At the beginning of 2024, two of us in the L'Ovary team were told, within a few weeks, of the presence of abnormal cells on the cervix of our respective uteruses.
Basically, we'd both contracted HPV at some point in our lives, and the persistent virus was turning into cancer.
In both cases, treatment had to be carried out as quickly as possible.
Needless to say, these announcements generated plenty of questions and discussion on both sides.
From this, one thing stood out: we don't hear enough about how crucial regular HPV testing is, and how much our reproductive health depends on it.
So here's our primer on HPV screening and why it's important to have it done regularly.
What is HPV?
"HPV" is an acronym for "human papillomavirus".
It's a very common contagious infection - more common, in fact, than all other forms of STBBI combined, according to the Canadian Cancer Society.
HPV can be transmitted through vaginal and anal sex, but also through oral-genital contact and direct genital contact, regardless of sex or gender.
If HPV symptoms develop, they can take the form of small wart-like bumps, itching and irritation, and sometimes lesions on the cervix that are invisible to the naked eye.
To date, over 200 types of HPV are known, and around 40 of them can infect the genital organs. HPV is also thought to be the main cause of cervical cancer.
Do HPV and cancer go hand in hand?
Not necessarily. In fact, HPVs are classified into two categories: "low-risk" and "high-risk".
Low-risk HPVs are fairly harmless and can cause benign health problems such as condylomas, those famous little external genital warts, which are generally well treatable.
High-risk HPV, on the other hand, can unfortunately lead to more serious complications and even cause certain cancers, like cervical cancer, to name the most infamous one.
It's important to note that most HPV infections are asymptomatic and disappear on their own without causing any health problems.
How is HPV tested?
Various tests can be performed to detect HPV, but here are the two main ones: the fairly well-known Pap test, and a relatively new test, the HPV test.
Pap test
The Papanicolaou or Pap test, also known as the "Pap smear", detects cervical cancer, which is itself most often caused by HPV.
It is performed by a doctor, gynecologist or nurse, who takes a sample of cells from the cervix.
To do this, he or she inserts a small instrument called a speculum into the vagina, giving a clear view of the cervix, and then takes a sample of cells using a swab or special brush.
These cells will then be examined under the microscope for any signs of abnormalities or precancerous lesions that could be caused by HPV infection.
The procedure takes a few minutes in all, and while it can be uncomfortable, it's generally not painful.
However, sensations can vary from one person to another, so if you feel pain during the test, don't hesitate to mention it, so the professional can adjust his or her technique or help you become more comfortable.
Pap smears are recommended every two or three years.
The HPV test
HPV testing is relatively new to the medical world, and is not yet systematically used everywhere.
Just like the Pap test, it involves taking a sample of cells from the cervix. What sets it apart, however, is that it intervenes much earlier, even before the development of cancer.
In fact, the HPV test can detect the mere presence of high-risk HPV in the body, enabling even faster preventive action.
HPV testing is recommended every five years, except for people under the age of 30, for whom HPV testing is not recommended.
Which test should you take?
Until 2023, the Pap test was the primary screening test for cervical cancer caused by HPV in Quebec.
However, following a recommendation issued in 2022 by the Institut national d'excellence en santé et en services sociaux (INESSS), the HPV test is gradually replacing the Pap test as the primary screening test for this type of cancer.
The replacement has been underway since 2023 and is scheduled for completion in 2025.
Thereafter, the Pap test may continue to be used as a complementary test in certain situations.
It's important to note that HPV, unlike other infections, cannot be detected by a simple blood test.
A healthcare professional will be able to guide you and tell you which test is best for you, so don't hesitate to ask your doctor.
At the time of publication of this article, self-collection is not available for HPV testing in Quebec.
What about men?
Although HPV is more often associated with women and people with a uterus due to its close link with cervical cancer, it can infect anyone, regardless of gender or sex.
However, to date, there is no approved HPV test for men or for people with penises.
Can HPV be cured?
To date, there is no treatment for human papillomavirus infections.
HPV treatment is therefore more about treating the symptoms caused by the virus than treating the virus itself.
In most cases, however, the immune system alone is able to eliminate the virus from the body, much like a cold, without any symptoms.
However, it's best not to take any chances and to have regular screening, because if any abnormalities or precancerous lesions are detected, in-depth examinations or appropriate treatment may be offered to prevent any complications.
Here are just a few examples.
Loop electrosurgical excision procedure
Loop electrosurgical excision, commonly known as "LEEP", is a procedure that removes abnormal cells from the cervix using a hot wire called a "diathermic loop".
This procedure is often used to treat low-grade precancerous lesions.
Conization
Conization is a surgical procedure performed to remove the part of the cervix containing precancerous cells.
This procedure is often recommended when precancerous lesions are of high grade, or when tissue samples are required for further analysis.
Cryotherapy
Cryotherapy is a technique that uses cold gas to kill abnormal cells in the cervix.
This procedure can be used to treat low-grade precancerous lesions.
Laser cauterization
Laser cauterization is a procedure that uses a laser beam to destroy abnormal cells in the cervix.
This technique can be used to treat high-grade precancerous lesions.
How can HPV infection be prevented?
There is no single, 100% effective way to prevent HPV infection.
However, there are a number of solutions that can be put in place to reduce exposure and minimize the risk of complications.
Getting vaccinated
Vaccination against the human papillomavirus is one of the most effective ways of preventing infection, regardless of gender.
The vaccine protects against certain types of HPV, including those responsible for condyloma and most cases of cervical cancer.
It is recommended for everyone, from the age of 9 and ideally before 14, even before the onset of sexual activity.
In Canada, two HPV vaccines are available: Gardasil 9 and Cervarix.
Adopting safe sex practices
Using condoms during sex reduces the risk of HPV transmission.
However, this solution is not miraculous and does not provide total protection, as the virus can also be spread by simple skin-to-skin contact of the genitals.
Limiting the number of sexual partners
Limiting the number of sexual partners can also reduce the risk of exposure to HPV and other sexually transmitted infections.
It's just basic math.
Getting screened regularly
HPV testing and regular cervical smears enable early detection and are crucial in helping to detect HPV infection and precancerous lesions.
They should not be overlooked.
Out of danger... for now!
The good news for the colleague and for me is that we were both treated in time (more on this in a future article, in which will talk about colposcopy, conization and more), and even though we're missing a tiny piece today, we know we're out of danger, at least for now.
But we're also aware that many other people aren't so lucky
We therefore make a point of stressing the importance of taking care of your reproductive health by getting regular HPV screening.
We know how invasive such procedures can be, and how much anxiety they can provoke.
Not to mention the stories we hear of gynecological violence, which are now finally being denounced, and that's a good thing, but which are undoubtedly an obstacle for many of us when it comes to taking an appointment with our doctor.
But keep in mind that regular screening is crucial to preventing cervical cancer (among other things), and HPV vaccines are also a great help.
So let's not let the fear of discomfort stop us from taking care of our reproductive health, and above all, let's not be afraid to assert ourselves in the doctor's or gynecologist's office.
We know ourselves better than anyone else, so let's be confident and express ourselves. Our bodies will thank us for it.
Power and health to all wombs on Earth!
With L'Ove,
Mme L'Ovary
References:
HPV Testing | Government of Québec
Human papillomavirus (HPV) | Government of Québec
Transition from Pap test to HPV test - Cervical cancer screening - Healthcare professionals - MSSS
Guide to sampling for HPV detection | CHU de Québec-Université Laval
Cervical cancer screening | Government of Québec
