Eight women meet monthly in a Sioux Falls neighborhood to play Bunco. As the dice roll, the neighbors and friends talk about personal issues, social issues and everything in between.
Children are a common topic. Between this group of eight mothers there are 15 daughters and nine sons. This night, they discuss whether or not their daughters should get the vaccine that protects against the human papilloma virus, or HPV.
"Let's face it, we don't know who our daughters' mates are going to be," says one mother. "Or their mates," says another.
"So let's take it a step further -- how do you know your daughter's not going to get raped?" asks Becky Keen.
Becky Keen has two daughters. One is in high school and the other in college. Both girls have talked to a doctor about HPV and they each received different advice.
The first doctor told her 20-year-old not to get the shot unless she intended to have sex before marriage. Then Keen took her younger daughter to a different doctor.
"I took Molly in and she (the doctor) was very proactive about it," says Keen. Seventy percent of sexually active women over the age of 30 have contracted some strain of HPV. Only two strains can cause cervical cancer. Often it's not something women know they even have.
“Let's face it, we don't know who our daughters' mates are going to be. ... and how do you know your daughter's not going to get raped?”Mothers discussing the HPV vaccine
"I see many women in their 40s who are having their first abnormal pap smear," says Dr. Maria Bell, a Sioux Falls gynecologist. "When I tell them this is related to a sexually transmitted disease, of course they are very concerned."
"They ask if their husband has been unfaithful, and other types of questions come up in the course of the conversation," says Dr. Bell. "I tell them there's no way we can tell if this is a new infection, newly acquired HPV or a reactivation of something you got in your 20s. There's no way for us to determine that."
As a result, Dr. Bell vaccinated her own 10-year old daughter. She was the first girl in South Dakota to receive the vaccine, which is called Gardasil.
"That's how strongly I feel about this vaccine. I didn't talk to her about the nitty gritty of HPV and sexually transmitted disease. I just told her this was a shot that will prevent a certain kind of cancer. That's true -- that's what it is," says Dr. Bell.
Dr. Matt Viel, a family practice physician in Edgerton, Minnesota, sees things very differently. He says kids at this age know more about sex than most people give them credit. He gives what some people call "the talk" to fifth grade boys.
"There were some boys there who, the vast majority, who really had no idea what we were talking about until we started talking. The other ends of the spectrum were those who felt they had already mastered the subject, and the whole spectrum in between," says Viel.
Viel is a conservative Christian. He promotes abstinence until marriage and a faithful marriage. He doesn't agree with government mandating a vaccine for a sexually transmitted disease. He says parents need to talk to their children so they don't learn about sex first on the playground.
Viel says if states do mandate the vaccine and don't pay for it, the people the states are trying to protect will be most at risk.
"Someone has to pay for it. By making parents responsible to pay for it, it puts the greatest burden on the portion of society who is most at risk, those in the lower and middle socio-economic classes," says Viel.
Viel says the best way to prevent cervical cancer is to promote regular screening -- regular pap smears. Each year, some 50 million pap smears are done in the United States. Seven percent of those require followup.
There is one other important factor to consider. Statistics show that for any vaccine to work, 80 percent to 90 percent of the population -- female and male -- needs to get the shot. But there isn't a vaccine for boys at this point, even though they can pass on the virus.
Dr. Maria Bell says that means all girls should have the vaccine. She says doctors need to do a better job of educating parents about the virus, the vaccine and the choices they have.