2nd Department of Obstetrics and

Gynecology,
University of Athens, Aretaieion Hospital,
Athens, Greece

HPV diagnosis: Is there an impact

on women’s sexual and mental
health?
Ferenidou F, Salakos N, Bakalianou K,
Vaidakis V, Papadimitriou GN,
Creatsas G.
 Does HPV affect only physical health?
HPV infection and diagnosis can cause:
• Hypochondriac fears, anger, depression, isolation, fear of rejection, shame, guilt, anxiety, stigma,
confusion, distress

• Personal stigmatizing with significant adverse impact on self-esteem and significant relationships

• Being frightened, angry, guilty, anxious, confused, dirty, regretful, and panicked. In addition, the
receipt of a positive HPV test result often calls sexual fidelity into question.

• Emotions related primarily to stigma, fear, self-blame, powerlessness, and anger. Most women
disclosed their disease to significant others, usually to a sexual partner

• Anogenital warts can cause: feelings of anxiety, guilt, anger, and loss of self esteem and create
concerns about future fertility and of cancer risk.

References:
• Krogh G, Lacey CJN, Gross G, Barrasso R, Schneider A. European course on HPV associated pathology: guidelines for primary care
physicians for the diagnosis and management of anogenital warts. Sex. Transm. Inf. 2000;76:162-168.
• McCaffery K, Waller J, Nazroo J, Wardle J. Social and psychological impact of HPV testing in cervical screening: a qualitative study. Sex
Transm Infect 2006;82:169–174.
• Perrin KK, Daley EM, Naoom SF, Packing-Ebuen JL, Rayko HL, McFarlane M, McDermott RJ. Women's reactions to HPV diagnosis:
insights from in-depth interviews. Women Health. 2006;43(2):93-110.
 Women’s expressions after HPV
diagnosis
• ‘less attractive’
• ‘tarnished’
• ‘let down by their bodies’
• ‘defiled’
• ‘contaminated’
• ‘dirty’

Reference:
Fylan F. Screening for cervical cancer: a review of women's attitudes, knowledge, and
behaviour. Br J Gen Pract. 1998 Aug;48(433):1509-14.
 HPV & Sexual life
• Problems with sexuality after the diagnosis

• Testing positive for HPV raised concerns about women's sexual relationships in terms of trust,
fidelity, blame and protection, particularly for women in long-term monogamous relationships

• Self-inflicted blame and hypochondriac fears as well as to problems with sexuality. High percentage
of sexual impairments after therapy, presence of fear of cancer and worsening in the emotional
relationship with the partner

• Negative influence on sexual life

• Sexual enjoyment and activity were also negatively affected by HPV

• Impairments in sleep and sexual interest have been noted.

• Loss on sexual functioning

References:
• Basen-Engquist K, Paskett E, Buzaglo J, Miller S, Schover L, Wenzel L, Bodurka D. Cervical Cancer: Behavioral Factors Related to
Screening, Diagnosis, and Survivors’ Quality of Life. Cancer 2003;98(9 Suppl):2009–14.
• Ideström M, Milsom I, Andersson-Ellström A. Women's experience of coping with a positive Pap smear: A register-based study of
women with two consecutive Pap smears reported as CIN 1. Acta Obstet Gynecol Scand. 2003 Aug;82(8):756-61.
• Lerman C, Miller SM, Scarborough R, Hanjani P, Nolte S, Smith D. Am J Obstet Gynecol. 1991 Sep;165(3):658-62. Adverse psychologic
consequences of positive cytologic cervical screening.
 Aim & Methodology
• The objective of the present study was to demonstrate the
impact of HPV diagnosis on sexual function and mental
health of Greek women.

• 51 patients, gynecological outpatient clinic of “Aretaieio”

Hospital, Athens, during 2008-2009.

• Patients had already been diagnosed with the HPV

subtypes that are responsible for cervical cancer.

• The participants were asked to complete a questionnaire

which included demographic and medical data and
questions regarding their sexual and mental health.
 Results - Demographics
• Mean age 36 years (Min 21, Max 68)
• 86.3% lived in Athens
• 62.8% were highly educated (college or
university)
• 33.3% smokers, 52.9% non-smokers, 13.7% ex
smokers
• 60.8% married or in a stable relationship
 Results – Gynecological history
• Mean age of first Papanikolaou (PAP) smear test
24.4 years (Min 17, Max 40)
• Mean frequency of PAP smear testing: every 9
months
• Mean age of HPV diagnosis: 33 years
• 72% of the participants found about HPV through
PAP smear testing
• 32% had genital warts
• 89.8% told their sexual partner about it
 Results – Sexual history
• Mean number of sexual partners was 6 (Min 1,
Max 30)
• Mean age of first sexual intercourse was 18.8
years (Min 15, Max 32)
• 88.2% had sexual activity during the last year
• 60.8% had sexual activity during the last month
• 41.2% have taken OCP in the past
• Contraceptive methods they use: 37.3% condom,
23.5% pull out method, 37.3% did not answer
 Results – Mental health
After HPV diagnosis, did you experience: quite – very much %
Distress 17.6%
Anxiety 76.5%
Guilt 41.1%
Anger 43.1%
Shame 21.5%
 Self-esteem 21.6%
Stigmatization 15.7%
Fear and anxiety regarding your health in the future 82.4%

• How much do you worry about your problem (HPV infection)?: 11.1% Extremely
28.9% Very much
40% Quite
6.7% A little
11.1% Not much
2.2% Not at all
 Results – Sexual health
After HPV diagnosis: Quite – very much
%
‘I felt less “sexual”’
33.3%
‘The level of my sexual desire decreased’
41.2%
‘The frequency I had sexual intercourse decreased’
43.1%
‘I was dissatisfied
Symptom Checklistwith my sexual
of Sexual life’ – Women (SCSF)
Function Yes
21.5% %
‘My you
Are sexual relationship
satisfied wassexual
with your negatively affected’
function? 74.5%
Do you have problems with little or no interest in sex?11.7% 35.3%
Do you have problems with reduced genital sensation? 17.6%
Do you have problems with reduced or loss of vaginal lubrication? 13.7%
Do you have orgasmic disorders? 21.6%
Do you have pain during intercourse? 23.5%
Do you have other problems? 7.8%
 Conclusions
• A quite long period of time (6 years) elapses between first
intercourse and first gynecological check up, demonstrating
that women should be motivated to seek preventive care
earlier in their life.

• Except for the important physical impact of HPV infection,

its diagnosis seems to trigger several negative feelings to a
woman such as anxiety, guilt, anger and fear for negative
consequences on their general health in the near future.

• Additionally, several sexual dysfunctions may arise

following HPV diagnosis, with the most prevalent being
reduced sexual desire disorder and pain during coitus.