Iris publishers- Iris Journal of Nursing & Care (IJNC)
HPV: Impact on Women’s Lives
Authored by Maria Cristina Porto e Silva*
Objective:b> To identify the feelings involved in the discovery of HPV infection and to point out the impacts on the woman’s life after a positive result for human papilloma virus.
Method: This is a descriptive and cross-sectional study, based on a theoretical and methodological basis based on the principles of qualitative research whose data were analyzed according to phenomenological inspiration. The study population consisted of women who had the presence of HPV in the last result of the cytopathological examination. The data were obtained through semi-structured interviews consisting of guiding questions, which, after approval by the ethics committee and authorization of the participants, were recorded.
Result: Nine units of meaning were identified with the following themes: the repercussion in the lives of the participants, the importance of hope after the discovery of HPV, the patient’s uncertainties regarding HPV, the unknown disease, the diagnosis of HPV as an unexpected fact, pointing out the impacts after the discovery of the infection, the impact of the diagnosis on the relationship, confusion of thoughts about the diagnosis, anguish caused by the HPV result, alarmed by the next relationships, without reaction on the exam.
Considerations:b> Sexual behavior is linked to the growth of the diagnosis of human papilloma virus, considering that changes in habits, such as condom use during sexual intercourse even with a steady partner, are necessary for safe sexuality. Feelings of fear and worry happen through an unexpected result, which can contribute to the re-signification of the lived world.
Keywords: Human papillomavirus; Feelings; Women; Nursing
The increase in the rates of Sexually Transmitted Infections (STIs) has been considering the behavioral change in sexual practices in society, being transmitted through sexual contact (oral, vaginal and anal) without the use of condoms, which can still occur in the form of vertical transmission during pregnancy, childbirth and through breastfeeding [1]. The human papilloma virus (HPV), an infectious agent that manifests itself through lesions known as culminated condyloma, genital wart or cock’s crest, has affected women in greater numbers, with contagious lesions that can be asymptomatic and transient, but some women develop persistent infections that can result in cervical cancer precursor lesions [2]. The persistent infection of some types of human papilloma has been the cause of cervical cancer, with infection by this virus being very frequent, and cellular alterations may occur and progress to cancer. The discovery can be by cytopathological examination or Pap smear, being curable in almost all cases [3]. Human Papillomavirus (HPV) considered a virus that causes a Sexually Transmitted Infection (STI) is the most common type, and worldwide, approximately 600 million people have HPV, and about 75-80% of the population acquire this virus. at some point in life [4]. The Human Papillomavirus (HPV) virus belongs to the Papovaviridae family of the genus Papiloma, it is a DNA virus composed of a circular double loop and the variants of the nucleotide sequences allowed to find more than 100 different types of viruses. It presents a tropism for epithelial cells where it replicates in the nucleus of squamous cells, generating infections by mucous membranes and skin in the form of warty lesions that compromise the epithelium [5]. Viruses are installed in basal epithelial cells, in which replication depends on the terminal differentiation of the host cell, promoting productive, transforming, and latent infections, that is, viral DNA replication occurs, absence of viral transcripts and transformation of infected cells into benign or malignant tumor cells [6]. The virus is transmitted to women and men through unprotected sex, in which a quarter of the population can present joint infection with two or more types of virus, thus being exposed to a greater risk of infection by oncogenic subtypes [5]. According to the National Cancer Institute, among subtypes of papailoma virus, there are those of oncogenic character and which may be related to cases of persistent infections, affecting mainly the cervix, but also the vagina, vulva, anus, penis, oropharynx and mouth. The treatment of women with HPV improves the quality of life, but unfortunately does not interrupt the chain of transmission of these infections, as HPV is not only curable for treatment and prevention [3]. Currently, the vaccine approved by the FDA (Food and Drug Administration) for women between 9 and 26 years old, which prioritizes girls between 11 and 13 years old who have not had sexual intercourse, is 100% effective and has no serious adverse event. Although the woman does not enter this age group and has already had sexual intercourse, vaccination is recommended, if she has contact with one type of virus, she may still be immunized against other viral types [7]. The vaccine that protects against Human Papillomavirus (HPV) was incorporated into the Unified Health System (SUS) in 2014 and is currently applied to girls and adolescents between 9 and 14 years of age (14 years, 11 months, and 29 days), boys and adolescents between 11 and 14 years old (14 years, 11 months and 29 days) of age and for groups with special clinical conditions [8]. The combination of the vaccine and regular Pap smear is the best way to guarantee the decrease in high rates of cervical cancer and in the future the disease will become less threatening to the lives of women [5]. A study reports that in view of the increasing involvement of women with STIs and the high influence caused by the socioeconomic context in the course of these infections, the importance of public policies that establish adequate strategies for their prevention, early diagnosis and treatment is highlighted, so that there is promotion of the quality of life of this population [4]. The increasing number of STI statistics has shown that the lack of knowledge both about the disease, as well as its transmission and prevention, has also been an impasse to change this scenario, thus making it a public health problem that has repercussions on the woman’s life and on the conjugal relationship. The study is important to strengthen a reflection on the sexual behavior of the population, allowing the knowledge of the feelings involved in the discovery of sexually transmitted infections mainly by the papilloma virus due to the impact it can have on the woman’s life, and consequently reflecting on the relationship the partner and in sex life. A study points out that health education is one of the main tools in contributing to knowledge about HPV infection, awareness about dissemination and care, promoting technical and popular knowledge and thus providing quality of life not only for the individual but also for the community [9]. For nursing, there is a need to act in preventing infection and promoting women’s health, with the consequence of improving the quality of life and mainly reducing the emotional disturbance that can surround the woman’s life. This study contributes to the community, as a means of clarifying the HPV contamination from the perspective of women who are affected by the precursor of cervical cancer, and thus helping professionals to have interventions focused on physical integrity and mental. Also, for supporting the preparation of the scientific community to develop strategies aimed at increasing the level of information of women and the health team, always promoting quality in the care and in the lives of the women affected. Therefore, the objective of the study was to identify the feelings involved in the discovery of the HPV infection and to point out the impacts on the woman’s life after the discovery of the infection.
This research has its theoretical and methodological basis based on the principles of qualitative research, with a descriptive and transversal approach, whose proposal will be to understand human phenomena from a concrete experience, lived in daily life, in the phenomenological perspective adopted for the analysis of the collected data. The study scenario was the outpatient clinic of Hospital das Clínicas that serves the city of Pouso Alegre-MG and surrounding municipalities, being a reference to medium and high complexity care. Women were selected who presented the presence of Human Papillomavirus in the last result of the cytopathological or Pap test. The interviews were scheduled and carried out in the care unit itself, which, after approval by the ethics committee and signature of the free and informed consent term, were collected in a restricted, comfortable and bright place, favoring a quiet and private environment for the subjects of the study. research. The inclusion criteria included women who presented the results of the cytopathological or Pap test in the period of 6 months with a positive result for Human Papillomavirus; women aged 18 years or older; women who agreed to participate in the research. And the exclusion criteria were those who refused to be part of the research; women who have not had a cytopathological exam or Pap smear with Human Papillomavirus; women who presented the results of the cytopathological exam or Pap smear over 6 months with Human Papillomavirus. The data were obtained through semi-structured interviews, which, after approval by the ethics committee and authorization of the participants, were recorded. They were guided by a script consisting of the following questions: For you, what was it like to know that the Pap smear result had an infection with the Human Papillomavirus, a precursor of cervical cancer? What in your life does that mean? It’s because? This research was submitted to the evaluation of the Ethics Committee of the Vale do Sapucaí University respecting what is recommended by Resolution No. 466 of 2012 of the Ministry of Health, which deals with research with human beings. The data related to the women’s reports about what it meant to have the result of the cytopathological examination presenting the infection with Human Papillomavirus and what repercussions it brought to their lives, were analyzed according to the qualitative approach of phenomenological inspiration, by the following steps: the recordings were listened to carefully in its entirety, transcribed in full and the content of the interviews was read in order to learn about the phenomenon and simultaneously highlighted the main points of each speech. This stage was carried out with each participant, and the similarities identified in the set of interviews were grouped, which, in turn, were constituted in themes, considering similar aspects, divergences and, finally, presented in a descriptive manner, based on the statements of women.
Data collection was carried out with eight women and it was possible to analyze the statements based on two themes that relate to the guiding questions and the objective of the study:
• The impact on the participants’ lives
• Point out the impacts after the discovery of the infection.
Four categories emerged from the first theme:
• The importance of hope after the discovery of HPV
• The patient’s uncertainties regarding HPV
• The diagnosis of HPV as an unexpected fact. And the second theme allowed us to divide it into five units:
• The impact of the diagnosis on the relationship
• Confusion of thoughts about the diagnosis
• Anguish caused by the HPV result.
• Alarmed by the forthcoming relationships.
• No reaction to the exam.
The repercussions on the lives of the participants
The importance of hope after the discovery of HPV: The result of the cytopathological examination with cellular alterations implies for women a lack of knowledge about the scientific aspect, but it is frightening as to its effects in daily life. For some of these women after having a clear diagnosis, they remain in the hope of six months later to repeat and obtain normal results. A study found that when diagnosed with a sexually transmitted infection, specifically HPV, women are faced with a reality that is imposed on them and with which they will inevitably have to deal with the unknown and with the doubt of loyalty [10]. The search for strength to cope makes the woman find the hope of improvement, as in the speech: What I felt was that for me it was everything that if God wants it will be all right, that I was not beaten, that is it (P2). These feelings awaken to an understanding of the world from which they lived experience is founded on the subject’s perception, intertwining body-world, giving new meaning, feeling what it is like to be in the world creating meanings through the perception of the unfolding place of life. before you for the experiences [11]. Believing that everything can have a positive outcome is the basis for facing the difficulties imposed on the body by the lived world. Therefore, positivity and the encounter with religion is necessary support to face what lies ahead. Having knowledge about the characteristics of the HPV virus, will favor having a better view of your health status, and the need for continuous care, helping to adhere to the proposed health treatment [9]. Perception of the world that materializes with it, in the body that moves, that suffers, that interacts with the environment, assigning meanings.
The patient’s uncertainties regarding HPV: The first information about HPV generates uncertainty and the possibility of having cancer, in which some studies show that women associate warts on the genitalia as a synonym for a malignant tumor. When they receive the information that some types of HPV are likely to develop into cervical cancer, fear is a dominant feeling, revealing the ghost of cancer as a destructive force, an invasive and silent disease [12]. Acquiring HPV means living with doubt when discussing the evolution of the disease, in which it is not possible to give an exact prognosis of the pathology [12]. It is the certainty that you have plunged into the world-disease that scares you. The idealized world loses its meaning. Ah! I was really worried, because when I found out about warts, right?! I already had condyloma there, it was very, well, very embarrassing because we already think a lot of bullshit and I already had breast cancer so in my fear it was like having cancer in the uterus too (P3). Ah, I was sad, I was sad, it was one, “I don’t know” it was an exam result that left me shaken (P7) I was very scared thinking that I had cancer’ (P5). Thus, meanings, goals and limitations arising from being affected by the disease provide the meaning of oneself from the difficulties that they have been going through in their daily lives related to changes in their natural body. The investigated subject’s experience of falling ill suggests something in the field of impotence, that is, the loss of power and control over the situation experienced.
The unknown disease: HPV is unknown and even its treatment, due to lack of information, arouses feelings of insecurity and fear, in which the situation requires decision-making to face and move forward. Existence is not explained by objectivity, by the world of ideas, but by understanding and experiencing the world, the lived world. Therefore, with all the feelings and changes that occur in life, receiving a positive diagnosis for HPV, orienting yourself and understanding your current situation and starting to face the new reality, is important at this time [9]. The lack of adequate information can result in misconceptions, which can generate negative behaviors, given the statement below: It was a “thud” because we don’t have any information in the region where we are it should be more at the health center or something like that to pay more attention, more explanation, let’s say so. Clear doubts (P4). When sick the attention turns to the part that is not working, at this moment the harmony between the object body and the lived body is broken, with the meaning of the simple mechanical dysfunction reaching the being-in-the-world, it loses the conscience of coping and lives the anguish of the assumption. Unawareness or little knowledge is a reason to cause sadness and dread in the face of the perception of the partner, family, and oneself, in addition to the concern about possible changes in their routine with the family and work [9]. I stayed, I did not know what it was yet and then I got scared (P6). The impact of the diagnosis meant discovering having a sexually transmitted infection and living with it is sharing moments of fear, insecurity, revolt, and uncertainty [10]. However, being sick is a presence that changes life, transforming the way we experience our bodies, react, and perform tasks. Getting sick is a painful way to reveal the intimately bodily nature of our being. Having STI makes women more exposed to bad feelings about their prognosis, making them more psychologically vulnerable to negative emotions that May arise [12]. It was a horrible feeling, it was a painful, horrible feeling. Wow, I do not even know how to speak, it hurts too much, it hurts too much, it is like, something that, you know, wow! The time I heard about it ended with me and it was very hard, very painful, I cried for several days until we go on talking to a person, the person gives us a word of friend, we calm down because otherwise you cannot bear it. It is hard, I wish it to anyone, because it’s a horrible feeling (P8). The significant experience of a situation where there is no body that suffers, but an incarnate being that feels pain, expression, meaning. Fear and pain are mixed when experiencing the new reality of being a woman with HPV, feelings being most aroused by this diagnosis and by experiencing a new reality [9]. The changes resulting from these feelings bring continuous changes in your being, giving you meanings and meanings for the world body. Knowledge does not bring fear, it shows that it is possible to face the diagnosis, the absence of information and the opportunity to have it, it makes the woman negatively experience the existence in the world.
The diagnosis of HPV as an unexpected fact: The diagnosis of any disease is not something that inspires positive and pleasant feelings, knowing that you have HPV comes as a surprise mainly because many women do not know the real severity of the disease and only discover later how the virus is transmitted. The body is an ally of consciousness that expresses the meaning attributed to transformations organic. In the experience of pain and suffering, the consequences of what the disease is imprisoned. There is now no body-object affected by HPV, but together, a subject body that feels, that means and assigns meanings. Ah, I was shocked, right?! Because I did not expect that (P1). The lack of knowledge about the existence of the disease is also a way of demonstrating impotence in the face of the circumstances caused by the contamination [12]. Research on the diagnosis of cancer shows that fear of the unexpected can lead to loss of emotional balance and health [13].
Point out the impacts after the discovery of the infection.
The impact of diagnosis on the relationship: The partner in some studies is directly or indirectly related to the new situation that the woman is experiencing and recognizing as having HPV [2]. The impact it causes on the lives of women is linked to the loyalty and trust that is built in the marital relationship, so the possibility of a betrayal in the relationship may exist or the impact on fidelity may weaken with the discovery for both. In this process of interaction with oneself and the world, a series of feelings and thoughts permeate the world of life. Now it will have to give a new meaning to an unexpected and natural situation, and, thus, transform it, inventing a better future [9]. Ah so I do not know, I do not even know how to speak, I know I was very upset with fear of dying and so in the beginning, I do not know, I thought it was my husband who transmitted it to me (P5). Fights and marital instability can be a consequence experienced by women. Consequently, the result of an HPV test interferes with the marital relationship, leading to a change in the couple’s attitudes, non-acceptance and, consequently, the discontinuity of the relationship [14]. Ah it hurt my life a lot, mainly, you know, because I have little time that I got married again. So, it hurt a lot, it hurt my married relationship (P1). Sexuality throughout all personal existence is conceived as an existential need and part of the general existence of the human being. For a woman who experiences an STI experience and during so many feelings, the woman wonders about the betrayal of her partner and at the same time it is visible the guilt she carries, an extra burden of betrayal that mix and this can be the end many relationships as well as the continuity of a moment.
Confusion of thoughts about the diagnosis: Doubt, anguish and incredulity are feelings that share space with hope, optimism and belief, the diagnosis of the precursor disease of cervical cancer can bring ambiguity of emotions and feelings [2]. I do not know that, right?! The answer I do not know how to answer because it was generated (P2). This feeling is attributed to the lack of knowledge about the disease or the lack of adequate assimilation of the value attributed to that moment of diagnosis. When the test result is positive for the HPV virus, there is a mixture of thoughts that drive attitudes and many of these are related to relationships experienced, such as distrust in the relationship or lack of communication with family members, fear of judgment and what others might think and worry about [15]. In Symbolic Interactionism, the human being acts in relation to things based on the meanings they have for him. These things are understood as physical objects, human beings, institutions, ideas, human actions, and other situations experienced in the individual’s daily life [14]. When there is a report in which the woman does not know why this happened, it is possible to realize that she does not understand why it was transmitted, and the word cancer refers that there was a lack of understanding or clarity in the professional’s explanation. It may be a moment attributed to the denial of everything that may have led to this experience and what may still suffer as a result of an examination of this.
Anguish caused by the HPV result: The sadness in the speeches reflects the lack of dialogue with the people around it is generating more anguish, feeling alone is one of the most dangerous feelings since some people are susceptible to depression. What did it mean? Ah. I was sad, I had to do the treatments, I was depressed (P6). For me what it meant, then it meant so much like that you know, “ain” hurt, it meant you know I said my God I can die leaving my little girl of five years old that was horrible (P8). These present feelings can be in the first moments instated by the discovery; however, it can be the beginning to take the government of their lives and to re-signify the moment lived, establishing another look on the situation.
Alarmed by the forthcoming relations: Women feel insecure in trusting their partners, even if it is something lasting, the risk of infidelity is something that surrounds personal life. Aiming that an unprotected relationship can bring several diseases and one of them, HPV, the woman feels insecure and suspicious about entering into new relationships. Upon being aware that HPV is a sexually transmitted disease, fidelity will almost always be threatened, and the marital relationship destabilized [10]. The whole human experience cannot separate body and consciousness, so the experience of having HPV brings a new look at life and future relationships. No, it meant that I got smarter, you know, because I probably took it with sexual intercourse without a condom, so we get smarter in life (P3). Women with an unstable marriage show a confirmation of infidelity and in view of the situation, a decision is necessary, especially if there are children involved in the marriage.
No reaction on the exam: One of the most frequent questions is what to do now, that is, how they should react to the virus, who to tell or whether to tell. In fact, the questions never stop. The news in the medical professional’s office can be a shock and each one has a different reaction, however many remain unresponsive, and it is only after this state has passed that they begin to react to the solution of the problem. Being a carrier of HPV is also living with doubt, especially when discussing the evolution of the disease [10]. Some infections are most of the time asymptomatic and when presenting in the cytopathological result it is surprising for them, in people’s conception the diseases have symptoms and signs which facilitates the early diagnosis, unfortunately others are asymptomatic. Na, it meant like I felt a person kind of impotent without knowing what was going on, I only found out when they referred me to the woman’s health. Ah, because she has no clarification, there is, um, how can I speak, people do not take questions from us at the health center, do not take questions from us as it was taken here, right?! Explained exactly why? How did we get it? Huh?! So, it was like that. No symptoms yet (P4). The health professional can contribute to the construction of the meaning of having or not the disease and thus will be able to minimize the distress of this woman [15]. Oh, I can’t even explain why I think it’s something that nobody wants to know, right, an exam result that I think nobody wants. He came to say that I “had” this virus (P7). The woman reports that no one would like to know about this result, thereby increasing the denial of the diagnosis, while intervention for treatment should be the priority to stimulate positive feelings and acceptance. Existence is not explained by objectivity, by the world of ideas, but by understanding and experiencing the world, the lived world.
Sexual behavior is linked to the growth of the diagnosis of Human Papillomavirus since changes in habits, such as condom use during sexual intercourse even with a steady partner, are necessary for safe sexuality, avoiding the sexually transmitted infection disorder. The knowledge deficit in relation to HPV is noticeable, the lack of knowledge is the mainstay for negative feelings, depression, anguish, and fear. Health professionals have an important role in raising awareness by acting in a safe and clear manner, using language that all women can understand. Information such as vaccination with quadrivalent HPV vaccine, the action of the virus on the woman’s body and prevention measures are topics that must be addressed in health actions, public places and meetings of the group of pregnant women, parents and educators as a way of alerting physical and emotional risks. Public policies must be implemented to prevent the disease, because when we talk about costs for managers, the prevention of cervical cancer is financially more economical than treatment. This is due to several factors, one of them, the low cost of the cytopathological examination, the training of health professionals in the primary care network, health actions in schools and information material distributed to the entire population. Considering that the nurse’s role is fundamental for the reduction of infection rates by the virus, acting in primary care actively capturing women resistant to the exam and guiding the population on the risks and benefits of care, are actions that help decrease the risk of increased infections. It is important to show women that emotional distress is greater than preventing cervical cancer.
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