Trans women and cervical cancer

If you’re a trans woman, you may not have given much thought to Pap tests and cervical cancer. And if you haven’t, that makes a fair amount of sense. After all, in order to get cervical cancer, you need to have a cervix — that is, the organ that connects the vagina to the uterus. Those of us who have not had bottom surgery aren’t at risk for cervical cancer.

If, however, you’re a trans woman who has had bottom surgery to create a vagina (vaginoplasty) and possibly a cervix, read on: you may want to think a bit more about cancer screening. That’s because there’s a very small risk that you can develop cancer in the tissues of your neo-vagina or neo-cervix. The risk depends on the type of surgery you had, the type of tissue used to create your vagina and cervix and your personal health history.

There isn’t much information on the risk of neo-vaginal or neo-cervical cancer in trans women. But here’s what we do know:

  • If you’re a trans woman who has not had any type of bottom surgery, you don’t need to be screened for cervical cancer.
  • If you’ve had a vaginoplasty that included the creation of a cervix, you should get regular Pap tests if you are age 21 and over, and sexually active. This type of bottom surgery is very rare.
  • If you had a vaginoplasty that didn’t include the creation of the cervix, you may have a very small risk of developing cancer in the tissues of your neo-vagina. Your risk may be higher if you have a history of HPV infections or a suppressed immune system. You should talk to your healthcare provider to figure out your specific cancer-screening needs as part of your overall pelvic health following surgery.
  • In some cases, a test similar to a Pap test called a “vault smear” or “cuff smear” can be used to look for abnormal or precancerous changes to your neo-vagina. These tests are not as effective as Pap tests in detecting cancer. You and your healthcare provider should decide together whether you should get these tests, based on your individual risk.

It can be difficult to make cancer screening a priority, especially when there’s not a lot of information out there about cervical cancer risks for trans women. You may also be concerned about things like experiencing transphobia during the screening process. Maybe you feel you have more pressing health concerns. Or maybe you just don’t want to think about cancer screening.

Still, it’s important to take care of your health by getting the cancer screening you need. Screening means checking for cancer before there are any symptoms. Here’s the bottom line: if you’re a trans woman who’s had bottom surgery, discuss your personal risk for cancer in your neo-vagina or neo-cervix with your healthcare provider, and come up with a plan for cancer screening that works for you.