I’m 44, never married, and expect to have new sex partners in the future. In that, I'm not alone: According to the U.S. Census Bureau, there were 3.5 million Americans aged 40-44 who have never been married in 2018. Adding in people who are divorced, widowed or separated, that number of unmarried people around my age swells to 6.5 million — or 35.7 percent of all people in that age group.
And that's just those who are single right now: As our society has moved away from lifetime marriage and monogamy, a large number of people my age and older have the potential to engage with new sex partners in the future.
But none of us has had access to the HPV vaccine before now. Gardasil (which has no generic version) was approved in 2006 for women ages nine to 26 to protect against four strains of the virus, two of which caused genital warts and two of which caused cancer; then 32, I was too old to qualify. (The approval was extended to men ages nine to 26 in 2009.)
Thanks, however, to a October 2018 decision by the Food & Drug Administration, women and men aged 27 through 45 finally have the opportunity to obtain Gardasil 9 (the latest version of the vaccine) protect ourselves from nine of the 200 strains of human papilloma virus, some of which are spread through vaginal, anal or oral sex and cause warts and cancer. This means that people between the ages of 38 and 45, who were above the age limit in 2006, can now get vaccinated.
Thus, I’ve begun the 3-shot course of Gardasil 9.
Anyone like me who missed the age window previously might think they do not need protection from HPV because they have already been exposed to various HPV types, have suffered no consequences or are in a committed relationship with no plans to have a new sex partner.
However, the Centers for Disease Control reports HPV is so common that nearly all sexually active men and women get the virus at some point in their lives. While most people can mount an immune response to a single HPV virus and clear it within a year, sometimes more virulent strains take 24 months or longer to go away.
And several recent studies have shown that older women remain at risk of HPV infection due to their sexual activity. In Canada, where there is no upper age limit for the HPV vaccine, health providers have warned about the risk of HPV in populations over age 40 because lifetime monogamy to one person is no longer the statistical norm. A 2017 U.S. study published in the American Journal of Preventive Medicine found that women close to age 65 are less likely to get screened for HPV. In Sweden, where women are not screened regularly after 60, 30 percent of cervical cancers present in that population.
By getting the HPV vaccine now, young Gen Xers can prevent avoid HPV infections later life.
For me, an HPV infection is not merely a possibility; it’s already happened. I was in my 20s when my Pap smear results showed that I had been infected with a strain of high-risk HPV. High-risk HPVs — of which there are 15 types — can cause cancer in any part of the body with cells affected by HPV, including the cervix, oropharynx (including the soft palate, the base of the tongue, and the tonsils), anus, rectum, penis, vagina and vulva.
According to the National Cancer Institute, high-risk HPVs cause 43,000 HPV-related cancers each year in the United States, which is 3 percent of all cancers in women and 2 percent of all cancers in men. It also causes cervical cancer, the 14th most-common cancer in the U.S., as well as anal cancer, which actress Marcia Cross has recently battled.
A 2019 study published in published in Cancer Epidemiology, Biomarkers & Prevention, found that the vaccine decreased infections of two high-risk HPV strains, leading to a smaller proportion of cervical disease.
Though my high-risk HPV was caught in time, my treatment was sufficiently unpleasant that I wish I could have received a vaccine to avoid it. After my diagnosis, I had several colposcopies — cervical biopsies — as the virus lingered in my body.
My infection also caused sufficient irregular cells (dysplasia, in the parlance) that I had to undergo a Loop Electrosurgical Excision Procedure, a surgery during which my doctor used an electrified wire to scrape away the bad cells from my cervix; I was under general anesthesia, though today LEEPs may be performed using local anesthesia.
There are potential long-term side effects to LEEPs: Some women to experience loss of sexual pleasure, and multiple cervical procedures can increase risks for cervical insufficiency, a significant risk factor for miscarriage.
Thankfully, my high-risk HPV infection was caught through routine screening, treated and never developed into cancer. Some women, however, do not get regular screenings. And, for heterosexual men, there is no HPV test and no currently available treatment. For men who have sex with men, some doctors recommend annual anal cancer testing via anal Pap smears. Otherwise, unless men are told about an infection by a partner, they may not know they have been exposed until cancer develops.
Anyone under 45 who plans to be sexually active in the future should not miss this window of opportunity and should take action before reaching the age cutoff. Talk to your doctor or pharmacist about getting the HPV vaccine. Three shots, a copay and some shoulder soreness are a small price to pay to be inoculated from cancer-causing viruses.