Perched on the edge of the exam table, my 12-year-old daughter shot me a perturbed look. Anticipating the seconds of pain it would involve, Louisa tried to convince me to change my mind.
"But I don’t need it," she argued, knowing that the HPV (human papilloma virus) vaccine isn’t required for seventh-graders. "Can’t we wait and do it later?"
We didn’t wait. The needle’s sting passed quickly, but her anger cooled only after 30 minutes of the silent treatment and a DQ Blizzard.
Maybe I shouldn’t have told her the vaccine was optional. But I wanted her to know that her dad and I chose this for her because we want to protect her from getting cervical cancer. It was one of those challenging parenting moments when I find myself advocating for long-term benefits, in opposition to an almost-teen who sees the world through more of a here-and-now lens.
The HPV vaccine Gardasil has been available in the United States since 2006. Administered in three doses, it protects against strains of HPV that cause 70 percent of cervical cancers and 90 percent of genital warts. The Centers for Disease Control and Prevention recommends vaccinating girls between the ages of 11 and 12, or as early as 9, before they become sexually active, to maximize the vaccine’s effectiveness. The vaccine is recommended also for young women between the ages of 13 and 26, regardless of whether they’ve become sexually active.
The vaccine is not mandatory in Minnesota — at least not yet. In a February 2008 report to the Legislature, the Minnesota Department of Health recommended against requiring the vaccine for school enrollment. Although the department considers the vaccine to be safe and effective, the report advised that because it’s so new, more time is needed to educate the public and to build up supplies. It also cited funding concerns; the vaccine costs about $300 for the three-shot series. Officials are expected to review the decision in a few years.
The health department estimates that about 175 Minnesota women are diagnosed with cervical cancer each year, and about 45 die. Because the vaccine doesn’t protect against every strain of HPV, and it doesn’t help treat someone who already is infected, the combination of the HPV vaccine and routine Pap smears is recommended.
Lois McGuire, a women’s health nurse practitioner with the Mayo Clinic in Rochester, says Pap smears have been extremely effective at reducing the rate of cervical cancer in the United States.
"[The vaccine] takes it a step further," she says.
Two concerns McGuire often hears from parents are about the vaccine’s safety and side effects. She reassures parents that it’s impossible to get HPV from the vaccine because it’s not a live virus, and explains that the most common side effect is pain at the injection site. She also acknowledges that parents who generally oppose vaccines are unlikely to support this one. But she has convinced even socially conservative parents about its benefits, despite worries that the vaccine might promote sexual promiscuity. She tells them that 74 percent of HPV infection occurs between the ages of 15 and 24, and that by age 50, 80 percent of women have been exposed to HPV. Even if a young woman abstains from sex until marriage, she can be at risk for HPV, depending on her partner’s exposure.
I feel uncomfortable putting the words "my daughter" and "sexually active" in the same sentence. But that awkwardness pales in light of the risk of her contracting a preventable disease. Instead of focusing on the fear of her making a bad choice, I wanted to reinforce the importance of prevention and empowerment to make decisions about her health care. If nothing else, I hope she knows that although I can’t protect her from every teenage hurt, I will be there to comfort her — and, if necessary, to lessen the pain with a hug and a frozen treat.
Joy Riggs lives and writes in Northfield.
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