If You’re a Woman of a Certain Age, Beware the Risk of HPV

Key points

• Human papilloma virus, or HPV, is not only a problem of the young.
• HPV can lie dormant for decades and is easy to contract anew.
• Medical guidelines recommend discontinuing pap smears at age 65 if they’ve been negative for 10 years.
• If you’re sexually active, you may want to reconsider that recommendation.

Baby Boomers came of age during the Sexual Revolution and learned something both older and younger American cohorts missed: how not to use a condom. Between the invention of the birth control pill in 1960 and the AIDS epidemic in the 1980s, many then-young and now-older adults “learned” to have sex without condoms or fear of pregnancy.

Now, a recent study in BMJ Global Oncology found that women aged 65 and over had the most rapidly rising rates of Human Papilloma Virus (HPV) of any age cohort—and HPV causes more than 90 percent of cervical cancers.

Current pap smear guidelines recommend stopping pap smears altogether in women aged 65 or older with a ten-or-so-year history of normal paps. Stopping is recommended even if, decades before, a woman had abnormal results and/or HPV.

As ever-growing numbers of women live beyond 65, however, there are several things you may want to consider regarding paps and HPV:

• HPV, often dubbed “the common cold of sexual activity” has, does, or will affect about 80-85% of all sexually active women (and 90% of sexually active men) during their lifetimes.
• The virus has multiple strains, some more implicated in cervical cancer than others. Pap smears detect HPV and can identify which strain(s) are present.
• HPV generally leaves no visible symptoms (with the exception of genital warts, caused by lower risk strains of HPV), and can spread easily without knowing you carry it.
• HPV spreads through skin-to-skin contact, not semen or vaginal fluids. This means it can spread without penetrative sex.
• HPV can lie dormant for decades. The fact that it’s increasing most rapidly in women over 65 is probably due to a number of factors: lower condom use in this age group, dormant viruses “waking up” decades after initial infection, lack of HPV vaccinations, and other factors we don’t completely understand.
• Vaccines are highly effective for HPV and can be used even if one already has HPV—vaccines can protect against other strains of the virus a person does not have—but are not approved or recommended for adults over 60.
• A BMJ Global Oncology study of more than 2 million women found found that almost 14 percent of women over 65 had higher rates of severe HPV cervical changes (compared to less than 9 percent in younger women). This further puts older women at greater risk for cervical cancer from HPV.

If you think you may be at risk for HPV, a pap smear will give you the information you need. If your provider doesn’t recommend a pap smear because you’re over 65, let them know you’d like one anyway. If they resist, it may be time to find another provider—one you feel comfortable discussing sexual behavior with and one who makes you feel heard and respected.

And if you’re over 65 and have been or will be sexually active with a new partner, it may be time to learn to use condoms. (Learning new skills in older adulthood is good for our brains, as well as our bodies.) If condoms are a bridge too far (pun intended), one alternative is to get tested for HPV and ask any new partner to do the same. And if you do have HPV, don’t despair: HPV can be managed, monitored, and treated, and treatments are becoming easier and more effective all the time.

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