HPV vaccine and 1st time cervical cancer screening at 28 years old?

[Lande]

I'm 28, but I've never seen a gynecologist. There's a few reasons:

- I'm nonbinary and I would hate to be referred to as, or assumed to be, a woman. Coming out of is out of the question, so it's just something I would have to put up with.
- I'm also a lesbian and being assumed to be straight by default is not great either.
- I've never had sex with anyone and am not expecting that to change any time soon. (I'm not against the idea, it's just something that's not realistically going to happen at present.)
- I haven't ever had any serious sexual health issues.
- I'm anxious about the prospect, especially since I'm very old for a first time consultation and I've never had sex. I'm worried the gyn will scold or judge me.

However, I think it's important for me to get screened for cervical cancer and receive the HPV vaccine, just in case. So here's a few questions:

- How relevant is cervical cancer screening for someone who is sexually inactive? How likely am I to get this kind of cancer if I don't have sex?
- Is it too late for me to get the HPV vaccine? Would it even serve any purpose since I'm sexually inactive?
- I have very bushy and prominent pubic hair, as well as thick leg hair, and I never shave it. Should I shave for a gyn visit? I'm worried about being mocked or judged.
- I recall hearing about a different method for pap smears that is more comfortable than the "typical" method and involves laying on one's side, but I don't remember the details. Is this something that can be requested? Do all gyns know of it?

Thanks in advance!

[Latha]

Hi there, Lande!

Honestly, those are all understandable reasons for going to the gynecologist- still, it is important to get the healthcare you need. It's true that doctors' offices can be a bit cis/heteronormative- I wonder, would you be willing to come out if you found a progressive and respectful doctor who would respect the fact that you're nonbinary and a lesbian?

1. If you've never had any kind of sex (not just intercourse), your risk of developing cervical cancer is very low, but not zero. To my understanding, guidelines are different in different countries- it may be best to ask a doctor about your specific circumstances.

2. It isn't too late for you to get the HPV vaccine- it would help if you ever have sex, since you're not against the idea.

3. You don't have to shave. No decent doctor will judge you for having pubic hair or scold you for coming in for your first consultation at your age- that would be truly ridiculous and inappropriate behavior.

4. Pap smears shouldn't hurt- if the typical method feels uncomfortable, there are modifications you can make. You're right that you can lie on your side with your knees bent up towards your torso. You could also try these other positions:

• The “letter M”: knees bent and feet on the end of the exam table, thighs apart.

• The “letter V”: on your back with legs straight out on the table, separated in a V shape.

• The “diamond”: knees bent, soles of feet together with legs open in a diamond shape.

And if you experience too much discomfort or any pain, you could request that the doctor use a smaller speculum or that they give you a numbing cream or anti-spasm medication.

I hope this helps!

[Lande]

Thank you very much, this helps!

If I found an accepting gyn, I would be willing to come out to them, though I would prefer if the topic didn't come up at all. I feel like my gender/sexuality are very unusual and not at all easily explained by just saying "I'm a lesbian/nonbinary".

1. That's reassuring! I've never had any kind of partnered sex. You said the risk is very low but not zero. How could I develop cervical cancer in those circumstances? Just curious!

3. I agree, but I've heard so many horror stories about rude, judgmental or outright bigoted gyns that I'm very scared, especially since I'm 28. I feel like almost no one does their first consultation this late. That said, I remembered a patient-created list of recommended gyns, so I'll definitely take a look at it and try to find someone who sounds accepting.

[Nicole]

Hi Lande,

From my experience, my gynecologist never assumed or questioned my gender identity or sexual orientation. Although, as Latha said, they can be cis/heteronormative. If anything, when you get the paperwork from the office to fill out your personal information, you could include your pronouns if that makes you feel more comfortable. Aside from that, I don't think the doctor would inquire more about how you identify, I think they are more interested in knowing if you are sexually active. It could get complicated if they start asking about the possibility of pregnancy, but I feel like that conversation won't be necessary if you have never been sexually active.

From my understanding, cervical cancer develops from HPV, which is not only spread by any sexual contact but also by skin-to-skin contact. Here is one of our resources on HPV: The STI Files: Human Papillomavirus (HPV)
and one of our resources on the HPV vaccine: Mythbusting The HPV Vaccine.

Also, I think it's better "late" than never to see a gynecologist and take care of your body! There is absolutely no shame in that. I wish you luck on finding the right gynecologist and if you need help from us on that end, just feel free to ask!