title: Human Papillomavirus Vaccination and Sexual Disinhibition in Females: A Systematic Review.
abstract: Some parents believe human papillomavirus (HPV) vaccination increases the chance of risky sexual behaviors among adolescents. This review summarizes the evidence available on adolescent girls and women engaging in risky sexual activity following HPV vaccination.
  
  
  
  Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in 2014 and updated in 2015. Literature was searched for articles published between 2004 and 2015 in MEDLINE, PsycInfo, CINAHL, Cochrane Database, Web of Science, and EMBASE without language limits. Studies were screened according to predefined inclusion and exclusion criteria. Methodologic quality of the included articles was assessed.
  
  
  
  The search resulted in 21 articles to be included in the review, with 527,475 participants. Included studies were conducted in 12 different countries using experimental and observational study designs. The review included data on girls aged as young as 11 years to women aged 40 years. Studies measured changes in sexual behaviors using a variety of outcomes, including age at sexual debut; risky sexual behaviors; use of condoms and contraception; and clinical indicators such as rates of sexually transmitted infections, HIV, and pregnancy terminations. Available data showed either no association between vaccination status and the outcomes of interest or a positive association between safer sexual behaviors, such as condom use and receipt of HPV vaccination. Methodologic quality of all but one study was moderate or weak.
  
  
  
  This review did not find sufficient evidence to support compensatory sexual risk behaviors following HPV vaccination among adolescent girls or women.
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida; Public Health Research Institute of India, Mysore, Karnataka, India. Electronic address: pmadhiva@fiu.edu.
authors.forename: Purnima
authors.initials: P
authors.lastname: Madhivanan
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida.
authors.forename: Dudith
authors.initials: D
authors.lastname: Pierre-Victor
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida.
authors.forename: Soumyadeep
authors.initials: S
authors.lastname: Mukherjee
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida.
authors.forename: Prasad
authors.initials: P
authors.lastname: Bhoite
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida.
authors.forename: Brionna
authors.initials: B
authors.lastname: Powell
authors.affiliation: School of Podiatric Medicine, Barry University, Miami, Florida.
authors.forename: Naomie
authors.initials: N
authors.lastname: Jean-Baptiste
authors.affiliation: Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida.
authors.forename: Rachel
authors.initials: R
authors.lastname: Clarke
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida.
authors.forename: Tenesha
authors.initials: T
authors.lastname: Avent
authors.affiliation: Public Health Research Institute of India, Mysore, Karnataka, India; Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida.
authors.forename: Karl
authors.initials: K
authors.lastname: Krupp
mesh_terms: D005260:Female; D014943:Global Health; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012309:Risk-Taking; D021841:Safe Sex; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D014611:Vaccination / Q000523:psychology*
chemical_list: D053918:Papillomavirus Vaccines