Birds, Bees, and the HPV Vaccine

There's nothing quite like the prospect of a birds-and-bees talk with your child to give a parent butterflies. Now, Washington, D.C., and Virginia are all but forcing the conversation, requiring girls entering sixth grade this fall to be immunized against the sexually transmitted human papillomavirus (HPV).

The vaccine is highly effective against the four most common strains of HPV. Along with causing genital warts on both women and men, the virus is the most common cause of cervical cancer, which affects about 11,000 women in the United States each year, and kills nearly 4,100.

"The goal of the vaccine is to reach girls before sexual activity begins," said Nathaniel Beers, deputy director for policy and programs at the D.C. Department of Health. And the statistics of when that happens are enough to snap even the most lackadaisical parent to attention. Nationally, 7.1 percent of kids are having sex before age 13 (in D.C., the rate is 15 to 20 percent), and a nationwide survey by the Centers for Disease Control's National Center for Health Statistics shows that half of all teens, ages 15 to 19, have had oral sex.

Unlike other vaccines against polio or Hepatitis B, say, which parents can opt out of only for medical or religious reasons, the HPV vaccine can be turned down without cause, though in Washington parents must sign a waiver. Still, there has been a lot of public and parental angst ever since the Food and Drug Administration expedited approval of the vaccine Gardasil nearly three years ago. Within a few months, 25 states and D.C. had bills pending that mandated the vaccination of middle-school girls. But the speed with which the process progressed caused a backlash among parents' rights groups, consumer safety advocates, and religious organizations pushing abstinence-only sex education.

The Family Research Council, a conservative Christian think tank, initially opposed the vaccine but soon became a proponent of its distribution to girls and young women, according to its position paper on the issue. But the organization advocates an "opt-in" approach, which it says gives parents the latitude to make their own decisions, versus the current "opt out" policy, which could make them "feel pressured into going with the majority," said Moira Gaul, director of women's and reproductive health in the FRC's Center for Life and Bioethics.

In Washington, the proposed legislation also touched a racial nerve. Writing in The Washington Post in 2007, columnist Courtland Milloy said: "... your daughter is 11 and probably black, so the assumption is she'll be having unprotected sex in no time – but don't take offense ... And please don't bring up that old paranoia about governmental agencies conducting experiments on black people. The Tuskegee syphilis experiments are old news."

Milloy was not the first person to raise questions about the vaccine's safety. The most common side effects are pain at the injection site and fainting. But as of last year, a number of cases of Guillain-Barre Syndrome, a rare neurological disorder, and 20 deaths had been reported after the vaccine was administered. Yet the Food and Drug Administration and the Centers for Disease Control and Prevention don't see any cause for alarm. The FDA's Web site says that the "adverse effects" occurred at the same rate as what would have happened by chance alone and that the deaths had no common pattern that suggested a link to the vaccine. In short, the FDA's position is that "Gardasil continues to be safe and effective, and its benefits continue to outweigh its risks."

It's too soon to know how many middle-school girls will roll up their sleeves in D.C. and Virginia. But Beers of the D.C. Department of Health is certain of one thing: It's never too early to talk to your kids about sex, since they are probably having the conversations among themselves.

"The challenge that's different for this generation of kids is that there's this emotional detachment that occurs with e-mail and texting," he told Politics Daily. "It liberates them to say things they would never say in person or on the phone." When they meet in person, many kids have agreed to do things they're embarrassed to go back on.

The title of a new documentary by a Canadian filmmaker, Oral Sex is the New Goodnight Kiss, says it all.