The Hamilton Spectator

Cervical cancer changed how I think about sex


I’ve long been a proponent of condom use and STI testing. I’m the woman who carries a rubber in her wallet just in case, and heads to the lab a couple times a year to have my blood and urine screened for gonorrhea, syphilis and other sexually transmitte­d infections.

I’ve foregone the condom occasional­ly. I’d like a guy and we’d sleep together a few times. One night, he’d suggest that it would feel way better if we skipped the condom. He’d keep the conversati­on light but would make it clear that we’d both have more fun if I’d loosen up. I wouldn’t want to come off as a killjoy or prude, so sometimes I’d give in.

Each time it happened and I received a clear STI test afterward, I’d sigh with relief and go on with my life.

I was diagnosed with cervical cancer after a routine Pap test, when I was 35. The third most common cancer in Canadian women ages 25 to 44, cervical cancer is almost always caused by human papillomav­irus (HPV), an STI with more than 200 strains that can also cause penile, anal and oropharyng­eal (throat, tonsils, soft palate and back of the tongue) cancer.

HPV often has no symptoms and cervical cancer can take one or two decades to develop after infection. Though condoms don’t guarantee protection, they reduce the risk of transmissi­on.

Cervical cancer can have a serious impact on a woman’s well-being and fertility. I was very lucky that my cancer was caught at the earliest stage: 1a1. I required two small surgical procedures (called LEEPs) to remove the cancerous cells, and now I get checkups every three months. If it was caught later, I might have needed a hysterecto­my, radiation and/or chemothera­py, which could have harmed my eggs or put me into early menopause.

There are certain phrases we hope to never hear in our lifetime, and one of them is “It’s cancer.” After I heard it, I spent a lot of time looking back on my sexual relationsh­ips. At first, I regretted ever having sex at all. Sex is what gave me cancer! But then I realized that just being alive carries risk and I don’t want to avoid intimate relationsh­ips just because I could get hurt.

Instead of abstaining from sex, I decided I wanted to get educated about my risk, then develop clear boundaries that I can confidentl­y communicat­e to a partner. I also want to break down the guilt or shame I feel about being a “killjoy” or “prude.” I have a great justificat­ion: a history of gynecologi­cal cancer. But no one should need a lifealteri­ng event to justify having sexual boundaries.

Still, it’s not easy. “You’ve been told your whole life that if you stand up for yourself you are difficult, and that it’s not feminine to be difficult,” says Frederique Chabot, sexual health educator and acting executive director at Toronto-based Action Canada for Sexual Health and Rights. She’s referring to all women. “It can also put you at risk of retaliatio­n, of reputation­al risks, of harassment. Also, people asking, asking, asking, asking. That erodes your consent. That’s not consent. That is getting pressured into doing something you’re not willing to do.” I’m now comfortabl­e with having a detailed chat about sexual history, STI testing, HPV vaccinatio­n and condom use before I get into bed with someone. Of course, it’s not only on me. Men are at risk for HPV and other STIs too.

So far, I’ve had this conversati­on with two guys. One responded badly; now he has no place in my life. The second agreed to have a fresh STI test before we had sex. He also looked into the HPV vaccine, which he ended up getting, and is OK with consistent condom use. We’ve been dating for almost a year.

I know that every woman in the world won’t share the same boundaries as me. That’s OK. But there are potential risks to sexual contact, even though our hookup culture likes to pretend otherwise. It’s about deciding how much risk you can live with and then feeling empowered to communicat­e that. I won’t let my desire for acceptance compromise my sexual health going forward. I hope, after hearing my story, no one else will either.


In Canada, Gardasil 9 is the go-to HPV vaccine and it protects against nine high-risk strains of HPV that cause cancer and genital warts. Health Canada currently recommends it for everyone aged nine to 26 and it’s offered for free in schools sometime between grade four and seven, depending on the province or territory. Though it’s most effective when administer­ed before becoming sexually active, it can still have benefits later in life. I wasn’t vaccinated at the time I was diagnosed with cervical cancer and all my health care practition­ers told me to get vaccinated immediatel­y. The Canadian Cancer Society recommends the HPV vaccine for all girls and women ages nine to 45.

Regular Pap tests

In Canada, most provinces and territorie­s rely on Pap tests to check for cellular changes that, if left untreated, may lead to cervical cancer. Generally, the recommenda­tion is to go to your doctor or a free sexual health clinic every three years (if everything looks normal) starting at age 21 or 25.

I had no symptoms for cervical cancer; it was caught early thanks to a routine Pap test. You still need to go for regular Pap tests even if you’ve been vaccinated, you’ve only had sex one time or you’re postmenopa­usal.

HPV testing

Free STI tests that you can get through your family doctor or a sexual health clinic do not check for HPV. They usually test for chlamydia and gonorrhea (and maybe also syphilis, HIV and hepatitis C). If a sexual partner tells you they’ve had a clear STI panel, they’re probably not talking about HPV since it’s a test that comes with a fee.

P.E.I. and B.C. are transition­ing from Pap testing every three years to HPV testing every five years. HPV testing is more accurate than Pap testing. It can detect certain strains of high-risk HPV with about 95 per cent accuracy, while Pap tests are only about 55 per cent accurate at detecting cellular changes on the cervix, which is why they need to be done more frequently.

The shift to provincial­ly covered HPV screening in other provinces is slow. Ontario, for example, may be years away from the transition.

DIY testing

Canadian company Switch Health has launched a new self-collection HPV test that can be ordered online for $99. You do your own internal swab, mail your results to the lab and get your results from an online portal — it can take as little as a week. It screens for 14 high-risk strains of HPV, including types 16 and 18, which cause 70 per cent of cervical cancers and precancero­us cervical lesions. If you test positive for one of the strains, you should see your family doctor, and if you don’t have one, Switch “will work to set you up with one of our partners for a virtual or in-person appointmen­t,” says co-founder Mary Langley.

The cost may be a barrier, plus privately purchased DIY tests aren’t supported by the infrastruc­ture that there is for Pap testing. “There are quality control checks in place. There’s evidence review on a regular basis. Many people will receive letters from (their provincial health agency) telling them they’re due for their Pap,” says Dr. Aisha Lofters, a scientist and family physician at Women’s College Hospital in Toronto. But if you aren’t getting regular Paps because you don’t have easy access to a doctor or you’re uncomforta­ble going in for the test, it’s a lot better than nothing.

 ?? UNSPLASH ?? Some provinces are transition­ing from Pap test screening every three years to HPV testing every five years.
UNSPLASH Some provinces are transition­ing from Pap test screening every three years to HPV testing every five years.

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