Introduction
Questions have recently arisen in the popular press about the association between specific sexual behaviors, namely, fellatio and cunnilingus, with head and neck cancers. Although there has been an overall decline in the incidence of head and neck cancers over the past 25 years, there has been a shift in the distribution of these cancers toward a particular type known as oral squamous cell carcinomas (OSCCs), and a younger demographic. These particular cancers, OSCCs, have been shown to be associated with the human papillomavirus (HPV). Several researchers have suggested that this shift in the epidemiology of head and neck cancers might be attributable to changing sexual practices. While this speculation has caught on in the popular press, there are several interesting contradictions in the existing evidence that suggest this conclusion might be premature and overreached.
Aim
The intent of this article is to help clarify the issues so that sexual medicine professionals can give accurate and up-to-date information to their patients.
Main Outcome Measures
This is a review article; no outcome data are reported. This is a review article; no measures were collected.
Methods
Pubmed search on HPV, oral sex, oral cancers, and OSCCs.
Results
One hundred ninety-six articles on HPV were found; 63 articles on oral sex, 55 on oral cancer, and 5 articles on OSCCs were identified as relevant.
Conclusions
HPV infections occur commonly and are usually cleared within 18 months, thus HPV infection should not be a cause for concern among monogamous couples with a rich and varied sex life as long as the sexual system remains closed and other immune compromising factors are not present. HPV becomes a concern in the context of immune system compromise and infection persistence. Factors contributing to immune system compromise, HPV persistence, and oncogenesis are reviewed.
Awareness of depression among OB-GYN physicians has increased with the result that more than 13% of pregnant women in the United States receive prescriptions for antidepressant medications. But the safety and effectiveness of these compounds has been exaggerated while the effectiveness of psychotherapy has been overlooked and distorted and various medical guidelines for treatment of perinatal depression have been downplayed or ignored. This article addresses the common fears and misconceptions surrounding treatment of depression during pregnancy and after childbirth. The effectiveness of strategic cognitive-behavioral therapy enhanced with hypnosis offers excellent results without the risks associated with these medications. Targets for focused intervention are identified and discussed.
Psychological factors present significant concerns when assisted reproductive technologies (ART) are needed, whether for the treatment of infertility or for nontraditional family building. Psychological evaluation of all parties involved is recommended when treatment involves gamete donation or the services of a gestational carrier. The American Society for Reproductive Medicine (ASRM) has offered guidelines for the psychological evaluation of involved individuals. These ASRM guidelines appear long and complex, but a careful reading suggests they are fairly similar to a routine in-depth psychological evaluation. This article reviews the process of doing an assisted reproductive psychological evaluation, the most critical psychosocial topics to explore, and assessment of the psychological capacity to successfully participate in an assisted reproductive procedure. Report preparation is also covered.
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