Q I suffer from numbness of the mouth and have small lumps inside my
cheek. Could this have anything to do with my giving oral sex to boyfriends
in the past?
DR THOMAS STUTTAFORD
A Regardless how you behaved in the past, you should now behave as any
patient with a mouth lesion should and consult your doctor or dentist.
The numbness of your mouth is unlikely to be anything to worry about. The most
common cause is overbreathing or hyperventilation, as when someone is
excited. But your description of “small lumps in the mouth” could apply to
several common problems, and a few that are rather more esoteric. It would
be surprising, however, if lumps you have noticed have anything to do with
long-ago oral sex.
Many changes in the mouth are the result of long-term contact with teeth
imprinting on soft tissue. But an expert’s opinion is needed to distinguish
natural changes from common infections and inflammatory conditions, or such
occasional problems as oral submucous fibrosis or chronic hyperplastic
candidiasis. There is an exceptionally rare condition, the mucosal neuroma
syndrome, in which the first and sometimes only sign is occasionally small
glistening lumps on the lips, tongue and in the mouth.
The most important and frequent cause of malignancies in the mouth is smoking.
This risk is, to some extent, dose-related. The likelihood of developing
malignant changes in the mouth increases markedly in those who smoke more
than 40 cigarettes a day. Alcohol is only a relatively minor cause of the
development of oral cancers in nonsmokers but becomes much more relevant in
heavy drinkers who also smoke. The combination of excessive drinking and
smoking is very dangerous. In women, it increases the chance of developing
mouth, lip or tongue cancer one hundredfold. In men, the hazard is increased
thirty-eightfold.
In research aimed at explaining the marked increase in recent years of head
and neck cancers, including those of the mouth, lip and tongue, various
factors have come under suspicion. And oral sex has over the past few years
been added to the list of possible suspects.
The rise in popularity of oral sex in Britain corresponds with a fundamental
change in national sexual habits. Since the Second World War, oral sex has
moved from the category of the sexually exotic to the sexual norm. This has
been ascribed to the influence of enforced travel and exposure to the sexual
practices of other nations during the war and, after it, once cheaper
international travel became established from the mid1950s onwards.
Oral sex has always been more widely practised on the Continent and in the
United States. As the Clinton inquiry revealed, the former President and
many Southerners, like European Continentals, thought of oral sex as a
halfway house between kissing and intercourse.
The evidence for the implication of oral sex as a cause of oral cancer doesn’t
only rely on the circumstantial evidence of the timing of the increase in
its incidence. It has also been found that people with oral cancer have
evidence of chronic infection with the human papilloma virus (HPV), which is
spread by intercourse.
Researchers at the University of Iowa have found evidence of the
cancer-forming strains of HPV in the mouths of nearly a quarter of the
patients with head and neck cancer, but in only ten per cent of patients
without these tumours.
Dr Thomas Stuttaford, The Times doctor, spent many years working in
a genitourinary clinic
SUZI GODSON
A Because it is supposedly more difficult to catch HIV from oral sex,
at some point in the past 10 or 15 years a sexual act that was once
considered the ultimate expression of intimacy became the next step up from
French kissing.
The pedestrianisation of oral sex has been beneficial for women, who find
receiving oral sex from a man a very effective form of foreplay, but the
common misconception that “oral” constitutes “safe” has led to a large
escalation in the number of sexually transmitted infections (STIs) in the
UK. Genital herpes, which can be spread by oral sex, was up by 9 per cent in
2006 alone; while genital warts have increased by 22 per cent in ten years.
The spread of STIs through oral sex is part of a wider and worrying rise in
infection: chlamydia rates have gone up 166 per cent in the past ten years;
and there were 1.8 million attendances at genitourinary medicine clinics in
the UK in 2006 – more than twice the number recorded in 2002 – and as
pressure on genitourinary clinics grows, waiting times increase, and the
infected, with their appointments pending, spread the STI epidemic a little
wider.
I am not a doctor and I would not dream of attempting to make a diagnosis
based on the symptoms you describe (although Google suggests neurotoxic
shellfish poisoning and I have had a similar reaction from sucking too many
Strepsils), however I do know that research carried out last year by the
Johns Hopkins Bloomberg School of Public Health in the US has indicated that
people who have had more than five oral-sex partners in their lifetime are
250 per cent more likely to have throat cancer than those who do not have
oral sex.
Scientists believe that oral sex transmits the human papilloma virus (HPV),
which is implicated in the majority of cervical cancers. The mouth is
structurally very similar to the vagina and cervix and both contain cells
that are targeted by strains of this cancer-causing virus.
I mention the C-word not to scare you, but to motivate you to get yourself to
a doctor as soon as you can. Regardless of the diagnosis – let’s hope it’s
not serious – you need to adopt a less casual approach to your sexual health.
In the heat of the moment it is difficult to remember the direct connection
between cause and effect, but there is absolutely no such thing as safe sex.
Only safer sex. Unless a guy tests with you at a genitourinary medicine
clinic and stays within your field of vision until his results come through,
there is absolutely no way of knowing that he is free from infection.
Until you find a partner who is willing to do that with you, the only way of
protecting yourself against STIs is by using condoms.
Naturally, our increasing dependence on these little rubber barriers is a
marketing opportunity that has not gone unexploited. In the past ten years
the range and quality of condoms on the market has expanded rapidly and you
can get condoms that vibrate, glow in the dark and fold your underwear.
Flavoured condoms have been developed specifically for oral (not penetrative)
sex. Not only do they prevent you getting diseases, they mask the smell and
taste of stale urine with a delicious fruity, choccy or minty twist.
Brilliant.
Suzi Godson is author of The Sex Book (Cassell, £16.99) and
The Body Bible (Penguin, £16.99)
timesonline.co.uk/love
E-mail your sexual dilemmas to body&soul@thetimes.co.uk or write to Body&Soul,
The Times, 1 Pennington Street, London E98 1TT
