Treatments
HPV Counseling / Gardasil Vaccines
Most cervical cancers are associated with human papillomavirus (HPV), a sexually transmitted infection. Widespread immunization with the HPV vaccine could reduce the impact of cervical cancer worldwide. Here's what you need to know about the HPV vaccine.
What does the HPV vaccine do?
Various strains of HPV spread through sexual contact and are associated with most cases of cervical cancer. Gardasil 9 is an HPV vaccine approved by the U.S. Food and Drug Administration and can be used for both girls and boys.
This vaccine can prevent most cases of cervical cancer if given before a girl or woman is exposed to the virus. In addition, this vaccine can prevent vaginal and vulvar cancer in women, and can prevent genital warts and anal cancer in women and men.
In theory, vaccinating boys against the types of HPV associated with cervical cancer might also help protect girls from the virus by possibly decreasing transmission. Certain types of HPV have also been linked to cancers in the mouth and throat, so the HPVvaccine likely offers some protection against these cancers, too.
Who is the HPV vaccine for and when should it be given?
The HPV vaccine is routinely recommended for girls and boys ages 11 or 12, although it can be given as early as age 9. It's ideal for girls and boys to receive the vaccine before they have sexual contact and are exposed to HPV. Research has shown that receiving the vaccine at a young age isn't linked to an earlier start of sexual activity.
Once someone is infected with HPV, the vaccine might not be as effective or might not work at all. Also, response to the vaccine is better at younger ages than it is at older ages.
The Centers for Disease Control and Prevention (CDC) now recommends that all 11- and 12-year-olds receive two doses of HPV vaccine at least six months apart, instead of the previously recommended three-dose schedule. Younger adolescents ages 9 and 10 and teens ages 13 and 14 also are able to receive vaccination on the updated two-dose schedule. Research has shown that the two-dose schedule is effective for children under 15.
Teens and young adults who begin the vaccine series later, at ages 15 through 26, should continue to receive three doses of the vaccine.
The CDC now recommends catch-up HPV vaccinations for all people through age 26 who aren't adequately vaccinated.
The U.S. Food and Drug Administration recently approved the use of Gardasil 9 for males and females ages 9 to 45.
Who should not get the HPV vaccine?
The HPV vaccine isn't recommended for pregnant women or people who are moderately or severely ill. Tell your doctor if you have any severe allergies, including an allergy to yeast or latex. Also, if you've had a life-threatening allergic reaction to any component of the vaccine or to a previous dose of the vaccine, you shouldn't get the vaccine. Even if you already have one strain of HPV, you could still benefit from the vaccine because it can protect you from other strains that you don't yet have. However, none of the vaccines can treat an existing HPV infection. The vaccines protect you only from specific strains of HPV you haven't been exposed to already.
Does the HPV vaccine carry any health risks or side effects?
Overall, the effects are usually mild. The most common side effects of HPV vaccines include soreness, swelling or redness at the injection site.
Sometimes dizziness or fainting occurs after the injection. Remaining seated for 15 minutes after the injection can reduce the risk of fainting. In addition, headaches, nausea, vomiting, fatigue or weakness also may occur.
The CDC and the FDA continue to monitor the vaccines for unusual or severe problems.
Is the HPV vaccine required for school enrollment?
The HPV vaccine is part of the routine childhood vaccines schedule. Whether a vaccine becomes a school enrollment requirement is decided on a state-by-state basis.
Do women who've received the HPV vaccine still need to have Pap tests?
Yes. The HPV vaccine isn't intended to replace Pap tests. Routine screening for cervical cancer through regular Pap tests beginning at age 21 remains an essential part of a woman's preventive health care.
What can you do to protect yourself from cervical cancer if you're not in the recommended vaccine age group?
HPV spreads through sexual contact — oral, vaginal or anal. To protect yourself from HPV, use a condom every time you have sex. In addition, don't smoke. Smoking raises the risk of cervical cancer.
To detect cervical cancer in the earliest stages, see your health care provider for regular Pap tests beginning at age 21. Seek prompt medical attention if you notice any signs or symptoms of cervical cancer — vaginal bleeding after sex, between periods or after menopause, pelvic pain, or pain during sex.
Pessary Placement
The pessary is a device that is placed into the vagina to support the uterus or bladder and rectum. It is a firm ring that presses against the wall of the vagina and urethra to help decrease urine leakage. The type and size of the pessary should be fitted to meet your individual needs and anatomy. A properly fitted pessary is not noticeable when it is in place.
If you have sensations of pressure or rubbing with continued wear of the pessary, or if you notice any unusual vaginal bleeding or spotting, call your health care provider immediately. It is not unusual to have to change the shape or size of the pessary after the initial fitting or even after continued wear. This is why it is important to keep your regularly scheduled clinic appointments.
You may notice an increase in vaginal discharge or secretions with pessary use. However, the pessary is made of silicon rubber and does not absorb odors or secretions. The Center for Urogynecology and Women's Pelvic Health recommends only external cleansing. Do not douche or use vaginal products unless they are specifically given to you by your health care provider.
Caring for a pessary is easy. Pessaries can be left in place for up to a week and removed for periodic easy cleaning. Some women choose to remove the pessary nightly before bed and replace it in the morning. It can be left in during intercourse if this is comfortable for you.
Inserting the Pessary
Wash your hands !
The notches inside the open ring and the openings in the ring-with-support are the flexible points. Grasp the device midway between these points and fold the pessary in half. The curved part should be facing the ceiling, like a taco. Put a small amount of water-soluble lubricant, such as KY Jelly, on the insertion edge.
Hold the folded pessary in one hand and spread the lips of your vagina with the other hand. Gently push the pessary as far back into the vagina as it will go. You can do this squatting, standing with one foot propped on the tub or toilet, or sitting with your feet propped up.
Removing the Pessary
Wash your hands !
Find the rim of the pessary just under the pubic bone at the front of your vagina. Locate the notch or opening and hook your finger under or over the rim.
Tilt the pessary slightly, to about a 30 degree angle, and gently pull down and out of the vagina. If you can fold the pessary somewhat, it will ease the removal.
Bearing down as if you are having a bowel movement can help push the rim of the pessary forward so you can grasp it more easily.