Cervical Screening (Pap Smears) for Pre-Op F.T.M. Transgenders

by Maggie Smith R.N.

(The Gender Centre advise that this article may not be current and as such certain content, including but not limited to persons, contact details and dates may not apply. Where legal authority or medical related matters are cited, responsibility lies with the reader to obtain the most current relevant legal authority and/or medical publication.)

Whether you are contemplating starting transition or already living as a man, Pap smears seems to be a taboo topic. Cervical screening is an important and often neglected area for men's health. If you are a pre-operative transgender man and still have a cervix it is advisable you have a regular Pap smear. The National Guidelines recommend a Pap smear once every two years.

There is an understandable fear and avoidance of discussion in the F.T.M. community; ignorance and discrimination from the health-care community, and having to discuss cervixes, vaginas, periods, any of that "women's stuff" with someone are all barriers to having a Pap smear. The procedure itself is not a pleasant experience, but it is an important one.

Studies now show that the Human Papilloma Virus (H.P.V.) better know as Genital Warts is responsible for the majority of cervical changes and cancer of the cervix.

H.P.V. is easily transmissible and affects a large percentage of the population. It affects men, women, gay, lesbian, bisexual, transgenders and queer alike. The virus does not discriminate. Nor does it seem to be dependant on the type of sex you have, be it penetrative or not. The wart virus can be easily passed on via genital skin to skin contact. Not all types of H.P.V. show visible warts, not seeing warts on your sexual partners genitals does not mean that you have not been in contact with the virus.

H.P.V. is responsible for the cell changes in the cervix. The only way to screen for these cell changes is with a Pap smear. A Pap smear is obtained by taking a small sample of cells from the cervix. As unpleasant as it sounds it is a painless procedure and takes a short amount of time.

A Pap smear detects cellular changes to the cervix, it does not check for cancer. A Pap smear is to observe cell changes before cancer occurs. Regardless of gender these cell changes can occur to the cervix.

Many of the barriers, concerns and fears a person has about Pap smears can be reduced or removed by talking to an experienced health-care professional. An initial consultation and talk with a doctor or nurse with whom you feel comfortable can help overcome the barriers. Your local sexual health service will be able to assist you with information on Pap smears, H.P.V., in a safe non-judgmental environment. The Gender Centre can help you with the appropriate contacts.

Cancer of the cervix is preventable. Regular Pap smears are the best way to be aware of any changes or possible problems. As unpleasant as the topic of Pap smears may be it is an important area of a person's health. By health care workers and F.T.M.s working together the stigma of Pap smears and the problems that can go undetected without them will be reduced.

The potential emotional and physical discomfort with having a pap smear can cause anxiety. There are a number of things that can help with this. Firstly, having a clinician (nurse or doctor) you feel comfortable with is an important step. If it is the first Pap smear let them know. Having the procedure clearly explained and being shown the equipment may be helpful.

A speculum is a plastic or metal instrument inserted in a vagina to allow the clinician to see the cervix. It may be more comfortable to insert the speculum yourself. If this is not offered and you feel it would be beneficial don't be scared to ask. Also speculums come in different sizes. Discuss this with your clinician. If you have had pap smears in the past and the clinician experienced trouble seeing the cervix they may have asked you to tilt your pelvis or place your hands under your buttocks. Communicate this to your new clinician. Everyone's cervix is in a different place and the clinician being aware of this will assist with making the Pap smear faster and more comfortable.

One of the main issues both you and your clinician need to be aware of is if you are using testosterone and its effect on lubrication in the vagina. How long you have been on testosterone and the levels of it in your system can affect the levels of lubrication in the vagina and thus the result of the pap smear. It is important to be aware of this. Lack of lubrication can make a Pap smear very uncomfortable. As well as drying the vagina, the testosterone can give it a red or irritated appearance internally and affect the cells obtained and therefore the result of your pap smear.

A way to reduce the discomfort and increase the likelihood of getting an accurate result from the Pap smear is to use an oestrogen pessary prior to the smear. The idea of using oestrogen can be met with fear and resistance but the oestrogen, when used as a pessary (a tablet inserted in the vagina) has a local and temporary effect. It temporarily changes vaginal and cervical lubrication. It will not counteract the effects of testosterone.

The one potential side effect to be aware of is a small amount of bleeding from the vagina. This does not happen to everyone who uses it and does not last long. The oestrogen will be out of your system within a week of it being stopped. This one potential problem is greatly outweighed by the problems that may be faced if oestrogen is not used.

The recommended pre-Pap smear dose of oestrogen pessaries is one daily for ten days prior to the smear and stop using them forty-eight hours before. The pessary will require a prescription from a doctor. This should be arranged prior to your Pap smear.

I cannot stress enough the benefits of using oestrogen if you have been on testosterone for a number of years or have had an abnormal result from a smear in the past. This pessary greatly reduces discomfort during the smear and increases the chances of getting an accurate Pap result. Not using oestrogen may lead to a result which requires another Pap smear and unnecessary further investigation.

These articles are about raising awareness, the need for pap smears and how to make them as comfortable and effective as possible. Pap smears are necessary. If you have a cervix and uterus you need a Pap smear. If you have not had a Pap smear in over two years you need one.

If you ever experience vaginal or abdominal pain or discomfort on orgasm, bleeding or spotting from the vagina, do not assume this is normal or related to your dose of testosterone. These are signs something may be wrong. You need a Pap smear. The early detection of abnormal cells in the cervix and regular screening reduces the risk of cancer. Make an appointment today.

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