Tuesday, December 9, 2014

HPV, Genital Warts, and being an 'unmarried' patient in Pakistan...


Hey Eiynah

Love the blog. Really refreshing reading about the possibility of brown people doing ze sexualzz. 

Khair, I know you've repeatedly said that you're not a doctor and you don't know the answers to STD questions and what not but, God ,I'm desperate. Any information you can give me will be appreciated.

So I contracted HPV, I think around a year or so back. I can't be sure of when and from whom I got it because I've had multiple sexual partners (I'm monogamous now) and I only knew I had it a year back when I saw the visible signs. Yeap. Genital warts. I know please don't hate me for being graphic and gross. I tried going to the gynaecologist. The first time I went she told me to wait because it had just broken out. But I never went to the doctor again because the moment you answer the question "are you married?" with a "no", they start judging you. I didn't get any sound medical advice apart from "abstinence until marriage".The problem is now the warts have increased and idk what to do. Like if I'm not mistaken, the body is supposed to fight off the infection itself but idk how long that would take and I'm kind of freaking out. Any advice would help. 

Love
B


Usually, if you come to me with a medical health question, I will tell you that I’m NOT a doctor and not qualified to help. And that you should go find a doctor ASAP. But the reasons B cited for not being able to consult a doctor, really hit home with me. I have personally experienced Doc-Judgyness in Pakistan and know its awful. Simply asking if your prescribed medication is compatible with booze is a no-no, so I can't even begin to imagine what this feels like.

When you're unable to have honesty with your doctor...it makes you feel very small, and helpless...I have been refused advice on caring for something as minor as an infected piercing because the doctor disapproved of the piercing in the first place. Sigh.

It is sad that our country cannot provide unbiased medical care to patients without imposing religion-based, subjective standards of ‘morality’ on them. For women this is a serious problem, because they are judged far more harshly than men. And this can sometimes lead to grave consequences.
I have heard from and spoken to countless women that have been stuck in this situation, where they have a serious issue but are fearful of the consequences of going to a doctor.

This should never be the case.

It’s unreal, and the risks this poses to our population are alarming. The spread of disease, risky abortions (it is a little known fact [rarely shared by doctors, even] that abortions are safely provided by organizations like Marie Stopes in Pakistan - you can call their 24/7 hotline if you need help regarding reproductive health 0800 22333) - all because most doctors function under religion before science. As I mentioned in my last post, this is incredibly harmful, and must be called out.

I wish I wrote for/about a country that valued what I did, and provided me with some sort of backing so I could help more people. But sadly I write about a country that is constantly trying to oppose, censor and block my work. 

Anyhow, B’s email hit hard. It highlighted an issue that I would like to talk more about. 

I searched for a *real* doctor in Pakistan, to get in touch with and consult. 

Luckily I was able to find one who could spare some time for an e-consultation with her. They exchanged questions back and forth through me (in order to maintain both people’s anonymity - what we might not realize is that doctors put themselves and their careers at great risk too if they treat and give advice to unmarried people [women especially] regarding sexual health). Luckily B was able to get some very helpful, thorough advice. But the doctor asked that she remain anonymous too. 

The extent of need for anonymity is indicative of the web of utter bullshit we have created for ourselves in Pakistan. There I was, being anonymous myself, in a situation where I am able to connect a patient with a qualified doctor - but had to be the go-between to protect each party's anonymity. 

It's fucked up, I tell ya. 


Pakistan-based General Physician, Specialized in Public Health and Research:

Hey Eiynah!

Thanks for getting in touch with me about this. I need some more details from the patient to help properly - a good patient history based on what details doctors think are relevant is vital for a proper diagnosis and management via a medium like the internet where I cannot use my senses to directly assess her condition. So if you could email her for me with these questions? That would really help. 

*Specific questions and responses have been edited out for privacy reasons*


A word of caution: HPV is a virus and once a person is infected with it, it will remain in their system for their entire life, and there are ways to manage the growths and outbreaks and such, but she cannot get rid of the HPV infection from her body now and it can manifest in symptoms sometimes, but she can manage these in different ways. However, the most important thing about having HPV infections and break outs is that she will have to keep going to gynaecologists for regular Pap smears (cervical smears) as there is evidence to show that certain strains of HPV (can be a co-infection) can lead to the (slow) development of cervical cancer and although that is a slow disease process (meaning it can be prevented and cured at many stages and monitored) and unlikely given the type of HPV she seems to have, but she might need to find a gynaecologist she trusts and who is good and just lie to her about being married (a necessary step, unfortunately), so she can keep going back for Pap smears to check how the cells of her cervix are doing if she is having very frequent breakouts of genital warts. Another option if you don't want to lie, is to say no but still insist on a Pap smear, if the doctor is perceptive enough, they'll take the hint, but most will assume (as marriage is a proxy for sex, unfortunately), that you've never had sex if you aren't married. Silly, but that's how much in denial doctors can be in Pakistan.


Further, HPV can pass on to others as well - not simply through sexual contact, kissing, body fluids, but also through towels and linen and touch of the infected parts (like either infected genitals to mouth, or vice versa)and from mother to her newborn. So she ought to be careful about spreading it to others - which is why the doctors said to abstain till marriage (awfully unhelpful advice, but it isn't without reason) although they should explain that abstinence will not stop or have any bearing on her own breakouts and course of infection, that advice is more so she doesn't spread the infection around to others, although it is incomplete advice too, as it is only one route of spread. More practical advice would be that a condom is helpful in preventing spread if it is worn even to prevent genital skin to skin contact.

The good news is that lots of creams/ointments and such are available to apply to reduce breakouts and manage warts from spreading, and for those warts that recur, removal of warts is possible - so there are lots of options - which she can explore and try out to manage what she has.

hope this helps. Please let me know how it goes, I am a bit swamped with stuff but knew I had to take out time for this because I can sense she is really very upset, scared, lonely and has no answers as it seems no one has even explained anything about what she has to her properly :( Doctors are such idiots.

****

After a thorough exchange of questions and answers the Doctor had this to say:

****

Okay, so that seems like good news from her answers so far. Glad the worst case scenarios are out the window.


Therefore, based on what her doctors have said, it is possible that her age is below 30 years and that is possibly why the doctors have not been too worried about the HPV, also because they have all been generally typical warts - no pain or such - mainly just uncomfortable to have and look at, yes? That being said, the most dangerous HPV infections don't manifest in warts, so I can't stress how much getting regular Pap smears after the age of 21 is vital every 4 years or so (for all women!)

So that means that you haven't had any pain or inflammation or bleeding, which is a very big relief and means the HPV you have is very likely a safer type and so you probably don't have to worry about cervical cancer from this strain of HPV.

Either way, go back to your doctor, regardless of whether you say you are married or not, and ask them to perform a pap smear on you, regardless of your marital status (they don't like doing pap smears on unmarried women - silly perception of theirs), so you will have to tell them to please do it either way. They should do one on all women above 21 years, every 4 years or so (even without any HPV!)

Then ask them if they can please prescribe you either a gel/ointment or cream for your external warts - they will say yes if your warts are not too big and easily breakable type. If they pressurize you too much about cryotherapy, tell them you can't afford it (usually it is very expensive) and ask them what other options you have. Also, if they say no to one treatment, always ask the reason why. As a patient it is your right to know why and no concept is too complicated for a doctor to explain simply.

Update me on her answer,

Take care and rest easy, it is something you have but not as worrying as it looks.
I hope this helps,

All my best,
Doc

*****

Again this is no substitute for an actual check-up. If you have or suspect an STD please go and consult a doctor. Not consulting one could result in serious harm to your health and other's health too.

9 comments:

  1. Hi! I read your post about how patients feel judged by doctors when it comes to sexuality. I want to share a personal story with you.
    I'm Norwegian-Pakistani and I was studying in Chicago, USA. (I have suffered from extreme acne so my Norwegian doctor recommended birth control pills in order to control my break out problem.I have also tried antibiotics & extreme drugs as Roaccutane).

    Back to the story:
    In Chicago I got sick and went to a hospital, where I came across Desi doctors( I think they were Indians). I told them that I had stomach ache & they started asking me questions. One of the question was if I'm on any drugs. I told them: 'yes, birth control.' They (desi doctor with his desi assistant) looked at each other and asked me: 'you are 23?' I answered yes. Then they asked me if I'm married. I said no. They looked at each other again. At this time I started feeling discomfort. Then they asked me very weird questions: 'are you Muslim? Looks like you are from India.' I tried to keep myself calm and answered their questions. They wanted me to take urine test and recommended that I take a test for HPV etc. At this time I was shocked and couldn't understand that I'm experiencing this in the USA and not in some country like Pakistan.
    End of the story: I requested a female doctor and went home with some painkillers. So those doctors just assumed that I'm sexually active since I'm on birth control & suggested STD tests & gynecological inspection. So ignorant & unprofessional!

    It has been years since this happened, but I still feel discomfort when I think about that visit. I'm sharing this to let you know that I experienced similar attitude from desi doctors in USA. This isn't limited to Pakistan.

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  2. There are a number of STDs, including HPV, condoms don't prevent. Seems like sex inside a mutually monogamous relationship(with an uninfected partner of course) is still the safest way, next to abstinence. No one is saying that relationship has to be marriage, it just has to be mutually monogamous.

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    Replies
    1. No, relationships don't have to be monogamous just because there might be a somewhat lower risk of STD transmission.

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    2. No one's forcing you to be monogamous. For all I care, you could play Russian roulette with your privates.

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    3. lol, seems like sex inside a mutually monogamous relationship with your right hand (or left, of course) is still the safest way, next to abstinence. No one is saying you should practice the sartorial stylings of bubble boy, but just don't have sex with anyone but yourself.

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    4. ROFL back at ya. I'm pretty sure abstinence is the same is having a relationship with you hands.

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    5. Not sure where you learnt that. But I hope you are carefully washing your hands or, better yet, abstaining. It's safer after all.

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    6. Naw. Wanking is perfectly safe. Never heard of anyone catching an STI after rubbing one off. That said there is a small chance of you getting someone pregnant if the man juice isn't disposed properly and it reaches a lady's hoo ha while it's still active(couldn't think of a better word). Now that would suck. Unless of course you're a sperm donor and you understand that your sperm might be used to conceive a baby.

      Washing your hands is always good advice though, both before and after.

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  3. Having sex out of a marriage relationship
    is sin !
    The price of sin is sickness and death physically and spiritually !
    Obey God do His commandments accept Christ !
    You will be spared a lot of diseases and a horrible life !

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