Guys Get Pap Tests Too: Developing Cervical Cancer Screening

Guys Get Pap Tests Too: Developing Cervical Cancer Screening Outreach
Materials for Female-to-Male Transgender Patients
Ida M.
Bernstein ,
Sarah M.
Peitzmeier ,
Sari L.
Reisner ,
Jennifer E. Potter
1 Harvard Medical School, 2 The Fenway Institute, Fenway Health, Boston, MA, 3 Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, 4 Department of Epidemiology, Harvard School of Public Health, 5 Beth Israel Deaconess Medical Center, 6 Fenway Health, Boston, MA
• It is recommended that FTM patients with a
cervix follow the same cervical cancer
screening guidelines as non-trans women1
Participant Demographics
• Unique barriers to screening for trans men
• Fenway Health FTM patients are less likely
to be up to date on Paps and 10 times more
likely to have inadequate Paps than nontrans women3
• Targeted interventions are needed to
improve Pap utilization among trans men
• Understand trans mens’ attitudes towards
and barriers to cervical cancer screening
• Develop novel cervical cancer screening
outreach materials for FTM patients
 Social media, FH website, community listservs
 21+ years, born with a cervix, self-identified
on FTM spectrum
LimeSurvey® SURVEY
 Explored participant experiences with Pap
tests and preferences for outreach campaign
 Interviewer field notes and online survey
responses incorporated into text and images
 Data compared to existing community-driven
education materials4,5
 Brochure reviewed by team of patient outreach
and transgender healthcare specialists
• 32 in-depth interviews
• Mean age 33.3 (SD=10.6)
• 18.8% racial/ethnic minority
• 65 completed online survey responses
• Mean age 33.4 (SD=8.98)
• 13.8% racial/ethnic minority
Key Themes Used in Brochure Text Design
“Have a dialogue with me about
what I need. Every trans person is
different, so each of us may need
support in different ways.”
“Avoid language that feminizes
the process and make it more of
a healthy medical thing that has
to be done to keep you safe and
doesn’t reflect your gender.”
“We need these exams, but a bad
experience with one provider can
limit the likelihood of returning to
care and opening ourselves up for
that type of vulnerability again.”
Patients and providers should jointly
customize Pap tests to fit individual
needs and comfort
Need for gender-affirming
communication of Pap and associated
health information
Feeling in control and confidence in
provider competency in trans
healthcare are priorities for FTM
Provide options:
• Bring support person
• Ask for chaperone
• Keep shirt on
• Pediatric speculum
• Topical anesthetic
• Gendered language
e.g. Pap as Women’s or
Reproductive Health
• Unnecessary use of
female anatomical
Focus on:
• Gender neutral
language e.g. Pap
as cancer prevention
• Masculine identity
• Professional
Adjust interactions
during exam
Consider low-dose
anxiety med, etc.
• Provider has experience in
trans healthcare
• Patient strategies for
exercising control of exam
Participant Feedback Informed the Selection of Images
• Desire for representation of diversity of FTM community (age, gender expression, race/ethnicity, etc.)
• Recommended exclusion of images of women, medical equipment, and anatomical diagrams
• Participant feedback reflects unique barriers to adequate
cervical cancer screening faced by the FTM community
1 American College of Obstetricians and Gynecologists. Committee opinion: Healthcare for
transgender individuals. 2011;512.
• Spectrum of comfort with Paps suggests communicating
customization options for the exam may be an effective
outreach tool
2 Feldman J. Medical and surgical management 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. 2008;365-392.
3 Peitzmeier SM, Reisner S, Harigopal P, Potter J. Female-to-male patients have high rates of
unsatisfactory Paps compared to non-transgender females: Implications for cervical cancer screening.
Manuscript submitted for publication. In press.
• Our brochure will be further evaluated by community
member focus groups to ensure effective tailoring to the
needs of FTM individuals
4 The Brown Boi Project. Freeing ourselves: A Guide to Health and Self-Love for Brown Bois. 2011
“Educate yourself and treat us like the humans we are. This
is a hard road we are traveling and something vital like
healthcare shouldn’t be such an obstacle for us.“
5 Sherbourne Health Center. Check it out guys. 2010. Accessed on Dec 12 2013.
Many thanks to the Scholars in Medicine Office, the
Center for Primary Care, and The Open Gate Foundation