Do lesbians and transgender folks need PAP smears? Yes. Cervical cancer is the third most common cancer globally and can affect anyone with a cervix. PAP smears/cervical exams look for precancerous and cancerous cells, which can be easily removed before they have a chance to turn into more aggressive cancers. Early detection for precancerous cells is key and cervical cancer mortality rates have dropped over 50% since the popularization of PAP screenings in the 1970s¹. However, there’s a lot of misconceptions that lesbians and transgender people don’t need regular cervical screening exams. This myth comes from the false idea that HPV (which is the leading cause of cervical cancer in over 90% of cases) is only passed between cisgender, heterosexual couples.
The truth is that everyone with a cervix who is of age should be getting regular PAP smears. This includes lesbians, bisexual people with a cervix, transgender men with a cervix, and some transgender women that have had genital affirming surgery (more on that below).
The short of it: if you’re someone with a cervix and you’ve had genital skin-to-skin contact with anyone of any gender you should be getting PAP screenings regularly. Cervical cancer is not picky and choosey of who it selects to affect, which is why it’s important for anyone with a cervix to be screened regardless of sexuality¹.
The recommended age and guidelines for cervical screening exams vary per region. Check with your local health unit for this information!
Lesbian, Bisexual & Queer Folks
Many lesbians are told that their risk of cervical cancer is lower by not having sexual contact with someone with a penis (note: sometimes this is not the case as some trans-women may have a penis). The providers sharing this information are not educated in queer-informed care and are putting people at risk by misinforming them. The Canadian Cancer Society strongly encourages anyone with a cervix that is sexually active over 21 to get screened for cervical cancer regardless of their sexuality². HPV can spread between any genital contact; it isn’t specific to only penis-to-vagina contact. It can even be passed from parent to baby during a vaginal delivery due to genital contact. This is why it’s so important to get screened regardless of who you are engaging in sexual activity with!
Transgender Men/ Nonbinary People
There are a lot of barriers to reproductive health care for transgender men, but if you have a cervix, you are still at risk for cervical cancer and should be getting screened. Being a transgender man with a cervix carries the same risk for potential cervical cancer as cisgender women with cervixes!
What about trans-men that have had hysterectomies?
It will depend on what type of hysterectomy was performed and if any parts of the cervix remain (not all hysterectomies remove the cervix completely). It’s best to check with your health provider to determine what degree of tissue was removed and if there are any cervical cells left that would be important to keep an eye on. If you’ve had a hysterectomy and your cervix is still fully or partially intact, it is recommended to continue getting regular pap smears. If you’ve had your cervix removed with a hysterectomy but have a history of pre-cancerous cells your health provider may recommend screening other regions of the genital area for cell changes still³.
Reproductive health care can be difficult for transgender men to access. Not all health providers are queer-informed and inclusive, which can cause concern for potential transphobia, misgendering, and gender dysphoria to be an issue. It’s completely understandable and valid to have these concerns! To try and tackle this barrier, it can be helpful to reach out to local LGBTQ2S+ support centres for referrals to trans-inclusive reproductive health providers. Studies have also found that requesting to guide the medical devices and HPV swab in yourself (rather than the doctor) can help to diminish psychological distress associated with cervical exams as a man⁴.
Transgender Women
Many transgender women have never considered needing PAP smears done, however, trans women that have had genital gender-affirming surgery may need regular cervical screening exams. The risk for trans-women that have had bottom surgery will depend on the type of surgery performed to create the vagina, as well as what tissue was used during the procedure. It’s helpful to chat with your health team about the type of surgery and what risk it may put you at for cervical cancer⁵.
Seeking reproductive care as a trans-women can be difficult as there may be barriers of transphobia, gender dysphoria, and health teams that are not educated in queer-informed care. If you’re worried about finding a safe place to have a PAP test done as a trans-woman, check in with your local LGBTQ2S+ support centres and health units for recommended health professionals.
Transgender women that have not had bottom gender-affirming surgery do not need to undergo PAP exams as they are not at risk for cervical cancer, though it should be noted that while there is no screening for HPV for people with penises, they can be carriers and pass it along to sexual partners.
So, Who Needs PAP Smears?
If you’re feeling confused about whether you need to be getting cervical screening exams done, here is a quick guide on who needs them and who does not…
Get screened if you are somebody with a cervix (including trans-women with a neo-cervix) even if:
You have no symptoms
Are no longer sexually active
Have only had one sexual partner in your life
Have been through menopause
Have had the HPV vaccine
Have only ever had sex with people with vaginas
Have no family history of cervical cancer
If you have had your cervix completely removed or do not have a cervix, you generally do not need to be screened for cervical cancer. The exception here is people who have had a cervix removed (whether it be hysterectomy or gender-affirming surgery) that have a past history of precancerous cells. In this instance, your doctor may recommend screening cells of the genital area regularly to catch any other reproductive health-related precancerous cells⁶.
PAP Smears Save Lives
The thought of PAP smears can be a frightening thought for many, but they save lives. There are some tips and tricks on how to make your cervical exam appointment go smoother. Remember, your health provider doesn’t want it to be uncomfortable for you, if you’re nervous, tell them!
If you’re still unsure if you should be getting screened, talk to your trusted health care provider and refer to your local health units for age guidelines.
References
Hsiao, K. T. (2016, June 17). Screening for cervical cancer in transgender men. Screening for cervical cancer in transgender men | Transgender Care.
Canadian Cancer Society. (n.d.). Lesbian, bisexual & queer women and cervical cancer - Canadian Cancer.
Canadian Cancer Society. (n.d.). Trans men and cervical cancer screening - Canadian Cancer Society.
Dhillon, N., Oliffe, J. L., Kelly, M. T., & Krist, J. (2020, June 3). Bridging Barriers to Cervical Cancer Screening in Transgender Men: A Scoping Review. American journal of men's health.
Canadian Cancer Society. (n.d.). Trans women and cervical cancer screening - Canadian Cancer Society.
Cancer Screening Recommendations for Transgender/Non-Binary Individuals. Cancer Care Manitoba. (n.d.). https://www.cancercare.mb.ca/screening/trans.