Is the HPV Vaccine Necessary for 44-Year-Old Women with No Sexual Experience?

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 had sexual intercourse, and I may not have it in the future.
In March of this year, I was diagnosed with endometriosis after experiencing severe menstrual pain and heavy bleeding for two to three years.
I have been taking medication for endometriosis, which has stopped my menstruation.
Many people around me have been diagnosed with cervical cancer, and 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 offer limited protection.
I would like to ask:
(1) If I have never had sexual intercourse, is the risk of contracting the virus negligible, making vaccination unnecessary? I previously asked my gynecologist if I could have a Pap smear, as I found online that there are methods to collect samples without a speculum for individuals without sexual experience.
However, my doctor firmly stated that a Pap smear is not needed for someone without sexual experience, implying that there is no concern for cervical cancer.
(2) If vaccination is still recommended, should I have a Pap smear before getting vaccinated to confirm whether I have an infection? If that is the case, and hospitals are unwilling to provide Pap smears for individuals without sexual experience, do hospitals or health centers currently offer "HPV self-collection kits"? I read online that this service has been discontinued in recent years due to poor effectiveness.
If that is the case, what other options do individuals in my situation have to prevent cervical cancer?
I apologize for the lengthy questions, and I greatly appreciate your reading and suggestions!

s, 40~49 year old female. Ask Date: 2022/11/17

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 who have not yet engaged in sexual activity.
In the past, it was believed that the cervical cancer vaccine could only be administered up to the age of 26 because early human trials only included participants up to that age, leading the government to approve it for that age limit.
However, recent studies have confirmed that individuals over 26 years old can still receive the nine-valent HPV vaccine, with an effectiveness rate of up to 89% in preventing HPV infections.
As long as vaccination is received, there is 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 want to consider these factors before deciding whether to get vaccinated.
Additionally, there is no requirement for 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: 2022/11/17

More Info

The decision to receive the HPV vaccine, particularly for a 44-year-old woman with no sexual experience, involves several considerations. Let's break down your questions and concerns.

1. Risk of HPV Infection: While it is true that HPV is primarily transmitted through sexual contact, it is important to note that HPV can also be transmitted through skin-to-skin contact in the genital area. Therefore, while your risk of contracting HPV may be lower without sexual experience, it is not entirely negligible. Additionally, HPV is quite common, and many people who are sexually active may not even know they are infected. The vaccine is designed to provide protection against the most common high-risk HPV types that can lead to cervical cancer, as well as other HPV-related cancers.

2. Need for Vaccination: The HPV vaccine is recommended for individuals up to age 45, and studies have shown that even those over the age of 26 can still benefit from vaccination. Research indicates that the vaccine can provide significant protection against HPV-related diseases, even in older adults. Although the efficacy may be somewhat reduced compared to younger populations, it is still worthwhile to consider vaccination as a preventive measure against potential future risks.

3. Pap Smear Testing: Regarding the necessity of a Pap smear before vaccination, it is generally not required to have a Pap test prior to receiving the HPV vaccine. The vaccine is effective regardless of whether an individual has had a Pap test. However, regular Pap smears are recommended for women starting at age 21, regardless of sexual history, to screen for cervical cancer. Your gynecologist's recommendation against a Pap smear due to your lack of sexual experience may reflect a common belief, but it is important to discuss this further with your healthcare provider, as guidelines suggest that all women should be screened.

4. Self-Testing for HPV: As for self-collection kits for HPV testing, these have been available in some regions, but their availability can vary. It's worth checking with local health departments or clinics to see if they offer such services. If self-testing is not available, you may want to explore other clinics or healthcare providers that might offer HPV testing options.

5. Preventing Cervical Cancer: In addition to vaccination, maintaining regular gynecological check-ups and screenings is crucial for early detection of any abnormalities. Even without sexual experience, being proactive about your health through regular check-ups can help catch any potential issues early on.

In summary, while your risk of HPV infection may be lower due to your lack of sexual experience, the HPV vaccine can still provide valuable protection against cervical cancer and other HPV-related diseases. It is advisable to discuss your concerns with a healthcare provider who can provide personalized recommendations based on your medical history and current health status. Regular screenings and preventive measures are key components of maintaining reproductive health, regardless of sexual history.

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