Pap Test Use Is Lower Among Female-to-Male Patients Than Non-Transgender Women

Peitzmeier, Sarah; Khullar, Karishma; Reisner, Sari L.; Potter, Jennifer

doi:10.1016/j.amepre.2014.07.031

Cited by 168 publications

(131 citation statements)

References 25 publications

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“…21 Many FTM patients face barriers to receiving needed services due to a combination of factors, including stigma and discrimination, 22,23 lack of insurance and access to genderaffirmative health care, 24,25 patient and health care provider misperceptions pertaining to HPV and cervical cancer risk (Table 2), and apprehension about undergoing intrusive procedures such as pelvic examinations, 10 leading to decreased rates of cervical cancer screening compared to cisgender women. 26 In addition, due partially to the atrophying effect of testosterone on the cervical epithelium, cervical cytology specimens are approximately ten times as likely to be unsatisfactory among patients on the FTM spectrum as among cisgender women. 27 Consideration of psychosocial history is crucial when providing clinical care to FTM patients, many of whom have had negative experiences accessing health care.…”

Section: Overview Of Key Clinical Concernsmentioning

confidence: 99%

“…1,44 Therefore, although antianxiety medication may be an important tool for some patients in overcoming barriers to being examined, informed consent should be obtained before using Since minor bleeding is common after cytology sampling, but can be an unpleasant reminder of menstruation or prior trauma for some patients, mention and normalize this possibility using non-gendered language (Table 3). In addition, because FTM patients are more likely to have unsatisfactory Pap results, 27 yet more likely to delay returning for repeated testing, 26 providers should prepare patients for the possible need to repeat a Pap and follow official guidelines that recommend retesting within 2-4 months of an initial inadequate test.…”

Section: Patient-provider Communication Before the Exammentioning

confidence: 99%

“…In addition to causing cervical epithelial atrophy, 26 testosterone treatment can induce vaginal epithelial atrophy 45 that may make passage of a speculum uncomfortable. Strategies to mitigate discomfort include the use of a pediatric or long, narrow speculum, application of a small amount of lubricant to the speculum, and application of topical lidocaine to the vaginal introitus 1 (Table 5).…”

Section: Patient-provider Communication Before the Exammentioning

confidence: 99%

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Cervical Cancer Screening for Patients on the Female-to-Male Spectrum: a Narrative Review and Guide for Clinicians

et al. 2015

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Guidelines for cervical cancer screening have evolved rapidly over the last several years, with a trend toward longer intervals between screenings and an increasing number of screening options, such as Pap/HPV co-testing and HPV testing as a primary screening. However, gynecological recommendations often do not include clinical considerations specific to patients on the female-to-male (FTM) spectrum. Both patients and providers may not accurately assess risk for HPV and other sexually transmitted infections, understand barriers to care, or be aware of recommendations for cervical cancer screening and other appropriate sexual and reproductive health services for this patient population. We review the evidence and provide guidance on minimizing emotional discomfort before, during, and after a pelvic exam, minimizing physical discomfort during the exam, and making adaptations to account for testosterone-induced anatomical changes common among FTM patients.

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Section: Overview Of Key Clinical Concernsmentioning

confidence: 99%

Section: Patient-provider Communication Before the Exammentioning

confidence: 99%

Section: Patient-provider Communication Before the Exammentioning

confidence: 99%

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Cervical Cancer Screening for Patients on the Female-to-Male Spectrum: a Narrative Review and Guide for Clinicians

et al. 2015

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“…Another review of medical records at the same institution focused on Papanicolaou smears (110). The up-to-date Papanicolaou smear screening was found in 74% of nontransgender female patients and 64% of transmen.…”

Section: Other Cancer Risk Factorsmentioning

confidence: 99%

Cancer in Transgender People: Evidence and Methodological Considerations

Braun

Nash

Tangpricha

et al. 2017

Epidemiologic Reviews

150

118

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Transgender people comprise a diverse group of individuals whose gender identity or expression differs from that originally assigned to them at birth. Some, but not all, transgender people elect to undergo medical gender affirmation, which may include therapy with cross-sex hormones and/or surgical change of the genitalia and other sex characteristics. As cross-sex hormones administered for the purposes of gender affirmation may be delivered at high doses and over a period of decades, the carcinogenicity of hormonal therapy in transgender people is an area of considerable concern. In addition, concerns about cancer risk in transgender patients have been linked to sexually transmitted infections, increased exposure to well-known risk factors such as smoking and alcohol use, and the lack of adequate access to screening. Several publications have identified cancer as an important priority in transgender health research and called for large-scale studies. The goals of this article are to summarize the evidence on factors that may differentially affect cancer risk in transgender people, assess the relevant cancer surveillance and epidemiologic data available to date, and offer an overview of possible methodological considerations for future studies investigating cancer incidence and mortality in this population.

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“…Uptake of cervical screening among transmen is lower than the cisgender female population, 47 confirming the anecdotal experience of clinicians. For those transmen with abnormal cytology, follow up is more likely to be delayed.…”

Section: Cervical Cancermentioning

confidence: 67%

The primary health care of transgender adults

Aitken¹

2017

Sex. Health

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Abstract. Gender dysphoria is associated with significant health disparity. Gender services perform specialised activities such as diagnosis, endocrine management and liaison with surgical services. Although providing these specialised transition services appears to be safe and improves well-being, significant health disparity remains. Engaging primary care providers is an important part of any strategy to improve the health care of transgender people. The relationships between gender dysphoria and a range of primary care issues such as mental health, cardiovascular disease and cancer are explored.

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Pap Test Use Is Lower Among Female-to-Male Patients Than Non-Transgender Women

Cited by 168 publications

References 25 publications

Cervical Cancer Screening for Patients on the Female-to-Male Spectrum: a Narrative Review and Guide for Clinicians

Cervical Cancer Screening for Patients on the Female-to-Male Spectrum: a Narrative Review and Guide for Clinicians

Cancer in Transgender People: Evidence and Methodological Considerations

The primary health care of transgender adults

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