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the sex issue: State of the sexual union.

Cancer SlutsDoes the HPV vaccine "promote" promiscuity?

By Meghan O'Rourke
Posted Thursday, Sept. 27, 2007, at 11:31 AM ET

Read more from Slate's Sex Issue.

(Continued from page 1)

On the contrary, the reason so many legislators and parents have conjured up a tie between vaccination and sex clearly has less to do with objective reality than with the age at which girls are supposed to receive the vaccine. Gov. Perry's executive order would have mandated that girls receive the vaccine as they go into sixth grade, at age 11 or 12—precisely the juncture between childhood and adulthood we're the most uncertain about how to conceptualize. According to Sydney Spiesel, a pediatrician and a Slate writer, parents often complain that 11 is too early for a Gardasil shot, because their daughters aren't sexually active yet. But that's not the point; the point is that these pre-adolescents need to receive the vaccine well before they are sexually active.

It may be that Merck miscalculated in not finding a way for vaccinations to begin in childhood rather than in pre-adolescence, even if it meant patients needing a booster series. The later age encourages parents and politicians to make a categorical error, associating Gardasil with the pill or with the sex talk, when it needn't be associated at all (just as hep-B shots aren't). Merck may also have miscalculated by recommending that the vaccine be administered only to girls, though boys are carriers of HPV, too—and in fact, scientists believe that the virus plays a role in head and neck cancers as well as anal cancer. Merck is currently testing the drug for boys, but by now the debate has fully catalyzed pre-existing latent anxieties about young women and sex.

Indeed, one of the most fascinating elements of the Gardasil debate is that the hysteria appears to have been internalized by some of the constituents themselves—a twist Freud might appreciate. Rumors abound about significant negative side effects, although pre-release statistics show nothing out of the ordinary. (To be sure, early studies may not capture the full range of drug-related risks.) At one school in Australia, 26 girls injected with Gardasil went to the campus medical office complaining of adverse effects; a couple were hospitalized. Since then, additional reports of group dizziness and fainting have been posted in the comments section of various Internet sites. Since many patients now know the vaccine is controversial, one has to wonder whether some of these instances have more to do with sublimated anxiety about sex and with sociogenic effects than with the drug itself. (Spiesel said that none of his patients had reacted adversely, though he had heard of one case where a patient had.)

And so liberal parents who distrust Big Pharma are also highly suspicious of Gardasil. But as Darshak Sanghavi, a pediatric cardiologist and a Slate writer, told me, speaking by phone from his office, "Looking at the science, I think it's highly unlikely that there is any significant side effect that hasn't been caught. For sure, there could be something rare. But there is no suggestion of anything masked." He stressed the importance of contextualizing the vaccine, pointing out that it takes a lot of research money to create vaccines, and it is not always a profitable enterprise. Given the very real dangers of cervical cancer, Sanghavi said, "I don't believe that they have pushed [Gardasil] in an unethical manner. They have a product that is almost certainly going to save lives." In the meantime, fears about the health risks of Gardasil have obscured the hidden moral calculus of the conservative opposition to Gardasil: that in the end, it may be worth it for several thousand women to die from cervical cancer every year as collateral damage in the war against premarital teen sex. Because, of course, even if the vaccination did encourage promiscuity, it's not clear that it's OK for women to die as a result.

Protesters in all camps of the anti-vaccine coalition are chafing at what they see as the paternalism inherent in making vaccines mandatory. But if anyone in the government is being paternalistically intrusive, it's not the Gov. Perrys of the world. It's the legislators who are pursuing the war against premarital teen sex when they could seize the chance to eradicate the HPV virus and its associated cancers from the lives of young Americans. On second thought, this isn't really paternalistic at all. To pretend for a little longer that their daughters will never grow up, and that we all can protect them by hiding our heads in the sand for another few years—actually, that's just childish.

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Meghan O'Rourke is Slate's culture critic and the author of Halflife, a collection of poetry.
Illustration by Alex Eben Meyer.
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