Dear Surly Amy,

I’m (very nearly) a 30 year old woman who has only had a handful of sexual partners in my life; only one of them entailing vaginal penetration. The HPV vaccine came out in my early 20s and when my doctor found out I was already sexually active he shrugged off the idea of even giving it to me. This didn’t seem entirely logical to me at the time and it still doesn’t seem to make the most sense. Wouldn’t it be a situation of ‘better safe then sorry!’ and just best to give it to me? My insurance should (shitty as it is!) cover it and failing that it can’t be -that- expensive! So my question really is: Is there any benefit in pressuring my doctor into giving me the HPV vaccine now or or is it really a situation where I shouldn’t bother? Having read many of your past Ask Surly posts I see you’re way more well connected with doctor types then me and with my social anxiety it really is that hard for me to pick up the phone and ask my doctor this question.

~Otokogoroshi

Dear Otokogoroshi,

We have addressed a similar issue here as an Ask Surly Amy question in the past. The question was phrased a bit different at that time and was essentially should moms get the vaccine for their sons and daughters? The answer to that question was a resounding yes. So I am not going to go into any detail about the benefits of the vaccine in terms of a preventative measure in children and young adults. You can read the prior post for that information if you so desire. Long story short – for young people yes, it is an important vaccine.

However, based on your age and sexual activity, what your doctor is saying is not at all outside the realm of what the CDC and the WHO is saying in terms of recommendation:

CDC continues to recommend the vaccination of 11 and 12 year old girls with 3 doses of vaccine to prevent the types of HPV that most commonly cause cervical cancer and genital warts. The vaccine is also recommended for girls and women ages 13 through 26 who did not get any or all of the doses when they were younger.

Additionally, Gardasil protects males against most genital warts. This vaccine is available for boys and men, 9 through 26 years of age.

There is not a lot of evidence to judge effectiveness of the vaccine in sexually active men and women over the age of 26. The vaccine was developed and studied for use in young adults. The verdict seems to still be out as to whether there is benefit in adults who are still sexually active. If you do decide to get the vaccine, you will most likely only suffer a sore arm. However again, this vaccine has really only been studied and deemed effective (to my knowledge) as a preventive measure, protecting against genital warts and cervical cancer in young men and women. It would have seemed reasonable to give you the vaccine when you were younger, but is quite reasonable not to recommend it now.

If you still feel uncomfortable with your doctor’s advice please seek a second opinion at a women’s health clinic or see another MD. I understand that you feel uneasy discussing this sort of thing in person, many people do but rest assured that doctors get these types of questions everyday. If discussing this on the phone or in person is really difficult for you – try emailing your doctor. My personal advice? Continue regular cervical cancer screenings, if you have sex, have protected sex, and follow the recommendation of your MD or seek a second, qualified opinion.

Got a question you would like some Surly-Skepchick advice on? Send it in! We won’t publish your real name, unless you want us to and creative pseudonyms get bonus points! Just use the contact link on the top left of the page.

Amy Roth

Amy Roth

Amy Davis Roth (aka Surly Amy) is a multimedia artist who resides in Los Angeles, California. She makes Surly-Ramics and writes about vegan food. She is the founder and president of the Los Angeles Women's Atheist and Agnostic Group: LAWAAG. Follow her on twitter: @SurlyAmy or on Google+.

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17 Comments

  1. Avatar of Curious Chloride
    January 16, 2012 at 2:09 pm —

    I’m no expert at all, but I always thought that the vaccine was tested on, and given to, young adults not because of any special quality of them being young, but to ensure they were vaccinated BEFORE becoming sexually active (and hence possibly getting the virus). I don’t believe the vaccine does anything once you have been infected (otherwise they would have been vaccinating everyone, everywhere). By that logic, someone that hasn’t been sexually active, and therefore is not likely to have the virus, should benefit from the vaccine, regardless of age.

    Again, I’m no expert and would appreciate if I was corrected on this.

    • Avatar of Amy Roth
      January 16, 2012 at 2:15 pm —

      Yeah that seems accurate But still, no one is recommending it for people over the age of 26. I am assuming it is because they haven’t tested it’s efficacy on that age group.

      • Avatar of Elyse
        January 16, 2012 at 2:21 pm —

        I believe you can still get the vaccine if you haven’t had sexual contact with anyone and you’re over 26.

    • Avatar of Amy Roth
      January 16, 2012 at 2:19 pm —

      And I apologize if I made “being young” sound magical. It is because it is a preventative vaccine.

  2. Avatar of Curious Chloride
    January 16, 2012 at 2:38 pm —

    Study Does Not Support HPV Vaccine in Older Women
    (from: http://www.medscape.com/viewarticle/717140)

    “The HPV vaccines that are available now are prophylactic,” Dr. Rodríguez told Medscape Oncology. “They can only prevent getting infected; they do not treat infections that are already present. In a given population with an average age at first sexual intercourse of around 15 to 17 years, to vaccinate women after the age of 30 is not cost-efficient.”

    Again, everything in the article is again based on sexual activity and the presence of HPV already. No one seems to discuss older, but not yet sexually active women.

  3. Avatar of kagehi
    January 16, 2012 at 2:39 pm —

    Yeah, have to go with the, “Is recommended for people who might not yet have been exposed.”, thing the rest said. Vaccines are vaccines, either they do what they are supposed to, or they don’t. Age wouldn’t be relevant unless you a) already caught it and b) succeeded in being one of those that fought it off, or where relatively unaffected. And, you can’t be certain that something else won’t effect your health, temporary or otherwise, resulting in *higher* susceptibility.

    Having a doctor tell someone that it isn’t helpful is, to me, right up there with having a dentist say, “Don’t worry about brushing, you will die before your teeth rot anyway, at your age.”, to someone in their 80s.

    Key point – While it might not necessarily be likely, there isn’t anything keeping a 30 year old from being exposed, then happening to sleep with someone later that *is* in the upper end of that age range, or for someone closer to that range to become exposed, via someone else’s exposure, then breaking up, and dating someone even younger, etc. Its preventative for everyone, not just the person taking it. Since you might know what you are doing in bed, but not necessarily what the few people you have in there with you are doing some place else, or before, or after, you where dating them. I would think those things need to be at least considered, rather than only looking at your own personal risk.

  4. Avatar of Melissa
    January 16, 2012 at 3:03 pm —

    I’m 37 and I got my first 2 of the 3 HPV shots last year. My doctor explained to me she thinks the only reason it’s only recommended to younger people is because that was the age group used for the clinical trials.
    It doesn’t make sense to me why doctors would recommend against getting the shot just because it hasn’t been tested for efficacy in your age group. If it’s possible to contract HPV at any age, then isn’t it reasonable to offer the vaccine at any age?

    • Avatar of Melissa
      January 16, 2012 at 3:11 pm —

      BTW, I got the HPV vaccine basically just as a big ‘fuck you’ to Michelle Bachmann. I do what I can.

  5. Avatar of weatherwax
    January 16, 2012 at 10:26 pm —

    This is a question I’ve had myself as an adult male, so thank you.

  6. Avatar of DebGod
    January 16, 2012 at 11:35 pm —

    I was 30 years old when I paid out-of-pocket for the HPV vaccine before becoming for-reals sexually active. I did a lot of research and learned the following:

    - Curious Chloride is right. The assumption is that anyone over 26 has already been sexually active. But if you’re not, there doesn’t seem to be a reason to think that the vaccine would be less effective (so the doctors told me).

    - The “probably” comes from the fact that the vaccine wasn’t tested on women older than 26. Again, the assumption is that just about everyone is sexually active by 26 and therefore has already been exposed.

    - Good luck getting your insurance company to pay! They don’t like paying for things they don’t need to. Since the vaccine was tested and approved for women age 9-26, my insurance company argued that it wasn’t approved for my age group and refused to contribute to the costs. I even found a doctor to argue with them about the whole not-sexually-active-yet thing. Didn’t work. I called Gardasil and Merck to try to get a voucher to help cover the cost. That didn’t work either; they said heck no as long as I’m over 26. (Not sure if the rules are different outside of the U.S.)

    - At my clinic in NY State, the cost was $150 per shot, and there are three shots overall. That, plus my $30 copay for each visit, was a bit pricey for me, but it seemed worth it. Cervical cancer, not good. Again, good luck with your insurance company!

  7. Avatar of Siveambrai
    January 17, 2012 at 12:21 pm —

    Please correct me if I’m wrong but isn’t HPV a type of virus with many forms, like the rhinovirus and the flu? I got stuck at the very edge of the upper limit because my doctors said that it was likely I already had some HPV exposure but inoculating myself against the ones I hadn’t been exposed to was a good idea.

    Different doctors told my younger sister the same thing. And she most def had been exposed.

    Good luck with the shots and insurance though. I just squeaked in at the age limit. If I had missed a shot it would have been $250 for each shot after in the series plus whatever visit fees.

    • Avatar of pciszek
      January 20, 2012 at 3:45 pm —

      There are indeed many strains of HPV. Supposedly the vaccine protects you against the ones that are known to cause such nastiness as cervical cancer and genital warts.

  8. Avatar of pciszek
    January 18, 2012 at 6:35 am —

    As I understand it, a larger fraction, but not all, sexually active adults have the relevant strains of HPV. I would think the issue would be “Are you already infected?”, and if you aren’t, you would want the vaccine. If there is no easy way to tell if you are already infected, why not get it anyway? The vaccine would be pointless only if you knew you were already infected.

  9. Avatar of sabell
    January 19, 2012 at 5:24 pm —

    I love the discussion thread about my question (I don’t know why I didn’t use Otokogoroshi as my screen name here, I use it damn near everywhere else!!).

    Considering I haven’t contracted HPV yet I’ll try to argue with my insurance about getting covered for it. My new doctor is a bajillion times better then my old one (the one who blew me off) so hopefully she’ll be very understanding.

    It’s a little funny to discuss my sexlife in an open forum like this but I’m not shy about much. :P It’s a natural healthy thing so no need for shame!

  10. Avatar of Jack99
    January 21, 2012 at 6:39 pm —

    I only just ran this one by my wife (an MD):

    “WHAT?! YES, GET IT!”

    Extra info:

    1 Logically, sexual activity is the relevant factor, not age
    2 Vaginal intercourse is not necessary to catch HPV, as any skin to skin contact is sufficient.
    3 Studies have been done on Cerverix from ages 26 to 46 and recommendations to Australian doctors do support vaccination at these ages.

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