With the promise of immunity from HPV — and, in turn, cervical cancer — you’d think the choice to roll up your child’s sleeve for this vaccine would be simple. Not quite.

It’s a note in your child’s backpack. It’s the heated topic on talk shows like Katie Couric’s, Katie. It’s the commercial that runs several times within an hour. Yet, despite having so much presence in schools and society, there’s an air of mystery and fear surrounding the human papillomavirus (HPV) vaccine.

Since its introduction in 2008, all Canadian provinces and territories have doled out free vaccinations against HPV through school-based clinics to females in one of Grades 4-9, and while some parents are quick to sign their kid up for the shot that’s touted to prevent cancer, others fear the unknowns surrounding it. Here’s what you need to know.

HPV InjectionWhat is HPV?
The most common sexually transmitted infection, HPV affects skin and the moist membranes lining the throat, feet, hands, nails, anus and cervix. There are more than 100 types of HPV, and while most strains are harmless and symptom-free, 40 of them can put contractors of the virus at risk of below-the-belt cancer.

In the grand scheme of things, that risk is minimal: the United States Centre for Disease Control and Prevention (CDC) says over 70 per cent of the infections in young females clear up within 12 months, while 90 per cent do so within 24 months, leaving between five to 10 per cent of cases with the potential for long-term repercussions.

Why get vaccinated?
According to the makers of Gardasil, cervical cancer caused by HPV is responsible for some 400 deaths in Canada each year. Roughly three out of four sexually active Canadians will be infected with HPV at some point in their lives, making the vaccine a literal lifesaver, says Dr. Gina Ogilvie, an HPV infection expert and medical director of clinical prevention services at the BC Centre for Disease Control.

What’s more, young girls between nine and 15 who receive this vaccine — it’s administered in three separate doses over a course of six months — it is ideally received before first sexual contact — have almost 100 per cent protection against diseases caused by HPV. (If someone is already infected with an HPV strain, the vaccine does not prevent further complications against that specific strain, though it does provide protection against others.)

Is it safe?
“Parents who have concerns need to know that the safety of the vaccine is paramount [to the medical community], and that we would never recommend something that could make healthy girls ill,” says Dr. Ogilvie.

According to the CDC, more than 56 million doses of the vaccine have been distributed in the U.S. alone, and only a very small percentage of adverse reactions have been reported. Of those, 92 per cent were classified as non-serious, such as injection site redness, soreness and fainting, while rare reports of adverse reactions have been linked to hospitalization, permanent disability, life-threatening illness or death. The latter reports have steadily declined since 2009.

Why the controversy?
Spend 10 minutes Googling HPV vaccines and their reported negative effects, and chances are you’ll feel more than slightly torn about whether to vaccinate your daughter.

Some parents insist children are being vaccinated too young, or that the inoculation promotes sexual activity. Others point to the vaccine as the root of serious health problems such as seizures, paralysis and even death following injections. The stories have impact — 30 to 40 per cent of Canadian girls go without the vaccine, reports a 2012 Globe and Mail article.

Allison Hayley, a mom of three who lives in Cornwall, Ont., says she and her husband are not allowing their 11-year-old daughter to get the shot. “She’s too young. We’ve done the research and don’t feel her having it is necessary at this time,” she says. “Not that we have blinders on, but this targeted age group is too young for our comfort.”

Dr. Ogilvie explains that the focus on pre-adolescents is preventative. “It doesn’t have an impact if you already have HPV, therefore we’ve taken the approach to administer it before HPV infections or pre-cancerous lesions become an issue. Also, kids aged nine to 12 have a better immune response.” She adds that U.S. studies have shown the vaccine has no impact on sexual activity among young people.

Hayley is aware of the rationale behind early immunization, but says it doesn’t faze her. “I had the kids get all the old-school vaccines as I felt they had been time tested,” she says. “Not this.”

Caroline Turner Jardine from Gilbert, Arizona is equally leery of the vaccine and won’t get it for her 12-year-old daughter. She is particularly suspicious of the aggressive marketing campaigns for the vaccine in the U.S., and the relationship between big pharmaceutical companies and regulatory agencies. “It’s too risky,” she says. “I’m not antivaccination completely, but we go to an immunization clinic here and have had to decline this vaccine three separate times. They were far too pushy about it for our liking.”

However, for Diana Guild from Hamilton, Ont, the choice to vaccinate her now 17-yearold daughter was easy. “After researching it, I didn’t have any concerns. If I remember correctly, all the girls in my daughter’s class got the vaccine. Our philosophy has always been to do whatever we can for our children. We are their biggest advocates.”

What are the benefits?
“Beyond the fact that it’s safe, we’ve been surprised at how effective it is at reducing infection and pre-cancerous lesions,” says Dr. Ogilvie. A study released by the CDC in June 2013 shows that HPV infections in teen girls have been cut in half since the shot came on the market. And among girls who got the vaccine, the drop was higher—a whopping 88 per cent.

Still, because the vaccine doesn’t protect against every HPV strain, experts recommend regular Pap screenings. In addition, though research shows that the vaccine provides protection for at least five years, it’s not clear whether a booster shot following those five years is needed.

Talking about HPV
Talking to your kids about topics related to sex can be about as appealing as a root canal, but experts say to consider it a necessary evil. Dr. Kirsten Smith, an OBGYN at North York General Hospital in Toronto, advises that parents approach the subject as they would any other vaccine conversation. “I would elaborate on HPV transmission specifically if the child asks and a parent thinks they will understand the answer,” she says. “Reassure them that it’s safe and doesn’t contain the virus itself, and in the case of a younger child, comfort them and let them know that having a vaccine can be frightening and even painful, but it’s important for long-term health.”

The bottom line
While there will always be parents championing vaccinations and others vehemently opposing them, making decisions based on what we feel is best for our child is a personal battle.

For Dr. Ogilvie, the benefits of vaccination far outweigh the risks. She has had her daughter and her son vaccinated against HPV, and suggests that instead of focusing on the confusion, people should focus on the prevention of cervical cancer. “It may not have the same sort of recognition that breast cancer does, but if I told you there was a vaccine for that, wouldn’t you want your daughter to get it?”