Should HPV Vaccination Be Considered for Sexually Inactive Women?

The necessity of receiving the nine-valent vaccine for elderly individuals with no sexual experience?

Hello Dr.
Zhang, I am 44 years old and have never engaged in sexual intercourse, and I may not in the future.
This March, I was diagnosed with endometriosis after experiencing severe menstrual pain and heavy bleeding for two to three years.
I have been taking Danazol since then, and my menstruation has stopped.
Many people around me have cervical cancer, so I am concerned about whether I should receive the nine-valent HPV vaccine to increase my protection.
However, I have heard that getting vaccinated at 44 years old may provide limited protection.
I would like to ask:
1.
If I have never had sexual intercourse, is the likelihood of contracting the virus negligible, and therefore is there no need for vaccination? (I previously asked my gynecologist if I could have a Pap smear, as I found online that there are methods to collect samples without using a speculum for individuals without sexual experience, but my doctor firmly stated that a Pap smear is unnecessary without sexual experience, implying that there is no concern for cervical cancer.)
2.
If vaccination is still recommended, would you suggest having a Pap smear to check for any infections before getting vaccinated? If that is the case, and hospitals are unwilling to provide Pap smears for individuals without sexual experience, do you know if there are still services available to obtain an "HPV self-collection kit" at hospitals or health centers? (I have read online that this service has been discontinued in recent years due to poor effectiveness.
If that is the case, what other avenues do individuals in my situation have to prevent cervical cancer?)
I apologize for the lengthy questions, and I greatly appreciate your reading and advice!

s, 40~49 year old female. Ask Date: 2022/11/16

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, based on your description, the cervical cancer vaccine not only prevents cervical cancer but also provides protection against HPV-related cancers such as vaginal cancer, vulvar cancer, penile cancer, anal cancer, and genital warts.
HPV can cause lesions beyond cervical cancer through indirect means, not just sexual contact.
The vaccine offers better protective value for young individuals without sexual experience.
The previous belief that the cervical cancer vaccine could only be administered up to age 26 was due to early human trials being limited to that age; therefore, the government approved it only for individuals up to 26.
However, recent studies have confirmed that receiving the nine-valent HPV vaccine after age 26 still provides up to 89% effectiveness in preventing HPV infection, and any vaccination offers protection.
The cervical cancer vaccine can prevent cervical cancer for 10 to 20 years into the future, and it is difficult for individuals to predict their health status decades later.
You may consider these factors before deciding whether to get vaccinated.
Additionally, there is no requirement to undergo a Pap smear before vaccination; it is generally recommended to have regular screenings after becoming sexually active.
However, regular check-ups for other reproductive organs (such as the uterus, ovaries, and external genitalia) are still advised.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2022/11/16

More Info

When considering HPV vaccination for sexually inactive women, particularly in your case as a 44-year-old with a history of endometriosis, there are several important factors to consider regarding HPV infection risk, vaccination benefits, and cervical cancer prevention.

1. Risk of HPV Infection: It is true that the primary mode of transmission for HPV is through sexual contact. If you have never engaged in sexual activity, your risk of contracting HPV is significantly lower compared to sexually active individuals. However, it is important to note that HPV can also be transmitted through skin-to-skin contact in the genital area, which means that while your risk is low, it is not entirely absent. Additionally, HPV can be present in the body without causing symptoms or being detected, which is why regular screenings are recommended for sexually active individuals.

2. Vaccination Considerations: The HPV vaccine, particularly the nine-valent vaccine (Gardasil 9), is designed to protect against the most common high-risk HPV types that are associated with cervical cancer, as well as types that cause genital warts. While the vaccine is most effective when administered before the onset of sexual activity, it can still provide benefits to those who are older or have had previous exposure to HPV. The effectiveness of the vaccine may be reduced in individuals who have already been exposed to one or more of the HPV types covered by the vaccine, but it can still offer protection against types that you have not encountered.

3. Cervical Cancer Screening: Regarding cervical cancer screening, the general recommendation is that women begin Pap smear testing at age 21, regardless of sexual history. However, your gynecologist's stance on not needing a Pap test due to your lack of sexual experience is somewhat aligned with traditional guidelines, but it may not fully account for the potential risks associated with HPV. If you are considering vaccination, it may be prudent to discuss the possibility of a Pap test or HPV testing with your healthcare provider, as this could provide additional information about your cervical health.

4. Self-Testing Options: As for HPV self-testing kits, these have been explored in various healthcare settings, but their availability can vary by location and healthcare provider. If self-testing is not available, you might want to inquire about other preventive measures, such as maintaining regular gynecological check-ups and discussing your concerns with a healthcare provider who specializes in women's health.

5. Vaccination After 26: While the HPV vaccination is typically recommended for individuals up to age 26, many health organizations, including the CDC, now recommend vaccination for individuals up to age 45, particularly if they are at risk for new HPV infections. Given your concerns about cervical cancer and the prevalence of HPV in the population, getting vaccinated could still provide you with additional protection, even at your age.

In conclusion, while your risk of HPV infection may be low due to your sexual history, the benefits of vaccination and regular health screenings should not be overlooked. Discussing your concerns with a knowledgeable healthcare provider can help you make an informed decision about whether to pursue HPV vaccination and any necessary screenings. Regular check-ups and being proactive about your health are key components in preventing cervical cancer and maintaining overall well-being.

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