You're Teaching My Child What? (12 page)

But penetration of the transformation zone's single layer is a cinch, making this area of the cervix prime real estate for genital infections. This is one of the reasons for our current pandemic of genital infections in teen girls.

Take note, however, that
infection
(the mere presence of an organism, an STI) is not enough to cause
disease
(an STD), which in the case of HPV, would be pre-cancerous changes.
⁸³
The body has mechanisms for eliminating the virus before it causes damage, and for fixing the damage should it occur; it has methods of preventing an infection from developing into a disease. But these strategies are impaired in an HPV-infected T-zone.

Like police forces in a city, the body has specialized units
⁸⁴
whose job is surveillance and safety. These are cells and organs that take care of “problems.” In the cervix, these security guards are called Langerhans cells.
⁸⁵
They watch out for unfamiliar “visitors.” When one is identified, it's taken into headquarters
⁸⁶
for “questioning,” and taken care of—eradicated. In the T zone, compared to the more mature cervix, the number of Langerhans cells is lower,
⁸⁷
the security is weaker, and dangerous “visitors” like viruses and bacteria may go unnoticed. Once HPV has settled in, the virus itself can incapacitate
⁸⁸
Langerhans cell functioning.
⁸⁹
,
⁹⁰
So aside from having a large area that's vulnerable to invasion, the young cervix also has a weaker “police force” to recognize and deal with the danger.

Also, cells in the T-zone are highly sensitive to estrogen and progesterone.
⁹¹
Studies suggest these hormones can enlarge the T-zone, empower HPV, and stimulate cervical cells to rapidly reproduce.
⁹²
That's a hazardous combination. First, it provides bugs with more available “real estate.” Because viruses can't replicate by themselves—they must hijack the machinery of the cell “hosting” them, their job is facilitated: hijacking is easier when the cell is working at high gear. So female hormones may boost the power of HPV to cause damage. They may also interfere with the actions of the “police force”—those Langerhans' cells. It's been demonstrated that taking birth control pills containing both estrogen and progesterone for eight to ten years places women at higher risk of cervical cancer. This is thought to be related to the hormones' direct effect on T-zone vulnerability: defense is lowered and HPV power is boosted.
⁹³

The virus has other tricks up its sleeve. When new cells are made, and DNA copied, errors occur. You don't want DNA mistakes; these are abnormal cells with cancer potential. A healthy cell has molecules that find these mistakes and repair them. HPV interferes with these molecules, allowing the damaged DNA to replicate. The abnormal cells proliferate, and a tumor begins to grow.

Amazing, isn't it, how complex this is? I was surprised to discover, while researching this subject, a number of textbooks about just this organ, the cervix. It's not as simple as we're led to believe:
get vaccinated, use a condom, have regular Pap tests.
Following those guidelines is essential, of course, but the immature cervix is undoubtedly a critical factor in girls' vulnerability to disease, and cannot be omitted.

There is an important caveat: Sexual intercourse speeds up the process of maturation. A study of teens who had multiple “partners” and were HIV-positive revealed that their cervixes were like those of
adults—covered by many layers of cells.
⁹⁴
Something associated with intercourse—the mechanical insult, a substance found in semen, or the presence of an STI—speeds up the process by which the T-zone matures.
⁹⁵

So if a girl is having vaginal intercourse, her body “knows” it, and responds by accelerating its defense: a thicker barrier of cells. But here's the problem. When the cells in the T-zone are proliferating rapidly, as they are after sexual debut, their replicating machinery is working overtime. As previously explained, the cell in high gear is the cell that HPV easily takes over. Since girls are likely to be infected with the virus from one of their first partners,
⁹⁶
this is bad news. The virus is present, and now the machinery through which it does its damage is working overtime. It is now likelier than ever that abnormal cells will get the chance to proliferate. So even though intercourse accelerates cervical maturation, a girl who has just begun having sex is more vulnerable than she was as a virgin, at least to the cancer-causing potential of HPV. This is something she should know, when she comes in for birth control or testing. The awareness of this risk, along with communication skills, may help her to begin saying “no.”

How long does it take for the cervix to mature? That's what I want to know from every gynecologist I meet. They tell me that everyone is different, but in general, as a girl moves through her teens and into early adulthood, her transformation zone decreases in size. A larger area of the cervix is covered by a thicker, tougher surface.

Now folks, this is big. Based on this finding alone—something gynecologists and pediatricians have known for at least
⁹⁷
twenty years, girls should be advised to delay sexual behavior. Yes, delay sexual behavior. Not for moral reasons, and not for emotional reasons (although those are significant as well, and we'll get to that in another chapter), but for medical reasons alone.

Question:
why don't we all know about this?
Why aren't pictures of the T-zone found in every sex ed curricula, and displayed on the websites of Planned Parenthood, Teen Talk, and GoAskAlice?
⁹⁸
Why no pamphlet about the cervix in the waiting rooms of adolescent health providers? What happened to a teens' right to “up-to-date, accurate medical information,” and to sex educators' claim of providing it?

I've scoured the resources on this, and read all the Q&A's from girls asking, “
am I ready? How do I know?”
The answer is always, “Only you can decide ....”
⁹⁹
Consider your values, your relationship, and how you feel about it, girls are advised. A responsible sexual relationship is
consensual
;
honest
;
mutually pleasurable
;
protected
. Always included are warnings not to have sex due to peer pressure or coercion. I didn't find a single “expert”—who declared:
you're not ready, take it from me, it's smart to wait
and then explained the immature cervix, and pointed to it as indisputable evidence that
teen sexual activity is high risk, especially for girls
.

How, in 2008, do organizations like SIECUS and Planned Parenthood get away with their 1960s-era mantras about kids being “open,” questioning what they learn at home and at church, and telling them, “only-you-can-decide-when-you're-ready,” all the while claiming to be based in science? How can they tell parents to “provide information,” back off, and respect their teen's decision—the same teen that forgets to bring a pencil to class, and has a meltdown when her sister gets more French fries than her?

In fact, adolescent brain specialists urge the opposite approach to what sex education activists recommend. Dr. Giedd says that parents should “stick around and sort of be the highly developed frontal lobe”—meaning, be involved with the tough decisions facing your teen, even if they resist.
¹⁰⁰
Be the CEO—within reasonable limits—until theirs is fully functioning. Dr. Dahl and other neuropsychologists remind us that adolescents need
social scaffolding
—constraints, support, protection, and “most importantly, the rules and behaviors of the adults that provide monitoring and a ‘safety net' for adolescents.”
¹⁰¹
Are
you hearing this? Along with our support and protection, they need our constraints and rules.

This scaffolding, they say, should come from parents, teachers, coaches and other responsible adults and should not weaken until the capacity to self regulate has emerged, and the individual is able to make increasingly independent judgments. “Adult monitoring is all too frequently and too prematurely withdrawn during this vulnerable period, leaving the adolescent to have to navigate situations alone or with peers at a relatively early age... [this] plays a part in creating a great deal of vulnerability for youth in our society.”

Amen. Teens are not small versions of adults. They need us, along with our rules and limit setting—even though they'll rarely say so. About sex, they must be told: of course you're interested, your urges are natural and healthy, but now is not the time. Trust us, this is not like cigarettes or fast food: one poor choice,
just one,
can affect the rest of your life. Be smart, we expect it of you, and we know you can do it.

Anything less than that is an awful disservice to our kids. We harm them by saying:
only you know
, as if, with all our wisdom and experience, we know nothing. We deprive them of the scaffolding they so need. Why then are we surprised when, like an unsupported building, they wobble and come tumbling down?

L
IKE ALL PHYSICIANS, Ruth Jacobs took an oath when she graduated from medical school. She stood up, raised her right hand, and swore to prevent disease whenever she could. Since that day, she's treated thousands of patients, learning the hard way that the fight against disease is sometimes lost. Early in her career, in fact, the news she gave many patients was bad; there was little to do but wait for the end. The grief of those left behind was heavy on her heart.

But Dr. Jacobs accepted the fact that some conditions are fatal, and every physician has patients who die. After doing all she could to prolong life, she'd mourn the loss and continue her work with the many others who needed her.

It was difficult, yes, and yet easier in some ways than her current ordeal. Dr. Jacobs is still fighting to prevent disease, but her foe isn't cancer or infection—she's up against her local Board of Education. She, along with other members of a group called Citizens for Responsible Curriculum (CRC), is dueling with school administrators over
what teens should be taught about risky sexual activities.
¹
This sort of battle is new to Dr. Jacobs; it's fought far from a dying patient's bedside, with lawsuits, not medication. But it's over this struggle, not her earlier ones, that she feels discouraged, sometimes even hopeless, about preventing disease. Why now, nearly thirty years after taking the doctor's oath, does staying true to her promise seem such a formidable task?

Dr. Jacobs is an infectious disease specialist in Montgomery County, Maryland. She was trained at the National Institutes of Health, arriving there in the early eighties—the start of the great plague of our time. AIDS was a mystery during those years. The NIH intensive care unit and immunology division was crowded with young men who should have been healthy and thriving. After being flown in from San Francisco, Los Angeles, and New York for the best in research and advanced care, they all died.

After seven years at the NIH, she worked at the Washington Veterans hospital, where the same scenarios continued. Science was still without an answer. By the time she opened a private practice in the nineties, Dr. Jacobs was more comfortable taking care of patients with HIV than those with the common cold. Like many health professionals who cared for AIDS patients through the eighties, Jacobs saw and experienced much sorrow.

Fast forward to 2005. Dr. Jacobs had been listed as one of DC's best doctors for years. At the request of a concerned mother, she reviewed a video
²
being shown to tenth graders as part of a newly devised Family Life and Human Development course in Montgomery County Public Schools. The video, called “Protect Yourself,” stated that condoms provide 98 percent protection against pregnancy and sexually transmitted infections, including HIV. It implied that this nearly perfect level of protection was effective during vaginal, oral, and anal sex.