Trans Cervical Health Primer

January is Cervical Health Awareness Month! The latest information and resources to help trans guys stay on top of cervical health are all rolled into this one-stop primer.

Facts About Cervical Cancer and Preventative Care

Cervical cancer screenings prevent cancer and save lives.

Trans men are at risk of developing cervical cancer even if they do not have penetrative sex. The major cause of cervical cancer, the Human Papillomavirus (HPV), is transmitted through genital skin-to-skin contact with anyone who has the virus. Note that using condoms, gloves, and other barriers reduces but does not eliminate the risk of transmitting HPV and other infections.

Nearly half (48%) of trans men surveyed reported postponing or avoiding preventive care out of fear of discrimination and disrespect. One in five trans men also reported being refused health care because of their gender identity. – National Transgender Discrimination Survey

Trans men have over 10 times higher odds of having an inadequate Pap test compared to female patients, and have longer latency to follow-up testing. Furthermore, it can be challenging to get interpretable results from Pap tests done on trans men.

I am on the FTM Spectrum… What Do I Need to Know About HPV and Cancer?

This 2014 guide from Fenway Health provides information about HPV, cancer screening, and what steps trans guys can take to feel more comfortable during an exam. More than 100 members of the FTM community contributed by sharing their stories and input. Download the PDF guide »

Do I Need a Pap Test?

The U.S. Preventive Services Task Force recommends that people with cervixes aged 21-65 should get pap smears every 3 years, or every 5 years for people over age 30 who also get an HPV test done. The Canadian Task Force on Preventive Health Care, which issued national guidelines in January 2013, advises that Pap tests are not needed until the age of 25.

Cervical Screening and Bottom Surgery

While there are currently no established recommendations for cervical cancer screening for trans men who have had bottom surgery, these surgeries can affect screening recommendations:

If a trans man has had a complete hysterectomy that included removing the cervix, AND he has no history of cancerous or precancerous cervical cells, then he will not need regular Pap tests.
If a trans man has had a hysterectomy that left his cervix partially or completely intact, then he will need regular Pap tests.
If a trans man has had a complete hysterectomy including removal of the cervix, AND also has a history of cervical cancer, precancerous conditions, HPV infection or immune suppression, he may need to have vaginal vault or cuff smears until he has three documented normal tests in a row.
Trans men who have had a colpectomy (removal of the vagina) or colpocleisis (closure of the vagina) as part of bottom surgery such as hysterectomy or metoidioplasty, cannot have a Pap test.

Source: Canadian Cancer Society

The Next Frontier: Self-Swabbing

When it comes to preventative screening for HPV, trans guys can take matters into their own hands. Self-swabbing is a viable alternative to having a provider collect a cervical cell sample as part of routine cervical-cancer screening. Not surprisingly, a 2018 study found that transmasculine people prefer self-swabbing. While self-swabbing detected fewer cases of HPV in the study, compared to traditional cervical testing, self-swabbing represents a reasonable and patient-centered approach that can increase patient engagement and improve preventative screening rates for those who typically avoid healthcare or who are unwilling or unable to undergo pelvic examination. As cervical cancer is five times more likely to develop for trans guys living with HIV, these routine HPV-related cancer screenings can be lifesaving. Self-swabbing is still relatively new and not widely available but access should improve as more research is done.

How to Improve Your Pap Experience

Guys Need Pap Tests, Too: A Trans Man’s Guide to Visiting the Gyno
A list of what things you can do when going through a gynecological exam to make it more comfortable.

Check It Out Guys! – No longer online but archived.
Developed by and for trans men and our healthcare providers, Check It Out Guys! provides more information about why you may need a Pap and how to make the experience of getting one better.