Podcast Summary: Dr. Chapa’s Clinical Pearls

Episode: SCIENCE CHANGES: New Data on HPV Vaccination Peri-Leep/Cone
Date: October 5, 2025
Host: Dr. Chapa

Overview: Episode Theme & Purpose

This episode focuses on a major shift in clinical guidance regarding the use of HPV (Gardasil 9) vaccination around the time of LEEP or cone excisional procedures for high-grade cervical dysplasia (CIN2/3). Dr. Chapa discusses a new large-scale study from the Netherlands (the Vacin Trial, published September 2025 in the Lancet Obstetrics, Gynecology, and Women’s Health) that challenges the standing ACOG (American College of Obstetricians and Gynecologists) guidance on offering HPV vaccination peri-procedurally to unvaccinated, immunocompetent women. He uses the episode to emphasize that medical science is always evolving—no guidance is ever truly "settled."

Key Discussion Points & Insights

I. Evolution in Cervical Dysplasia & HPV Management

Recaps progress from classic Pap smear to liquid cytology, primary HPV screening, and now to molecular/dual stain technology (P53/Ki67) as the latest advance for triage ([00:25]–[02:00]).
Highlights how cytology is becoming less relevant:

"Cytology is pretty much now irrelevant. If you follow the dual stain technology, which doesn’t even look at the cells at all..." (Dr. Chapa, [01:35])
Outlines the preventive rationale for Gardasil vaccination and its evolution from bivalent to quadrivalent to Gardasil 9 ([02:00]–[03:18]).

II. Historical Guidance vs. New Evidence

Since about 2013, growing evidence suggested that perioperative HPV vaccination (“adjuvant” use) may reduce dysplasia recurrence after LEEP/cone ([03:15]–[05:00]).
ACOG (July 2023) guidance recommended considering vaccination perioperatively for immunocompetent previously unvaccinated women aged 27–45 ([05:00]–[06:50]):

“...consider adjuvant HPV vaccination for immunocompetent previously unvaccinated people aged 27 to 45 years who are undergoing treatment for CIN2, end quote.” (Dr. Chapa quoting ACOG, [05:40])

III. The Vacin Trial: 2025 Game-Changer

Introduces the Vacin Trial, Netherlands:
- Largest multicenter phase IV randomized placebo-controlled trial on peri-procedural HPV vaccination ([06:55]–[08:20]).
- Studied 3 Gardasil 9 injections vs. placebo around time of LEEP/cone for CIN2/3.
Key Results (Dr. Chapa quoting directly from the article, [08:40]):

“...Our trial suggests that adjuvant HPV vaccination is not effective in reducing the recurrence of CIN 2 to 3 lesions, contradicting conclusions of previous works and previous guidance. End quote.” “...guidelines should be more reticent in recommending additional prophylactic HPV vaccination after treating CIN lesions.” ([09:50])
Dr. Chapa’s reaction:

“Yikes. Okay, let me say that again. Yikes. I mean, so, guys, now, I’m not telling you what to do...you do you, honey. You do you, bruh. Because this is where shared decision-making comes in.” ([09:05])

IV. Details of the Vacin Trial & Statistical Interpretation

Study design:
- 3-dose Gardasil 9 vs. placebo IM given perioperatively (some just before, some after LEEP/cone) ([15:10]–[16:50]).
- 24 months follow-up.
Results:
- Recurrence rate: 9% in placebo vs. 6% in vaccine group (absolute 3% reduction).
- Quote:
  
  “P value was not good, our P value was above 0.5 and the confidence interval hovered and hugged 1, which showed there was no difference.” ([17:40])
Clinical vs. statistical significance:

“While that is statistically true, is a 3% clinically valid. I don’t know. I don’t know if that’s a big enough number to move anybody’s needle...it’s a 3% reduction compared to placebo for something that’s not cancer.” ([19:10])
Asserts the trial is Level 1 evidence and directly contradicts earlier practice recommendations ([20:15]–[21:30]).

V. Implications for Practice & Science

Repeated emphasis: “Science is settled—never” ([07:15], [13:40], [22:00]).
Advocates for ongoing questioning and adjustment of clinical recommendations as new high-level evidence emerges.
Counseling patients:

“Talk to the patient and tell her science is never final. Testing the science is how we do science.” ([24:40])
Safety note:

“Nobody grew an extra eyeball because they received Gardasil with this trial, nor has anybody ever grown an extra eyeball because they received Gardasil.” ([25:30])
Summing up, Dr. Chapa encourages shared decision making, weighing tiny absolute risk reduction versus lack of statistical significance.

Notable Quotes & Memorable Moments

On the state of science:

"This proves, guys, this proves... science is settled never. Because the way that you do science is you keep testing the science." ([07:10])
Reacting to the new trial’s conclusion:

"Our study provides level one evidence that contradicts these Current guideline recommendations. Oh no, you didn’t..." ([22:10])
Addressing medical organizations:

"In a time where some medical professional organizations sound more like pharmaceutical commercials… What does the data say? Let's make it a no spin platform here." ([22:50])
On the human side:

"You do you, honey. You do you, bruh. Because... this is where shared decision-making comes in." ([09:05])
On safety:

"Nobody grew an extra eyeball because they received Gardasil with this trial, nor has anybody ever grown an extra eyeball because they received Gardasil." ([25:30])

Timestamps for Key Segments

00:25 — Review of cervical cancer screening evolution
02:45 — History of HPV vaccination & prevention
05:00 — Prior data and ACOG July 2023 guidance
07:10 — "Science is settled never" principle
08:30 — Introduction & findings of the Vacin Trial (Netherlands, Lancet 2025)
09:50 — Direct quote from trial urging more “reticence” in guideline recommendations
15:10 — Vacin trial methodology (Gardasil 9 protocol, timing)
17:40 — Trial results, p-values, confidence intervals, and clinical significance debate
19:10 — Dr. Chapa’s personal perspective on 3% reduction
22:00 — Confronting established guidelines, call for “no spin”
24:40 — Patient counseling and shared decision-making
25:30 — Safety reassurance about Gardasil
26:18 — Episode wrap-up and recurring message on evolving science

Conclusion: Clinical Pearls & Takeaways

HPV vaccination (Gardasil 9) as a perioperative measure for recurrence prevention after CIN2/3 treatment is now under question by new Level 1 evidence—the Vacin Trial.
The absolute reduction of recurrence (3%) did not reach statistical significance, challenging current ACOG recommendations.
No new safety concerns arose; Gardasil remains safe.
Science is never "settled"—ongoing re-evaluation is fundamental.
Transparent, up-to-date patient counseling and shared decision-making are key in light of evolving evidence.

Stay informed, question the science, and always consider new high-quality studies when making clinical recommendations.

Transcript

A (0:03)

When did making plans get this complicated? It's time to streamline with WhatsApp, the secure messaging app that brings the whole group together. Use polls to settle dinner plans, send event invites and pin messages so no one forgets mom 60th and never miss a meme or milestone. All protected with end to end encryption. It's time for WhatsApp message privately with everyone. Learn more@WhatsApp.com it's amazing how far we have come in the world of cervical dysplasia and detection of HPV and its effect on the cells. I mean, thank goodness for Giorgio Papinicolaou who first started the slide based cytology evaluation that became of course the Pap smear. Well then obviously, decades later came the recognition and the ability to test for the causative agent, which is hpv. So we went from primary cytology from a slide to primary cytology in a liquid to reflexing to find the causative agent called hpv. In cases where we weren't sure what to do with the weird cytology, like ask us, or at times even low grade squamous intraepithelial lesion where if the HPV was not detected, maybe you could buy more time in the observation. Then we went to primary HPV screening, which is pretty much where we're at now. And I've got plenty of episodes of course that have tackled that. Now the latest development, and we have an episode on this as well, of course is now going to molecular assessment of HPV and its byproducts. So now we have dual stain technology, not a sponsor. So of course now that takes primary HPV screening and kicks it up a notch to use molecular assessment using the dual stain for P53 and Chi67. Because if that dual stain is positive, that goes straight to copo. But if it's negative, you can just follow them up in a year, taking away cytology altogether, which poor Giorgio Papanicolao would probably, probably be rolling around in his grave. Yep, cytology is pretty much now irrelevant. If you follow the dual stain technology, which doesn't even look at the cells at all, it's primary HPV 16, 18 straight to COPO. Other high risk types look at dual stain. If they're a positive, they go straight to copo, and if it's negative, you can just check for a primary HPV screen again in a year. We've covered this and nowhere in that molecular triage is is cytology a thing. So all to say, we've learned a lot about what HPV does The same way we've learned a lot about the prevention of primary HPV infection with the use of Gardasil. And that itself has gone through its own evolution. It started, of course, with two agents and then it went to a quadrivalent. Now we, of course we have Gardasil 9, which is a nonovalent. And there's been a lot of changes there. Now the de facto, the primary indication of course is exposing patients to this viral particle so they can make antibody to be primary prevention. Okay, so it's still a prophylactic agent. That's the goal. But of course we've known that since 2013 or so. That's over a decade. There has been data that's accumulated that shows that perioperative treatment, meaning peri, LEEP or pericone treatment, treatment of those who had not received Gardasil in the past, those who are receiving treatment for high grade dysplasia, CIN2 or CIN3 and not yet vaccinated. There is evidence that giving the vaccine to those individuals who are immunocompetent can reduce the rate of recurrence. Now, that data actually came kind of to a head with ACOG's practice bulletin in July of 2023. Now, trust me, we're going somewhere. Because when I saw this article that we're going to highlight, I haven't even gotten to that article. But the article is out of a brand new journal that we have actually already highlighted. But it was launched in September of 2025, which is the Lancet. And this new form or flavor of the Lancet is called Obstetrics, Gynecology and Women's Health. The Lancet, Obstetrics, Gynecology and Women's Health. We're going to highlight an article here from September 2025 called the Vaccine Trial without the E V A C C. This is the vaccine study. This is the largest yet. This is multicenter. This is phase four randomized placebo controlled. In the Netherlands. Okay. In the Netherlands. This is a big deal. And I'm going to read you what they say because they are spinning the whole world of peri treatment of dysplasia, HPV vaccination on its head. Okay, so let me just tell you where I'm going. We're going to cover an article from the Lancet's new journal, Obstetrics Oncology and Women's Health from September 2025, calling into question whether administering Gardasil 9 in those who had not yet received it and who are immunocompetent and who are getting treatment with a LEEP or a cone for high grade dysplasia, whether that's effective to prevent recurrence or not. Now here's why this is a big deal. Now I got three things to say. One, we typically cover obstetrics, but you know, I, I, we got to know our gynecology as well. So I'm giving gynecology some love. Number two, this proves, guys, this proves. Well, we've said many times on this show that science is settled. Never. Science is settled. Never. Because the way that you do science is you keep testing the science. And this new publication did just that. They said, look, all right, let's, let's, let's take a look at ACOG's practice bulletin in July of 2023 which was titled Adjuvant Human Papillomavirus Vaccination for patients Undergoing Treatment for Cervical Intra Epithelial Neoplasia 2 + okay, now this was, remember, this was where ACOG said, look, if they had not yet received vaccination in those undergoing treatment for CIN2 plus, if they're immunocompetent, then definitely, as an updated ACOG recommendation is, consider giving those patients the HPV vaccination based on data on the benefit of adjuvant HPV vaccination. ACOG recommends adherence to the current Centers for Disease Control and Prevention recommendation for vaccination for individuals aged 9 to 26 and to consider adjuvant HPV vaccination for immunocompetent previously unvaccinated people aged 27 to 45 years who are undergoing treatment for CIN2, end quote. Well, these people would otherwise be called women. So all to say is that ACOG is saying, look, there is data here that if they haven't received Gardasil 9 in the past due to the regular schedule, and we're not really clear if it's better to give it before the leap or after, but there is good data that giving it before the procedure so they have antibodies already on board to help fight the healing tissue, help keep the healing tissue healthy and prevent reinfection. There is data that giving this before for the leap anywhere from, you know, immediately before to up to a one to three months prior to cone or leap. That seems to be better, although we need more high quality studies to tell us that is what ACOG said in July of 2023. Okay, so it was settled. The science is settled. July of 2023. But I love this because watch this, this came out September 2025. Now let me read you just very quickly. They put that statement to the test. They took patients short of, short of it is multi center. A randomized. Very well done. Three injections of garden Sil nine or three injections of placebo and then whack. They whacked off part of the cervix for their leep or cone for treatment of CIN2. Very nicely done. Now let me just read you this and we're going to get into. Dissect this a little bit because this is totally flipping that practice guidance from July 2023 a little bit upside down. Now let me just be very clear. Nobody's issued a retraction. Nobody is saying not to do this. The current guidance from the college right now as of July 2023 is, yes, this is valid. At least consider telling these patients who had not yet received Gardasil 9 and undergoing some kind of cervical treatment, some kind of excisional treatment for CIN2 plus about vaccination. But let me read you this new publication from the Netherlands. All right, let me read this to you. Not the whole thing. Guys, we're in the intro. I gotta wheel it back because I'm still in the intro. Still. In the end, we're gonna get to it. That's why I want to set this up just right. Check this out. Quote, to our knowledge. So these are the authors writing about their study called the vaccin and vasin or vaccine, I don't know, basin vaccine, whatever. It doesn't have the E, which is a multi center phase 4 randomized placebo controlled trial. Where in the Netherlands? I don't know why I say it that way. Netherlands, I think. You know what? When I was. And I love the Netherlands, been there many times. As I said before, somebody actually told me that welcome to the Netherlands. And I said, say that again. And they said, to the Netherlands. And it's just stuck with me. I don't know. Who knows? That was like 15 years ago. And I still got it in my head. Anywho, my goodness gracious. Michael, what is happening? Oh, yeah. Okay, okay. All right. So I'm brought back. I'm brought back. Thank you. So here. So here we are. It goes away on my screen and I lose where I'm at. Thank you. So here we are. Quote, to our knowledge, these are the authors speaking. This is the largest double blinded placebo controlled trial on prophylactic HPV vaccination in women treated for CIN 2 to 3. Although previous studies. I'm still reading directly, Although previous studies, including meta Analyses and observational studies have shown that adjuvant HPV vaccination reduces the recurrence of cervical dysplasia after surgical treatment. Our trial suggests that adjuvant HPV vaccination is not effective in reducing the recurrence of CIN 2 to 3 lesions, contradicting conclusions of previous works and previous guidance. End quote. Yikes. Okay, let me say that again. Yikes. I mean, so, guys, now, I'm not telling you what to do. I am not. Remember our. We are called the no spin zone. I'm just giving. I'm just letting you know the data. You do you, honey. You do you, bruh. Because I. This is where shared decision making comes in. But. But this was perfectly timed with my pet peeve, which is science is settled. Science is settled. Never. So, according to this, brand new data just got published last week in a new journal. As they say in their separate paragraph, quote, Although our study has limitations, guidelines should be more reticent in recommending additional prophylactic HPV vaccination after treating CIN1. End quote. Wow. Oh, hold on. Did I say that word wrong? Think. Oh, Michael said. Say that again. Oh. Should be more reticent. I'm so sorry, guys. I grew up on the border. I grew up in the border of Texas and Mexico, so I put an R in there. Thank you. Thank you. So reticent. Reticent. Reticent. R E T. I, C E N T. That's not a word you use every day. Reticent. I'm going to tell my residents. You should be more reticent about that. I got to figure out if I'm using that right. In other words, should be more cognizant. Should be more restrictive, more mindful. Let me say that again. Quote. Although our study has limitations, guidelines should be more reticent in recommending additional prophylactic HPV vaccination after treating CIN lesions. End quote. Wow. That's the intro, guys. Now if you thought. If you're thinking, well, okay, I'm done. Okay, I get it. That Vascin or vaccine trial, something about the Netherlands came out in new journal. May not work after LEEP treatment. Okay, I got it. Good. No, no, no. Hold on. Let's take this. Get out of the intro. I'm gonna come back. I'm just gonna read a little bit more about the methods, how this was done, and we're gonna call it a day. But. Mind blowing. Mind blowing. Remember our three reasons why we're doing this? Number one, even though we focus on obstetrics got to know gynecology. Still, number two, science is never settled. It always is alive. It's how we do science. So these authors tested the science and said, no, I don't think the guidance is right. And then number three, this is not to tell you what to do if you want a patient who has not received Gardasil 9 in the past, who is getting a LEEP or a cone to receive it. Because there has been plenty of meta analyses and observational studies that have said that it can help prevent its recurrence, especially when done zero to three months before the procedure. Although there's still benefit to do in giving it based on those studies at time of the procedure or within about a month thereafter. We don't really know what the best timing is. This new publication is saying it's really not worth it because the primary indication we should have adhered to, which is for primary prevention. So once you've already been exposed, it is the natural healing process of the cervix itself. That's where we're going. The LEEP or the cone and the cervical remodeling and the healing and the cytokines and the inflammatory substances that helps clear the burden. So odd. So again, I'm not telling you what to do. I'm telling you. I'm giving you two conflicting pieces of information. I'm giving you practice advisory From July of 2023 that says this is an updated ACOG recommendation. ACOG recommends adherence to the current CDC recommendation for vaccination for 9 and 26 and even for 27 to 45 for those who are undergoing treatment for CIN2 plus and who are immunocompetent and unvaccinated. It's recommended to offer this vaccination as it seems to help prevent recurrence. This new publication is saying we're the largest to look at this and this is not what we saw. Super fascinating. Let's get out of the intro because I am looking and my producer on the screen saying he was giving me the you're out of time. I. I see. Relax. Let's get out of the intro. We'll be right back. Your teen adjective used to describe an individual whose spirit is unyielding, unconstrained, one who navigates life on their own terms, effortlessly. They do not always show up on time, but when they arrive, you notice an individual confident in their contradictions. They know the rules, but behave as if they do not exist. New Teen, the new fragrance by Miu Miu, defined by you. Tired of all The Spin in women's health education. Yeah, so are we. This is Dr. Chapa's OBGYN no Spin podcast. What can I get you? I'd like a large coffee. Okay. So hot coffee, hard coffee. Okay. Room for cream. Totally leave room for cream. Why are you talking like that? Why are you talking like that? Well, going to a coffee shop has become kind of an adventure and kind of an ordeal, hasn't it? I mean, from our beloved baristas who ask you if you want room for Coffee cafe. Room for cream. I can do it to just the ten dollar cup of coffee, y'. All. There's a better way. So I'm thankful that the Strong Coffee Company has partnered with our podcast. That is strong, as in striving to reach our natural greatness. Striving to reach our natural greatness. 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All right, yo, I've got four words for you before we get very quickly because I've kind of given the whole thing here in the intro. Very quickly, how this was done. Four quick words. Fascinating. Fascinating. Fascinating and good for these authors in the Netherlands, multi site randomized. These patients had, had. This was a good design. And they're like, I'm not seeing it here. I'm not seeing what everybody else saw in smaller RCTs, smaller prospective slash observational studies. I mean, we're just not seeing the results here that others did. It's remarkable. Now, once again, does this mean that ACOG is going to issue, you know, a new statement? I have no idea. I don't know. But it stands in stark contrast to the current recommendation from July of 2023. Now, again, it's fine. July 2023. That's the data that we had been. How many times in this show, guys, have I said, as of, this is what we know? Well, as of this day, and it is October 5, 2025, when we're recording this, the latest multi center randomized trial, Level one evidence that, that has looked at this periprocedural HPV vaccination and those not yet vaccinated undergoing treatment for CIN2 or above, it didn't seem to show any difference. Okay, fascinating. Now, if you're thinking, well, maybe it was a different vaccine. No, it was Gardasil 9. It's, it's the same one that's recommended by ACOG for this very treatment. It was three IM injections and it was done at a regular schedule. It was done at enrollment two months later and then six months after that. And the first vaccination, I'm reading directly from the methods here, the first vaccination, quote, was planned to be administered by a research nurse on the day of leap, but it could be accepted up to four weeks after the leap, once the pathology was confirmed in a C and treat case. End quote. All right, great. And so they had some variants here, like. Oh, that's, that's maybe why it didn't work. No, but it's still pretty perioperative in terms of when it was given. And remember, even in ACOG's guidance from July of 2023, it's very clear. It says, look, there is data that giving the vaccine zero to three months prior to the cone, rather than zero to 12 months after the cone leap. That seems to be more effective. However, quote, at this time, this is in ACOG's guidance. Now, the optimal timing of adjuvant HPV vaccination remains unknown. Large randomized control trials are needed to inform practice recommendations, end quote. That's from the college. Now notice what that says. Large randomized controlled trials. So amazingly, literally two years later, we have a large randomized controlled trial that said our P value was not good, our P value was above 0.5 and the confidence interval hovered and hugged 1, which showed there was no difference. Now, let me actually hedge that comment a little bit, okay? Because there is a difference, as I've said many times before, between statistical significance, which here there was no statistical significance, and the confidence interval crossed one, which means whatever they did find likely was chance, it wasn't a good result, was invalid, wasn't strong, there could be some clinical benefit. So let me just tell you right off the bat, we already know who got it and these are patients. Oh my gosh, you've got dysplasia. You need, you need to have some kind of cervical excision. Have you been vaccinated? No. Well, let's follow the guidance. Remember, this is the Netherlands. But let's follow general guidance from the CDC that says that you, if you get this, you can prevent recurrence. And they looked for this over a two year interval. Right? This was 20 more, 24 month follow up. All right, looking for a recurrence of CIN 2 to 3 and those who were treated and had vaccination versus those who were treated and had placebo. Okay, so yes, this was. They actually got, you know, failing injections because that would be placebo controlled. Now the clinical aspect here is that in those patients over the 24 month interval, the recurrence rates of CIN 2 to 3. So let me give you the numbers. In those who did not have vaccination but had placebo and were treated, it was 9% chance of recurrence, 9%. That was compared to those who were treated and, and who actually did have true vaccination, which was 6% recurrence. So it was less. Guys, I'm telling you just to be fair here, these authors said it's no good, it didn't work, it's not a big deal. The P value is not good. The confidence interval crossed one and all. That's valid. However, the absolute percentage difference was actually 3%. That's why they said there's no significant difference here compared to placebo. Now that is a classic. Guys, remember this is called a no spin podcast for a reason. I'm giving you the rebuttal to their conclusion, which is, hey, I'll take a 3% reduction, but damn, it's 3%. At least it wasn't a 0%. 3% is better. So if you tell the patient you have a 3% chance that better of not getting recurrence versus whether I give you this three month injection, you got the three time injection, you got to come back three different times or I don't. Is that valuable to you? I don't know. 3% recurrent. I'm telling you, I've got some patients like, I'll take my chance, man. I mean, remember, this wasn't about cancer. So it's not like these develop cancer. This is just in persistence of CA2 to 3. So put it in perspective. If this actually prevented true cancer, 3% chance, I'll take that. Nobody wants that. Nobody wants that. But it's CA2 to 3 recurrence okay, right now at the Home Depot shop fall savings and get up to 40% off select appliances like Frigidaire. Get ready for a season of hosting with the Frigidaire Stone Bake Pizza oven, the only oven that reaches 750 degrees for restaurant quality pizza in as little as two minutes. Start making hosting easier with fall appliance savings today at the Home Depot only when using Stone Bake Pizza Mode offer Valley October 2 through October 22 US only C store online for details. So I don't know, I'm just kind of hedging that bed a little bit. And those who were treated and had vaccination in this Netherlands study, the rate of recurrence was 6% compared to 9% in those who received placebo vaccination. So that the P value was not good. The p value was 0.11 with a confidence interval that literally hugged the point of 1, which means it pretty much chanced. Okay, the confidence interval, 95% confidence interval was 0.40 to 1.11. So 0.4 to 1.1 hugging one, which is like guys, no difference here. That is true. Based on statistics. It's a wash. Forget about it. Forget about. It's not a big deal. So while that is statistically true, is a 3% clinically valid. I don't know. I. I don't know if that's a big enough number to move anybody's needle. It's a 3% reduction compared to placebo for something that's not cancer. I mean Cin 2 to 3 and you're going to catch it later anyways. I, I don't know. So all I'm saying is I'm just trying to show here how we've got to keep up to date. If you read the July 2023 guidance and said got it. Those who are getting leaped and never had Gardasil give it because it's gonna help. All right, maybe. But this study, which according to the author's own verbiage is the largest multi center level one evidence which is challenging the current guidance. Maybe it doesn't. So let me tell you again. Let me read you the implication of all of the available evidence based on their study. And again, that's. That's where I messed up. That word. That is reticent. Reticent. Okay. Quote some clinical guidelines like acogs recommend additional prophylactic HPV vaccination after treating can lesions based on a lower level of evidence. Our study provides level one evidence that contradicts these Current guideline recommendations. Oh, no, you didn't. Although our study has limitations, guidelines should be more reticent in recommending additional profile. I'm sorry, I'm reading this and I got a pop up from Michael. Why do you have to do that? Let me answer. Let me just stop the script here for a minute. Let me. I do that because this is how I talk. So if you don't like it, you can cut it out later. I don't care. So I'm. I'm telling you because this is a big deal. This is changing. This is the biggest level one evidence that's saying maybe we shouldn't do it. And in a time. Oh, here we go. He's. Michael, you're not gonna like what's coming. Brace yourself, son. Here we go. In a time when medical professional organizations sound. This is me. This is. I'm not reading from anybody. This is Chop a soapbox. So brace yourselves. In a time when at times where some medical professional organization sounds more. Sound more like pharmaceutical commercials. Uh, oh, I just. What does the data say? What does the data say? Let's make it a no spin platform here. That's what we're trying to do. That's why we changed the whole name of Clinical Pearls, Although we still have Clinical Pearls, which will be going away soon. It's that if you stop questioning the science, like the July 2023 guidance from the college, like, I get it. It's all, we should give HPV vaccination for those who haven't had it before, who are immunocompetent and are undergoing cervical excision for CIN2 plus. That's what I'm supposed to do, according to this, which is, quote, challenging current guidances and recommendations, end quote. And calling for people to be more reticent in those recommendations, just to know that medicine and science keep moving forward. Personal note to Michael. Mike, just leave that in there. If you edit all that, I'm gonna be. I'm pissed. Just leave it in there. It's good conversation. So this study that we've covered. The title is Adjuvant Prophylactic Human Papilloma Vaccination for Prevention of Recurrent High Grade Cervical Intrapathil Lesion in Women Undergoing lesion surgical treatment, a multicenter Phase 4 randomized placebo control trial in the Netherlands. End quote, y'. All. That's the title. The short title is the Vasin Trial. V A C I N or vaccine. I don't know. Whatever. Vasin vaccine. I guess technically it's Vasin because it doesn't have the E. But that is the Vasin trial from the Lancet Obstetrics Gynecology in Women's Health. And that came out September 2025. Fascinating. So clinical recommendation. What do we do with this? Number one, talk to the patient and tell her science is never final testing. The science is how we do science. And there's some benefit, according to some studies, that this can help. But as of September 2025, with the largest multicenter, groundbreaking kind of randomized trial, it didn't really seem to help much. It was a 3% absolute reduction compared to placebo. And the probability that that was related to chance was there because the confidence interval crossed one. So having said that, and knowing that there was no adverse issues. Guys, let me just put it here. Nobody grew an extra eyeball because they received Gardasil with this trial, nor has anybody ever grown an extra eyeball because they received Gardasil. Gardasil, actually, as a vaccination has kind of, you know, evaded some of that vaccine controversies because there really hasn't been anything to it to that. So it doesn't seem to be an adverse event issue. But in terms of absolute benefit, this is challenging. Those current guidances that we have. Fascinating or what, y'? All. This is why you listen to our podcast. I hope, hope it's not for the asinine comments, but for the data, because I think we've done it just today. Question the science. That's how we do science. And this is living proof that sometimes you got to keep up to date to make the best informed, no spin recommendation for our patients. Podcast family, as always, we're thankful for you. We're glad you're part of our podcast community. Oh, my goodness. Poor Michael on my ski, shaking his head. There's nothing wrong with this episode. Nothing wrong with this episode. Now that we said all that, let's take it home. Podcast family, we're thankful for all of the support that you've given us throughout the years. This has been the OBGYN no Spin podcast. We'll see you on the next episode. Zoo.