High Risk of Poor Pap Tests for Female-to-Male Transgender Patients

Abnormal Pap TestDespite the importance of Pap tests for cervical health, female-to-male transgender patients are much more likely to have inadequate cell samples taken during screening than female patients, says a new study published the Journal of General Internal Medicine.

Until the introduction of screenings such as the Pap test, or Pap smear, cervical cancer was the leading cause of cancer death for females in the United States. A method of cervical screening used to detect potentially pre-cancerous and cancerous processes in the endocervical canal, a Pap test involves the collection of cells from the outer opening of the cervix of the uterus and the endocervix by gently scraping the area.

Cervical cancer can affect female-to-male transgender patients because many of these individuals do not undergo full sex reassignment or have a full hysterectomy later in life. Female-to-male transgender patients who retain their cervices are advised to follow the same cervical cancer screening protocol as females. Current recommendations are for a Pap test every three years between the ages of 21 and 65.

However, little information has been available on the accuracy of Pap tests for female-to-male transgender patients.

For the present study, researchers led by Dr. Jennifer Potter — director of women’s health at Fenway Health in Boston, Massachusetts — analyzed the results of Pap tests from 3,625 female patients and 233 female-to-male transgender patients. T Pap tests were performed between 2006 and 2012.

After adjusting for compounding factors such as age, race, and body mass index(BMI), the researchers discovered that female-to-male transgender patients were 8.3 times more likely to have inadequate samples taken when compared with the female patients.


Female-to-male transgender patients were also more likely to have multiple inadequate Pap tests and went longer intervals between Pap tests.

Although the researchers note that the inadequate Pap testing for FTM transgender patients was independently linked to testosterone therapy, hormone therapy did not fully account for the results.

Dr. Potter comments on the findings:


“Pap tests are important for FTM patients but it can be challenging to obtain interpretable results.

“More information is needed on the effects of testosterone on the cervix and effective cervical screening strategies that do not rely on a Pap test.

“While we wait for results of studies that address these questions clinicians should do everything possible to increase patient comfort during the exam and alert FTM patients that repeat Pap testing may be necessary after an initial, inadequate result.”

More research needs to be perform to determine the reason for the high rate of Pap inadequacy in female-to-male transgender patients in order to improve the Pap test procedure.


Female-to-Male Patients Have High Prevalence of Unsatisfactory Paps Compared to Non-Transgender Females: Implications for Cervical Cancer Screening:
High Risk of Poor Pap Tests for Female-to-Male Transgender Patients:

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Written by Heather

Heather is a writer, librarian, linguist, wife, homemaker, homeschooler, and mother.

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