Red Tent Sisters

I’ve been using the DivaCup for over 3 years now and I certainly don’t need to be convinced of its many virtues. However, my recent trip to Costa Rica gave me one more reason to love my reusable cup.

I arrived in San Jose on day two of my period. Having recently gone off the pill, my flow was particularly heavy. Unfortunately, there were no bathrooms except for the public washroom in the bus terminal which charged 250 colonnes (about 50 cents). Having arrived with $50 US bills (the banks in Toronto didn’t take into account that these would be rather useless in a third world country where the average meal is less than $4), I was out of luck. I was going to see if I get some change from the ticket booth operator, but our bus arrived before I got the chance. The bus didn’t have a washroom, which would have been fine except the trip was about 4 hours and we didn’t stop once! We finally got onto the ferry, which thankfully had a toilet (that you didn’t have to pay for!) I was grateful that I wasn’t wearing a tampon, since I would have had to worry about toxic shock. Not to mention you aren’t allowed to flush anything (including toilet paper) in Costa Rica because their septic system can’t handle it. While I’m not concerned with hiding my menses, I’m not sure anything else needed to be added to the overflowing garbage bin (don’t get me started on the smell . . .)

Considering I spent the entire week in my bathing suit, I was grateful I didn’t have to wear a pad, nor did I have to scrounge up change to use the bathroom every couple of hours. While I could have done without the cramps on my travels, the Divacup made my period a minor inconvenience, rather than a disaster.

* There are over 100 strains of HPV, 35 of which affect reproductive/genital organs. Some of these 35 are high-risk, which means that, if persistent, they can cause cervical cancer in women. Some are low-risk, which means they are less frequently associated with cancer, but can cause genital warts (which can be treated much like warts on other parts of the body). With a healthy immune system and low risk factors, most women’s bodies fight the infection and eliminate it within 9 to 13 months of contraction.

* Most women with HPV do not contract cervical cancer. Most fatal incidents of cervical cancer affect poor women, women with compromised immune systems, and women who face structural inequities and oppression such as racism, colonialism, and violence in their lives. About 0.002% of the female population – around 400 women – dies of cervical cancer in Canada per year. Death rates are higher in parts of the world where Pap screening is unavailable and where poverty and poor nutrition are prevalent issues.

* Gardasil is the first HPV vaccine approved for use in North America. It prevents infection from strains 6 and 11, which can cause genital warts, and from strains 16 and 18, which can cause cervical cancer. These strains are responsible for 70% of cervical cancer cases. The vaccine does not protect against other types of HPV which account for the final 30% of cervical cancer cases. The vaccine is a preventative measure; it does not cure cancer or warts associated with HPV.

* The vaccine costs about $405 per woman/girl and is a three-injection process. [The vaccine is injected in a girl’s/woman’s arm at two months and six months after the initial injection. It is covered by private health plans, which, of course, is only helpful for women/girls with access to a private health plan.]

* There is some discussion of covering the vaccine through the Canadian health plan, and some suggest that there is not enough evidence that this vaccine is effective/necessary enough to justify the cost to the system. The women’s health network suggests that providing budgetary funding to ensure that all women receive regular Pap tests would be a much better use of funds. This is because cervical cancer is considered 90% preventable with screening and treatment through Pap smears. Also, the vaccine does not eliminate the need for Pap tests because it doesn’t prevent all strains of HPV and does not cure HPV if a woman is already infected at the time of injection.

* The HPV vaccine does not replace the need for safer sex techniques; a woman’s chances of contracting cervical cancer increase with multiple sex partners and earlier initiation of sex. Women who have sex with women are sometimes considered to be not at risk for HPV, but this is a false assumption.

* In Canada, the vaccine is recommended for girls 9-26, particularly for those who have not yet had skin to skin sexual contact, i.e., have not yet had the possibility of being exposed to HPV. [However, women who have had sexual contact can still opt for the vaccine]. There are fewer studies of the effects of the vaccine on the younger age category, so there is some concern about the effects on younger girls. There are also concerns that the long-term effects are not yet clear enough, particularly for young girls.

The above information, except for the square brackets […] which contain my own input, was collected and then paraphrased from the following source: The Canadian Women’s Health Network. “Gardasil: What you need to know about the HPV vaccine. Pap tests still the best tool in preventing cervical cancer.” by Women and Health Protection and the Canadian Women's Health Network, with assistance from Judy Norsigian, Alicia Priest, and Robin Barnett. http://www.cwhn.ca/resources/cwhn/hpv.html

A side of the debate that I’m particularly interested in is the ‘moral panic’ side. Some people are suggesting that providing the vaccine for girls as young as 9 in Canada (and the US recommends routine vaccination for girls at ages 11 and 12) would encourage promiscuity and give girls this age ‘permission’ to have sex at an early age and with multiple partners. However, Gardasil and health care providers recommending it don’t make a claim that the vaccine replaces safer-sex practices, and, to my knowledge, there is no evidence that vaccination is associated with girls’ decisions to become sexually active, to have multiple sex partners, or to discontinue use of safer-sex practices.

At a grad student conference that I attended last spring, a colleague raised the question that since the vaccine addresses HPV, which can cause, but is not the same as, cervical cancer, why is there not a similar initiative to provide routine vaccinations to boys as well, since boys can/do spread HPV? Certainly boys will not contract cervical cancer as a result of HPV, but is there a kind of policing/controlling of female bodies going on when boys are not held equally responsible for the spread of the virus? This follows a tradition of placing the burden of responsibility for birth control and safer-sex practices on women and girls, as well as a social attitude that women/girls can’t demand the same kind of conscientiousness about safe sex from their male partners that they are supposed/expected to have themselves.

There are so many sides to the debate: the issue of long-term effects/insufficient studies (although the vaccine has been approved); the cost of the vaccine and whether it should be paid for by the Canadian health plan when there is perhaps insufficient evidence that the vaccine is more effective in the prevention of cervical cancer – which effects few Canadian women fatally – than regular Pap screening is. This issue is inflamed by the fact that the vaccine does not replace Pap screening, and that, as it is, not all women even have access to regular Pap tests. However, I also find the suggestion a little questionable that, essentially, not enough women are dying to justify the allocation of federal funds (although certainly I understand the point that there are few health funds already, and that putting them toward Gardasil might not be the best way to spend what little we have). Further, while privately distributed, the cost of the vaccine is prohibitive for poor women who are more likely to die from cervical cancer. There are also the social and ‘moral’ concerns about female sexuality: from the Right that vaccination would increase sexual promiscuity among girls, and from the Left that vaccination represents more control of women’s/girl’s bodies. And certainly the debate is larger than these already tangled issues; the HPV vaccine is currently a contentious and complex debate. The decision to be vaccinated (or not) is a personal one to be made by individual girls/women in consultation with a trusted health-care provider.

During my first week in South Korea I attended an orientation session on "how to teach conversational English and how to adapt to Korean culture". During one class the facilitator was showing us how to use a word search engine ... enter a word and words that are most often used with the first word will appear. For example, enter smile and whimsical, wry, happy etc. comes up. After some group work the facilitator said "I looked up woman and it's not the greatest corresponding words but look up here on the screen and you can see what came up", and he rattled off a few words. Turns out that menstruating was one of the words ... not surprising since a large part of the female population, especially those people commonly referred to as women, are menstruators. An outgoing, very loud young woman a few rows behind me said "ewww gross". EXCUSE ME??!! Not as loud as her but loud enough that others around me could hear I said "all women do it, why is it gross?!" Still in shock and still shaking my head I sarcastically said to my pair of female table mates "I'm menstruating - does that make me gross? Should i go to my room and stay there?" Saying that makes obvious how ridiculous the first woman's comment was. The funny/interesting/unfortunate thing is that probably more people had a reaction like hers rather than a reaction like mine. Sheesh. Cheers, E.