I have good news about cervical cancer screening! (Yes, really!)
Did you know that now there is an alternative to the pap smear for some folks: a self-administered swab HPV test? And it's starting to be covered by insurance.
If you're thinking that this info is not relevant to you because you don't have a cervix, well, we all read about the risk of prostate cancer in trans people, so it's only fair that you read about cervical cancer screening. And you probably know someone who does have a cervix - so maybe this info will help you gain more empathy.
You are welcome to read this article regardless of your anatomy!
Rey Katz
And the HPV vaccine is recommended for young people of all genders - anyone can get or spread the virus that can lead to cervical cancer.
I am not a medical professional and this article is not medical advice. Please consult a doctor if you are able for any concerns you may have.
Why is cervical cancer screening important?
Cervical cancer is the fifth most commonly diagnosed cancer in people with a cervix. It's generally caused by some strains of HPV, a virus. Five-year survival is over 90% if caught at the localized stage, and vaccinations and screening have really helped reduce the danger of this cancer over the last few decades.
Screening usually consists of a pap smear, but recently, an HPV self-collection test has become available for some people, which is very good news for people who can't tolerate a pap smear or find it uncomfortable.
What is this new HPV test?
HPV self-collection consists of a swab, like a long Q-tip, that you use on yourself at the doctor's office to collect a sample. Kind of like a Covid test but it's not in your nose. This is generally much easier and more comfortable compared with a pap smear, with a medical professional using an invasive piece of equipment to collect a sample.
The FDA approved in-office HPV self-collection in 2024, and in 2026, updated guidelines made HPV testing the preferred screening method for average risk people with cervixes ages 30-65.
Insurance coverage is coming also: starting the beginning of 2027, most insurers should cover HPV self-collection.
So what is a pap smear and why is it so difficult?
A pap smear is primarily a test for indicators of cervical cancer, although some STIs can also be checked for using the same process. The main reason this test is so uncomfortable for many people is because a medical professional has to insert a device called a speculum, made out of hard metal or plastic, and then insert a swab down the center to collect the sample.
This is difficult and painful for many people. Physically, a lot of nerves run through this sensitive area of the body, including the vagus nerve - a nerve responsible for dizziness, nausea, and fainting. Emotionally, it requires allowing a stranger to manipulate a very personal area of the body. And culturally, penetration can mean a loss of virginity or value - I'm not defending these beliefs, just stating they make certain medical tests very challenging or impossible for some people.
For transmasculine people, getting a cervical cancer screening can additionally mean getting misgendered ("well woman exam" is a common euphemism) or having to argue with the staff that yes, you need this exam even though you grew a beard, and no, you're not there with your girlfriend.
Many trans people feel dysphoria about this area of their body, and feel an intense discomfort during this kind of test. Maia Kobabe describes the miserable experience of a gynecological exam in eir excellent graphic memoir, Gender Queer:
"What I experienced next was 45 seconds of the most excruciating pain of my life. I felt as if I had been stabbed through my entire body and with this came a wave of psychological horror at the realization that things can go inside my body. Of course I already knew this fact intellectually; embodied knowledge is an entirely different matter. What my body told me was that this intrusion of the outside world into my internal physical being was wrong on a level too deep for words."
Everyone's experience is different, and some trans people (including myself) can tolerate such an exam. These differing experiences are why it's so important for medical professionals to ask questions and not make assumptions based on stereotypes.
I actually came out to my primary care provider as trans in the same appointment I was scheduled for a pap smear. As if it wasn't awkward enough already, am I right? She did ask me if I was still okay with proceeding with the exam given what I shared, and I confirmed that I'd had one before and was reasonably okay with it.
What does research show about cervical cancer screening and risk in trans and nonbinary people?
Trans men have a similar risk of HPV infection and cervical cancer risk as cis women, but screening rates are lower in trans men.
UCSF's Gender Affirming Health Program describes how trans men are more likely to have bad experiences with pap smears, and in addition to suggesting some ways to improve the patient experience, they suggest that self-collected HPV tests or even urine tests for HPV could be good alternatives.
In general, if providers are more knowledgeable and understanding about being trans, it's my assumption that more trans people would be willing to access preventative healthcare.
I was really glad to hear about the new HPV self-collection test as an alternative to pap smears. Hopefully this will make screening accessible for more people so we can live healthier lives.
In other news, check out the Thrive Fund - Financial aid for gender-affirming needs by Point of Pride
Point of Pride has opened applications during August for their Thrive Fund: providing small grants for gender-affirming care. Some examples of this care include updating a passport, voice training sessions, and reproductive healthcare.
You can apply for a grant if you meet some requirements, like identifying as trans and having a financial need. Please check it out!
