Tuesday, June 4, 2013

No more Cunnilingus after what happened to Michael Douglas

Michael Douglas, 2012 by David Shankbone
CC Michael Douglas, 2012 by David Shankbone
When America heard from Michael Douglas on Monday, June 3rd that his throat cancer may have been caused by the human papillomavirus (HPV) through cunnilingus (oral sex performed on a woman), many readers must have shuddered. Some by the thought of contracting oral cancer through performing oral sex and others by the thought of not receiving it anymore. After all, in a study quoted by the Kaja Sex blog (2013), coitus made women orgasm only 25% during their sexual escapades with their partners, “but oral sex brought them to climax practically every time”

So lets us look beyond the CNN article, go a bit deeper into what is causing these cases cancer, the strain of the virus behind it, how many cases there are each year and how you can reduce the risk of transmission. 

So what is this human papillomavirus?

To understand the meaning of a term, I like to take it apart: 'Human' is pretty clear so is 'virus'. But what about this Papilloma? Actually we have two words combined here: papilla stems is a Latin word and means “nipple/swelling” and the Greek suffix -oma in medical context indicates a morbid (i.e. unhealthy) growth/tumor. So the name itself means ‘a virus that causes unhealthy growth of nipple/swellings with humans’.

It received that name because the virus was first classified in 1956 to cause skin warts. However since then over 40 different types have been found and they infect various parts of the body from cervix, anus, general pubic skin area, feet to even inside our throat. In most cases our immune system fights these infections and no symptoms develop. However, in some cases cancerous cells can develop over time (usually many years). The strains HPV16 and HPV18 have been identified to be the main cause of cervical and anal cancer. 
These numbers look high and in fact, as we already covered in our trust article, HPV is the most prevalent sexually transmitted infection in the United States. In fact, it is so common, that nearly all of sexually active individuals will get HPV at one point in their lives

Now, let us compare some numbers from general HPV infection down to HPV-induced throat cancer cases to get a better picture:

Another disadvantage when it comes to oral HPV is being a Man. Men are found to be both generally more infected with oral HPV and also suffer around 4 times more cases of HPV induced throat cancer than women. The exact reasons for this imbalance are still unclear. Some speculate that hormonal differences in women might help protect them from the virus. Others deem that oral sex on women for some reason causes a greater likelihood of transmission. I also asked a question HealthTap and Dr. Jeff M. Livingston responded that ' the current thought is that the vagina harbors HPV more frequently therefore so men performing oral sex are at higher risk'.

Besides oral sex, it is even speculated that oral HPV can be transmitted by kissing or other means as in some studies, patients were diagnosed HPV positive that never had sex or oral sex. 
cc - Delicious Mango by Miro42 via Compfight 

HPV-induced oral cancer cases on the rise

To get a perspective on the trend of these HPV-induced throat cancer cases, I talked to Dr. William Owen in the Davies Medical Center. He has been working with sexual health before HIV was even known and can provide a truly holistic view:

Dr. William Owen, photo from owenmed.com

"It has been said that we are witnessing a rise in diagnoses of oropharygeal cancer attributable to HPV over recent years. This increase is definitely a phenomenon that I've observed over the 3.5 decades that I have been in private medical practice in San Francisco.  

I think that the key to this rise is the latency, that is, the long "incubation period" between the time one is infected with HPV and the time when he or she begins to develop manifestations of cancer. We see this pattern of latency with HPV related anal and cervical cancers as well. "
And on the note that Michael Douglas might have stated that cunnilingus was also the best cure for throat cancer, Dr. Owen crushes our hope for this false remedy but thanks Michael anyway:
"I think that Michael Douglas was being a bit facetious when he was quoted as saying that cunnilingus is the best cure for throat cancer. Although the statement might seem outrageous, time and again we've seen that whenever a star weighs in on some serious disease, people listen. Farah Fawcett did this for anal cancer, Rock Hudson and Elizabeth Taylor for AIDS, Michael Fox for Parkinson's, and the list goes on. The point is that these luminaries raise public awareness about these often neglected medical conditions."

How to reduce risk of transmission of oral HPV

There are a number of options available today to prevent or greatly reduce the risk of an oral HPV transmission:
  • There is a vaccine! Gardasil is available today for men and women under 26 (Cervarix for women). It protects the body against the dangerous HPV types 16 and 18 that are related to various types of cancers, as well as type 6 and 11 which are related to the genital warts. Ideally, the three shots should already be given to children at the age of 9 - way before they become sexually active and are exposed to the virus. So get vaccinated if you are under 26. Unfortunately, way too little Americans are receiving all three shots of the HPV vaccination today.
  • There is a condom for cunnulingus. It is called a dental dam, a 6x6 inch latex sheet that can be placed over the vagina or anus. Check out the Blisstree blog for more information and instructions
  • Keep good oral hygiene and ask your dentist to include cancer screening of the posterior areas of your mouth in your annual dental exam. As with so many conditions, treatment options and success rate will be tremendously higher if the cancer can be detected early. 
  • Reducing Partners: The Mount Sinai Medical Center in New York estimates that men who give oral sex to 6 or more women are 8.6X more likely to contract HPV-induced throat cancer than those men who never had oral sex. 
On the regular oral cancer screenings, Dr. Owen also states:
"The key is to be aware of your body and to see the doctor to check out any suspicious growths, whether in the mouth, on the tongue, or in the neck glands (lymph nodes). That's because the earlier you find these cancers, the more likely it is to treat them successfully. So remember that your dentist can be a powerful ally in helping to diagnose mouth related cancers at an early stage."

To sum it up, a huge part of our society is affected by HPV, many carry the virus orally and 1% even carries the high risk HPV16 strain. However, as Dr. Debby Herbenick concludes in Men’s Health (2011), “most people who give or receive oral sex will not get HPV. And most people who get HPV will not go on to develop cancer”. Again, its our immune system that keeps the virus from developing further in most cases. So keep that immune system up and running and reduce your risk as appropriate. 

Follow up action for you:
Please make a list of your relatives and friends with children. Give them a quick call and ask them or their parents if the HPV Vaccination has been given. Insist that it should be given to boys as well as girls. And as Dr. Owen recommends: "even if they missed that age 9 to 14 timeframe, do motivate them to get vaccinated against HPV as soon thereafter as practicable." 

This will be your good deed for today!

CC - Gardasil vaccine and box by Jan Christian


  1. I remember when they first came out with the Gardasil vaccine and there was alot of controversy over whether it should be a mandated vaccine and what the appropriate age should be to receive it. Just like an vaccination, its to the benefit of the public to prevent the spread of disease, it's a public health issue. While developing throat cancer from HPV is not common, the general spread of HPV is. I think its necessary that you get HPV vaccinated regardless of whether you are high risk or not...if you're sexually active you are automatically at risk period.

  2. Can't women get tested so they know whether they have the virus or not?

    1. Yes, there is an HPV test available for women that detects abnormal cells in her cervix. It also looks for DNA for many of the HPV strains. Please see:

  3. I'm surprised to see no mention of fellatio! Its probably more frequently done than cunnulingus -- any info on the risk level?

  4. Its still a not very well researched topic in terms of correlation of exact sexual practice and HPV Throat Cancer. A doctor I interviewed has seen HPV associated throat cancer with gay men in San Francisco. So it might be a prevalence on the giving end. In the post, we wrote about the speculations of different hormone balance of women that seem to protect them from oral HPV16 throat cancers. Its all very high speculative at this point.

    I have asked a similar question you posted on healthtap and added a response from Dr. Jeff M. Livingston to the post.

    I think we need more actors to keep the topic in the press and keep scientists motivated to continue their research!

  5. Using a piece of plastic food wrap "Glad wrap" in this country is an effective protection against HPV while engaging in oral sex. Dental dams are expensive and hard to find. Just use a little lube and place it over vulva......

  6. The medical community is seeing a rise in the prevelance of oral cancer due to HPV. Same as anal cancer, detection and diagnosing has improved. Could this be the cause of the increase ?? In the past very little was known and I don't think we even suspected it, as our undertanding increases we can now diagnose and TREAT early. Question on HPV in men, are we talking MSM or hetero ? In MSM the number of partners would be the deciding factor. Hetero men may have maybe 40-60 life time partners while MSM may have up to 300-400 partners. Very true that Guardasil is underutilized in men, not sure why since we are half the population :-) Women are not giving it to themselves :-) The issue is if we don't consider our selves "risky" then the need to vaccinate is not in our radar. Also many will say but I past the age, so what !! If your still quite active and we can vaccinate, then why not. We screen all our clients for HPV then we can determine if the vaccine will still be helpful. Also HPV is a field infection, so transmission may occur at a different site other than site it presents. The last presenter we had said, if a person had more than 6 life time partners the chance of acquiring some type of HPV is about 80% or more. Needless to say we gasped at that :-) In Immunocopetent individuals HPV can self resolve in a 2 year period. As I stated if we start worrying too much about WHAT we can acquire while having sex, NONE of us will have sex :-) It's about taking reasonable precaution, getting to know your partners, taking care of ourselves, and eventually taking responsibility when things happens. Since most of us do not intend to do harm.

  7. Doris Irvin-LakeyJune 5, 2013 at 8:42 AM

    I commend Michael Douglas for going public with this public health issue. We counselors/educators in public health have known about the relationship between some HPVs and cancer(check out CDC's website). In my "healthy sexuality" discussions, I educate people about the risks of STIs and the need for health screenings and protection. I think Michael Douglas' statement will raise the awareness or many!

    1. Hi Doris, thank you for the feedback! Your work sounds impressive - would like to explore doing a guest blog together!

  8. I was especially happy to read this last article about HPV, which I find particularly scary as there are currently no diagnostic tests for men, who often show no symptoms. I actually started a HPV vaccination and awareness campaign at my school when I was in college, where we organized Gardasil vaccine clinics on campus where students could receive all three vaccines for free throughout the year. We also petitioned to have the vaccine mandated for students, with the option for students to opt out if they did not want to get it, but unfortunately being in conservative Texas it did not pass. I think that sexual health is really important and way too often ignored by young adults, so I'm glad programs and apps such as Beforewedo are working to make information and testing more accessible! Major props! :)

    1. Thank you so much, Kelly! Your commitment to HPV vaccinations is impressive! So did all your young family members get vaccinated?

  9. Why are HPV vaccinations limited to people under the age of 26? Is the assumption that by age 26 people have already been exposed to the virus? Or that it is ineffective after that age? I know that there are sexually active individuals older than 26 who could be exposing themselves or others to passing this virus...

    1. That means that the medication has only been clinically tested for this age group. The reasonable for that is that the primary target group for the vaccine are individuals that have not been fully exposed to sexual activity or not as much as someone in their 50ies for example.

      However, as Dr. Owen writes in our blog post, you can still request a vaccination from your doctor.

      Also, see this about.com article covering exactly your question:

  10. Basically men should only have sex with women born 1995 and after that have taken the Gardasil vaccine, then you will not get HPV...

  11. Maybe he should have had his tongue and lips cut off as a prophylactic measure.

    What the Hell is it with what celebrities are pushing nowadays?!

    1. Hi Doreen, can you explain your sentiment further? What are you referring to when it comes to what celebrities are pushing nowadays?

  12. I'm gay, but only in the past 15 years or so did I admit to it. Over the majority of my years, I was engaged in heterosexual acts, with a couple of wives and girlfriends. I happily engaged in cunnilingus during those relationships because I thought it was the right thing to do, and I actually enjoyed making my sexual partner happy through my efforts. I guess the thought of danger never crossed my mind, nor my female partners. I guess that down through the years I was fortunate not to have become diseased as a result of my licking pussy. I must say that the subsequent years of kneeling in front of glorious men has not caused me any harm either. I hope that a cure...a treatment...a medical discovery...will arrive at once! I consider myself fortunate.

  13. No hesitation the plight of homosexuals is on the top of the list of social problems professed in the EU because this week a meeting is taking place in Europe to address the fact that not everyone is getting onboard with the "gay agenda. Homophobia, transphobia and other forms of sexual orientation discrimination is said to still exist in the EU on a larger scale than the Union wants to see.

  14. This is really confusing. After a routine gynecological exam, my doctor told me I had tested positive for HPV. She said it's no big deal and usually goes away on it's own within a year or two and that I didn't need to tell sexual partners since it's so common and generally harmless. But Michael Douglas's story makes me think I should tell any potential partners. Even if most sexually active people have or had it, I feel embarrassed and confused. Is it wrong to not tell partners?


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