Sexual Health Expert Explains Whether HPV Actually Causes Genital Pain

It's the most common STI in America, but does it hurt?

Human papillomavirus is one of the most popular STDs around, with an estimated one in every four Americans carrying the infection. But, as Taylor Swift reminds us, fame takes a toll on your reputation, and so it has with HPV and the misleading myths surrounding it. A common one? That HPV is painful, particularly on mens’ testicles.

There are nearly 200 different strains of HPV, but only a handful cause symptoms or increase the risk of more serious health concerns. Of those strains, 14 are “high-risk”, but the only two that cause most HPV-related cancers are strains HPV-16 and HPV-18. The “low-risk” HPV strains, like HPV-6 and HPV-11, cause about 90 percent of genital warts cases.

Does HPV Cause Ball Pain?

Genital warts might look a bit scary, but professor emeritus of medicine at the University of Washington, H. Hunter Handsfield, Ph.D., says that genital warts are usually painless.

“HPV is never painful, except for especially large warts that become macerated or infected,” he tells Inverse.

HPV virus
An illustration of the HPV Virus 

Though most genital warts cases go away on their own, the immune system is unable to handle them in a small number of cases. In these situations, warts can continue to grow and become infected or “macerated.”

Sometimes, HPV cases are associated with Buschke-Lowenstein tumors, which are very large growths that look a lot like genital warts. These tumors have been described as “slow-growing cauliflower-like tumors” and can be painful. “This is almost entirely a problem of long-neglected warts that are allowed to grow to giant size (sometimes an inch or more) before seeking medical care,” he says.

But for the most part, Buschke-Lowenstein tumors aren’t the main reason genital warts might become painful. Handsfield says that most macerations or infections happen when people neglect to get treated, or, unfortunately, pick at the warts. 

“But another possible circumstance causing pain is when affected persons pick at them or try to remove them without medical advice, which would always be painful,” says Handsfield. “But warts and HPV itself is always painless.”

How To Treat Genital Warts

Fortunately, there are a number of good treatments and preventative measures available to combat HPV. For cases where the warts have already manifested, the warts can be treated with prescription creams. Notably, creams meant to remove warts on the hands and feet are not intended for genital warts. Other options include cryotherapy, which freezes them off, or loop electrosurgical excision procedure (LEEP), which uses an electric current and a wire to lance them off.

The CDC’s treatment guidelines make it clear that not all methods are appropriate for all cases. And it’s possible for the warts to come back if the virus reactivates.

A simple preventative measure to protect against the more concerning strains of HPV in the first place is to get vaccinated. He previously told Inverse that the vaccine is “is biologically the most effective vaccine ever developed for any medical condition.”

The most concerning issue regarding HPV is not ball pain — or pain in general — but that the majority of patients actually have no outward symptoms at first, and so they may not know whether they have the infection and are carrying a potentially serious strain. This is why regular screenings, which test for the high-risk types, are recommended for some people — particularly women.

“Unfortunately, most people who have a high-risk type of HPV will never show any signs of the infection until it’s already caused serious health problems,” June Gupta, associate director of medical practices at Planned Parenthood, tells Inverse. “That’s why regular checkups are so important.”

Media via CDC, Children's Hospital of Philadelphia , Unsplash