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Dear Dr. Roach: I would like a clear reason why older women who are not infected with HPV are not offered the HPV vaccination. I am a 65-year-old woman who was married close to 40 years. My spouse died six years ago. He was my only partner my entire life, until his death. I verified through my OB/GYN that I was HPV-negative until recently. I am in a monogamous relationship with a gentleman I met two years ago. Before we began our relationship, he agreed to a full exam and was tested for AIDS, etc. All tests were negative. However, I am now positive for HPV and am not happy. Why was I not offered the vaccine? Should I get a hysterectomy, even though my doctor has performed a colposcopy, which shows no adverse tissue at this time?

D.F.

Dear D.F.: The most recent data on the HPV vaccine shows continued protection for women who were immunized at the recommended age (11-13) from the HPV infections that lead to cervical cancer. I strongly recommend this vaccine, which also may protect against other HPV-related cancers, for both males and females. It may be given up to age 26.

There is no data, as far as I can find, about the safety and effectiveness of the vaccine for a 65-year-old woman. Most women in their 60s already have been exposed to the virus, which would make the vaccine much less effective, if at all. (That’s why it’s recommended to be given to boys and girls before the onset of sexual activity.)

My guess is that for those few women who have not already been exposed to the virus, it is likely to be effective and unlikely to be harmful. However, the risk of developing cervical cancer is very small, and regular screening tests almost certainly are more cost-efficient in older women.

The vaccine is not indicated for women over 26 by the Food and Drug Administration, meaning it would be given “off-label” at the discretion of your physician. A woman in your situation certainly would have to pay for it out of pocket (about $600 in the United States).

As far as hysterectomy, that is not appropriate at this time. Most women get over the infection without treatment, and you should follow up as your doctor recommends.

Dear Dr. Roach: I’m a 20-year-old woman. I have had intense abdominal pains during my periods for the past five or six months. These are not regular cramps; it’s like flashes of rippling pain.

H.R.R.

Dear H.R.R.: Cramping during menstruation is very common, and the pain can go from mild to debilitating. Dysmenorrhea (from the Greek roots for “painful menstruation”) is a common cause of missed work. Cramps often, but not always, can be treated with anti-inflammatory medications. Hormone therapies, such as birth-control pills, are very helpful for some women with moderate to severe symptoms.

I also would be concerned about the possibility of endometriosis. In endometriosis, cells that normally line the uterus have migrated to different parts of the pelvis and abdomen (and sometimes in rare places, like the lungs, breast or bones).

The most common reasons women with endometriosis seek care from the gynecologist are pain (especially during menses or sex), infertility or an ovarian mass. If the endometriosis is affecting the intestines, that might explain why you are having this kind of abdominal cramping.

It is not easy to make a diagnosis, because many conditions have similar symptoms. I recommend that you see an expert on women’s issues, such as a gynecologist, a general physician or a nurse practitioner with expertise in women’s health.

Email questions to ToYourGoodHealth@med.cornell.edu.

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