Study Explores Less Invasive Options For Transmasculine Sexual Health Screening

Female-to-male (FTM) transgender men and transmasculine individuals are people who are assigned female at birth but identify as male or as masculine. Many FTM transgender men and transmasculine individuals are born with reproductive organs typically labeled as female (e.g. cervix), and most FTM transgender men and transmasculine individuals do not choose to undergo a full hysterectomy (removal of the uterus, cervix, fallopian tubes, and ovaries).1 Because of this, many FTM and transmasculine people are at risk for cervical cancer, human papillomavirus (HPV), as well as other sexually transmitted infections (STIs) and may not realize it.

It is recommended that anybody who has a cervix, including those on the FTM transmasculine continuum, have regular cervical cancer screenings.2 These screenings are known as Pap tests, and involve a medical provider collecting a sample of cells from the cervix to look for pre-cancerous changes. Pap tests are often regarded as invasive and uncomfortable; additionally, Pap tests may cause transmasculine individuals to have increased feelings of gender dysphoria. Part of the reason for this is because the Pap test experience is very “gendered” and may involve sitting in a waiting room with only female-identified people, feminine terminology being used to refer to anatomy, and outright discrimination and lack of understanding by healthcare providers.3 As a result, many transmasculine individuals have a difficult time adhering to and accessing Pap testing, resulting in lower rates of cervical cancer screening compared to cisgender females.4 Alternative means of screening for cervical cancer are currently being explored with cisgender (i.e., non-transgender) female patients, notably the use of a self-collected swab of the genital tract to test for high-risk strains of HPV, which is the leading cause of cervical cancer.5

The Trans Masculine Sexual Health Collaborative, funded by the Patient-Centered Outcomes Research Institute, is the first study to explore less invasive means of cervical cancer screening with FTM transmasculine individuals. The goal of the study is to assess the acceptability and comparative effectiveness of self-swab HPV testing compared cervical swabs and Pap tests done in a doctor’s office, as well as to investigate STI rates in sexually active FTM transmasculine adults. The broader purpose of the project is to fill gaps in clinical knowledge about sexual health in transmasculine individuals by comparing the effectiveness of alternative strategies for sexual health prevention, screening, and diagnosis. The study enrolled 150 FTM or transmasculine individuals between the ages of 21 and 64. Participants came to Fenway for a one-time, 3-4 hour visit that included a questionnaire, a Pap test performed by a provider, and a self-swab test that could be done independently. They then had an interview to discuss their feelings about the self-swab test in comparison to the provider swab. All participants were compensated, and testing was provided at no cost to them. The study is now completed, and study staff are currently analyzing data and preparing a final report.

The Trans Masculine Sexual Health Collaborative was truly a historic study selected by PCORI through a highly competitive review process. It is anticipated that the Trans Masculine Sexual Health Collaborative will have a national and international impact on sexual health screening for transmasculine patients. It will potentially lead to alternative screening strategies that are less invasive and could contribute to the overall improvement of transmasculine health and transgender healthcare. We at The Fenway Institute hope this research will help improve the health and wellbeing of FTM and transmasculine people.

If you’re a transmasculine individual and you are interested in participating in research, we have several HIV prevention studies going on right now that you may be eligible for. Please call the Recruitment Team at 617.927.6450 to find out more about how you can get involved.

  1. Kaufman R. Introduction to Transgender Identity and Health. In: Makadon H, Mayer KH, Potter J, Goldhammer H, eds. The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. Philadelphia: American College of Physicians; 2008:331-363.
  2. American College of Obstetricians and Gynecologists (ACOG). Committee Opinion no. 512: health care for transgender individuals. Obstet Gynecol. Dec 2011;118(6):1454-1458.
  3. Peitzmeier SM, Reisner SL, Harigopal P, Potter J. Female-to-male patients have high prevalence of unsatisfactory Paps compared to non-transgender females: implications for cervical cancer screening. J Gen Intern Med. May 2014;29(5):778-784.
  4. Peitzmeier SM, Khullar K, Reisner SL, Potter J. Pap test use is lower among female-to-male patients than non-transgender women. American journal of preventive medicine. Dec 2014;47(6):808-812.
  5. Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. The Journal of pathology. Sep 1999;189(1):12-19.

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