Author: Jeanne Sager

When Amanda LaFleur quotes the PMDD statistics for America, she quickly adds an asterisk.
The medical community estimates 3 to 8 percent of cisgender women of reproductive age have premenstrual dysphoric disorder (PMDD). But that figure may be a wild underestimation of the number of cisgender women, transgender men, and non-binary folks who do battle with the condition every month, says LaFleur, who is the co-founder and executive director of the Gia Allemand Foundation, a non-profit focused on reducing the stigma and raising awareness of reproductive mood disorders, suicidality, and depression.
The foundation is named for Gia Allemand, an actress whose death by suicide rocked the country, her family, and her friends in 2013. Allemand had been diagnosed with PMDD before her death, putting her in that 3 to 8 percent. But PMDD is a condition that many folks don’t realize exists at all, and misdiagnosis is rampant, LaFleur says.
So what is PMDD? And why is it so hard for those who have it to find help? We asked the experts to shed a little light on the mental health condition and how to get treatment if you need it.

What is PMDD?

Most people have heard of PMS or premenstrual syndrome, the symptoms that crop up anywhere from a week to a few days before your period starts. You may feel bloated, have cramps, and even have some mood swings.
PMDD is not PMS. At least not exactly.
Someone with premenstrual dysphoric disorder may have some of those symptoms, and they will show up in the week prior to menses, but PMDD is both more severe and more debilitating, says Cindy Basinski, MD, an OB-GYN from Newburgh, Indiana.
“The symptoms experienced are more severe in PMDD as they affect the ability of a woman to perform normal daily activities,” Basinski explains. And while as many as 80 percent of women experience PMS on a regular basis, PMDD is considerably more rare.  
What sets the two apart?
PMDD is characterized by five or more of the following symptoms, says Nicole B. Washington, DO, a board-certified psychiatrist from Broken Arrow, Oklahoma, and chief medical officer at Elocin Psychiatric Services:

• Mood swings
• Sudden sadness
• Increased sensitivity to rejection
• Anger or irritability
• Depressed mood
• Sense of hopelessness
• Self-critical thoughts
• Tension
• Anxiety or feeling on edge
• Impaired concentration
• Change in appetite or food cravings
• Decreased interest in usual activities
• Low energy
• Feeling out of control
• Breast tenderness
• Bloating
• Aching joints or muscles
• Impaired sleep

The symptoms typically disappear as soon as the period starts or within a day or two of the first sign of blood—only to return again a month later.
Exactly why PMDD happens to some people and not others isn’t fully understood in the medical community, although Washington says it’s thought to be triggered by changes in sex hormones during what is known as the luteal phase of the menstrual cycle.
“This only occurs in susceptible women, but what we don’t really know is what makes one woman susceptible over another,” Washington says.
That’s not for lack of trying by scientists. The more awareness there is of PMDD, the more researchers are trying to suss out what happens to patients in the days and weeks before their period. A National Institutes of Health (NIH) study released in 2017 seems to have keyed in on one of the major components: a hormone susceptibility that only PMDD sufferers have. The scientists said their findings indicate molecular differences detectable in the cells of those with PMDD.
“We found dysregulated expression in a suspect gene complex, which adds to evidence that PMDD is a disorder of cellular response to estrogen and progesterone,” Peter Schmidt, MD, of the NIH’s Behavioral Endocrinology Branch, said in an NIH press release. “Learning more about the role of this gene complex holds hope for improved treatment of such prevalent reproductive endocrine-related mood disorders.”

Getting a PMDD Diagnosis

The path to diagnosis should be simple enough. PMDD is in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), the official guide of the American Psychiatric Association.
But Washington says the frequency of misdiagnosis comes down to issues on both the patient’s and the provider’s part.
“[The patient] may not be thinking that happens around that time of the month,” Washington says, “And the provider may not think to ask.”
In part, LaFleur blames this on a profound lack of understanding of how PMDD differs from PMS. People who struggle in the run-up to their menstrual cycle often doubt themselves, she says, even blaming themselves for not being able to pull themselves up by their bootstraps and muddle through a time of the month that’s hard on just about every person in their shoes.
“So many go through life thinking, ‘Oh, everyone goes through PMS, I’m just being dramatic’,” LaFleur says. In reality, a PMDD sufferer isn’t “just” going through PMS. While timing is the same, the symptoms are far more troublesome. That’s one of the cornerstones of PMDD itself: Symptoms have to interfere with life in order for the diagnosis to be made.
But the condition isn’t talked about very often—not nearly as much as PMS, which most Americans have heard of.
“It has the double stigma of the female problem of menstruation, which isn’t talked about because people think ‘ew, icky, blood, we don’t want to talk about that,’ and then you have the stigma of mental health on top of it,” LaFleur says of PMDD.
Even within the medical community, PMDD patients face stigma. As recently as 2002, the American Psychological Association ran an article in which some psychiatrists and psychologists said PMDD should not be classified as a mental illness at all.
Add to that the fact that some PMDD symptoms can crop up with other mental illnesses, and it’s no wonder there are misdiagnoses, Washington says.
In particular, LaFleur sees a number of patients who say they were first diagnosed with either borderline personality disorder or bipolar disorder before it was finally ascertained that they were experiencing PMDD.
Why?
According to Washington, borderline personality disorder is characterized by mood swings and extreme reactivity. Both are traits that crop up in PMDD sufferers. The difference? Personality disorders are what the medical community calls pervasive, meaning they are there all the time, rather than showing up only cyclically, as PMDD does.
Similarly, bipolar disorder is characterized by extreme mood changes that limit daily functioning—a symptom that can crop up with PMDD—but bipolar disorder is not related to the menstrual cycle.
Narrowing down the correct diagnosis can take time. Patients often don’t even recognize the tie to their menstrual cycle or have repressed it because of the fear that they’re blowing “normal” PMS out of proportion.
Washington says she encourages her patients to begin keeping a diary with their symptoms over a course of several months. She asks them to include important dates, especially the start and end of their periods, so she can see if there’s a link between the mental health component and a patient’s menstrual cycle.
Getting a patient the right diagnosis is crucial for myriad reasons.
First, treating someone for the wrong condition means putting them through unnecessary treatments, Washington says. The medicines used to treat bipolar disorder and borderline personality disorder are different from those used for PMDD, and getting the appropriate treatment right away spares someone having to deal with taking the wrong medication.
What’s more, getting the right treatment can help someone get their life back on track.
The Gia Allemand Foundation estimates that 15 percent of PMDD sufferers will attempt suicide, a shockingly high number that can be lowered by treatment.
Even for those who don’t face suicidal thoughts, the effects of PMDD can be life altering.
Carol (who has asked for her name to be changed) remembers the day she slapped her son in the face. It was the day before she called her counselor and asked for help.
“He was 3, and I thought he was trying to manipulate me,” Carol recalls. Now she realizes she was wrong to hit her child and to put that sort of burden on his shoulders, but at the time, she had no name for her feelings or means to control them.
Having one out-of-control moment that serves as a tipping point and sends them seeking help is common for PMDD sufferers.
“I can think of people who have been hospitalized, who have had marital problems, who have lost their jobs because they snapped at work,” Washington says—all this because they were experiencing untreated PMDD.
In Carol’s case, she’d always been susceptible to mood swings related to her hormones, but she says it wasn’t something her mother had ever talked to her about.
“We never really discussed that kind of stuff in my house,” she recalls.
When she went to find help, the counselor at first thought Carol was in a bad place in her marriage. But by the end of their second session, the counselor had pinpointed a problem related to her menstrual cycle.
“She said, ‘OK, now I see what is going on. I would like you to go see this gynecologist. She should be able to help you out,’” Carol recalls. She went to the OB-GYN, who directed her to keep a diary much like Washington’s patients, and then began treatment.

How to Deal With PMDD

In Carol’s case, treatment was a combination of birth control pills (meant to control her cycle to reduce hormonal ebbs and flows) and a prescription for a selective serotonin reuptake inhibitors (SSRIs), a medication typically used to treat depression.
It hasn’t cured her of PMDD, but it has curbed her symptoms immensely.
“My guys are fully aware of my meds, my freakouts, everything,” she says of her sons and husband. “I make sure they understand that it is my issue and overreaction and not them. I always explain how I was out of line. Sometimes I don’t say I am sorry because I don’t want them to feel as if they have to accept my apology. But I explain that my behavior was out of line.”
The medicine has enabled her to live with her PMDD without it massively impacting her life.
For some patients, more conservative PMDD treatments do work and work well, Basinski says; those can include increasing exercise, meditation, reduction of salt and sugar intake, and getting more rest. Some over-the-counter options, such as black cohosh and St. John’s wort, are also available, but data varies on their success in treatment.
For many patients, however, medication is required up until the beginning of menopause. Typically that means birth control in the form of oral contraceptive pills or hormone injections (such as the Depo-Provera shot) to regulate hormone levels, Basinski says, while some may opt for Mirena, an IUD that includes a hormonal component.  
Some doctors may add an SSRI to the mix as well as or instead of the birth control pill. But unlike those taken by depression sufferers, sometimes the SSRI will be given only during the luteal phase of the cycle, says Lisa Valle, DO, an OB-GYN at Providence Saint John’s Health Center in Santa Monica, California.
For some people, like LaFleur, the next step is surgery. She opted for a full oophorectomy and hysterectomy several years ago, allowing doctors to remove much of her reproductive system, including her uterus and ovaries. This stopped her periods and the hormonal shifts that come with a menstrual cycle, ending her fight with PMDD.
It’s a drastic move, and one that LaFleur acknowledges is not appropriate for many people. It puts an end to any chances of carrying a baby and sends the body into menopause early in life.
But ending her own personal battle with PMDD has empowered LaFleur to fight for more cisgender women, transgender men, and non-binary folks in her position.
“I want them to know it’s not about mental strength. It’s not about willpower. You didn’t do anything wrong to have this happen to you,” she says.
And there is help out there. Beyond the treatment options, the Gia Allemand Foundation offers online support through its website, along with symptom trackers and other tools for PMDD sufferers.

Gender-fluid. Genderqueer. Non-binary. Gender non-conforming. The language of gender is changing, and it’s doing it faster than you can say LGBTQIA.
Whether your best friend has just asked that you start referring to them as “they,” or your child has come home and shyly asked if it’s okay that they don’t really “feel” like a boy or a girl, it can be hard to know what to say and when to say it.
That hesitancy and confusion is absolutely normal, says Joel Baum, senior director of professional development at Gender Spectrum, a San Francisco area non-profit dedicated to creating a more gender-inclusive world for kids and adults alike.
“Gender hasn’t changed that much,” Baum says, “But we’re understanding it differently.”
And that understanding has brought along with it what Baum calls a “language explosion,” with a host of new terms that many people are struggling to understand. Sometimes they’re trying to figure out if those terms are right for themselves or an appropriate way to describe their own gender identity. Sometimes they’re trying to understand the terms used by friends, family members, or their kids, hoping to say the right thing and not be offensive or cruel.
What matters most, Baum says, isn’t the words you use at the outset but the ability to be open to hearing from others what their chosen terms mean and to be able to change.
“A big part of the work around this is becoming more comfortable with not knowing and being able to ask,” Baum says.
So what is gender-fluid? And how about non-binary, genderqueer, or gender non-conforming, for that matter?

Gender-fluid is just one term.

If you go by its dictionary definition, gender-fluid refers to “a person whose gender identity or gender expression is not fixed and shifts over time or depending on the situation.” That fluidity doesn’t mean that people can’t make up their minds. But it does mean that their identity is not constrained to just one binary, such as boy or girl.
Non-binary and genderqueer, on the other hand, are defined by GLAAD as “terms used by some people who experience their gender identity and/or gender expression as falling outside the categories of man and woman. They may define their gender as falling somewhere in between man and woman, or they may define it as wholly different from these terms.”
GLAAD defines gender non-conforming as “a term used to describe some people whose gender expression is different from conventional expectations of masculinity and femininity.”
So do they all mean the same thing?
Not at all, says Ellen Kahn, director of the Children Youth and Families Program at the Human Rights Campaign Foundation.
“Most of us are familiar with a binary, with male and female,” Kahn says. “We know folks who are transgender and binary too. Jazz Jennings is a binary person; she expresses herself as female, she identifies herself as female. Chaz Bono likewise is binary. He identifies as male.”
But for many people, the constraints of the binary are just that: constraining.
“In the middle range of binary there is a range of experiences,” Kahn notes.
That’s where these other terms come into play for people. They are words that have evolved in our language to allow people to give a descriptor for their gender identity. And just as each person’s identity is extremely personal, so too is their relationship to the words they use to identify themselves.
While “gender-fluid” is in the non-binary experience, the actual lived experience of folks who identify as gender-fluid or non-binary or genderqueer or gender non-conforming can all differ in qualitative ways, Kahn says.
In a forthcoming Human Rights Campaign survey of LGTBQ teens, Kahn says the kids were given the chance to describe their own identity in their own words. The responses included at least 50 different terms the kids used to identify themselves. And not a single one of those kids was “wrong” for using a different word.
“I’m surprised and intrigued at how the language is evolving,” Kahn says. “Young people don’t feel confined, don’t feel constrained. You can be free to be who you are.”

Ask, don’t tell.

Some people may identify as gender-fluid, some as non-binary, and so on. What’s important, Kahn says, is to be open to allowing people to describe their own identity to you.
Part of that is asking someone their preferred pronouns. While many who identify as gender-fluid or non-binary identify as “they” rather than using “he” or “she,” pronoun usage is again very personal.
For Sula Malina, the decision to ask friends and family to call them “they” was years in the making. Malina, who works as a children, youth, and families coordinator at the Human Rights Campaign Foundation, came out as queer as a teenager.
At the time, Malina says they began to dress in a manner largely associated with masculinity in our society, and eventually began binding, a technique wherein fabric is used to minimize the appearance of breasts. When they applied to college, Malina did so identifying as a cisgender female.
But their understanding of their identity was already shifting, and that shift became more pronounced at college.
“There was a lot of grappling with whether I was more transmasculine,” Malina says. And yet, they were very aware that they did not have the experience of the many transgender people who knew they were a gender other than the one assigned at birth from an early age.
“I don’t think it’s inaccurate to have identified as a girl growing up,” Malina says.
But after top surgery to remove their breasts, Malina says they found that acknowledgement of their masculine side made them all the more comfortable exploring their feminine side. Eventually, Malina came out to friends and family as non-binary.
“There’s something that was really empowering about it,” they recall. “It’s who I am, and it also aligns with what I stand for.”
The relationship to one’s identity can be difficult to explain to people who are cisgender, Malina says, because there is no correlating experience.
“With sexual orientation, there’s an analogy. Just as you love a boy, for example, you can say I love a girl. But with gender there isn’t an analogous experience,” Malina says.
While gender identity is not a choice, it’s often something people have to think about and come to an understanding of, if only because society is still very much built on a binary system, wherein children are assigned “boy” or “girl” in the delivery room.
When someone comes out to you about their gender identity, be it as gender-fluid, non-binary, genderqueer, or using any other term, the fear of making a misstep is often there.
This is where you should give yourself a break … at least to a point, Malina says.
“I think people are stressed about definitions,” they said. “But it’s very complicated and yet in some way very simple. The real skill and real gain when you are developing ally skills is to ask people about their experience.”

Don’t force disclosure.

So asking is okay. What’s not okay?
Forcing someone to disclose their gender identity is never okay. While it’s becoming more common in college and business settings to ask people to identify themselves and their pronouns, that has to be done with safety measures in place, Malina says.
It’s not okay to simply go around the room and make everyone share their name and pronouns because that can force folks who identify as non-binary to out themselves in spaces that may not be friendly to people who don’t identify as “male” or “female.”
Instead, Malina suggests a one-on-one conversation where you give someone the choice to share their identity. Doing it that way lets the person know they’re in a safe space and that their identity is respected.
It’s also not okay to make dismissive statements about gender identity, Baum says, casting it as a choice or phase.
“If you’re dismissing another person’s experience, that’s really arrogant,” he notes. Worse, for those who are opening up about their gender identity, having people dismiss their experience can be downright dehumanizing.
“Suddenly it’s not just ‘I’m a different kind of kid,’ it’s ‘I’m a sick kid,’” Baum says. That can have devastating effects. Suicide rates for the transgender and gender non-conforming population exceed the national average, and a study by the Williams Institute found that as much as 57 percent of people in this demographic have experienced families who refuse to speak to them, and 69 percent have experienced homelessness.
It’s something Malina tries to explain to people who are grappling with how to be good allies. Malina’s mom, a gender studies major in college and an educated woman who supported her child’s transition, struggled with the transition to “they/them” pronouns because grammar rules had been ingrained in her head dictating the use of these terms only in reference to multiple people.
But she called Malina one day and said, “Every time I think about how hard it is for me to use they/them pronouns, I think about how hard it is for non-binary people to exist.”
For allies who are struggling with the transition, Malina puts it this way: “Maybe you can’t end trans-violence, but you can certainly use someone’s pronouns!”
One final note from the experts? It’s also important to understand that gender identity and sexual orientation are not synonymous.
Coming out as gender-fluid, non-binary, or any other term beyond “male” or “female” does not equate with being gay or lesbian. Again, it’s important to have open communication with someone and to let them lead you.
People can identify themselves in many different ways, and the words they choose to do so are important. More important, however, are the humans behind the words and the efforts taken to understand their experiences.
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Ellen (name changed by request) was just 19 years old when she was rushed to the emergency room. The problem? Excruciating pain during sex. The diagnosis was human papillomavirus (HPV), which had created abnormalities in Ellen’s vagina, resulting in pain—and later a diagnosis of cancer.
“I was young. I felt this awful fear,” Ellen tells HealthyWay. “Who would want to be with me? How do you tell someone that you are a carrier for an STD? I had a lot of guilt and disgust.”
It’s true that HPV is a sexually transmitted infection or STI (a term that’s replaced the phrase sexually transmitted disease or STD in medical circles in recent years), and with it has come an unfortunate stigma for the women and men who are diagnosed.
But while cancer and other complications from HPV are real, the truth is, being sexually active in America means your chances of coming in contact with HPV are sky high. It’s almost guaranteed that sexually active Americans will encounter this common STI at some time in their lives.
Sounds like an exaggeration, right? One virus can’t possibly be so prevalent that nearly everyone will be exposed to it at one point or another. Guess again.
The Centers for Disease Control and Prevention (CDC) has labeled HPV as the “most common sexually transmitted infection in the United States.” CDC literature even goes so far as to state that “HPV is so common that nearly all sexually active men and women get the virus at some point in their lives.” Every day, approximately 14,000 individuals ages 13 to 24 are infected with HPV, and every year, more than 30,000 cases of cancer are tied to human papillomavirus.
With 40 distinct types, human papillomavirus isn’t just prevalent. This STI is also wildly contagious, which is why at any given time an estimated 42.5 percent of Americans in the 18 to 59 age range are walking around with a case of HPV.
“Other than abstinence, there is no reliable way to prevent transmission,” says Steven Vasilev, MD, a gynecologic oncologist and medical director of integrative gynecologic oncology at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, California. He tells HealthyWay that “A condom will not help prevent transmission, because the virus can be present on multiple genital areas, not just the penis. Other than vaccination at an early age, before exposure to the virus, there is no reliable medical way to prevent spread.”
For Ellen, HPV came with a sexual assault when she was just a tween. For hundreds of thousands more Americans, HPV can come at any time as a result of a sexual encounter, be it one that’s consensual or not.
Because it’s so contagious, the risk is high. But with warnings that some types of HPV (although not all) can cause cancer and it’s nearly impossible to avoid, how worried should you be about HPV? And is there anything you can do to protect yourself or your family?
We asked the experts to weigh in on the real deal with this STI.

What is HPV, anyway?

Short for human papillomavirus, HPV is a virus, just as its name would imply. That means it’s a microscopic organism that replicates inside the cells of a host organism. According to Amesh A. Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, human papillomavirus chooses mucosal surfaces as host and tends to live in or on the vagina, penis, anus, and/or mouth, which is where it spreads from person to person via sexual contact.
That means HPV infection can be genital, anal, or oral, depending on the mode of sexual contact, Adalja says. In other words? Oral sex, anal sex, and any other form of genital-to-genital contact can spread HPV. So unlike with pregnancy, simply avoiding sex that puts a cisgender male’s penis in contact with that of a cisgender female will not keep someone safe. Even the use of condoms in those cases can still do little to prevent transmission, as HPV lives in the area around the vagina and anus, not just inside.
Because there are 40 different types of HPV, what happens next depends on what kind you’ve contracted. Most types will cure themselves, passing through the body in six to 12 months without ever showing any symptoms, Vasilev says. But it’s not always that simple.
“Sexual activity timing could be such that the infection is passed back and forth between a monogamous couple for a prolonged period of time,” Vasilev says. What’s more, certain types of HPV can cause complications—some as serious as cancer.

Low-Risk HPV

Most types of HPV are what’s termed “low risk” by doctors. That doesn’t mean it won’t cause problems in your life, but it does mean it’s unlikely to cause cancer.
Low-risk HPV includes the types that cause warts or, as they’re known in medical circles, papillomas (hence the name), says Gerald J. Botko, DMD, a master of the Academy of General Dentistry and dentist chief of service at VA Miami Healthcare System. These warts typically crop up in the genitals and anus of men and women, although women may also have small cauliflower-type growths on the cervix and/or vagina, and oral warts are a possibility. The warts are usually painless but cause some irritation, itching, or burning, Botko continues. Low-risk genital HPV typically goes away on its own without treatment.
“In oral HPV infections, the warts colonize in the back of the mouth (throat), including the tongue, base, and tonsils,” Botko explains. In those cases, contagious lesions found in the gingiva (gums) and palate typically have to be excised surgically for a cure, although sometimes oral HPV can go away on its own as well.
Low-risk HPV can also cause wart-like lesions called condylomas. Again, these can be found on the genitals or in the mouth (the latter from oral–genital contact). Condylomas can cause disfigurement and are difficult to treat, Botko says.
Although low-risk HPV types 6 and 11 cause 90 percent of genital warts, they are still termed low risk because they rarely cause cancer, Botko says.

High-Risk HPV

About a dozen of the 40 types of HPV are considered high risk, but there are just a few that have been linked to cancer. Despite that bit of good news, it turns out that 79 percent of the cancers of the vaginal region, anal region, and mouth are caused by HPV. Researchers have tied most of those back to human papillomavirus types 16 and 18. According to the National Cancer Institute, the most common types are:

• Cervical cancer: Types 16 and 18 are responsible for about 70 percent of all cases of cervical cancer.
• Anal cancer: Approximately 95 percent of anal cancers are caused by HPV, most by type 16.
• Oropharyngeal cancers (which includes cancers of the middle part of the throat, including the soft palate, the base of the tongue, and the tonsils): Approximately 70 percent of oropharyngeal cancers are caused by HPV, more than half by type 16.
• Vaginal cancer: About 65 percent of cases are caused by HPV, most by type 16.
• Vulvar cancer: Approximately half of all vulvar cancers are linked to HPV, most caused by type 16.
• Penile cancer: More than a third of all penile cancers are caused by HPV, most by type 16.

Unfortunately, high-risk HPV tends to be silent, says Renée Volny Darko, DO, an OB-GYN and founder and CEO of Pre-med Strategies, Inc. That means there aren’t signs that scream “I have HPV,” such as pain or itching. Typically, the first sign of infection will be a precancerous lesion—or cancer itself.

Finding HPV Before It Turns to Cancer

Because HPV doesn’t have symptoms until it causes a disease such as genital warts or cancer, most people don’t show up in a doctor’s office complaining that they have an issue. Men can’t currently be tested for HPV, as no such test exists. With women, however, testing can be done at your annual exam to determine if you have HPV.
Although it can’t be picked up via a regular Pap smear, Darko says HPV can be tested from the same sample collected for your Pap smear.
Confused?
“A Pap smear is looking at cells of the cervix under a microscope to determine if they are normal or abnormal,” Darko explains. “HPV can be hiding in cervical cells. Another test can be done on that same sample of cervical cells to determine if HPV is present in the cells.”
If HPV types that are considered low or high risk are noted, your doctor will advise you on the next steps. For example, those tied to cancer may indicate you should have more frequent screenings to ensure that no such cancer has developed.

Preventing HPV Before It Starts

So nothing prevents HPV, right? Sticking to oral or anal sex, condoms—none of that will keep you safe?
Yes and no. Some HPV cases simply can’t be avoided, save for complete abstinence, but Darko says, “HPV vaccine is the next best line of prevention against several types of HPV.”
For children and women under the age of 26, there is now a trio of options out there to prevent the highest-risk forms of human papillomavirus. Gardasil and Cervarix have both been found to help prevent HPV type 16 and 18 infection. Gardasil 9, a more recent vaccine, prevents types 6, 11, 16, 18, 31, 33, 45, 52, and 58.
The vaccine can be given up until age 26, even if you’ve already been sexually active. If you’re pregnant, it’s best to put off the vaccination, says Lara Millar, MD, a radiation oncologist with the Eastern Virginia Medical School, as there’s not enough research on the safety of the vaccine for pregnant women. If you’re afraid you may contract HPV in the meantime and put your baby at risk, Millar says transmission from mother to child can happen but is extremely uncommon.
If at all possible, it’s recommended that you get the HPV vaccine well before pregnancy—and even before having sex.
Darko advocates that parents in particular talk to their children’s pediatrician about it earlier rather than later, no matter how uncomfortable it is to think of their child one day encountering an STI.
“The vaccine is most protective when it is given before the first sexual encounter. So it is recommended for males and females as early as age 11 years,” she says.
Kids who get a dose of the vaccine typically only need one follow-up shot, whereas older women and men who opt for vaccination may require three doses to be fully vaccinated.

Is it worth it?

Consider this: Since the U.S. Food and Drug Administration’s approval of vaccination for human papillomavirus more than a decade ago, doctors have seen a reduction in infection rates. Six years after the vaccine’s approval, a study of infection rates for the four most common high-risk types of HPV showed a 64 percent decrease among females age 14 to 19 years and a 34 percent decrease among those age 20 to 24 years.
It’s also worth using condoms and dental dams regardless of whether you’ve gotten the shot, Darko says. Although they are not 100 percent effective in preventing HPV, contraceptives like these can prevent other STIs (and pregnancy). And if the HPV infection is living inside the vagina or anus or on the penis (rather than outside on labial tissue or near the penis), that coverage may indeed make a difference.
One final note of relief? Although the internet is rife with myths on how HPV is spread, the American Cancer Society assures women and men both that they cannot contract human papillomavirus via a dirty toilet seat, by swimming in a pool or hot tub, or by simply being unclean.