Is Oral Sex Really a Dangerous Carcinogen? Let’s Take a Closer Look

Abstract

Introduction Questions have recently arisen in the popular press about the association between specific sexual behaviors, namely, fellatio and cunnilingus, with head and neck cancers. Although there has been an overall decline in the incidence of head and neck cancers over the past 25 years, there has been a shift in the distribution of these cancers toward a particular type known as oral squamous cell carcinomas (OSCCs), and a younger demographic. These particular cancers, OSCCs, have been shown to be associated with the human papillomavirus (HPV). Several researchers have suggested that this shift in the epidemiology of head and neck cancers might be attributable to changing sexual practices. While this speculation has caught on in the popular press, there are several interesting contradictions in the existing evidence that suggest this conclusion might be premature and overreached. Aim The intent of this article is to help clarify the issues so that sexual medicine professionals can give accurate and up-to-date information to their patients. Main Outcome Measures This is a review article; no outcome data are reported. This is a review article; no measures were collected. Methods Pubmed search on HPV, oral sex, oral cancers, and OSCCs. Results One hundred ninety-six articles on HPV were found; 63 articles on oral sex, 55 on oral cancer, and 5 articles on OSCCs were identified as relevant. Conclusions HPV infections occur commonly and are usually cleared within 18 months, thus HPV infection should not be a cause for concern among monogamous couples with a rich and varied sex life as long as the sexual system remains closed and other immune compromising factors are not present. HPV becomes a concern in the context of immune system compromise and infection persistence. Factors contributing to immune system compromise, HPV persistence, and oncogenesis are reviewed.

Relationship between human papilloma virus and benign and malign lesions of oral cavity and oropharynx, current approach

“…(42) HPV pozitif orofaringeal skuamöz hücreli kanserin cinsel ilişkiye ve artan cinsel partner sayısına bağlantılı olduğunu ancak az cinsel partneri olan birçok bireyde de ortaya çıkabildiğini bildirmiş-tir. Rosenquist (43) bir makalede, serviks kanseri ile ilgili verileri özetlerken HPV ile enfekte olan kadın-ların çoğunda serviko-vajinal enfeksiyonların kendiliğinden ortadan kalktığı, bunun sonucunda serviks kanseri gelişen küçük bir yüzdenin kaldığını belirtmiştir. Böylece serviks kanseri gelişiminde HPV enfeksiyonunun tek faktör olmadığı ortaya konmuştur.…”

“…(43) oral seks, HPV ve kanser arasındaki bağlantının basit bir neden ve sonuç ilişkisi olmadığı sonucuna varmışlardır. Rosenquist, bir HPV enfeksiyonunun kalıcı hale gelmesi ve daha sonra kanserojen hale gelmesi için birçok faktörün dahil olması gerektiğini vurgulamış, bu faktörlerin bazıla-rının bilinmediği ve olasılıkla bağışıklık sistemi ile ilgili olduğu belirtilmiştir.…”

The most important questions in cancer research and clinical oncology

“…In a provocative article, Rosenquist [8] summarized the data for cervical cancer and noted that the majority of HPV-infected women were able to clear their cervico-vaginal infections spontaneously, leaving only a small percentage subsequently developing cervical cancer; thus making HPV infection a necessary, but not the sole factor, in the development of cervical cancer. She further highlighted several studies that showed that cervico-vaginal HPV infection is predominantly self-limiting with a median duration of 8–12 months.…”

“…She further highlighted several studies that showed that cervico-vaginal HPV infection is predominantly self-limiting with a median duration of 8–12 months. In large epidemiological studies, “the risk factors most consistently associated with progression of high-risk HPV to cervical cancer were as follows: high parity (number of children), long-term oral contraceptive use, smoking, and co-infection with other sexually transmitted diseases” [8]. …”

“…A literature review on the sexual transmission of virus infections by Edwards and Carne [10] in 1998 concluded that “the evidence favouring oral transmission of HPV is both based on case studies, and is only correlational evidence.” Rosenquist [8] further highlights a large survey ( n  = 12,571) done in 2002 by the United States Centers for Disease Control and Prevention, showing that cunnilingus was practiced by 90% of male respondents and fellatio by 88% of female respondents. “Similarly, research from other cultures shows oral sexual contact to be very common, and oral genital contact is more common than anal intercourse among gay and bisexual men.” Thus, the “link between oral sex, HPV and cancer is not a simple cause and effect relationship,” especially as oral sex behaviors appear to be common and widespread, thus making any perceived relationship not significant.…”