It's been an unsexy week for oral sex, with headlines sounding the alarm about a link to cancer. The same thing happened last year and a couple of years before that, all thanks to emerging research, and each time it stirs a panic. It can be hard to determine just how real the risk is, though, so I went to a couple of experts for some clarity -- and it turns out that we all need to take a deep breath.
The essential link between oral sex and cancer is HPV, which, as you've no doubt heard, can also cause cervical cancer. The vast majority of the time, the body fights off the infection like a cold or flu and people aren't even aware that they've had it. "It's almost ubiquitous at this point," says the National Cancer Institute's Aimée Kreimer, a researcher behind one of the definitive studies on the oral sex-cancer link. "We don't want to create a crisis and scare everyone. Most likely people will see this infection in their lifetime and they'll fight it." But in some cases it does develop over time into cancer.
Given that HPV is sexually transmitted, and that the infection generally develops in the location where it's first introduced, researchers have drawn a connection between oral sex and oral cancers where the virus is present. The link is strongest in the oropharynx, which includes the tonsils: Infection with HPV causes about half of these cancers in the United States. "However, the most important risk factor is multiple lifetime sex partners," says Raphael Viscidi, a professor at Johns Hopkins Bloomberg School of Public Health, who conducted the study mentioned above with Kreimer. "It is difficult, given this risk, to tease out the importance of any particular sexual practice." Kreimer agrees: "Sexual behavior is not straightforward. We think that kissing can also transmit the virus, and we've seen that people who say they don't have oral sex can have the [oral HPV infection]."
What has never been clear to me in the coverage of recent research on the issue is whether we're talking about heterosexual or gay couples, blow jobs or cunnilingus (side note: isn't it about time to develop a more appetizing word for that?). Viscidi says, "There is no obvious reason why transmission would differ within heterosexual versus homosexual couples, after accounting for number of partners and sexual practices." Men are more likely to get these cancers -- but it could be because men used to smoke more.
The reason we're seeing this evidence now likely has to do with the sexual revolution of the '60s and '70s. "Cancer is a long process," says Kreimer. "We know that cancer takes probably 20 years, if not longer, to develop from the infection, so many decades later we're seeing this trend increasing."
The obvious question is whether people need to start using rubbers during oral sex. Like any good public health expert, Kreimer points out that there is already good reason to do so, although she recognizes that it is far from the norm. "People view oral sex as a safe behavior and don't recognize that it can transmit infections but it can, simply put," she says. On the other hand, Viscidi says, "There is very little evidence to suggest that condom use prevents transmission of HPV, based on studies of cervical vaginal HPV as the endpoint. A concerted push for an unproven benefit would seem unwise and condoms would not protect men." There is a bit of good news, though: He points out that oral cancers are "almost entirely due to HPV 16 which is now preventable through vaccination."
The key thing here is maintaining perspective: Despite the near-ubiquity of HPV, oral cancers that are linked to the virus are incredibly rare. They occur in approximately five per 100,000 people, according to Kreimer. The greatest risk for oral cancer does come from sucking on a phallic object -- but it's cigarettes. There's a good reason that smoking, and not performing BJs, gets stamped with a surgeon general's warning.