is worth mentioning that conscious and safe sex, with a condom, not only protects against sexually transmitted diseases, such as HIV, syphilis or hepatitis, but also reduces the risks of spreading HPV, which, indirectly, provides benefits against cancer of the uterine cervix, penis, mouth and anal region.

What is HPV?

HPV is the acronym for Human Papilloma Virus. These are sexually transmitted viruses capable of infecting the skin or mucous membranes, causing from non-specific symptoms to the formation of warts and malignant tumors. Currently, more than 100 types of HPV are described. However; around 13 are considered oncogenic, that is, they are associated with the development of cancer. The main ones are types 16 and 18, which together are involved in 70% of cases of malignancy. HPV 6 and 11 are the most common and the main ones involved in benign genital warts, also called “venereal warts”. The latter, in theory, have a low potential for malignancy, but also require evaluation by a specialist doctor, since it is not uncommon that infection by more than one viral type coexists.

I am no longer a virgin, should I get vaccinated against HPV?

HPV is a sexually transmitted virus and, as is known, it is closely related to the development of cancer of the vulva, vagina, cervix, anal, penis and mouth. Currently, two types of vaccines are available that provide very satisfactory results in terms of protection against it: bivalent (Cervarix®) and quadrivalent (Gardasil®). The main difference between the two is that the former provides protection only against the main types of viruses involved in cancer, while the latter, in addition to reducing the chances of infection by HPV 16 and 18, also provides protection against types 6 and 11, which are related to the development of genital warts.

Vaccination aims to use viral antigens to induce a protective antibody response in the body, before it comes into contact with the microorganism. Thus, the defense cells will be prepared to fight HPV when it comes into contact with it. The idea of prioritizing the vaccination of virgin women is based on this concept. Therefore, the chances of a virgin women having had previous contact with the virus are minimal and the vaccine would work to its full effect. However, this does not mean that it is useless in women who have already started their sexual life. By logic, what happens is that the more partners a woman has had sexual relations with, the greater are her chances of having already contracted the disease. And that makes the role of the vaccine questionable.

In Brazil, the government recommends that only girls aged 9 to 12 years receive the vaccine through the Unified Health System, but we prefer to follow recommendations from countries with more experience in the subject and that place benefits for the population above any financial issue. In Canada, for example, vaccination is indicated for all women and also for men, between 9 and 26 years of age, even if they have already started their sexual life. The age limit for them, in this case, is almost a bureaucratic issue and is limited only because the studies that approved the vaccines involved only people in this age group. Thus, even for individuals over 26 years of age, they specify and recommend its inclusion in the vaccination schedule. In fact, some experts argue that the risks are practically non-existent, while mass vaccination can bring benefits not yet known to science, due to the lack of the data available at the moment.

Do I need to remove the uterus if I have this type of cancer?

Treatment for cervical cancer may involve minor surgery that preserves the uterus, hysterectomies (removal of the uterus), or even chemotherapy and radiation therapy. Therapeutic planning will depend on several factors, including the clinical stage in which the disease is, and should be carried out by professionals with experience in the area.

Can cervical cancer cause infertility?

In some cases, depending on the clinical stage at which the disease is diagnosed, a more extensive surgery, which involves the complete removal of the uterus, may be the most recommended procedure. In this sense, unfortunately, infertility is a reality, despite the ovaries maintaining the ability to produce eggs with fertilization potential. In addition, in cases treated with partial uterine surgeries, or with chemotherapy and radiotherapy, uterine sequelae that hinder implantation and development of the embryo may remain. If you are experiencing this situation, talk to your doctor and he will be able to guide you on the best way to carry out family planning.

Does uterus removal mean the end of a woman's sexual life?

No. Hysterectomy, as partial or total removal of the uterus is called, does not directly affect sex life. Associating a woman’s sexuality with her ability to bear a child is a mistake. The procedure does not change the sensitivity or lubrication of the vagina. In some cases, there is even an improvement in the quality of sexual life, as women eliminate the discomfort they previously felt. Talk to your doctor and seek guidance.

Is irregular period a sign of cancer?

Changes in the menstrual cycle can signal several diseases associated with hormonal factors and benign conditions, such as endometriosis, hypothyroidism or fibroids. Persistent bleeding or bleeding that occurs after sexual intercourse needs to be investigated because there is a possibility that it is related to some types of cancer, such as cervical, endometrial and ovarian cancer.

Is vaginal bleeding after menopause a sign of cancer?

Vaginal bleeding after menopause is not normal. It is necessary to investigate the origin of its cause. Find a gynecologist you trust. Some cancers, such as cervical, endometrial, and ovarian cancer, are associated with persistent bleeding or bleeding after sexual intercourse.