FTM transgender patients are more likely to have inadequate Pap tests

A new study finds that female-to-male (FTM) transgender patients had over 10 times higher odds of having an inadequate Papanicolaou (Pap) test compared to female patients. The findings, by Fenway Health's Jennifer Potter, MD, and colleagues at Fenway, Harvard Medical School and the Johns Hopkins School of Public Health, appear in the Journal of General Internal Medicine, published by Springer.

The researchers found that FTM patients were more likely to have an inadequate Pap, with prevalence of inadequate samples 8.3 times higher among tests of FTM patients (10.8% vs. 1.3% of tests); were more likely to have had multiple inadequate Pap tests; and had longer latency to follow-up testing. Time on testosterone therapy was also independently associated with, but did not fully account for, Pap inadequacy.

Cervical cancer can still occur in FTM transgender men, the majority of whom do not undergo complete sex reassignment surgery or undergo total hysterectomy later in life. Because of this, national guidelines recommend that transgender men with a cervix follow the same screening protocol as non-transgender females.

This study points to the need to better understand and address possible reasons for Pap inadequacy among FTM patients, including cytological changes induced by testosterone and patient/provider discomfort with the pelvic exam.. In addition, alternatives to repeated Pap testing, such as cytologic reprocessing of inadequate samples or primary HPV DNA screening should be studied for efficacy and acceptability among FTM patients.

"Pap tests are important for FTM patients but it can be challenging to obtain interpretable results," said Dr. Potter, Director of Women's Health at Fenway Health. "More information is needed on the effects of testosterone on the cervix and effective cervical screening strategies that do not rely on a Pap test. While we wait for results of studies that address these questions clinicians should do everything possible to increase patient comfort during the exam and alert FTM patients that repeat Pap testing may be necessary after an initial, inadequate result."

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