Cervical Screening (Pap Smears) for Pre-Op F.T.M. Transgenders Part 2

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.)

This is a follow up to the article in the last issue of Polare on cervical screening (Pap Smears) in pre-op Female to Male (F.T.M.) transgenders.

The previous article addressed what pap smears are and the requirement for pre-op F.T.M. to have them. This article will look at more specific issues such how to make the pap smear more comfortable and accurate.

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.

Polare is published in Australia by The Gender Centre Inc. which is funded by the Department of Community Services under the S.A.A.P. Program and supported by the N.S.W. Health Department through the AIDS and Infectious Diseases Branch. Polare provides a forum for discussion and debate on gender issues. Advertisers are advised that all advertising is their responsibility under the Trade Practices Act. Unsolicited contributions are welcome, though no guarantee is made by the Editor that they will be published, nor any discussion entered into. The editor reserves the right to edit such contributions without notification. Any submission which appears in Polare may be published on our internet site. Opinions expressed in this publication do not necessarily reflect those of the Editor, The Gender Centre Inc.I, the Department of Community Services or the N.S.W. Department of Health.