Information and Pictures
Genital Warts – Human Papilloma Virus (HPV Infection)
© Helen Knox – Sexplained Books
This is an extract from Sexplained One – Sex & Your Health by Helen J Knox – used here, with permission. For further information about Helen and Sexplained Books, please click this picture.
This item covers both genital warts and HPV infection since they both relate to HPV in the genital area.
What is HPV?
HPV stands for Human Papilloma Virus, which is a latent virus. This means that it can lie quietly in the surface layers of the skin or in mucous membrane (warm moist areas) of the vulva, vagina, cervix, penis, urethra, foreskin, anus, rectum, mouth or throat, for quite some time.
HPV is the most common sexually acquired viral infection in the world and this book talks about the different types of HPV that affect the genital area.
Some types of HPV commonly cause warts or harmless fleshy growths of skin to form, although it can survive in an inactive, invisible state without them appearing.
It is an important virus because some types of HPV cause cell changes, which are strongly associated with different types of cancer.
What is the difference between genital warts and HPV Infection?
Genital warts are the physical manifestation of the effects of some low-grade types of HPV. In other words, they are not very serious.
HPV Infection is when some high-grade types of the virus are present, that don’t cause warts but which may cause serious underlying cell changes that can’t be seen with the naked eye.
How common is HPV in the genital area?
Genital HPV is an incredibly common viral infection of the skin, which sometimes appears in the genital area.
The majority of sexually active adults are infected with HPV and able to pass it to others whilst oblivious to the fact that they carry it.
Some people nickname it ‘the common cold of sexual activity’ since it is so common.
Genital HPV is called condylomata acuminata when the physical manifestation of a wart appears.
In this book, they are called genital warts but they are also known as venereal or ano-genital warts (AGW). In other words, they affect the genital area, including the anal area.
When talking about the higher grade ‘invisible’ types, this book talks about Genital HPV Infection or just HPV Infection, since the virus is present without a warty manifestation.
Where does Genital HPV come from?
Genital HPV is a sexually acquired infection.
There are over 120 different types of HPV; approximately half of which affect the genital area; while others affect different parts of the body and are not sexually acquired.
When warts affect the feet they are called verrucas (or plantar warts).
Most, low-grade or not serious types of HPV infection are visible to the naked eye and appear as warts.
Although they can be embarrassing, they do not generally cause long-term health problems.
Other, high-grade or potentially serious types of HPV infection, invisible to the naked eye, are associated with problematic cell changes and different cancers.
How is Genital HPV passed on?
Genital HPV enters the body through micro-abrasions (tiny little tears) in the skin or through cells in mucous membranes.
It is transmitted during the skin-to-skin friction of sexual activity (oral, anal or vaginal sex or other genital intimacy).
HPV is not thought to be transmitted by sharing towels, flannels, sheets.
It may be passed if sex toys are immediately shared without washing or a protective condom not changed.
Occasionally, HPV can be passed by ‘vertical transmission’ (from a mother to her baby) during delivery.
Non-sexually – there can also be autoinoculation (self-transfer of the virus) if someone scratches a wart and then another area of their skin. This is rare, though.
How long does it take for genital warts to show?
Typically, genital warts show at any time from three to 18 months after transmission, but it could be longer.
What might I notice if I have HPV?
Sometimes HPV lies dormant (it is latent or sleeping) for a long time during which you may not notice anything, or even know you carry the virus.
In this case, it is present in a sub-clinical state (without showing symptoms), invisible to the naked eye and it is sometimes destroyed by the body’s immune system.
You may only find out about the presence of HPV Infection, and that you are a ‘silent carrier’ when a partner notices that they have warts or are told they have the virus; perhaps after a well-woman check-up when abnormal cell changes are detected by cervical cytology (smear or pap test).
When visible or low-grade types are involved, genital warts usually appear as fleshy growths of variable number, size and consistency. They are either flat or lumpy. But, they may appear pedunculated (as if on a stalk ) or as ‘cauliflower-like’ clusters of warts, too.
You may have a feeling of lumps growing on your skin, which may appear different in colour to the surrounding skin.
You may also notice inflammation, irritation, itching and/or tenderness in your genital area or around your anal area (back passage), where you may experience bleeding, especially when opening your bowels.
if they have affected your urethra (urine passage), you may notice a change in the strength and direction of your urine stream — and possibly some blood in it.
Where are genital warts found on the body?
The most common site for genital warts is, as the name implies, the warm, moist, non-hairy genital area. They may occur in other parts of the body, including ‘hairy genital areas’.
They are often found in the peri-anal area (close to the anus) in both sexes and may be found in the anal canal, particularly of some men who have sex with men.
They may be found in the opening of the urethra (urine passage) or inside it.
They may also be found on the vulva, in the vagina and on the cervix in women, and under the foreskin or on the shaft of the penis, in men.
HPV Infection is sometimes detected rectally amongst women who have not had anal sex but have had cervical cancer. Why this occurs is not fully understood.
Away from the genital area, they may be found in the mouth, the throat or even the eyes, nasal cavity or other warm, moist areas of the body.
NOTE: different types of HPV are commonly found on the hands and feet and warts can develop around the anus of either sex, even if anal sex is not practised.
Yes. It’s complicated but this aims to clarify the difference in a way that’s easy to understand.
It’s important not to jump to conclusions or ignore it if you notice a new lump or bump appearing.
The growth may not be a wart but something else entirely. So correct diagnosis is important to avoid missing something serious, but also to avoid fear or panic about something simple!
Which other conditions have a similar appearance as genital warts?
This list is not exhaustive, but some conditions which may present with a similar appearance to genital warts include:
* contact dermatitis or inflammation
of the skin after contact with an irritant substance;
* Molluscum Contagiosum – another viral skin condition (see Molluscum Contagiosum);
* skin tags (fibroepithelial polyp);
* haemorrhoids commonly called piles;
* pigmented naevus (mole);
* Penile Pearly Papules – PPPs or Fordyce tubercles, which are smooth, round, benign (non-cancerous) growths that develop in rows and look like a row of little pearls along the rim of the coronal sulcus (the rim of the glans penis)(see Penile Pearly Papules)
* Fordyce spots – these are perfectly normal sebaceous glands which appear as small raised papules (white spots) on the penis or the vulva that are not associated with a hair follicle;
* sebaceous cysts – or ‘little white spots’ which are tiny glands on the skin that secrete fat and sebum: a semi-fluid substance consisting of fat, keratin, and cellular material (see Little White Spots);
* vulval papillosis — the female equivalent of PPPs or Fordyce tubercles, smaller than 1mm on the inside of the labia;
* folliculitis — inflammation of hair follicles, which, when infected can become a boil — this can occur in any area but this section deals with the genital area where they commonly occur when people shave or wax to remove their pubic hair;
* warty dyskeratoma — a single abnormal growth of sun-exposed skin that appears to come out from a hair follicle: usually on the scalp, face or neck. (Also called isolated follicular keratosis);
* Bowenoid papules — small and potentially malignant growths which are now thought to be associated with HPV Infection and should be investigated very carefully;
* trichofolliculoma – benign tumours (non-cancerous growths) that originate in a hair follicle which often mimic either a wart or basal cell carcinoma;
* squamous/basal cell carcinoma – a type of skin cancer, which requires careful diagnosis and investigation;
* fibroepithelioma — a type of malignant (cancerous) skin condition;
* secondary syphilis;
* seborrhoeic keratosis (common non-cancerous skin lesions);
* actinic keratosis (also called solar keratosis and senile keratosis) — common skin lesions caused by too much sun that are usually benign but which can become malignant (cancerous);
* lichen planus — usually presents as pus-filled, purplish, flat-topped papules. (see Lichen Planus)
What tests are there to check if I’ve got genital warts or am carrying HPV?
A qualified and experienced healthcare professional can inspect the growths, perhaps with a magnifying glass and a good light, to see if, from their appearance, you have warts or something else.
They may paint them with a small amount of acetic acid (vinegar-like solution). Depending on their appearance, a biopsy (small sample) may be taken using a local anaesthetic (to ensure that no pain is felt) and sent to the laboratory for analysis before treatment is started.
Over a quarter of patients presenting with their first episode of genital warts also have other STIs, so you may be offered tests to rule out the presence of other infections, such as chlamydia, gonorrhoea, syphilis, HIV and/or Hepatitis B and/or C.
For women, vaginal speculum examination is often advised so that the cervix (neck of the womb) can be seen. Because the cervix sits about four inches into the vagina it can’t be seen without internal examination.
A speculum is a device that is inserted into the vagina and opened gently, in order for the cervix to come into view and to enable inspection and sampling.
Depending on what is seen on examination, swabs (sample using something that looks like long cotton wool buds) may be taken to check for different infection. A cervical cytology sample (cervical smear test, also called a Papanicolaou or pap test — named after the person who invented it) may be taken to check for abnormal cell changes on the surface of the cervix.
Although not always performed, but because some types of HPV are strongly associated with pre-cancers, the cervix can also be tested during screening for specific DNA analysis to see if particular types of HPV are present. if they are, the woman is closely monitored.
When analysing cervical cytology samples, the laboratory reports what is seen. It also recommends whether to repeat the test routinely in two to three years or ‘watch and wait’ with a repeat test in about six months. It also advises if the woman should be referred for a colposcopic examination of her cervix.
Colposcopic examination is merely the same ‘speculum examination’, but this time the cervix (neck of the womb) is viewed using a colposcope
(a special pair of magnifying binoculars).
After painting the cervix with a solution of trichloroacetic acid (vinegar-like solution), the extent of any abnormal cell changes can be seen. Since some HPV-associated cell changes have a specific pattern, they can easily be seen and diagnosed this way.
Biopsy or sampling of abnormal areas can also be undertaken easily and suitable treatment recommended.
Proctoscopy involves viewing the anus and rectum with an instrument that allows internal visualisation, sampling and, as appropriate, initiation of treatment.
It is similar to the ‘speculum examination’ that is used to see inside the vagina and look at a woman’s cervix but of the back passage.
It may be carried out on either sex but proctoscopy is more commonly offered to men who have anal sex with other men — especially if they have irritating anal symptoms.
Since HPV is also implicated in some anal cancers. There is a growing demand for rectal smear analysis to take place routinely in the same way as cervical cytology screening. The clinical benefits of this continue to be researched.
if the growths are on the meatus (opening to the urine passage) this area may be viewed using a magnifying glass.
Sometimes urethroscopy (examination of the urethra or urine passage) may be recommended if growths have caused an alteration of urine flow.
If growths have developed in the oral cavity (mouth), nose, eyes or anywhere else, these can also be examined and sampled carefully using magnification.
In the same way as doctors and dentists are trained to recognise and diagnose a wide range of medical conditions, many present in the oral cavity.
Therefore, having a regular dental check-up is strongly advised, especially if you indulge in unprotected oral sex.
After unprotected sex, how soon can I be tested for genital warts?
After unprotected sex, unless you have a lump or bump that someone can see, there’s no way to tell that one will develop later.
HPV can be passed during protected sex if the area of infection is not fully covered by a condom. However, since so many people carry the virus without knowing, just live your life safely, without worrying that something may appear in the future.
If it does and you develop a skin lump or a bump that concerns you, then let your healthcare professional see it before it heals up or disappears.
Take A Picture
If you can’t see a healthcare professional quickly, it is very useful if you can take with you a clear digital or printed picture of what you can see when you visit, so they can see what you are or were concerned about if it’s healed.
They may not be able to confirm a diagnosis from a picture, but it will help with a probable diagnosis when they can combine the picture with your description of what you noticed.
How accurate are the tests for genital warts?
Genital warts have a particular and distinctive appearance, which is most commonly diagnosed very easily by an experienced practitioner who examines them.
If the growths are sampled, the accuracy of laboratory tests is excellent.
Can the test show how long I’ve had Genital HPV?
No. Tests cannot tell how long you’ve had HPV. Since HPV is a latent virus it can be present asymptomatically (without symptoms) for quite some time.
Do I need to be tested after treatment for genital warts, to make sure I’ve been cured?
No. A test of cure is not required after treatment of genital warts. The virus may disappear completely or it may remain in your system and warts may reappear sometime in the future.
If I have genital warts, should I have an HIV test?
Yes. if you have genital warts you should have an HIV test. Having one sexual infection increases the risk of contracting another. Knowing your up-to-date HIV status is very important.
Remember, though, that if you have recently had unprotected sex, your body needs enough time to make the HIV antibodies or antigens for the tests to detect.
It is usually best to wait three months from the time of anticipated risk (unprotected intercourse) before testing for HIV.
However, earlier testing may be suggested to give a ‘base situation’, with a repeat HIV test advised shortly afterwards.
What treatment is there if I’ve got genital warts?
Some genital warts spontaneously regress (shrink or disappear without treatment), while others require medical intervention.
Treatment aims to remove visible warts and reduce the amount of HPV present so that the immune system can fight the remainder of the virus much better.
Treatment varies depending on the size, number and location of warts. It’s important to mention any allergies and for women to say if they are pregnant before starting treatment.
In many cases, treatments containing podophyllotoxin or imiquimod may be prescribed as creams for, initially, treating yourself at home, followed by hospital/clinic treatment if they don’t disappear easily.
Some cases respond to careful and direct painting with a solution called podophyllin (not suitable for pregnant women or home use). Others need to be lasered, frozen (cryotherapy) or cauterised (heat treatment), sometimes under local anaesthetic.
Treatment may take several weeks, be a little uncomfortable, involve several visits to the clinic and may involve a combination of therapies.
Following a close inspection by colposcope and depending on what is seen, some cervical and/or anal cell changes may require minor surgery.
Although genital warts may return after treatment, recent studies show that the majority of patients clear the virus within 12-24 months of acquisition.
NOTE: Wart treatment for other parts of the body (e.g. feet) is not suitable for genital warts.
You may hear people recommend garlic oil for eradication of warts but this should NOT be used in delicate genital areas.
Other people suggest rubbing a banana peel on a wart regularly which won’t hurt in the same way, but a correct diagnosis is important first. Your immune system may deal with the wart in the same time that you use garlic oil or banana skin, anyway!
Will the treatment interfere with my contraceptive pill?
No. Local treatments for genital warts do not interfere with hormonal contraception.
Can genital warts disappear without treatment?
Yes. Genital warts may disappear without treatment but can take over a year to do so. if the immune system is under pressure they may not do so without assistance.
At other times they may grow larger or multiply in number.
They are not harmful but can be unsightly, uncomfortable and embarrassing.
Having genital warts treated reduces the risk of passing the viral infection to someone else.
How soon will I feel normal again after treatment for genital warts?
Once your treatment ends, healthy skin will return, and be back to normal quite quickly, but depending on your skin type and the treatment used, scar tissue may remain visible for a while.
Is there anything I should do during treatment for genital warts?
During treatment, be guided by the person treating your genital warts and make sure you follow their instructions carefully. if the treatment is uncomfortable and the area stings, try bathing it in salty water to aid healing.
Add a small handful/tablespoon of kitchen salt to your bath. Avoid using soap, bubble bath, bath oils, creams or other potentially irritating products until treatment ends. Use soap substitute or emollient cream, instead.
After bathing, dry yourself carefully with a clean towel that you don’t share with other people — or, very carefully, blow the area dry with a warm hair dryer for a short time. Don’t burn yourself!
What should I do after I finish treatment?
After treatment observe the site in case genital warts return and require further treatment. Live normally — don’t let the fact that you had them rule your life.
Although your present partner will have been in contact with the area already, it’s wise to use condoms with him/her until you are advised to stop.
It’s certainly important to use them routinely with any new partner(s) to reduce your risk of catching another type of HPV or even another infection.
Will my partner need to be treated, too?
Unless your partner also has genital warts they won’t need treatment. if they’ve not been screened recently, they should be checked to make sure they don’t have any other infections.
Can genital warts be cured?
Genital warts can be treated successfully but sometimes they return and need to be re-treated.
At other times the immune system deals with them and they disappear completely within a few months, without treatment.
Can I become immune to HPV or can I catch it again?
No. You won’t become immune to HPV after having it once.
There are so many types of HPV that after treatment for one type, you could still contract another.
Is there a vaccine against HPV?
Yes. There has been vaccination available against different types of HPV since 2006.
Who is the HPV vaccine suitable for?
The HPV vaccine is licenced for use by young men and women aged nine to 26 years of age, who have never been sexually active.
if their doctor agrees to prescribe it, older people who have only had a few sexual partners may still benefit from having it, but they may have been exposed to one or more types of the virus already and not gain as much if any protection.
At present, there are two vaccinations available.
One is only, but greatly, effective against types 16 and 18. The other is greatly effective against types 6, 11, 16 and 18 which are the types associated with 90 percent of genital warts (6 and 11) and 70 per cent of cervical cancer (16 and 18), respectively.
Since one vaccine protects against the most common types that cause genital warts several public health experts also recommend it for young men and boys — especially young gay men who may have multiple partners and who may be more exposed to the virus in the future
Do genital warts cause cancer?
No. Genital warts are not linked with cancer. They are merely embarrassing growths of skin.
What complications may occur if Genital HPV or genital warts are not treated?
Complications depend on the type of HPV involved.
The low-grade, common types of HPV that cause genital warts are not associated with cancer.
If warts develop in the urine passage, the flow may be altered.
If they are in the anal canal, they may cause bleeding when bowels are opened during defaecation (pronounced de-fe-ka-shun — which means ‘having a poo’).
Sometimes, genital warts become infected, itch and bleed, causing pain and discomfort, which requires additional treatment.
Genital warts may return after treatment, which can sometimes be difficult to explain to a partner and can put a strain on a relationship.
Several high-grade types of the HPV (mostly types 16 and 18) are linked to cell changes and tissue abnormalities, including some types of pre-cancerous cell changes when combined with other “co-factors”.
Two examples of co-factors are smoking or a suppressed immune system (poor ability to fight infection).
Some of the high-grade types of HPV are increasingly implicated in several different cancers and apart from cervical intraepithelial neoplasia (CIN or pre-cancerous cell changes at the cervix).
They include cancers of the:
* vulva (VIN or vulvar intraepithelial neoplasia);
* vagina (VAIN or vaginal intraepithelial neoplasia);
* anus (AIN or anal intraepithelial neoplasia);
* rectum (back passage);
* penis (PIN or penile intraepithelial neoplasia and erythroplasia of Queyrat);
* mouth; and
Can genital warts or HPV Infection cause infertility?
No. Neither genital warts or HPV infection is associated with infertility.
Some forms of treatment for pre-cancerous or cancerous cell changes at the cervix (neck of the womb) may cause a delay in the ability to get pregnant easily. This is not a long-term situation, and certainly not a good enough reason to decline treatment – or stop using contraception.
Do genital warts or HPV affect the baby if a woman has them when she’s pregnant?
A mother can pass HPV to her baby during pregnancy or delivery. Although the risk is thought to be very low,
they could be at risk of developing laryngeal papillomatosis after birth (warts on the larynx / in the throat).
The child may, however, have no signs or symptoms of HPV until or unless they develop warts in later life.
Can I have sex as soon as I’m treated?
After treatment, be guided by the person treating your genital warts because resuming sexual activity depends on their severity and on the chosen treatment.
There is a risk of passing on HPV from skin cells at any time, particularly when warts are present and being treated, so friction during mutual masturbation or sex increases the opportunity for transmission.
Remember: condoms only protect the area of skin that they cover or contact at the time they are used, not other areas or skin.
What about HPV, oral and anal sex?
HPV can affect the mouth and throat if protection is not used during oral sex — just as it can easily affect the anal area during unprotected anal sex.
However, HPV can even extend into the anal canal of people who have not practised anal sex.
It is increasingly found in HIV-positive women, many of whom may never have practised anal sex. Why or how this happens is not clear.
Is there a link between genital warts and cervical cancer?
Genital warts are visible growths caused by low-grade, non-cancer causing types of HPV.
There is a strong link between high-grade types of HPV and many cancers, in particular, HPV 16 and 18.
Is this why cervical screening programmes are encouraged?
Yes. Vital in the fight against cervical cancer, screening programmes are encouraged because abnormal cell changes, which may lead to cervical cancer, can be detected and treated promptly, saving lives.
Should women who have sex with other women have a cervical smear (Pap) test?
Yes. Women who have sex with other women should have regular cervical smear (Pap / Papanicolaou) tests, in the same way that other women do.
In some countries, there are national screening programmes and all women in certain age groups are invited for routine cervical cytology (smear tests).
For example, in the UK, at present, women between the age of 25 and 64 are invited for routine cervical screening every three to five years.
Other countries have different programmes for this simple lifesaving test and start screening at a younger age. Some developing countries start their programmes at a later age.
The test is also called a Papanicolaou or ‘pap’ test, named after George Papanicolaou, a Greek pathologist who, in 1928, discovered that uterine and cervical cancer cells could be diagnosed this way.
Cervical cytology can be undertaken at times outside the screening programme if a healthcare practitioner feels it is appropriate to do so.
Due to it’s extremely high prevalence and as HPV can lie dormant for many years, ALL women who have EVER had sex, with either a man or another woman, willingly or against their will – even if they are now celibate – should have regular smear tests to monitor the health of the cells of their cervix (neck of the womb).
Women who are known to have HIV infection should have yearly smear tests because their compromised immune system may encourage HPV to multiply more rapidly.
Can a woman catch HPV if she has sex with other women?
Yes. HPV can be passed between women who have sex with other women, in a similar way as when they have sex with men.
Although it may occur, rarely, there is a risk that HPV can be passed by immediately sharing unwashed objects such as sex toys with someone who carries the virus.
Can a man catch HPV if he has sex with other men?
Yes. A man can transmit HPV to another man, and many do.
Can a child contract genital warts?
Yes. Children can contract genital warts.
However, because they are not the same types as those that cause verrucas (warts on the feet) or warts on the hands, parents or carers of children who develop them should expect to be asked some potentially uncomfortable questions when doctors need to treat children with genital warts.
Child Protection is paramount and when a child is found to have genital warts healthcare professionals have a duty of care to the child.
Careful sexual history assessment will be requested of both the parents and/or carers to see if the child is at risk of child abuse, in addition to questions about general hygiene.
What about using condoms?
Condoms can only protect the area of skin they cover or are in contact with at the time they are used.
Condoms cannot protect against warts on other areas of skin.
Condoms are thought to help against exposure to different types when both partners have the virus.
Remember that when using local treatment (especially creams), condoms may be weakened by oily substances in medication. Sex should be avoided until treatment is finished and the OK is given to start having sex again.
Do condoms protect the cervix?
Yes. Condoms can protect the cervix (neck of the womb).
Since the cervix does not mature until a young woman is approximately 23 yrs of age, and there are many sexual infections to avoid, consistent and correct condom use is routinely advised.
This is even in addition to another method of contraception, whatever your age or sex.
Smoking suppresses the immune system and research shows that smokers are at increased risk of developing cervical cancer through HPV-induced cell changes than non-smokers.
HPV 16, in particular, is increasingly implicated in a wide range of cancers, including head and neck and also lung cancer.
So, if you smoke at the moment, seriously consider giving up to protect your cervix and your future ability to have children as well as your lungs, throat, bladder and other areas of your body.
Although genital warts and HPV are extremely common around the world, the psychological impact of having them can affect people differently.
Some people become so distressed that they benefit greatly from seeing a counsellor to discuss and unravel why they feel this way.
If this happens to you, don’t ‘suffer in silence’. Ask for help. Whoever treats you will know someone you can speak to.
How long does HPV survive outside the human body?
As other bacteria and viruses, HPV requires its host for survival. It cannot live outside the human body for longer than a few seconds.
Can I really pass HPV to my partner without realising?
Yes. You can pass HPV to a partner without knowing you carry it.
This is called asymptomatic transmission and is how a large number of infections occur.
What is the chance of contracting HPV?
The risk of contracting HPV from a single act of unprotected sex with an infected person is approximately 10 percent — or one in 10.
The more partners someone has, the greater the risk. It is estimated that up to 80 percent of the sexually active population will have contracted at least one type of HPV in their lifetime.
The immune system deals with it for most people, but others need assistance.
How long does it take for genital warts to show?
Typically, genital warts show at any time from three to 18 months after transmission, but they could take longer.
Could I catch genital warts from a toilet seat?
No. You can’t catch genital warts from a toilet seat.
Even if there were viral particles on the seat, it would need an access route; healthy skin is an excellent barrier.
It only enters the body through micro-abrasions (tiny little tears in the skin) or through cells in mucous membranes (moist areas of the body).
Likewise, you cannot get genital warts from regular social contact, such as hugging, kissing cheeks, sharing baths or swimming pools, cups, plates or cutlery.
Normal domestic hygiene measures are sufficient to avoid the virus.
NOTE: Types of HPV that cause verrucas on the soles of the feet, do remain active in moist conditions for longer, so suitable footwear should be worn around swimming pools and shared leisure facilities.
How can I avoid HPV?
Be honest with each other about your sexual history before you consider having sex.
Although a condom can’t protect areas it does not cover or contact, it is still the best protection to help anyone avoid catching HPV or other sexual infections.
So, always use a condom during penetrative vaginal or anal sex, and use additional water or silicone-based lubricant, as required.
To protect the mouth, it is safer to use a flavoured condom or oral dam for any kind of oral sex.
To protect fingers, wear latex gloves or a condom over a finger during insertive foreplay, mutual masturbation or during fisting (see Safer Sex).
If you have never had sex, consider having the HPV vaccination to protect you against the most common types.
* No condom, no sex.
* Keep safe.
* Make no assumptions.
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