Ask the Experts About LGBT Health
Q: Pap smear for transgender women?
I am a medical professional searching for a credible medical opinion/evidence about whether my MTF patients who have undergone sexual reassignment surgery should 1) be having pap smears and 2) if so, how frequently.
A: Response from Dr. Raney
Thanks for raising this question. Most MTF patients who have undergone vaginoplasty (surgical creation of a vagina) do not have a cervix and therefore do not need cervical Pap smears. However, in some vaginoplasties, the glans penis is used to create a neocervix. For these patients, the current recommendation is to provide cervical Pap smears following the same guidelines as for natal females.
You may want to also consider giving a regular vaginal Pap smear to your MTF patients who have a history of genital warts, and a regular anal Pap smear for those who engage in receptive anal sex, particularly if they are HIV infected or otherwise immunocompromised.
Finally, even if your MTF patients do not require Pap smears, we feel they will benefit from getting regular vaginal exams. Neovaginas are usually created with grafted skin from the genital region. A speculum exam can help reassure both patient and physician that the tissue and urethral meatus are healthy, and that there is no evidence of infection.
Thanks for writing,
Pat Raney, MD and Harvey Makadon, MD
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Forum Experts
 Harvey J. Makadon, MD is Clinical Professor of Medicine at Harvard Medical School and Director of Education and Training at The Fenway Institute at Fenway Health in Boston. He is a member of the Division of General Medicine at Beth Israel Deaconess Medical Center and is the lead editor of The Fenway Guide to LGBT Health, published by the American College of Physicians in 2007. He has long been involved in developing both educational and clinical programs to serve gay, lesbian, bisexual and transgender populations.  Patricia Raney, MD, is a staff physician at Fenway Health in Boston, Massachusetts. She is a graduate of the University of Massachusetts Medical School and is Board Certified in Family Medicine. Her clinical interests include women's health and wellness, primary care, preventive care and the health concerns of lesbians, bisexual women and transgender people. On a more personal note, she is an avid stone carver. |
