More HPV fun!


Shieva Ghofrany: [00:00:00] Sunday, Sunday. Okay. It's Sunday. I'm not on call and I am actually gonna try to stay home in my exercise clothes, even though I haven't exercised in a painfully long time. And I'm working on my ebook that Jenny and I are finishing. I'm editing the ebook. on paper because I'm still old, so that we can get out our pregnancy kit in the next couple weeks. 

But I'm gonna talk about HPV because we talked about the pap smear. We talked about the coloscopy. Now we're gonna do a little bit more details about the HPV virus, just nuggets that don't always fit into what I was talking about, cuz you guys have so many dms. And maybe later I'll do a live about it because again, this is a really important topic because it causes a lot of confusion and. 

And it really is impactful for our health, but is something that is so common that many of you will avoid any problems with it, but you won't avoid anxiety from it. So that's why I want you to know, cuz really, really, when people say What is it? What is it that you wanna keep doing? What's your thing? 

[00:01:00] Here's my thing. This is my nugget, this is my thing. I want to increase your knowledge so that I can decrease your anxiety because we are all anxious about stuff that we don't understand. The more we understand things, the less anxious we're gonna be. It is painfully exhausting to have to do this because we have to talk about things a lot. 

And guess what people, it's not a very masculine trait, is it? It's a very feminine trait, and that doesn't mean that men cannot espouse that feminine trait, but it is a very feminine. thing to really try to explore and describe things and explain them. But the magic is in understanding. The more we understand, the less anxious and worried we have to be. 

Right? Like imagine one day if we really do understand that there is an afterlife, which I really hope there is, and I think there is. Imagine if we understand that. Imagine how much anxiety will be relieved by just knowing that like, oh, once my body's gone, I still got some time on the other side. Like, there's so much about understanding that helps us. 

So here's an effort to help you understand h. Human papillomavirus, dozens of [00:02:00] strains of the virus. They're broadly divided into two categories. I hate these names. I didn't name them. High risk and low risk. Low risk hpv. Which contains, again, dozens of strains of H P V, includes the strains that can cause warts. 

Warts are nothing more than gross. They're gross, they're annoying. Nobody likes genital warts, but they can exist on the vulva, which is the outside of the female genitalia. They can exist in the vagina, on the cervix and in the anus. Okay? Which is where you poop from. So they can exist in any of those places, including, believe it or not, on your vocal cords. 

They are low risk. They don't cause harm. They don't cause danger, they cause discomfort. They can be itchy. They can sometimes just be embarrassing. I have tons of patients who come to me and say, I just don't like the way they look. I just don't like them. And I say, great, I got it. So we're gonna remove them. 

And the way to remove them, there's a few different choices. You can use tca, tri chlorotic acid to just dab some acid with a Q-tip on the wards. And after [00:03:00] sometimes a couple days, sometimes 10 to 12 days, they'll kind of crumble and fall. That's very painful, but very quick. In the office. Super quick and like when I say painful, it burns as you can guess. 

So that's one way. Some doctors, especially dermatologists, have a cryo machine, which is a freezing machine. They can freeze them. There is a cream that you can use that's now thankfully, finally generic, so it's very cheap. It's really important when you use the cream to put a dab just on the wart at night, every other. 

Wash it off the next morning because then it will help your own body's immune system fight against it. But if you mistakenly slather it everywhere, you're gonna have a hot mess of just inflammation. So don't make that mistake. Make sure you dab it and wash it off the next day and only every other day. 

So acid freezing cream or removing them. Sometimes patients just don't wanna screw around with any of these things. They just want it to be removed. So we give a teeny little shot of lidocaine, which is numbing. And just cut it off. And sometimes patients wanna remove because it's not always so obvious if it's a skin tag or [00:04:00] a wart, they can look very similar. 

There are times where it's obvious. There are times where it's not the times where it's less obvious for psychological reasons. Patients just feel better if we remove it because of course they hope it's a skin tech. Now, do I think that warts are fun? Hell no. They're who likes 'em? Nobody. But you have to put it within the bucket that it is, which. 

Annoying and gross. And that is it. It is part of the fallout of having sex. So before we talk about the high risk, I wanna say this very clearly. When you decide to have sex ladies, young women, you have to accept certain things. You have to accept that there is zero way to avoid every, um, consequence of having. 

Some of which are not good. The consequences of having sex that are beautiful and wonderful are feeling bonded and engaged with your partner. It's amazing, but there are consequences that are not good. The potential to get pregnant can be amazing or not. The potential to get any kind of STI sexually transmitted infection is essentially never good right now. 

[00:05:00] Can you fully avoid it? You cannot. If you have sex with one person in your entire. And that one person has had sex, even oral sex with one other person. And let's assume you use condoms. You still could get exposed to herpes and hpv. You will avoid hiv, hepatitis, and syphilis most likely cuz those are not so common. 

And those can be avoided with condoms. But herpes and HPV v I will repeat it 50,000 times a. Are very common and they live on our skin outside of the area of the shaft of the penis. They don't necessarily live in the fluid within the penis, and they don't only live within our vagina, so they live in the external part. 

The vulva, they live around the, the anus and rectum. They live in the throat and they live on the outside part of the shaft of the penis, which is the base of the penis, all that skin, which means even if you're using condoms, you can get exposed. Should that be something horrible and scary? No. No, let me repeat. 

No, not scary. What it should mean is you're [00:06:00] going to calmly go into your relationship saying, I'm gonna try to avoid the things I can. I'm gonna be judicious in how I approach sex and maybe who I choose to have sex with. I'm gonna protect myself in the way this, that I can by using male condom, female condom birth control. 

And I'm gonna accept because I'm a mature adult and that's the only time I should choose to have sex as a mature adult, I'm gonna. , then I might catch some things, and the things I'll probably catch if I'm being proactive are only the annoying ones like herpes and hpv. I'm unlikely gonna get hiv, hepatitis and syphilis. 

If I use condoms. I'm unlikely gonna get chlamydia and gonorrhea if I use condoms. If I've chosen not to use condoms, it's because I've decided willfully that I'm in a relationship where that partner is monogamous with only me. And if I'm not sure I'm gonna use. Does that little thing I just said happen often? 

Hell no. I can't tell you how many times a day. Every day I have patients come in and they're like, wait, what? What happened? Why? Yeah. No, I mean, I didn't use [00:07:00] condoms with this kid I'm having sex with, but like, I mean, I thought he was only with me, which truthfully, ladies, I don't get it. You know that you're having casual sex with someone, why would you think he's only has having casual sex with you? 

So this is not a matter of shame. This is not a matter of me telling you you shouldn't have casual sex. That is absolutely your choice and your desire. I should not condone or not condone it. I'm not here to condone those things. I'm here to really educate you on what you can do within your power. To be really sure that you're protecting yourself. 

I do think protection has to do with psychological and physical. So psychologically I think having casual sex with multiple partners is something I personally can't understand. But that doesn't mean it's right or wrong. So again, this is not a judgment zone. This is a, let me give you information to increase your knowledge, to decrease your anxiety. 

When you come to me and tell me, oh my God, if you told me I had gonorrhea or chlamydia or herpes or hpv, I will be. Then I will say back to you, okay, then you shouldn't have sex. Because if you are having sex, what comes along with sex is these risks. [00:08:00] How can you decrease these risks? Condoms, judicial choice of who you have sex with, and open mind to the fact that there are certain things you cannot prevent a hundred percent. 

and thank God the things that you can't prevent a hundred percent are really unlikely going to be harmful. Okay, now let's talk about the high risk strains of HPV V. High risk, terrible name, because that implies to you that you are at high risk of getting the things that are onerous, like cervical cancer, like anal rectal cancer or like head and neck cancer, which are the three types of cancers that we know right now. 

HPV can cause. I should include also vulva and vaginal. Those are not very common, thank God. But those can also be caused by it. Hence, the reason it's a good idea to get the vaccine. Now, high risk strains of which again, there are dozens, are the ones that will cause the abnormal changes in your cervix that we catch through the pap smear test. 

Okay, so you get the pap test, talk to your doctor about when to be screened, the guide. [00:09:00] Are, um, very clear on paper, but very confusing. And they alter based on your age, your, um, risk factors, what your previous pap smear history is, maybe your autoimmune status, and frankly yours and your doctors. Um, own personal histories and how they approach medicine. 

And the screening guidelines can vary between one to five years, depending on all those factors. So talk about it with your doctor. Guidelines are not rules. They are guidelines. Many of us feel like we still practice an art of medicine where we may alter guidelines slightly in order to encourage patients to understand things more or feel more comfortable with things. 

So again, I'm not gonna say more about the guidelines because they. You talk to your doctor about what screening protocol she adapts, and if she sticks with the screening protocol of only looking every three to five years. That is not wrong. That's actually the right answer on the test as I call it. But some people like me choose to do it slightly more frequently for various reasons. 

None of which by the way, include me getting paid extra. I do not. Um, but it's not [00:10:00] wrong to adhere to the every three to five year guidelines. So I don't want patients to be upset with their providers if their doctors are the ones who are sticking with those guidelines. I applaud sticking with those guidelines for various reasons. 

I also think it's very appropriate to, um, change your own practice based on other factors. Okay. Guidelines or guidelines. They are not rules. So as far as the high risk strain, Those high risk strains, of which there are dozens, there are a couple that we're most concerned with so far, 16, 18, and 45. Those are the ones that are more likely to cause changes in your cervix that can more likely and aggressively turn into cervical cancer. 

But again, the chance of having cervical cancer, if you have H P V, is still teeny. As I say, the number of us have hpv 80 to 90%. The number of us who have abnormal pap smears, of that 80 to 90% estimates are anywhere from, like, you can find data that says like 10 to, I think 18% of patients will have an abnormal pap [00:11:00] s. 

Seems like higher in my practice. And then of those abnormal pap smears, the number who will ultimately get cervical cancer is teeny. Because if you have severe changes on that coloscopy test, the microscope test from your abnormal pap smear, then your doctor will remove the changes before they turn into cancer. 

We are lucky in America, despite all the ills with our medical system, of which there are many, and let us pray that after Tuesday things improve. My dogs are going crazy when I said that. Um, we are lucky that we still have access to pap smears, colposcopies screening test because that's how we have largely prevented cervical cancer. 

There are countries throughout the world, predominantly third world countries, like many of the countries in Africa that don't have access to screening because they need to. The doctors who perform the tests or nurses or midwives, they need to have people who look at the slides. They need to have the follow up colposcopies, and then the ability to actually remove parts of the cervix and follow up again. 

So we are still lucky to be here. [00:12:00] My little thing the other day about what doesn't suck, what doesn't suck in America is that we have screening tests. What does suck is that for the amount of money and knowledge we have, Lord, we could be doing better in our medical world. So let's all strive for. So again, if you have hpv, please don't despair. 

You are merely common, like one of the rest of the 80 to 90%. Should you tell your partners? I believe so. I think we need to be in a position to educate men. Men do not get it. It is not their fault kind of. Maybe it is. That's okay. But men need more education. Boys need more education. Moms and dads, please educate yourselves so that you can educate your boys and your girls about what is hpv, what is. 

How to protect themselves, what they should be concerned about. Okay, so if we all know more, we'll all be less anxious, and then we won't practice avoidance. We won't practice death like, you know, despair. When we find out bad news, we will be calm and say, all right, adult endeavor had sex. Figured [00:13:00] I could get it. 

Turns out like 80 to 90% of us, I got it. And now I'm just gonna go see my gynecologist and make sure that everything is. Okay. Also don't smoke because like I said, nicotine improves the virus's ability to do things that are more aggressive. Also, there is some data, which I like, the kind of crunchy alternative integrative data. 

I shouldn't even call it that. That sounds disparaging. I don't mean that. I mean the non-Western medical data. There is some data that seems actually fairly good, hopefully will increase that. There are certain strains of mushroom. A HCC is the one in particular they studied that might have, um, benefits for us against the HPV virus. 

And that makes sense. There's a lot of data actually about Rishi mushrooms and other mushrooms, lions main and um, Cor, decept, all these interesting names that we've known. Mushrooms have some medicinal properties, so there are things that can be done in our future, but keeping your immune system robust, sticking with the guidelines, trying to avoid it by using condoms, recognizing that condoms don't a hundred percent protect you and not [00:14:00] freaking out. 

That's probably number one. Okay. I'm gonna go read my transcript so that I can um, get out this stuff for you guys cuz I'm excited for. And for you guys. And so if you haven't signed up for Tribe called V, just to be on the wait list, you're not committing to anything, I promise you're just gonna hear more stuff from me. 

Um, and if you haven't followed Tribe called V on Insta and Facebook, go ahead and do it. Okay? Have a great Sunday.