Respectability ruptured: embodied risk, moral labor, and clinic encounters

This section traces the pre-diagnostic and early diagnostic moment in which HPV is largely imagined as a risk belonging to others rather than to the self. Before diagnosis or before exposure through a close other, HPV remains an abstract hazard, projected onto “other women” imagined as less careful or respectable. Risk is thus located outside participants’ own bodies and biographies, drawing moral and relational boundaries as much as biological ones (Nack Reference Nack2008). Diagnosis marks a turning point in this process, rendering the virus personally legible and transforming an externalized risk into a proximate moral event.

The distinction between the self and the imagined “other woman” reproduces longstanding hierarchies of respectability. Participants map risk onto figures marked by sexual and moral deviance, revealing the classed and gendered underpinnings of respectable femininity (Skeggs Reference Skeggs2002). While some participants question moral judgments around HPV, others reproduce them. Boundaries are drawn between the “self” and the imagined “risky other” like sex workers, women with multiple partners, or those seen as reckless. Taken together, these distinctions reflect what Braun and Gavey (Reference Braun and Gavey1999) describe as the binary between “worthy” and “risky” femininity, a moral sorting mechanism that privatizes blame and erases structural conditions. These boundary-making practices are not merely attitudinal; rather, they are sustained by medicalization, as clinical categories and routines stabilize moral hierarchies around sexuality, positioning women’s bodies as the preferred site of surveillance and correction (Tiefer Reference Tiefer1996).

For women who have invested in normative feminine performances such as monogamy, sexual restraint, and emotional labor, the diagnosis destabilized their symbolic claims to purity. “I was pür-i pâk,” said Feride, mobilizing an Ottoman–Persian idiom (pür “entirely” + pâk “clean”) to stake a claim to moral purity within respectability politics (aged thirty-six years, university graduate, partnered). Her self-perception rested not on medical invulnerability but on adherence to cultural ideals of sexual virtue. The diagnostic moment thus marked a symbolic rupture, one that challenged one’s place within the symbolic order of “good womanhood” (Lupton Reference Lupton1993).

This rupture had consequences. The virus recalibrated how women felt in and about their bodies: it was no longer an external hazard but an internal vulnerability demanding ongoing vigilance. Participants described scanning their bodies, calendars, and fluids; re-reading sensations; and moving from episodic checkups to self-surveillance. The body became a ledger where risk and responsibility were recorded, and women were positioned as both those who have failed to prevent infection and the sole agents tasked with preventing onward transmission (Kavanagh and Broom Reference Kavanagh and Broom1998). Moral labor thus attached to the body as both “proof of failure” and terrain of repair.

Repair scripts followed gendered lines. Self-imposed abstinence surfaced repeatedly, not as physician-mandated but as moral containment and restitution. “Don’t do it. You won’t die if you don’t have sex,” said Ayla (aged thirty-two years, university graduate, unpartnered). Abstinence operated as public responsibility and private self-control, thereby privatizing psychic, physical, and sexual costs. Several postponed intimacy “until [they are] sure,” which extended anxiety. Alongside abstinence, participants adopted caution routines: insisting on condoms during testing windows, tightening schedules for Pap and HPV retests, avoiding casual touch read as sexualized, and distancing from prior social settings.

After the first shock, many described a shift. Information seeking and conversations in feminist or peer networks softened the judging voice. This was not a clean break; negotiation continued. HPV was recasted as common rather than a moral verdict, yet shame returned in softer episodes. Practice moved from self-punitive repair to pragmatic risk management – timed follow-ups, partner testing, and boundary setting. Several named the “good woman” ideal as gendered pressure crystallized by HPV, even as family expectations and clinical admonishment continued to shape choices. Ambivalence remained: they knew it was social moralizing, yet they still felt its pull.

This negotiation was reinforced in clinics, where routine procedures often functioned as respectability tests that turned bodily risk into a moral file. Thin privacy and crowding produced stress and disengagement rather than care: “Every visit meant about five hours of waiting … doctors didn’t really attend,” recalled Rüya (aged twenty-four years, university student, partnered). Intimate information was sometimes handled publicly, sorting women by respectability in real time. Kardelen, an assistant in a gynecology clinic, could not obtain testing at her private workplace and went to a public hospital for cost reasons (aged thirty-three years, PhD student, partnered). She described the environment as, “three of us are lined up with the same diagnosis, and the doctor explains my next steps in front of them” (aged thirty-three years, PhD student, partnered). At other moments, the patient became a teaching display: “They brought many people to look: ‘this patient has HPV,’” said Burcu (aged twenty-eight years, PhD student, partnered).

Gatekeeping also operated through language. A clinician’s first question, “Are you married?” functioned as a legitimacy filter rather than a clinical need. “What does that determine? I was tired of hearing it,” said Gamze (aged twenty-two years, university student, partnered). In some rooms, admonishment policed femininity and relocated responsibility onto women. A senior professor told Leyla, “If you sleep around like that … if you don’t protect yourself … hygiene … do I have to teach you that?” – a case of norm-setting that converted counsel into moral judgment (aged twenty-seven years, university graduate, partnered) (Foucault Reference Foucault1978).

There were also counterexamples that de-moralized risk and re-centered the patient. After changing her doctor and hospital, Rüya described a different encounter: “Do not think about whether you will transmit it to a man or not; focus on your present risk,” the clinician advised (aged twenty-four years, university student, partnered). This reframing helped her choose next steps without drowning in guilt. Even here, gendered responsibility did not disappear. The clinician prioritized Rüya’s health and lowered the expectation that she should manage men’s risk, but the broader framing of HPV as women’s responsibility remained unchallenged. Overall, routine practices rendered sexual risk morally legible and shifted labor onto women; rare alternatives softened the load without undoing its gendered terms.

Privatized care, gendered responsibility: the unequal burden of managing HPV

In the wake of diagnosis, participants did not perceive themselves as passive recipients of biomedical information but as morally accountable actors, expected to manage both their own risk and that of others (Rose Reference Rose2007). This responsibilization was deeply gendered: women internalized the duty not only to seek follow-up care and conduct personal research, but also to disclose their diagnosis – an act experienced as ethically necessary, emotionally taxing, and socially asymmetrical. They were positioned as the “knowers” who must disclose, since HPV and STI screening regimes focused predominantly on women. As a consequence, women carried both the responsibility to tell and the risk of rejection, whereas men largely did not share this burden.

Participants emphasized timing: disclosure should occur when sex was likely but not yet underway, so consent was informed and rejection did not land mid-intimacy. Burcu put it simply: “there’s no point saying it later” when chemistry shifts “from friendship to something else” (aged twenty-eight years, PhD student, partnered). She described disclosure at that moment as a moral obligation (boynumun borcu – literally “a debt on my neck”). Eylül endorsed a risk-based norm in which the knower enables the other’s informed choice: “if there is any risk, we should tell, so the other can decide” (aged thirty-three years, PhD graduate, unpartnered). Many echoed phrases such as “responsibility to tell” and “the right to know,” which, under conditions of knowledge asymmetry, fell more often to women and men respectively. For some, including Ayla (aged thirty-two years, university graduate, unpartnered) and Eylül (aged thirty-three years, PhD graduate, unpartnered), this duty extended into self-restriction until uncertainty cleared, such as avoiding new partners, abstaining, or delaying intimacy. Candan identified fear of disclosure as the main reason for avoiding new relationships (aged twenty-six years, university graduate, unpartnered). Like Candan, most participants felt responsible for informing potential partners yet remained uncomfortable doing so.

Such narratives reflect a gendered economy of care around sexual health: women carry emotional labor, risk management, and ethical responsibility, while many male partners remain disengaged, uninformed, or dismissive. İrem recalled a partner who mentioned prior genital warts only after sex, who said “warts don’t cause cancer,” and refused testing, claiming HPV “doesn’t affect men that much anyway” (aged thirty-three years, university graduate, unpartnered). These moments align with what Tronto (Reference Tronto1993) terms “privileged irresponsibility,” where men are excused from knowledge and accountability and women absorb the psychosocial costs of shared risk.

Participants frequently linked HPV care to hormonal contraception, another domain in which responsibility fell disproportionately on women. Like contraception, managing HPV became part of a broader moral script of feminine respectability, in which being a “good woman” meant being informed, cautious, and self-sacrificing (Braun and Gavey Reference Braun and Gavey1999; Nack Reference Nack2002). Women described finding themselves explaining the virus, educating partners, anticipating reactions, and buffering emotional fallout. “In every relationship, I was the one explaining it,” Suzan said (aged twenty-eight years, university graduate, unpartnered). “It always fell on me.”

Participants framed this uptake not as choice but as the only workable path, given low trust that male partners or institutions would act. Burcu put it bluntly: “Let’s be honest, men won’t care. If I don’t deal with it, no one will” (aged twenty-eight years, PhD student, partnered). This resigned realism turned anticipated male neglect into a practical reason for expanded female labor. Even when they named the injustice, many internalized the burden as necessity. The pattern echoed the “second shift” in domestic labor, childcare, and contraception management, in which women absorbed cognitive, emotional, and logistical work to avoid worse outcomes (Faircloth Reference Faircloth2021; Hochschild and Machung Reference Hochschild and Machung2012). Some narratives also resembled what is popularly called “weaponized incompetence,” where anticipated male non-participation left women carrying sexual health responsibilities. They continued to comply with this unequal division of labor, despite complaint, because they could not afford to wait for men or the state to act.

Anticipated male non-participation also translated into women paying – literally. Without public coverage, vaccination remained prohibitively expensive. In 2020, a three-dose quadrivalent course costed approximately 1,752 TL (three doses × 584 TL), when the net monthly minimum wage stood at 2,324.70 TL. By February 2026, following severe inflation, the price of a three-dose nine-valent HPV vaccine course (the only vaccine currently accessible in Turkey) reached approximately 14,004.72 TL (three doses × 4,668.24 TL), while the net monthly minimum wage was 28,075.50 TL. The full vaccination course thus corresponded to nearly half of a monthly minimum wage, underscoring how the cost of prevention continues to be shifted onto individuals – most often women – under conditions of limited public provision. In cases of infection, costs extend beyond vaccination. Pap smear and HPV DNA tests are free for women aged thirty years and over; younger women who seek testing pay out of pocket. Candan reported spending over 10,000 TL on follow-up care alone, more than four times the 2020 minimum wage (aged twenty-six years, university graduate, unpartnered). Others delayed or forewent vaccination despite wanting it. Zeynep explained, “I really wanted the shots, but it was just too expensive. If it were free, I’d already have gotten it and taken my friends [to get it], too” (aged thirty-four years, PhD graduate, partnered). Even among financially stable women, price rendered access conditional and precarious. “If we break up, maybe I’ll get it,” she adds, illustrating how partnership status and monogamy functioned as a safety proxy that deferred vaccination.

These accounts point to structural burdens shaping health decisions, including income inequality, gendered expectations, and institutional absence (Cockerham Reference Cockerham2021). Even educated, urban women struggle to obtain vaccination, demonstrating that the problem is systemic rather than individual. “If you have money, you can protect yourself. If you don’t, you just take your chances,” Suzan said (aged twenty-eight years, university graduate, unpartnered). In this setting, responsibilization operated as a core technique of governance: the state withdrew and delegated, markets priced care, and women were cast as prudent subjects who must self-educate, disclose, and pay for follow-up (Rose Reference Rose2007). Apparent neglect functioned as a demand to self-regulate and absorb risk in silence, shifting health from a collective right to a moral duty and relocating emotional and financial burdens onto women, while normalized male non-responsibility remained intact.

Stigma, shame, and the moral governance of women’s sexuality

This section examines the moral reconfiguration that follows once HPV is experienced as a personal condition rather than a distant risk. It focuses on the affective and moral consequences of diagnosis, tracing how HPV reorganized women’s sense of self through shame, sexual scrutiny, and the fear of being read as a “bad woman” within family life, intimate relationships, and clinical encounters.

“The first thing I had to digest,” recalled Burcu, “was that there’s a sexually transmitted virus in my body. It’s not like having the flu” (aged twenty-eight years, PhD student, partnered). The verb “digest” signaled an embodied struggle with stigma, in which something foreign must be metabolized into the self. The diagnosis was not experienced as a neutral medical event but as a morally charged condition that became part of everyday self-management.

HPV was difficult to “digest” not for its clinical severity but for its symbolic and moral implications. Unlike illnesses perceived as random or morally neutral, such as influenza, HPV was read through a gendered sexual politics that ties women’s sexuality to risk and blame. In Turkey, benevolent as well as hostile sexism predicts sharper disapproval of women’s premarital sex and men’s preference for a virgin spouse, thereby tightening the link between “virtue” and sexual restraint (Sakallı-Uğurlu and Glick Reference Sakallı-Uğurlu and Glick2003). Diagnosis therefore registered as a rupture in moral and bodily integrity, threatening internalized ideals of propriety, caution, and respectability and unsettling the symbolic order that linked feminine virtue to sexual restraint and bodily discipline (Skeggs Reference Skeggs2002).

Moral expectations around women’s sexuality were learned early in family, school, and daily life. Many participants grew up in environments where sex was cast as dangerous or left unsayable. In contemporary Turkey, neoliberal and neoconservative rationalities intersect to police intimacy through modesty, honor, and the family as a moral welfare unit; the state withdraws as moral regulation expands, delegating care to families and positioning women as default caregivers (Acar and Altunok Reference Acar and Altunok2013; Akkan Reference Akkan2018). These regimes normalize surveillance and respectability and shape how young women manage risk and speak about sex (İlkkaracan Reference İlkkaracan, Hunt, Jung and Balakrishnan2001; Özyeğin Reference Özyeğin2015). As Feride noted, “If I had been taught to talk about sex, maybe I would’ve had a more fulfilling sexual life” (aged thirty-six years, university graduate, partnered).

Many participants could not speak about HPV openly, especially with family, not because it posed serious medical danger but because it signaled an active sex life and sexual agency. Several withheld disclosure less out of fear of the virus than fear of moral exposure. “My family doesn’t know I have a sex life, so how could I tell them I have HPV?” asked Mine (aged twenty-three years, university student, partnered). These silences also carried financial consequences, as some participants could not ask families for help with testing or vaccination costs. Silence left women feeling cut off: “When you have HPV, you can’t really talk to anyone; you’re cut off even from your own support networks,” said Pınar (aged thirty-four years, university graduate, unpartnered). At the same time, women friends and sisters often formed the most reliable support networks for information, accompaniment, and moral backing. Many described asking sisters to accompany them to the hospital, to care for them after a LEEP (loop electrosurgical excision procedure), a minor procedure used to remove HPV-related abnormal cervical tissue, or turning to non-judgmental friends who understand and accept them.

Stigma also surfaced in intimate relationships, where disclosure often brought suspicion, surveillance, or withdrawal rather than care. Several participants described being silenced, blamed, or morally disqualified by male partners. Composure was read as deceit; calmness as manipulation or guilt. Rüya’s partner, fearing reputational damage, asked her to hide the diagnosis from their shared circles (aged twenty-four years, university student, partnered). For Kardelen, disclosure triggered a new ritual: her boyfriend began showering after every sexual encounter (aged thirty-three years, PhD student, partnered). The repeated act framed her body as contaminated; over time, she reported a rupture in sexual self-perception: “I couldn’t get aroused anymore. It felt like I had to defend my body even during sex.” Others echoed similar dynamics. Partners responded with suspicion, interrogated sexual histories, or insisted the infection must have come from the woman. “He said he’d never had anything like this before, so it had to be me,” recalled Dilek (aged twenty-six years, university graduate, partnered). Rather than enabling shared responsibility, disclosure activated accusation, erasure, and shame. These reactions were not isolated but constituted gendered practices aligned with wider discourses of sexual blame and bodily discipline. Women were again positioned as guardians of both biomedical and moral hygiene, expected to disclose, absorb blame, perform guilt, and repair the relationship. Even in intimate spaces, the burden of care was not shared but shifted onto women, mirroring the structural asymmetries of public health governance.

These partner reactions did not only assign blame outward; they also seeped inward. Many women turned the moral gaze on themselves, measuring their choices against both traditional respectability and newer expectations of constant, individual risk management. In this mix, older norms did not vanish; they fused with medicalized ideals of vigilance and self-optimization.

Internalized blame surfaced in plain language. “I had too many partners. I was reckless. This is what I get,” said Suzan (aged twenty-eight years, university graduate, unpartnered). Feride put it this way: “Even though I know it’s not my fault, I still feel like I invited this. There’s a little judge living inside me” (aged thirty-six years, university graduate, partnered). Even those steeped in feminist critique felt the pull. “I reject the idea that women should be punished for their sexuality, yet I couldn’t stop feeling guilty,” reflected Eylül (aged thirty-three years, PhD graduate, unpartnered). As Rose (Reference Rose2007) argues, contemporary health subjects are asked to anticipate, prevent, and self-discipline. Under this regime, guilt shifts register: it is not only about sexual propriety but also attaches to perceived failures of vigilance, knowledge, and care. The result is a double bind. Feminist interruptions may loosen the grip of honor and purity, yet a neoliberal morality of personal responsibility keeps guilt in place, rendering women answerable for managing risk at all times. Faced with this twin pressure of honor codes and neoliberal self-responsibility, participants turned to situated tactics for getting through daily life.

Strategic silence and feminist disclosure: reimagining care

For many participants, disclosure was not merely telling a partner; it constituted gendered and moral labor that was emotionally taxing, politically loaded, and unevenly distributed. Women were not only managing their own health; they were also performing relational care in the absence of reciprocity. While disclosure was often framed as a duty to male partners, it was described more powerfully as a duty to other women. “I didn’t want another woman to go through what I did,” said Halide (aged thirty-five years, university graduate, partnered). Ayla called it “a sisterhood responsibility,” thereby reclaiming care from a privatized, heteronormative script and recasting it as horizontal feminist practice grounded in solidarity rather than compliance (aged thirty-two years, university graduate, unpartnered). In this reframing, responsibility shifted from the couple to the collective, and from weak institutional scaffolding to feminist networks.

Yet solidarity did not remedy structural abandonment. The emotional, logistical, and financial costs of living with HPV were still borne unevenly by individual women. For some, silence functioned as defense – a strategic way to negotiate morality in a stigmatizing terrain. “Men probably carry it too,” İrem said, “but when I say it, I become the sick one,” pointing to the combined effects of knowledge asymmetry and stigma (aged thirty-three years, university graduate, unpartnered). The inequality was clear: women were expected to know, reveal, and manage, while men remained unmarked and unaccountable. Men’s absence was neither accidental nor benign; it was produced by a public health discourse that framed HPV as a women’s issue and was sustained by the silence of male partners and medical institutions. By contrast, women’s silence operated as a form of resistance and boundary-setting (Scott Reference Scott1990). In a context that demanded women’s vulnerability without protection, silence can function as a refusal to be morally exposed. “Why should I be the only one to carry this burden?” asked Jale (aged thirty-seven years, university graduate, unpartnered). Where disproportionate moral labor is demanded of women and men are excused, silence cannot be reduced to irresponsibility. Even when some participants framed disclosure as a duty, others used silence as strategic defense rather than apathy.

Some participants turned disclosure into a tool of collective resistance. “At first I didn’t want to talk about it,” Rüya said, “but then I told all my friends to get tested” (aged twenty-four years, university student, partnered). Such moments disrupted the privatized logic of shame and reframed the virus through shared care. Disclosure here triggers earlier diagnoses, recasts personal narratives, and builds small networks of protection. As Ablon (Reference Ablon2002) argues, destigmatization is not passive unlearning but the active making of alternative scripts grounded in mutual recognition. In these acts, care moved from the personal to the political, and stigma became a site of collective struggle. Rather than a woman’s duty within a couple, disclosure functioned as collective prevention rooted in shared vulnerability, where mutual exposure to risk provided a basis for solidarity rather than shame (Butler Reference Butler2004).

Building on these micro-acts of disclosure as collective prevention, participants widened their focus from intimate circles to the public sphere. Several women underlined the need for feminist campaigns, media interventions, and collaborative education efforts. These proposals redefined care not as an individual responsibility or a gendered sacrifice, but as a collective right. Still, their visions carried the weight of resignation. “We know the state won’t do anything,” remarked Nazan, echoing a broader affective landscape in which abandonment was normalized (aged twenty-six years, university graduate, partnered). Yet she insisted on breaking silence in public as well as private. “People need to hear this in shows, in books, on social media,” she said. Feride added, “Maybe one day we’ll be able to say we had sex and got HPV” (aged thirty-six years, university graduate, partnered). These were not only calls for awareness; they were demands for recognition and for a cultural vocabulary that allows women’s embodied experiences to be speakable without shame. In this sense, reimagined care extended beyond clinics and intimate relationships to contest the symbolic economy through which HPV is organized as a site of asymmetry, silence, and the feminization of blame.