Skip to main content
Top

10-07-2015 | Gynecologic cancers | Article

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

Journal: Journal of General Internal Medicine

Authors: Jennifer Potter, MD, Sarah M. Peitzmeier, MSPH, Ida Bernstein, BA, Sari L. Reisner, ScD, MA, Natalie M. Alizaga, MPH, MPhil, Madina Agénor, ScD, MPH, Dana J. Pardee, BS

Publisher: Springer US

Abstract

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.
Literature
1.
Bates CK, Carroll N, Potter J. The challenging pelvic examination. J Gen Intern Med. 2011;26(6):651–657.PubMedCentralCrossRefPubMed
2.
Unger CA. Care of the transgender patient: a survey of gynecologists’ current knowledge and practice. J Womens Health (Larchmt). Epub 2014 Dec 19.
3.
American College of Obstetricians and Gynecologists Practice Bulletin Number 131: screening for cervical cancer. Obstet Gynecol. 2012;120(5):1222–1238.
4.
Moyer VA. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;156(12):880–891.CrossRefPubMed
5.
Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62(3):147–172.PubMedCentralCrossRefPubMed
6.
Qaseem A, Humphrey LL, Harris R, Starkey M, Denberg TD. Screening pelvic examination in adult women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(1):67–72.CrossRefPubMed
7.
Peitzmeier SM, Agenor M, Bernstein I, Alizaga N, McDowell M, Reisner SL, et al. Barriers and facilitators to cervical cancer screening among female-to-male patients. In preparation.
8.
Bernstein I, Potter J, Peitzmeier SM. If you have it, check it: overcoming barriers to cervical cancer screening with patients on the female-to-male transgender spectrum. Gay and Lesbian Medical Association; 2014; Baltimore, MD.
9.
Smith YL, Van Goozen SH, Kuiper AJ, Cohen-Kettenis PT. Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals. Psychol Med. 2005;35(01):89–99.CrossRefPubMed
10.
Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend. 2012;13(4):165–232.CrossRef
11.
Driak D, Samudovsky M. Could a man be affected with carcinoma of cervix?--The first case of cervical carcinoma in trans-sexual person (FtM)--case report. Acta Med (Hradec Kralove). 2005;48(1):53–55.
12.
Kaufman R. Introduction to transgender identity and health. In: Makadon H, Mayer K, Potter J, Goldhammer H, eds. Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health. Philadelphia: American College of Physicians; 2008:331–363.
13.
van Trotsenburg MA. Gynecological aspects of transgender healthcare. Int J Transgend. 2009;11(4):238–246.CrossRef
14.
Feldman J. Medical and surgical managment of the transgender patient: What the primary care clinician needs to know. In: Makadon H, Mayer K, Potter J, Goldhammer H, eds. Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. Philadelphia: American College of Physicians; 2008:365–392.
15.
Bauer GR, Travers R, Scanlon K, Coleman TA. High heterogeneity of HIV-related sexual risk among transgender people in Ontario, Canada: a province-wide respondent-driven sampling survey. BMC Public Health. 2012;12(1):292.PubMedCentralCrossRefPubMed
16.
O'Hanlan KA, Dibble SL, Young-Spint M. Total laparoscopic hysterectomy for female-to-male transsexuals. Obstet Gynecol. 2007;110(5):1096–1101.CrossRefPubMed
17.
Kenagy GP. Transgender health: findings from two needs assessment studies in Philadelphia. Health Soc Work. 2005;30(1):19–26.CrossRefPubMed
18.
Grant JM, Mottet LA, Tanis J, Herman J, Harrison J, Keisling M. National Transgender Discrimination Survey Report on Health and Health Care. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2010.
19.
Bauer GR, Redman N, Bradley K, Scheim AI. Sexual health of trans men who are gay, bisexual, or who have sex with men: results from Ontario, Canada. Int J Transgend. 2013;14(2):66–74.PubMedCentralCrossRefPubMed
20.
Reisner SL, White JM, Mayer KH, Mimiaga MJ. Sexual risk behaviors and psychosocial health concerns of female-to-male transgender men screening for STDs at an urban community health center. AIDS Care. 2014;26(7):857–864.PubMedCentralCrossRefPubMed
21.
American College of Obstetricians and Gynecologists. Committee Opinion: Health Care for Transgender Individuals. Obstet Gynecol. 2011;118(6):1454.CrossRef
22.
Poteat T, German D, Kerrigan D. Managing uncertainty: a grounded theory of stigma in transgender health care encounters. Soc Sci Med. 2013;84:22–29.CrossRefPubMed
23.
Reisner SL, Gamarel KE, Dunham E, Hopwood R, Hwahng S. Female-to-male Transmasculine adult health a mixed-methods community-based needs assessment. J Am Psychiatr Nurses Assoc. 2013;19(5):293–303.CrossRefPubMed
24.
Grant JM, Mottet L, Tanis JE, Harrison J, Herman J, Keisling M. Injustice at every turn: A report of the national transgender discrimination survey. Washington, DC: National Center for Transgender Equality; 2011.
25.
Snelgrove JW, Jasudavisius AM, Rowe BW, Head EM, Bauer GR. “Completely out-at-sea” with “two-gender medicine”: a qualitative analysis of physician-side barriers to providing healthcare for transgender patients. BMC Health Serv Res. 2012;12(1):110.PubMedCentralCrossRefPubMed
26.
Peitzmeier SM, Khullar K, Reisner SL, Potter J. Pap test use is lower among female-to-male patients than non-transgender women. Am J Prev Med. 2014;47(6):808–812.CrossRefPubMed
27.
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. 2014;29(5):778–784.PubMedCentralCrossRefPubMed
28.
Cruz TM. Assessing access to care for transgender and gender nonconforming people: a consideration of diversity in combating discrimination. Soc Sci Med. 2014;110:65–73.CrossRefPubMed
29.
Hendricks ML, Testa RJ. A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the Minority Stress Model. Prof Psychol Res Pr. 2012;43(5):460.CrossRef
30.
Reisner SL, Pardo ST, Gamarel KE, White JM, Pardee DJ, Meier SC. Trans masculine experiences of stigma in U.S. healthcare: a gender minority stress model of substance use to cope with mistreatment. LGBT Health. Forthcoming 2015.
31.
Stewart FH, Harper CC, Ellertson CE, Grimes DA, Sawaya GF, Trussell J. Clinical breast and pelvic examination requirements for hormonal contraception: current practice vs evidence. JAMA. 2001;285(17):2232–2239.CrossRefPubMed
32.
Goodyear-Smith F, Buetow S. Power issues in the doctor-patient relationship. Health Care Anal. 2001;9(4):449–462.CrossRefPubMed
33.
Eckstrand K, Sciolla A, Potter J. Trauma and resilience in the lives of people who are LGBT, gender nonconforming, and born with DSD: Implications for Clinical Care and Health Outcomes. In: Hollenbach AD, Eckstrand KL, Dreger A, eds. Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who are LGBT, Gender Nonconforming, or Born with DSD. Association of American Medical Colleges; 2014: 32–39. http://​lgbt.​ucsf.​edu/​sites/​lgbt.​ucsf.​edu/​files/​wysiwyg/​AAMC_​LGBT-DSD%20​Report%20​2014.​pdf. Accessed June 16, 2015.
34.
Human Rights Campaign. Healthcare Equality Index. 2014. http://​www.​hrc.​org/​hei. Accessed June 16, 2015.
35.
Callahan EJ, Sitkin N, Ton H, Eidson-Ton WS, Weckstein J, Latimore D. Introducing sexual orientation and gender identity into the electronic health record: One Academic Health Center’s Experience. Acad Med. Epub 2014 Aug 26.
36.
GenIUSS Group. Best practices for Asking Questions to Identify Transgender and Other Gender Minority Respondents on Population-Based Surveys. http://​williamsinstitut​e.​law.​ucla.​edu/​wp-content/​uploads/​geniuss-report-sep-2014.​pdf: Williams Institute. 2014. Accessed June 16, 2015.
37.
Cahill S, Singal R, Grasso C, King D, Mayer K, Baker K, et al. Do Ask, Do Tell: high levels of acceptability by patients of routine collection of sexual orientation and gender identity data in four diverse American Community Health Centers. PLoS ONE. 2014;9(9):e107104.PubMedCentralCrossRefPubMed
38.
American Cancer Society. Tobacco and the GLBT community. http://​www.​lgbttobacco.​org/​files/​TObacco%20​and%20​the%20​LGBT%20​Community.​pdf. 2003. Accessed June 16, 2015.
39.
The Network/La Red. Partner Abuse Happens to Trans Folks Too! http://​tnlr.​org/​wp-content/​uploads/​2011/​04/​trans-partner-abuse-handout.​pdf. Accessed June 18, 2015.
41.
Fenway Health. I’m on the FTM spectrum: What do I need to know about HPV and cancer? http://​fenwayfocus.​org/​wp-content/​uploads/​2015/​06/​com166_​hpv_​cancer-digital2.​pdf. Accessed June 16, 2015.
42.
Müller A, Gender DynamiX: Sexual Health for Transgender & Gender Non-Conforming People. http://​www.​genderdynamix.​org.​za/​wp-content/​uploads/​2013/​05/​GDX-Safer-Sex-Bklt-Eng.​pdf. Accessed June 16, 2015.
43.
The Fenway Institute. Protecting yourself from HIV through pre-exposure prophylaxis: What you need to know. http://​www.​lgbthealtheducat​ion.​org/​wp-content/​uploads/​12.​125_​PrEPdocuments_​consumers_​cover_​v3.​pdf. Accessed June 16, 2015.
44.
Badura AS, Reiter RC, Altmaier EM, Rhomberg A, Elas D. Dissociation, somatization, substance abuse, and coping in women with chronic pelvic pain. Obstet Gynecol. 1997;90(3):405–410.CrossRefPubMed
45.
Baldassarre M, Giannone F, Foschini M, Battaglia C, Busacchi P, Venturoli S, et al. Effects of long-term high dose testosterone administration on vaginal epithelium structure and estrogen receptor-α and-β expression of young women. Int J Impot Res. 2013;25(5):172–177.CrossRefPubMed
46.
Amies A-ME, Miller L, Lee S-K, Koutsky L. The effect of vaginal speculum lubrication on the rate of unsatisfactory cervical cytology diagnosis. Obstet Gynecol. 2002;100(5, Part 1):889–892.CrossRefPubMed
47.
Brady K, Sizemore K, Duff P, Aamodt L. The effect of bacteriostatic lubricant on group B streptococcal cultures of the female genital tract. Obstet Gynecol. 1989;74(6):848–850.PubMed
48.
Griffith WF, Stuart GS, Gluck KL, Heartwell SF. Vaginal speculum lubrication and its effects on cervical cytology and microbiology. Contraception. 2005;72(1):60–64.CrossRefPubMed
49.
Harer WB Jr, Valenzuela G, Lebo D. Lubrication of the vaginal introitus and speculum does not affect Papanicolaou smears. Obstet Gynecol. 2002;100(5, Part 1):887–888.CrossRefPubMed
50.
Acs G, Gupta PK, Baloch ZW. Glandular and squamous atypia and intraepithelial lesions in atrophic cervicovaginal smears. Acta Cytol. 2011;44(4):611–617.CrossRef
51.
Arbyn M, Verdoodt F, Snijders PJ, Verhoef VM, Suonio E, Dillner L, et al. Accuracy of human papillomavirus testing on self-collected versus clinician-collected samples: a meta-analysis. Lancet Oncol. 2014;15(2):172–183.CrossRefPubMed
52.
Cox JT, Castle PE, Behrens CM, Sharma A, Wright Jr TC, Cuzick J. Comparison of cervical cancer screening strategies incorporating different combinations of cytology, HPV testing, and genotyping for HPV 16/18: results from the ATHENA HPV study. Am J Obstet Gynecol. 2013;208(3):184.e181-184.e111.
53.
Zhao C, Li Z, Nayar R, Levi AW, Winkler BA, Moriarty AT, et al. Prior High-Risk Human Papillomavirus Testing and Papanicolaou Test Results of 70 Invasive Cervical Carcinomas Diagnosed in 2012: Results of a Retrospective Multicenter Study. Arch Pathol Lab Med. Epub 2014 Apr 2.