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Cervical cancer screening is essential for anyone with a cervix, including trans men and nonbinary AFAB (assigned female at birth) adults. If you’re between the ages of 25 and 65 and haven’t had your cervix removed, routine screening is recommended by the American Cancer Society.
About 92% of trans and nonbinary people retain their cervix, making this a critical health consideration. At FOLX, about half of our members taking testosterone express a desire to get a hysterectomy at some point in their lives. However, only 3-5% have undergone the procedure. If you have a cervix, it is crucial to continue regular screenings, even if you plan to have your cervix removed in the future.
Breaking Down the Barriers
- Physical and Emotional Discomfort: Pelvic exams can be uncomfortable, especially for those taking testosterone. Changes in cervical and genital tissue from testosterone can make exams more painful or lead to unsatisfactory test results.
- Psychological Discomfort: It’s common to feel psychological distress or dysphoria during exams, and those feelings are valid.
- Lack of Training: Many providers lack the knowledge or experience to work respectfully and competently with trans and nonbinary patients.
- Unwelcoming Environments: Clinic settings may feel uncomfortable due to gendered signage or misinformed staff. Gynecology offices are often tailored for cis women and obstetrics.
- Administrative Challenges: Scheduling appointments can add additional stress due to assumptions and misunderstandings. For example, calling to schedule an appointment with a deeper voice may confuse staff about why you’re scheduling for yourself, leading to awkward or unnecessary questions. Additionally, if your insurance documents are marked "M," administrative staff may require you to explain your needs, which can feel invasive, uncomfortable, or invalidating.
How Hormone Therapy Can Help
Did you know that regular check-ins with your provider for testosterone therapy can make it easier to access other preventive care, like cervical cancer screening? In fact, people on testosterone are more likely to stay up to date with cervical cancer screening than those who aren’t. Building a relationship with your provider through regular visits helps create a safe and affirming space to discuss your health, including screenings. While we can’t perform your Pap smear, we can walk you through the process, help you find an affirming provider, or even provide medications to help with the discomfort or anxiety around cervical cancer screening.
Take Action
- Speak Up for Your Needs: Don’t hesitate to request accommodations that make you feel more comfortable. Your clinician may be able to use alternate equipment (like a smaller speculum or more lube) if exams are painful or distressing. Letting them know how you feel can help them come up with the right approach for you or explore alternatives to a pelvic exam.
- Bring a Friend: If it helps, bring a friend or your partner with you to the exam. Whether you need them to help speak up for you if someone misgenders you or you want them to hold your hand during the exam, having someone else there may make things easier. Some people even hire a doula who is experienced with trauma to help during the exam.
- Seek Gender-Affirming Clinicians: Look for providers experienced in working with trans and nonbinary patients. They are more likely to provide a respectful and comfortable experience. LGBTQIA+ health directories, local community centers, and FOLX can help connect you to affirming providers. If a designated clinic is not available in your area, when you call to make an appointment ask if any of the providers have experience with trans or nonbinary patients.
Cervical cancer screening saves lives. If you have a cervix and are between the ages of 25 and 65, talk to a trusted provider about getting screened. Remember, you deserve care that respects your identity and supports your well-being.
In addition to a cervical screening, you can also get STI testing done at the same time if you would like to.
How FOLX Can Help
Our clinicians can be your PCP! They are well-versed in LGBTQIA+ care and can answer any questions you have, ensuring you get the proper screenings for your age and the body parts you have. We can provide referrals to affirming specialists from our nationwide network for any in-person care and screenings. FOLX goes beyond standard care by connecting members with clinicians who provide affirming, compassionate support at every step.
If having a pelvic exam and Pap smear simply isn’t feasible, an at-home HPV test is a suitable alternative. Your FOLX clinician can order and set this up through our partners, making it easier for you to stay on top of your health. Although at-home HPV screening doesn’t fully replace a Pap smear, research shows that HPV-only tests can help detect cervical cancer. In other words, it’s certainly better than forgoing screening altogether.
Also, you don’t have to do this alone! Through our Community Platform, you can chat with other FOLX members about their experiences, share tips, and get advice from peers navigating similar challenges.
Resources
The CDC’s Screening Tool : The CDC’s screening tool helps individuals find low-cost or free cervical cancer screening locations.
See also our Cervical Cancer Screening Guide for LGB Cisgender Women
