Understanding barriers to cervical screening uptake in trans men: an exploratory qualitative analysis

Joanna Semlyen (Lead Author), Kogliavani Kunasegaran

Research output: Contribution to journalAbstract


Background: Cervical cancer is one of the most frequently encountered gynaecological malignancies that is highly preventable through screening. Therefore, screening for cervical cancer is a public health priority. No recommendations exist for screening lesbian or bisexual women or for female to male transgender individuals. Evidence suggests that trans men attend cervical screening far less than cisgendered women and also are more likely to receive an inadequate cervical smear test. We aimed to explore barriers to cervical screening uptake in trans men.

Methods: Qualitative interviews were carried out with trans men who had an intact cervix and were eligible for cervical screening. Recruited through trans organisations, seven participants based in London and Manchester were interviewed or took part in a focus group. Because of the sensitive nature of the research, there were few expressions of interest for the study, so every request was highly valued. Interview and group discussions were audio-recorded, transcribed verbatim, and analysed by thematic analysis. Ethics approval was granted from London Metropolitan University.

Findings: Four themes emerged. The trans men reported the importance of social and peer support in providing motivation to seek health care. The need for their gender identity, post-transition, to be accepted by health-care professionals was crucial in influencing the decision for screening uptake. Despite the participants' understanding of the importance of cervical screening on their health, previous negative experiences deterred attendance. There was a recognition that education about the importance of screening within the trans community was needed.

Interpretation: Trans men need sensitive and respectful cervical screening experiences. Promotion of cervical screening through provision of education for trans men and health-care professionals is essential to increase awareness and understanding of the importance of screening in this group and to develop sensitive environments for screening to take place. Although we interviewed a small sample, our findings are novel and valuable. Future research is needed to develop interventions to increase understanding and awareness, promote screening attendance, and create a trans friendly environment. Guidelines for delivering appropriate services are warranted.
Original languageEnglish
Article numberS104
JournalThe Lancet
Issue numberS2
Publication statusPublished - Nov 2016

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