Human Papillomavirus Disease Prevention in the United States and Germany Among Gender Diverse Adults with a Cervix

Purpose: This study describes human papillomavirus (HPV) vaccination, cervical cancer screening (CCS), and HPV-related knowledge, attitudes, and behaviors among gender diverse adults with a cervix. Methods: This was an anonymous online survey of 1096 adults aged 25+ years who were assigned female sex at birth, have a cervix, had not identified as a woman for at least a year, and lived in the United States (U.S.) or Germany. The survey (April–October 2023) collected demographic information, gender identity, and HPV-related knowledge, beliefs, and behaviors, including sexual behaviors, HPV vaccination, and CCS. Descriptive statistics were generated and country differences explored with chi-square and Mann–Whitney U tests. Results: HPV-related risk behaviors were common: 42.8% reported penile–vaginal intercourse and 38.1% performed oral–vaginal sex in the past year. Sixty-one percent had had a health care provider recommend the HPV vaccine; 54.7% had been vaccinated. Vaccination was 1.6 times more common in United States ( p < 0.001). Unvaccinated U.S. respondents were more likely to believe that they were not at risk for cervical cancer (16.4% vs. 4.8%, p = 0.008). A total of 82.1% had a CCS in their lifetime, but only 64.5% had been screened since last identifying as a woman. CCS barriers centered on concerns about lack of gender-affirming care or discrimination related to gender identity, concerns which were more prevalent in Germany than the United States. Conclusion: Despite prevalent HPV risk behaviors, HPV vaccination and CCS rates were low in these gender diverse adults with a cervix, and there were notable country differences. Findings highlight the need for gender-neutral policies and gender-affirming health care practice.