February 22, 2025 • 15 mins
Karen unpacks the risks of HPV for women in their perimenopausal and menopausal years. She explains how the virus spreads, why it can re-emerge decades after initial exposure, and how hormonal and immune system changes impact its persistence.
Visit our website itchyandbitchy.com to read blog posts on the many topics we have covered on the show.
Visit our website itchyandbitchy.com to read blog posts on the many topics we have covered on the show.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
The content of this podcast is provided for general informational
purposes only and is not intended as nor should it
be considered a substitute for professional medical advice. Hi everyone,
(00:22):
This is Karen Nickel, family nurse practitioner, and this is
Itchy and Bitchy, a podcast that provides answers to your
many unanswered health questions. This is a reminder about my
course called the Perimenopause Answer. If you are going through
this phase of life called perimenopause, or if you don't
know if you're in perimenopause, I would love to have
the opportunity to talk to you about the course to
(00:45):
see if it's the right fit for you. There is
a link on our website Itchyanbitchy dot com and our
Facebook page I n B Podcast where you can schedule
an appointment for a zoom call with me. When you
make an appointment, I will I'll be sitting at my
little desk waiting for you to join the one on
one zoom call. In my practice and in my perimenopause course,
(01:09):
I get questions about the human papaloma virus HPV and
what kind of risks it poses to women as we age.
Of course, HPV can impact women and men of all ages,
especially if they are or have been sexually active. But
(01:29):
during this episode, I would like to discuss HPV and
women in their perimenopausal and menopausal years. This is part
one of a two part series on the subject. I
will be releasing part two next week. I'm going to
be talking about the areas of the body that are
impacted by HPV and about the types of sexual activity,
(01:54):
so keep that in mind if there are little ones
around as you listen. Let's start by reviewing information about
the different strains of HPV. HPV has more than two
hundred strains or types, some of which are spread through vaginal, anal,
(02:15):
or oral sex. Sexually transmitted HPV types fall into two groups,
low risk and high risk. High risk HPV can cause
several types of cancer. There are twelve high risk HPV types.
I won't torture you by listing all the numbers of
(02:37):
the strains, but two of the twelve strains, HPV sixteen
and HPV eighteen, are responsible for most HPV related cancers.
I'll talk about those cancers in a bit. Low risk
HPV types rarely cause cancer, although a few low risk
(02:57):
HPV types can cause war on or around the genital's anus, mouth,
or throat. The virus that causes HPV infection is transmitted
through skin to skin contact. Most people get a genital
HPV infection through direct sexual contact, including vaginal, anal, and
(03:19):
oral sex. Because HPV is a skin to skin infection,
intercourse isn't always required for the virus to be transmitted
from one person to the next. An amazing but I
guess not too surprising statistic is that more than eighty
percent of women are infected with HPV by the age
(03:41):
of forty five years old. Many people have HPV and
don't even know it. They have no symptoms, and you
can still contact it even if your partner doesn't have
symptoms doesn't know he or she has HPV. It's also
possible to have momultiple types or strains of HPEV at
(04:03):
one time. So once you have an HPV infection, what
happens and how do you get rid of it? Actually,
ninety percent or nine out of ten HPV infections go
away on their own within two years. According to the CDC.
The body's immune system clears the virus from the body. However,
(04:27):
during those two years, when the body is working on
clearing the virus. It's still clearing it. But it might
have low levels, but it's still working on clearing it.
The virus is still present in the person's body, and
that person during that time may unknowingly transmit HPV. When
the virus doesn't go away on its own, it can
(04:50):
cause some serious health problems. These include genital warts, cervical cancer,
and other cancers of the genital's head, neck, and throat.
Since the low risk strains of HPV that cause warts
are different from the high risk strains that cause cancer,
genital warts caused by HPV doesn't mean that you will
(05:13):
develop cancer. Cancers caused by HPV often don't show symptoms
until the cancer is in the later stages of growth.
Regular screenings can help diagnose HPV related health problems earlier.
This can improve outlook and increased chances of survival. I'll
talk more about this in part two of this series.
(05:36):
So I'm sure many of you know how screening for
HPV happens, but just to review, HPV can be checked
using a papsmere typically on a PAP smear of the cervix.
An HPV test is not routinely run on the sample
so when you get a papsmere, HPV is not routinely
(05:59):
run on that sample. It is usually run on the
test only if that PAP is abnormal. In those practicing
anal sex, a PAP smeror can be done with a
sample collected from the anus. As I said earlier, this
episode is going to be focused on HPV and women,
but I do want to share that for men, some
(06:21):
strains of HPV can cause penile, anal, and throat cancers.
Some men may be at more risk for developing HPV
related cancers, including men who receive anal sex and men
with a weakened immune system. Back to women, I had
patients in their fifties and sixties who always had normal paps,
(06:44):
then all of a sudden, they wind up having an
abnormal PAP with a positive HPV. When they got that result,
I reviewed with them that HPV is usually a sexually
transmitted disease, and they were ready to go home and
their spouses. I always had to say, whoa nelly, Just
(07:04):
take take a moment and remember that just like chicken
pox virus which can lie dormant in your body for decades,
then emerge and cause shingles, the human papaloma virus can
also behave that way, you can contract it, say in
your twenties, and it is suppressed for thirty or forty years,
(07:28):
and then it re emerges. So it doesn't mean that
your partner is necessarily up to no good. However, you
should share with your partner that you have had a
positive HPV testing. The test will include which strains of
HPV were positive. The human papaloma virus infection in women
(07:50):
during or after menopause may actually be an infection that
was acquired when they were younger. Came from new research
published in the Journal of Infectious Diseases which suggests that
after one or two years, HPV may still exist below
(08:12):
limits of detection. I'm going to say that again that
HPV after a couple of years may still exist in
the vaginal area at levels that are below the limits
of detection. This process can happen with other viruses such
as Vericella disaster, which causes shingles. It can lie dormant
(08:33):
and then re emerge decades later. The report emphasizes that
more studies need to be conducted in order to gain
more knowledge on HPV infections and understand the part that
persistent and reactivated HPV play in women who are in
their fifties and sixties. Many reports have demonstrated that certain
(08:58):
types of HPV can be detected again after not being
detected for a long time. However, scientists are unsure whether
it's because of a low level, persistent infection or a
new infection. The data gathered in the study raise the
possibility that the risk of HPV reactivation may increase around
(09:19):
the age of fifty years and contribute to a larger
fraction of HPV detection in older ages. The results also
showed that women who became sexually active during and following
the sexual revolution of the nineteen sixties and seventies are
at a considerably increased risk of HPV infection later in life,
(09:43):
more so than females who became sexually active before nineteen
sixty five. The authors believe that the reason is because
of a greater number of sexual partners throughout their life
in the group of women who became sexually active after
night teen sixty five. After this quick break, I'll talk
(10:04):
about the role of declining hormones and immune system function
in women as we age.
Speaker 2 (10:10):
Stay tuned, Welcome back.
Speaker 3 (10:27):
The study. I referred to prior to the break did
not look into the role of declining hormones and immune
system weakening that we experience as we age. When our
female hormones decline, our vaginal health also usually declines. Our
tissues become drier and rougher, and we have a loss
(10:49):
of the good bacteria called lactobacillis that keeps the vaginal
area healthy. There is a study looking at the relationship
between having healthy levels of good bacteria in the vagina
and the frequency of HPV infection. Evidence indicates that the
likelihood of HPV persistence is higher among women with an
(11:13):
altered vaginal microbiota. When we have more bad bacteria than
good bacteria in the vagina, the pH of the vagina
goes up, which allows for more growth of opportunistic organisms
like yeast and viruses. With increased levels of bad bacteria
causing a high vaginal pH, HPV can adhere more easily
(11:38):
to the vaginal walls. The stage is set for chronic inflammation,
persistent HPV infection, and the progression of infection, which can
potentially lead to the development of cervical cancer. Female hormones
significantly influence the vaginal microbo. Specifically, estrogen plays a crucial
(12:04):
role in preserving the collagen content of the vaginal epithelium.
Healthy collagen levels help maintain the tissue's thickness and elasticity.
Estrogen also contributes to the maintenance of moisture on the
vaginal wall surface. When our estrogen levels decline in menopause,
(12:27):
the walls, as I said, become dry and rough, which
can contribute to the persistence of HPV growth in the vagina.
In addition to declining female hormone levels in postmenopausal women,
our immune system function also declines as we age. Our
body has a harder time suppressing low levels of the
(12:50):
human papillomavirus that can be present in the vagina. Studies
suggest that reduced immunologic fitness is an important player in
HPV infections that occur among older women. The studies indicate
the possible existence of very low level HPV infections that
(13:11):
become detectable among older women even in the absence of
re exposure through sexual activity. The main factor associated with
this detection of these reactivated infections was a weak immune response.
In Part two of this HPV chat, I will provide
(13:32):
more information about the types of cancer that HPV can
cause and what we can do to prevent it or
lower our risk of HPV related diseases or cancers. I
thank you for listening. Wherever you listen to this podcast,
please leave a review and rate the podcast. As I've
(13:53):
said before, your reviews and ratings really do matter. Also,
make sure you follow the show so that it will
be automatically downloaded. That matters too. I encourage you to
visit our Facebook page I and B Podcast, where you
can give us a like and leave comments or questions
for me. Our website is itchyanbitchy dot com, where there
(14:15):
are blogs with some of our subjects available for you
to read. On the Facebook page and website, we have
the information about how to schedule an appointment with me
so we can chat about how my perimenopause course can
help you if you're going through this phase in life.
As always, thank you so much to Forest Winzl, our
producer and composer of our theme music and the person
(14:39):
who does all the behind the scenes work to make
this podcast possible. Thank you so much, Forest, and Forest,
as I've said before, has started his second of four
semesters to earn a master's degree. In Music Composition at
the prestigious Peabody Music Conservatory. If you want to listen
to some of his music other than my favorite Itchy
(15:00):
and Bitchy theme song, you can go to his website
Forrestwinsle dot com. That's f O R R E S
t w E N t z e l dot com.
Your health is in your hands.
The content of this podcast is provided for general informational
purposes only and is not intended as nor should it
be considered a substitute for professional medical advice. Hi everyone,
(00:22):
This is Karen Nickel, family nurse practitioner, and this is
Itchy and Bitchy, a podcast that provides answers to your
many unanswered health questions. This is a reminder about my
course called the Perimenopause Answer. If you are going through
this phase of life called perimenopause, or if you don't
know if you're in perimenopause, I would love to have
the opportunity to talk to you about the course to
(00:45):
see if it's the right fit for you. There is
a link on our website Itchyanbitchy dot com and our
Facebook page I n B Podcast where you can schedule
an appointment for a zoom call with me. When you
make an appointment, I will I'll be sitting at my
little desk waiting for you to join the one on
one zoom call. In my practice and in my perimenopause course,
(01:09):
I get questions about the human papaloma virus HPV and
what kind of risks it poses to women as we age.
Of course, HPV can impact women and men of all ages,
especially if they are or have been sexually active. But
(01:29):
during this episode, I would like to discuss HPV and
women in their perimenopausal and menopausal years. This is part
one of a two part series on the subject. I
will be releasing part two next week. I'm going to
be talking about the areas of the body that are
impacted by HPV and about the types of sexual activity,
(01:54):
so keep that in mind if there are little ones
around as you listen. Let's start by reviewing information about
the different strains of HPV. HPV has more than two
hundred strains or types, some of which are spread through vaginal, anal,
(02:15):
or oral sex. Sexually transmitted HPV types fall into two groups,
low risk and high risk. High risk HPV can cause
several types of cancer. There are twelve high risk HPV types.
I won't torture you by listing all the numbers of
(02:37):
the strains, but two of the twelve strains, HPV sixteen
and HPV eighteen, are responsible for most HPV related cancers.
I'll talk about those cancers in a bit. Low risk
HPV types rarely cause cancer, although a few low risk
(02:57):
HPV types can cause war on or around the genital's anus, mouth,
or throat. The virus that causes HPV infection is transmitted
through skin to skin contact. Most people get a genital
HPV infection through direct sexual contact, including vaginal, anal, and
(03:19):
oral sex. Because HPV is a skin to skin infection,
intercourse isn't always required for the virus to be transmitted
from one person to the next. An amazing but I
guess not too surprising statistic is that more than eighty
percent of women are infected with HPV by the age
(03:41):
of forty five years old. Many people have HPV and
don't even know it. They have no symptoms, and you
can still contact it even if your partner doesn't have
symptoms doesn't know he or she has HPV. It's also
possible to have momultiple types or strains of HPEV at
(04:03):
one time. So once you have an HPV infection, what
happens and how do you get rid of it? Actually,
ninety percent or nine out of ten HPV infections go
away on their own within two years. According to the CDC.
The body's immune system clears the virus from the body. However,
(04:27):
during those two years, when the body is working on
clearing the virus. It's still clearing it. But it might
have low levels, but it's still working on clearing it.
The virus is still present in the person's body, and
that person during that time may unknowingly transmit HPV. When
the virus doesn't go away on its own, it can
(04:50):
cause some serious health problems. These include genital warts, cervical cancer,
and other cancers of the genital's head, neck, and throat.
Since the low risk strains of HPV that cause warts
are different from the high risk strains that cause cancer,
genital warts caused by HPV doesn't mean that you will
(05:13):
develop cancer. Cancers caused by HPV often don't show symptoms
until the cancer is in the later stages of growth.
Regular screenings can help diagnose HPV related health problems earlier.
This can improve outlook and increased chances of survival. I'll
talk more about this in part two of this series.
(05:36):
So I'm sure many of you know how screening for
HPV happens, but just to review, HPV can be checked
using a papsmere typically on a PAP smear of the cervix.
An HPV test is not routinely run on the sample
so when you get a papsmere, HPV is not routinely
(05:59):
run on that sample. It is usually run on the
test only if that PAP is abnormal. In those practicing
anal sex, a PAP smeror can be done with a
sample collected from the anus. As I said earlier, this
episode is going to be focused on HPV and women,
but I do want to share that for men, some
(06:21):
strains of HPV can cause penile, anal, and throat cancers.
Some men may be at more risk for developing HPV
related cancers, including men who receive anal sex and men
with a weakened immune system. Back to women, I had
patients in their fifties and sixties who always had normal paps,
(06:44):
then all of a sudden, they wind up having an
abnormal PAP with a positive HPV. When they got that result,
I reviewed with them that HPV is usually a sexually
transmitted disease, and they were ready to go home and
their spouses. I always had to say, whoa nelly, Just
(07:04):
take take a moment and remember that just like chicken
pox virus which can lie dormant in your body for decades,
then emerge and cause shingles, the human papaloma virus can
also behave that way, you can contract it, say in
your twenties, and it is suppressed for thirty or forty years,
(07:28):
and then it re emerges. So it doesn't mean that
your partner is necessarily up to no good. However, you
should share with your partner that you have had a
positive HPV testing. The test will include which strains of
HPV were positive. The human papaloma virus infection in women
(07:50):
during or after menopause may actually be an infection that
was acquired when they were younger. Came from new research
published in the Journal of Infectious Diseases which suggests that
after one or two years, HPV may still exist below
(08:12):
limits of detection. I'm going to say that again that
HPV after a couple of years may still exist in
the vaginal area at levels that are below the limits
of detection. This process can happen with other viruses such
as Vericella disaster, which causes shingles. It can lie dormant
(08:33):
and then re emerge decades later. The report emphasizes that
more studies need to be conducted in order to gain
more knowledge on HPV infections and understand the part that
persistent and reactivated HPV play in women who are in
their fifties and sixties. Many reports have demonstrated that certain
(08:58):
types of HPV can be detected again after not being
detected for a long time. However, scientists are unsure whether
it's because of a low level, persistent infection or a
new infection. The data gathered in the study raise the
possibility that the risk of HPV reactivation may increase around
(09:19):
the age of fifty years and contribute to a larger
fraction of HPV detection in older ages. The results also
showed that women who became sexually active during and following
the sexual revolution of the nineteen sixties and seventies are
at a considerably increased risk of HPV infection later in life,
(09:43):
more so than females who became sexually active before nineteen
sixty five. The authors believe that the reason is because
of a greater number of sexual partners throughout their life
in the group of women who became sexually active after
night teen sixty five. After this quick break, I'll talk
(10:04):
about the role of declining hormones and immune system function
in women as we age.
Speaker 2 (10:10):
Stay tuned, Welcome back.
Speaker 3 (10:27):
The study. I referred to prior to the break did
not look into the role of declining hormones and immune
system weakening that we experience as we age. When our
female hormones decline, our vaginal health also usually declines. Our
tissues become drier and rougher, and we have a loss
(10:49):
of the good bacteria called lactobacillis that keeps the vaginal
area healthy. There is a study looking at the relationship
between having healthy levels of good bacteria in the vagina
and the frequency of HPV infection. Evidence indicates that the
likelihood of HPV persistence is higher among women with an
(11:13):
altered vaginal microbiota. When we have more bad bacteria than
good bacteria in the vagina, the pH of the vagina
goes up, which allows for more growth of opportunistic organisms
like yeast and viruses. With increased levels of bad bacteria
causing a high vaginal pH, HPV can adhere more easily
(11:38):
to the vaginal walls. The stage is set for chronic inflammation,
persistent HPV infection, and the progression of infection, which can
potentially lead to the development of cervical cancer. Female hormones
significantly influence the vaginal microbo. Specifically, estrogen plays a crucial
(12:04):
role in preserving the collagen content of the vaginal epithelium.
Healthy collagen levels help maintain the tissue's thickness and elasticity.
Estrogen also contributes to the maintenance of moisture on the
vaginal wall surface. When our estrogen levels decline in menopause,
(12:27):
the walls, as I said, become dry and rough, which
can contribute to the persistence of HPV growth in the vagina.
In addition to declining female hormone levels in postmenopausal women,
our immune system function also declines as we age. Our
body has a harder time suppressing low levels of the
(12:50):
human papillomavirus that can be present in the vagina. Studies
suggest that reduced immunologic fitness is an important player in
HPV infections that occur among older women. The studies indicate
the possible existence of very low level HPV infections that
(13:11):
become detectable among older women even in the absence of
re exposure through sexual activity. The main factor associated with
this detection of these reactivated infections was a weak immune response.
In Part two of this HPV chat, I will provide
(13:32):
more information about the types of cancer that HPV can
cause and what we can do to prevent it or
lower our risk of HPV related diseases or cancers. I
thank you for listening. Wherever you listen to this podcast,
please leave a review and rate the podcast. As I've
(13:53):
said before, your reviews and ratings really do matter. Also,
make sure you follow the show so that it will
be automatically downloaded. That matters too. I encourage you to
visit our Facebook page I and B Podcast, where you
can give us a like and leave comments or questions
for me. Our website is itchyanbitchy dot com, where there
(14:15):
are blogs with some of our subjects available for you
to read. On the Facebook page and website, we have
the information about how to schedule an appointment with me
so we can chat about how my perimenopause course can
help you if you're going through this phase in life.
As always, thank you so much to Forest Winzl, our
producer and composer of our theme music and the person
(14:39):
who does all the behind the scenes work to make
this podcast possible. Thank you so much, Forest, and Forest,
as I've said before, has started his second of four
semesters to earn a master's degree. In Music Composition at
the prestigious Peabody Music Conservatory. If you want to listen
to some of his music other than my favorite Itchy
(15:00):
and Bitchy theme song, you can go to his website
Forrestwinsle dot com. That's f O R R E S
t w E N t z e l dot com.
Your health is in your hands.
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.