As trans men, some of us have been told by doctors and other healthcare providers that we do not need Pap tests, or we have avoided them because of discomfort and discrimination. However, anyone with a cervix needs a pap test. Below are some commonly asked questions about who should get a Pap test.
Do trans men need pap tests?
Yes. If you have a cervix and are 21 or older you should get a Pap test, regardless of who you’ve had sex with. Regular screening is the best way of preventing cervical cancer or finding it early, when treatment is most effective. Anyone with a cervix can get cervical cancer.
My doctor says I don’t need a pap test because I have sex with women.
The Ontario Cervical Screening guidelines state that folks who have sex with women should follow the same cervical screening guidelines as those who have sex with men. If you have ever in your life had any kind of sexual activity with anyone that involved the genital area, you need a Pap test.
I don’t have sex that involves penetration. Do I need a Pap test?
Yes. HPV, the major cause of cervical cancer, is a sexually transmitted infection that is passed on through genital skin to skin contact. You do not need to have penetrative sex in order to get HPV.
I’ve never had sex with a non-trans man. Do I need a Pap test?
Yes. Guys who have sex exclusively with women (or with other trans men) can still get HPV and are still at risk of cervical cancer.
I only had sex with a non-trans man once. Do I need a Pap test?
Yes. Trans men who have been sexually active, even only one time, with someone of any gender should still have Pap tests.
I haven’t had sex in years! Do I need a Pap test?
Yes. Even if you’ve only been sexually active one time or haven’t been sexually active for decades, you should still have Pap tests.
I just had a Pap test. Do I need another one?
You should get a Pap test every 3 years.
I only started having sex this year. Do I need a Pap test?
You should start getting pap tests within 3 years of becoming sexually active if you are over 21. For example, if if you started having genital skin-to-skin contact at the age of 16, you would wait until you are 21 to get screened, and if you are older than 21 but haven’t had genital skin-to-skin contact with someone else, then you can wait to get screened until 3 years after your first sexual experience.
I have never been sexually active with anyone. Do I need a Pap test?
If you have never had sexual contact of any kind with another person, it is unlikely you are at any risk of having HPV, the major cause of cervical cancer. If you become sexually active, you should start getting pap tests within 3 years of becoming sexually active. However, pelvic exams are still recommended, to check for signs of conditions that aren’t related to sexual activity or HPV.
It’s been over 10 years since I’ve had a Pap test. Do I need a Pap test?
Yes. Even if you haven’t had a Pap test in years, it’s not too late. Schedule one as soon as you can.
I am HIV positive. Do I need a Pap test?
Yes. HIV positive trans men should have a Pap test every year.
I am pregnant. Should I still get a Pap test?
Yes. Make sure your healthcare provider is aware that you are pregnant before getting the Pap test.
I am post-menopausal. Do I still need a Pap test?
Yes. Pap test screening should not be stopped until you reach 70 years of age and have had 3 or more consecutive normal Pap tests in the last 10 years.
I’ve had a hysterectomy. Do I still need a Pap test?
If you had the kind of hysterectomy that left your cervix intact, then yes, you need a pap test. If you had a complete hysterectomy (including removal of your cervix) but had a history of HPV or abnormal Pap test results, you may still need other kinds of tests for HPV-related cell changes, such as ‘vault’ or ‘cuff’ smears. (If the results of previous Paps are unknown, they may recommend that you have at least one ‘vault’ smear). Talk to your doctor for more information. If you’re unsure whether or not your cervix was removed, ask your surgeon (if possible) or your doctor.
What if my ‘front hole’ has been surgically closed/removed?
If you have had colpectomy (removal of the vagina) or colpocleisis (closure of the vagina) as part of bottom surgery such as metiodioplasty, you obviously cannot have a pap test. These procedures occur after (or as part of) a full hysterectomy, during which your cervix would have been removed. If you have a history of cervical dysplasia or cervical cancer this should be discussed with your surgeon and other healthcare providers before surgery.
I am a trans woman who has had bottom surgery. Do I need a Pap test?
If you had the kind of bottom surgery (vaginoplasty) where a cervix was created, then yes. If you had the kind of bottom surgery where a cervix was not created, then you don’t need a traditional Pap test. However, you should still talk to your doctor about having a pelvic exam, as HPV can lead to cell changes (dysplasia) in the vaginal walls that could lead to vaginal cancers. If you have had bottom surgery and have a history of genital warts and/or are HIV-positive or immunocompromised, it is recommended that you have yearly vaginal ‘cuff’ smears.