Gardasil and pelvic familiarization

The HPV vaccine Gardasil

Gardasil Cervical Cancer Vaccine More Cost-Effective Than Cervarix

“(Research: Comparing bivalent and quadrivalent human papillomavirus vaccines: economic evaluation based on transmission model)

http://www.bmj.com/cgi/doi/10.1136/bmj.d5775
(Editorial: Comparing bivalent and quadrivalent HPV vaccines)
http://www.bmj.com/cgi/doi/10.1136/bmj.d5720

The quadrivalent cervical cancer vaccine (Gardasil) is more cost-effective than the bivalent vaccine (Cervarix) if the two are equally priced, concludes a study published on bmj.com today. This is despite the fact that Cervarix may provide better protection against cervical cancer.

However, the authors stress that considerable uncertainty remains about the differential benefit of the two vaccines.

Human papillomavirus (HPV) is a common sexually transmitted infection seen most often in young women and adolescents. There are more than 100 types of HPV - some cause genital warts, but others cause cancers including cervical cancer.

Two HPV vaccines (Cervarix and Gardasil) are currently available. Both protect against HPV types 16 and 18, which cause over 70% of cervical cancer cases, as well as several other types of cancer. Gardasil also protects against types 6 and 11, which cause the majority of genital warts as well as a rare disease called respiratory papillomatosis.

In 2008, the UK government chose the bivalent vaccine Cervarix for its HPV vaccination programme, based partly on analyses by Mark Jit and his colleagues at the Health Protection Agency suggesting that Cervarix would have to be £15 to £23 cheaper per dose to be as cost-effective as Gardasil. However, the choice of vaccine will be re-evaluated when the current tender for the vaccination programme ends.

Since then, further evidence has emerged to differentiate the two vaccines. For instance, Cervarix appears to give better protection against cervical cancer caused by HPV types other than 16 and 18. Gardasil has now also shown protection against vulvar, vaginal and anal cancer.

Using this latest evidence within a mathematical model, Mark Jit and his team set out to re-evaluate the two vaccines to inform the next round of vaccine tendering.

They found the price differential between the two vaccines was larger than their 2008 analysis. Based on the most recent evidence, Cervarix would have to be £19 to £35 cheaper per dose to be as cost-effective as Gardasil, mainly due to a lack of protection against genital warts.

When all differences between the two vaccines are considered, "the quadrivalent vaccine (Gardasil) is still more cost effective if the two are equally priced," conclude the authors. However, they stress that "considerable uncertainty remains about the differential benefit of the two vaccines."

An accompanying editorial says that modeling can help decision makers, but ultimately the tender price is the final determinant of cost-effectiveness.”

Personal comment: St Lucy’s was fortunate that we had good advice when we chose Gardasil as protection against cervical cancer as now it has been found to protect against genital warts as well as vulvar, vaginal and anal cancer. This year all new St Lucy’s students must have completed the series of three Gardasil injections over an interval of six months before they are allowed on campus for orientation. All our male partner/instructors have had the full Gardasil regimen as well to provide maximum protection to themselves and their student partners. Gardasil has recently become a topic of debate among candidates for the Republican nomination for the 2012 presidential election. The conservative candidate Michele Bachmann seems to be very poorly informed and continues to blunder on about mental retardation and the dangers of vaccines. Sigh!

New St Lucy’s entry requirements, Pt II: I was remiss when posting about changes to St Lucy’s entry requirements for the 2011/12 school year. I failed to mention that all entering students must have had at least four years of ballet training consisting of not less than four hours a week for at least fifty weeks per year. We aren’t a ballet academy, but the physical and mental development (poise, grace, discipline, confidence and pelvic muscle development) of the students is so closely tied to ballet training and discipline that any less and a student has a very difficult time keeping up. One might think that this requirement would dissuade parents from enrolling their daughters at St Lucy’s, but that hasn’t been the case as highly qualified applicants far outnumber the seats available for new students. Parents (especially their mothers) are determined to begin preparing their daughters years in advance to get into St Lucy’s.

Pelvic Familiarization for post-menarche students: Because the health syllabus at St Lucy’s is heavily weighted toward teaching female sexual skills we require all post-menarche students to take a pelvic familiarization (PF) course. This course covers menstruation, feminine hygiene products and their proper use, reproductive tract devices for contraception (IUDs, condoms and cervical barriers), dealing with the hymen and sex toys. The course purpose is not only to familiarize the student with the range of products and devices available, but to have her become comfortable and confident about touching her own genitals so she won’t be afraid or embarrassed when she takes Contemporary Sexual Health and Advanced Sexual Techniques. To that end we teach and recommend the students masturbate to learn what arouses them and what doesn’t so they can guide a male partner/instructor when that time arrives.

Students in this course usually range in age from 13 to 15 as all train heavily for ballet which often delays menarche. You would be surprised at the number of girls who have been brought up to think that touching themselves “down there” is dirty or shameful so PF has reduced the number of girls needing counseling due to psychological issues from becoming more intimately aware of their own bodies. We are very pleased with the PF student’s response to the classes on the clitoris, condoms, dildos and vibrators and all have delighted in their new found source of self-pleasuring with the toys provided each student for lab exercises.

Having pelvic familiarization taught in a gentle, non-threatening and supportive way our psychologists believe will result in very young students not suffering from stress related Vaginismus: http://en.wikipedia.org/wiki/Vaginismus a condition where any vaginal penetration – or sometimes in severe cases even the thought of penetration occurring - causes clenching of the pelvic muscles making any penetration extremely painful and so tight penetration is impossible for an erect male. There are physiological reasons – which we test for and if found prevent the student from entering St Lucy’s - as well as psychological reasons for Vaginismus. In the past we have had an occasional case of stress related vaginismus after a student has been accepted so our psychologists believe the PF course should prevent that from occurring