Inadequate collection of endocervical cells during a Papanicolaou (Pap) test prevents the detection of cervical cancer and dysplasia. The prevalence of inadequate Pap tests among trans masculine (TM) individuals is up to ten times higher than that of cisgender women; yet little is known about the demographic factors, health characteristics, healthcare experiences, and traumatic circumstances that may place some TM individuals at greater risk for an inadequate Pap.

Methods

Between 2015-2016, we enrolled 150 TM adults in a survey study assessing demographics, health characteristics, healthcare experiences, trauma history, and Pap history. Bivariate and multivariable logistic regression analyses examined associations between age, length of time on testosterone, cigarette smoking history, having to educate a provider about transgender people to receive appropriate care, anticipated healthcare stigma, post-traumatic stress disorder (PTSD) identified through a self-administered PTSD screener, and lifetime history of an inadequate Pap.

Results

Participants’ mean age was 28.0, 53.3% had used testosterone for one year or more, 41.3% had PTSD, and 14.7% had an inadequate Pap in their lifetime. In the multivariable model, age (aOR=1.15; 95% CI=1.04-1.27; p=<0.01), lifetime testosterone use of one year or more (aOR=3.51; 95%CI=1.02-12.08; p=0.046), and PTSD (aOR=3.48; 95% CI=1.10-11.00, p=0.03) were significantly associated with increased odds of having an inadequate Pap.

Conclusion

Older age, testosterone use, and PTSD are risk factors for receiving an inadequate Pap among TM adults. Clinicians should assess TM patients’ trauma and testosterone use history before Pap tests and utilize trauma-informed testing practices that facilitate the adequate collection of endocervical cells.