Objective To explore the knowledge of human papillomavirus (HPV) vaccination among adult women and analyze the factors influencing their hesitancy in vaccination. Methods Using convenience sampling, 185 adult women undergoing health examinations at the hospital from January 2024 to December 2024 were surveyed. A questionnaire assessed participants ’ knowledge of HPV vaccination and vaccination hesitancy. Participants were categorized into hesitant and non-hesitant groups based on vaccination hesitancy. General characteristics were collected and compared between groups. Collinearity analysis was performed on variables showing differences. Variables without collinearity issues were included in Logistic regression analysis to identify factors in?uencing HPV vaccination hesitancy among adult women. Results Among the 185 adult women included in the study, 33 cases (17.84%) had inadequate knowledge and 152 cases (82.16%) had adequate knowledge, indicating a generally good understanding of HPV vaccination among the participants; there were 72 (38.92%) hesitating to vaccinate and they were assigned to the hesitant group, while the remaining 113 (61.08%) did not hesitate and were assigned to the non-hesitant group. Significant differences were observed between the two groups in terms of occupation, HPV infection history, trust in immunization policies, and vaccine risk perception (P < 0.05). Logistic regression analysis revealed that no history of HPV infection and high perceived vaccine risk were risk factors for adult women hesitating to receive HPV vaccination, with OR values of 6.30 and 5.06 respectively (both P < 0.05). Medical profession and high trust in immunization policies were protective factors, with OR values of 0.15 and 0.23 respectively (both P < 0.05). Conclusion Adult women demonstrated good knowledge of HPV vaccination, and their hesitancy in vaccination was in?uenced by occupation, HPV infection history, trust in immunization policies, and vaccine risk perception.