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Having a Pap test is often difficult for trans men. But Pap tests are important for our health, so below are some tips that can help make getting the test just a little bit easier.

What happens during a pap test?

  • The Pap test usually takes 2-3 minutes.
  • The doctor or nurse will ask you to remove your clothing from the waist down. You can leave your socks on (unless the doctor needs to see your skin as part of a complete physical). They will give you a sheet or gown to cover yourself with. The doctor or nurse usually leaves the room or pulls a curtain around you for privacy while you do this.
  • They will ask you to lie on the examination table on your back with your knees up and bent and your feet in stirrups (foot rests).
  • While you are lying on an examination table, the doctor or nurse will put on latex or vinyl gloves and then carefully insert a small metal or plastic instrument called a speculum into your front hole to open it so that its walls and the cervix can be seen clearly. Ideally, the speculum should be the smallest size needed (depending on your body, a longer or larger speculum may be better) and should be warm to touch. (insert diagram of speculum here).
  • A doctor or nurse will take a small sample of cells from the cervix using a little broom or brush and then put the cells into a container with a preserving liquid in it.
  • Some doctor’s offices and clinics use an older method of collecting cells that involves smearing the cells on a slide for analysis, which is why the test is sometimes called a Pap smear.
  • The sample is then sent to a lab, where a cytologist (a specialist trained to look at cells and interpret a Pap test) reviews it.
  • You may feel some discomfort or pressure during a pap test. Try your best to relax and remember to breathe.
  • Some trans men describe pap tests as a painful experience. For trans men who have experienced sexual abuse or assault, or for those who don’t experience penetration, the procedure may be more challenging. Read on for some tips on how to make getting a Pap test easier for you.

Preparing for a Pap Test

  • You may find it helpful to talk with someone you know who has had a Pap test.
  • You might want to have a separate appointment with your doctor or nurse to discuss the pap test and your particular concerns or needs before the day you actually have the test.
  • Book your pap test for a day when you are not bleeding.
  • If possible, avoid the following for 2 days before the Pap test to increase the accuracy of the test:
    • Vaginal medications (unless advised by your doctor)
    • Douches
    • Any kind of contraceptive such as spermicidal jelly, gels or foams
    • Avoid ‘front hole’ intercourse with toys, dildos or penises for 24 hours before the test.
  • If it will make you feel more comfortable, ask for a female or male doctor or nurse. While having a female-identified practitioner or a queer-identified practitioner may reduce the discomfort and/or the likelihood of judgment and transphobia, it doesn’t necessarily mean you’re going to like their manner or their personality or their approach to giving paps. The best you can do is ask for what you need as explicitly as you can.
  • If you are not used to penetration, getting comfortable with it at home either on your own or with a partner before you get a pap test can help. Many sex toy shops and clinics will give/sell you a disposable plastic speculum you can experiment with at home or you can try small sex toys and/or fingers.

Getting Through the Pap test

  • You can bring a friend or family member to stay with you during the test. Think about and let them know in advance what you would like them to do: hold your hand? Tell you stories to distract you? Remind you to breathe?
  • Give yourself a pep talk – you are doing this for your health, screw cancer, it only takes a few minutes, etc.
  • No matter who your healthcare provider is, there is no guarantee you’re going to like their personality or their approach to giving paps. The best you can do is ask for what you need as explicitly as you can.
    You can ask your doctor or nurse to provide you with a mild painkiller and/or sedative before the exam if you find pap tests particularly painful or stressful.
  • Tell the doctor or nurse if this is your first exam so they know to be extra gentle.
  • If you tend to find discussing your needs in-person to be difficult, you can give your doctor or nurse a written explanation of your needs before the exam.
  • You can also ask for extra time to relax in the exam room before the test, and extra time to compose yourself and get dressed afterwards.
  • Don’t take your clothes off until you have to. Ask the doctor or nurse if they’re doing a patient interview first and if so, request that you do the interview before you take your clothes off.
  • During the interview, you can decide whether or not to disclose your sexual orientation and practices. You also may be able to decide whether or not to disclose your gender identity, depending on how you are being perceived. Some guys who don’t “pass” as male may choose not to disclose in order to avoid an uncomfortable conversation, while others are only comfortable getting a pap with a provider who understands their male/trans identity. Disclosing can result in a better and more informed health care experience. It also, however, can put you at risk of trans/homophobia and discrimination. The choice to disclose is yours and yours alone. If you feel you are being treated badly, you can stop the examination at any time and leave.
  • Ask the practitioner to use terms that you prefer.
  • Speculums can look scary, especially the metal ones. Some clinics use plastic speculums instead because they are disposable. Remember that speculums are just a tool – your doctor or nurse needs them to hold the walls of your front hole open so they can see your cervix. If you have a history of painful exams, you can ask the doctor or nurse to use one that you know has been ‘ok’ in the past. It is also useful to share information that you may remember previous doctors telling you, such as “my cervix is far back” or “to the side.” The exam with two fingers before your pap can also be helpful for the provider to locate your cervix and to assess the best speculum for you.
  • Ask the doctor or nurse if it’s possible to raise the back of the exam table so you can be more upright during the exam and if not, prop yourself up on to your elbows. This will give you a better view of the process and can help you feel more in control. Your abdominal muscles will relax and it’ll be easier to focus on breathing, staying present, etc.
  • Taking long, slow and deep breaths can help you relax the muscles inside your front hole and help it to open up. If you find meditation or breathing exercises helpful in your life, this is a great time to use them.
  • Ask the doctor or nurse to explain what they are doing as they do it ie: “You will feel me inserting the speculum”, etc. Or, if you prefer, ask the doctor or nurse to talk about something totally unrelated or to simply be quiet.
  • Distract yourself: count the ceiling tiles, do your grocery list, decide what you’re going to do when you win the lottery or chat with the doctor or nurse or your companion.
  • Technically speaking, pap tests can cause mild discomfort but they shouldn’t hurt or cause significant pain. However, some trans men report that they are painful. For trans men who don’t engage in frontal sex or find it traumatic, penetration of any kind can be difficult and painful. This may also be the case if you have experienced pelvic trauma or survived abuse. Some also report that dryness caused by testosterone can make pap tests painful. Some of the tips on this list may help to make paps easier for you.
  • If anything feels uncomfortable, tell the practitioner. If at any time you need the exam to stop, tell the practitioner to stop and withdraw the speculum.
  • Lube is not traditionally used during pap tests as the cytology labs prefer it not to be. If, however, you would really prefer that lube be used, you can ask the practitioner (they just need to be sure to note this on the lab form).

After the Test

  • Appreciate practitioners for doing things right. If they took extra time, were extra gentle or particularly respectful, let them know – this reinforces their good work and makes it more likely you, and other patients, will experience the same good treatment next time.
  • Treat yourself afterwards – take yourself out for breakfast, go for a walk with a friend or have a celebratory drink.
  • Ask the doctor or nurse how long it will take to get your results back and how you will be notified. It can take several weeks.

Follow-up and results

  • A negative or normal test finding means that all the cells in the sample are of a healthy size and shape.
  • A positive or abnormal test finding means that something unusual is in the sample. The test found cells of a different size and shape.
  • Each clinic has its own practice but usually if there is a negative or normal test, you will not be contacted.
  • If the results are abnormal, your doctor or nurse will contact you either by letter or by phone. For peace of mind, you can also call the clinic to get the results.
  • If you get an abnormal result, it is really important to follow-up to make sure you get any treatment that is required.
  • Remember: abnormal Pap test results are common – cervical cancer is not.
  • There are many reasons a Pap test result could come back abnormal and there are many stages of an abnormal result.
  • If there are changes in the cells of your cervix, this does not mean you have cancer. These early cell changes are called abnormal cells, not cancer. For most people, the abnormal cells change back to normal on their own.
  • If you have an infection, such as an STI like Chlamydia or a yeast infection, once the infection is treated, your Pap test result usually returns to normal.
  • At this stage, your doctor or nurse will likely have you come back for a repeat test. Repeat Pap tests often come back normal. Depending on the results of the repeat test, you may be required to have further follow-up.
  • Some people prefer to go see a naturopathic healthcare provider when they find out they have cervical cell changes. This kind of health care is not covered by OHIP. And remember - it is still important to follow-up with repeat Pap tests.
  • If the repeat test confirms you have cell changes in your cervix, this means they did not change back to normal on their own. These are called pre-cancerous cell changes. These cells can become cancer cells if they are not treated.
  • At this stage, you will likely be referred to a specialist who will look at your cervix more closely with an instrument called a colposcope. This device helps the practitioner see your cervix more clearly. This process is called a colposcopy.
  • While doing a colposcopy, the practitioner may also take a biopsy, a small piece of tissue from your cervix that can be examined more closely under a microscope.
  • This is the only way to determine if the cells are pre-cancerous or cancerous.
  • Pre-cancerous cells can usually be removed through a biopsy procedure.
  • If the cells are cancerous, there are many effective treatments for cancer of the cervix, including surgery, radiation, chemotherapy and other treatments.

Frequently Asked Questions about Paps

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