by Martha Kempner

One of the back-to-school rituals that I remember as a kid was the trip to the pediatrician’s office for the annual check-up which often involved shots.  I am petrified of going to the dentist and hate throat cultures but shots never bothered me so I didn’t really think twice about this visit.  At this year’s annual visit,  parents of young girls 11 and older will likely be offered the option of vaccinating their child against Humanpapilloma Virus (one the most common sexually transmitted diseases) in the hopes of preventing cervical cancer.  And, according to a recent article in the Minneapolis Star Tribune, many of them will think twice about whether or not to go ahead with the vaccine.

While there are always legitimate reasons to question the healthcare we’re offered for our children (is it safe and does it work being the most obvious and important), the article suggests that many parents are waffling on the vaccine because they fear it sends a mixed message to young girls about sex.

Today there are two HPV/cervical cancer vaccines that are offered in the United States sold under the names Gardasil and Cervarix.  Both vaccines have been shown to prevent the two strains of HPV which are responsible for most cases of cervical cancer.  While the number of cervical cancer cases in this country dropped significantly once routine pap tests (which can detect abnormal changes to the cervix before they become cancer) were introduced, the disease still affects about 10,000 women each year and causes almost 4,000 deaths.  Gardasil also protects against two other strains of HPV that cause genital warts and other cervical abnormalities.

The debates over the vaccines began long before the FDA approved them.  Opponents argued that vaccinating young women against a sexually transmitted disease (STD) would be akin to giving them license to have sex.  Some suggested that young women would feel over confident and take unnecessary risks while others felt it would simply undermine any messages parents gave girls about staying abstinent or delaying sex. This “logic” isn’t new.  The same arguments were made when the birth control pill was first invented—women will become too promiscuous if they don’t have to worry about pregnancy.  They were made again more recently when emergency contraception (a type of birth control pills that can be used after unprotected sex) was up for FDA approval—women will be irresponsible about sex if they have such a safety net.  And they have consistently been made during debates about whether to teach teens about the benefits of condoms in preventing STDs and pregnancy —teens won’t hear any message about abstinence if we even let them think condoms can work.  Still, I had a hard time believing that when provided with the opportunity to prevent not just an STD but cancer and possibly death, parents would fall for this kind of logic. 

Apparently, I was wrong.  The article explains that the vaccine is a tough sell in Minnesota because parents don’t want to think of their daughters as at risk for an STD.  (This may be especially true because the Centers for Disease Control and Prevention (CDC) suggests the vaccine be given to girls at age 11 specifically because this is before they are likely to be sexually active and exposed to HPV.) And they  don’t want to be seen as giving their permission or consent to sex.  As one mother put it, "Yeah, it would definitely send a mixed message.  We don't want you to have sex, but just in case you do, here you go?"

I still don’t get this.  When it comes to topics other than sex, we routinely keep our kids safe by giving them information, tools, and guidance and we don’t worry if the messages are mixed.  We tell them not to play with matches but also show them where the fire extinguisher is; we tell them not to drive recklessly but also impress upon them the importance of wearing seatbelts whenever they’re in a car; and we tell them not to drink alcohol but also remind them of how very dangerous it is to drive drunk or get in the car with a drunk driver and (hopefully) we go as far as to offer to pick them up should this ever become an issue. 

Why don’t we worry about mixed messages in these situations? Is it that we acknowledge that drinking is a typical part of adolescence and we want to keep them safe despite that?  Is it because we trust that they are smart enough not to  intentionally set anything on fire? Is it because we know that teens occasionally act reckless but don’t want to see them suffer life-long consequences? 

I realize that none of these examples are perfectly analogous to teen sexual behavior, but they represent a level-headed approach to safety and parenting that I hope we can all adopt even when it comes to teen sex.  Such an approach understands that denying protection to kids in the hopes of controlling their behavior is foolish.  It recognizes that our kids are extremely smart and a shot (or a pill or a condom) will not undermine the values we have instilled in them but can, and will, keep them healthier and safer. 

So, if you haven’t already done so, when you head to the pediatrician’s office for this year’s back-to-school check-up, ask your doctor if she thinks the HPV vaccines work and are safe, but please, don’t worry about the messages it may or may not send.