The HPV Vaccine Controversy: Sex, Cancer, God, and Politics
by Shobha S. Krishnan, M.D.

Praeger, 2008. ISBN 978-0-313-35011-5.
Reviewed by Susan Andrus
Posted on 10/27/2008

Nonfiction: Body Language; Nonfiction: Cultural/Gender Focus; Nonfiction: Relationships

If you care about your health, you must read this book. The HPV Vaccine Controversy: Sex, Cancer, God, and Politics. Shobha S. Krishnan, M.D. gives you practical, jargon-free information about one of the most widely spread sexually transmitted diseases—Human Papilloma Virus (HPV). Krishnan reported that "Over 50 percent of sexually active men and women will acquire genital HPV infection at some point in their lives."

If that doesn't wake you up, try these facts: You can carry HPV and never show any symptoms; HPV could cause embarrassing warts on hand, feet, and/or the area around your anus and genitals; and HPV "could lead to precancerous and cancerous lesions of the cervix, vulva, vagina, urethra, anus, penis, mouth, and throat." About 250,000 women die each year from cervical cancer. 99 percent of these cases originated with the HPV virus.

But rather than frighten the reader with facts and statistics, Krishnan uses a conversational tone that provides information to make decisions about having an annual gynecological exam, gives parents assistance in deciding whether or not to have their daughters immunized, and leaves the reader feeling confidently informed of the nature of this virus and how she can protect herself from its effects.

Krishnan includes charts, diagrams, and graphs to help the reader understand the points she makes. For example, in the chart, "Guidelines for the Management of Abnormal Pap Test Results," she defines and explains twelve possible results under the headings "What the report means." She explains the Pap test and how it can identify early stages of HPV and pre-cancer. She also cites research showing that among women who develop cervical cancer, "about 50 percent have never had a Pap test, and another 10 percent have not had a Pap test in the past five years." Because HPV sometimes clears up on its own and cervical cancer grows slowly, an annual Pap test helps doctors observe changes in the cervix and identify when these changes might be reason for concern.

Men also need to read this book. Krishnan shows how in different cultures, men's sexual behavior predicts the incidence of women's cervical cancer better than the women's sexual behavior. To protect women from contracting HPV from men who often have no symptoms, Krishnan wants the reader to make an informed decision about the HPV vaccine. When it is administered to girls between the ages of 9 and 14 who are not yet sexually active, five-year studies show good results. She emphasizes that it will take twenty to thirty years before definitive statements can be made about the vaccine, so those willing to be vaccinated now will be pioneers in this research.

Only 230 pages long, this book includes information on topics including sex, cancer, religious beliefs, politics, the emotional impact of the HPV diagnosis, and a case study of a woman in India whose experience provides a sobering reminder of important it is to take responsibility for ourselves. Krishnan also addresses the lack of testing and vaccinating in poorer countries and includes a glossary, references, notes, and a comprehensive index.

Shobha S. Krishnan, M.D., is Staff Physician at Columbia University's Barnard College Health Services. A board-certified gynecologist and family-practice physician, she has also worked as a surveillance physician for the federal Centers for Disease Control and Prevention. Prior to joining Barnard, she was in private practice for ten years. In addition, Dr. Krishnan has worked as a physician at the Institute on Aging and as Chief Resident in the Family Practice Department at St. Vincent Hospital, Indianapolis.

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