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Health: cervical screening for trans men

Tue 28 Jul 2015 In: Health and HIV View at Wayback View at NDHA

A World Health Organisation Report is calling for regular and respectful cervical cancer screening for transgender men, something which is part of official advice from the Ministry of Health here in New Zealand. The July 2015 health update says trans men who retain female genitalia are at increased risk of ovarian, uterine and cervical disease. It says they can miss out on cervical screening and other health services, such as breast cancer screening, as they may not seek them out - or may be excluded. [The information comes from a wider report looking at trans people and HIV, which we’ll have more on soon too] That’s backed by a 2012 US report which found nearly half of trans men postponed or completely avoided preventative care out of fear of discrimination. It said one in five trans men refused healthcare because doctors and other medical staff refer to them as the wrong gender. The World Health Organisation has released clear guidelines, and says access to cervical screening should be provided routinely without disclosing a transgender man’s sex assigned at birth. It says health-care providers should also recognise that some transgender men might experience emotional and physical discomfort with some procedures. “Health-care systems need to be knowledgeable about transgender health issues and provide quality, respectful services to transgender people.” In the report, the WHO also says while HIV prevalence among trans men appears to be low, more research is needed on whether the risk is higher among trans men who have sex with men. It also says relevant, but respectful and non-invasive, gender-identity questions. It says there is a dearth of data on cervical and ovarian cancer among transgender men, data which is needed to combat diseases that affect them disproportionately. What’s the official standard in New Zealand? Official New Zealand Ministry of Health advice, from a 2012 good practice guide, is that regular cervical smears are recommended for trans men who have not had a hysterectomy and their ovaries removed, because of the increased risk of cancer. It says a need for screening should be emphasised to trans men, who have historically been reticent to seek out gynaecologic care. “However, rigid adherence to guidelines in the face of patients who suffer significant physical or emotional discomfort with exams may have the reverse of the desired effect. It should be remembered that the goal is to preserve patient health and well-being. A pap smear and pelvic exam done regularly every 2–3 years is far superior to no preventative examinations at all.” The Ministry says providers unable to provide checks should assist patients by referring them to sensitive alternatives in their area. “These referrals should be discussed in advance with the gynaecologic provider to ensure that she and her staff are comfortable providing care for transgender men and will be sensitive to their individual needs.” The Ministry of Health says breast cancer risk is likely significantly lower in the transgender male population simply because many transmen have bilateral mastectomies which decreases, but does not eliminate, the amount of breast tissue in which malignancy can potentially develop. “However, no mastectomy can completely remove all breast tissue and patients must understand that their risk of breast cancer, while much lower, is not zero. It should be emphasised to patients that any suspicious lumps must be evaluated by a health care professional.” The Ministry of Health says trans men who do not choose to have mastectomies should have breast self-exams, clinical breast exams, and screening mammography according to appropriate age and family history based guidelines for cisgender women. But is it happening? While it’s obviously a very personal subject, we’d love to hear from New Zealand trans guys about their experiences. Are our health services getting it right? We won't use your name. You can email Jacqui Stanford in complete confidence at jacqui@gaynz.com Jacqui Stanford - 28th July 2015    

Credit: Jacqui Stanford

First published: Tuesday, 28th July 2015 - 10:59am

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