Sex, Cancer, and Surgery

When a woman develops cancer in her genital tract, be it the vulva (the outside of the vagina), the vagina itself, the cervix, uterus, tubes or ovaries, it is often the presumption that it is in some way related to sex. Often people harbor feelings of guilt as to whether they have done something wrong in the past that is now coming back to them in the form of a cancer. This impression has been further fostered by much of the tabloid press, where there regularly appear articles, suggesting that such and such a cancer is because of “promiscuity.” The definition of “promiscuity,” I always tell my students, is having had one more partner than your doctor! It is really a totally meaningless term. One person’s promiscuity is another person’s normality. Having said all of these, it is true that endometrial cancer is associated with never having been sexually active and not having had children. It is also true that taking the pill reduces your chances of ovarian cancer by 40%. It is also true that use of condoms protects one from bacterial sexually transmitted infections but not from virus infection, which is implicated in causing cervical cancer. Having said this, up to 85% of all men and women at some time in their lives will have human papilloma virus infection, irrespective of number of partners, but an incredibly low percentage of these will ever go on to develop cervical cancer itself. If you look in the cervical cancer chapter, you will see that there is much talk about cervical intraepithelial neoplasia (CIN), which is the cell change that takes place before women get cervical cancer. It has been, to my mind, extremely unfortunate that CIN, which should be stated by using the initials C, I, N has occasionally been referred to as “sin.” It is obvious that anybody hearing a doctor talk about “sin” would immediately think that this must be related to something that they have done wrong! This is really just not the way it is!