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Female-to-male transgender patients at higher risk for inconclusive Pap test
Female-to-male transgender patients are more likely than non-transgender females to have inconclusive Pap test results, according to results of an observational chart review.
Researchers utilized electronic medical record (EMR) data to locate female-to-male (FTM) transgender patients and non-transgender female patients who received a Pap test at Fenway Health in Boston.
FTM patients were defined as those born with female reproductive organs who identify as male. Those included in the study were aged 21 to 64 years and had been active patients for at least 1 year from 2006 to 2012. Of 3,858 patients, 8,009 Pap tests were identified for analysis.
Information about Pap results and adequacy of the specimens were obtained from the EMR query. The investigators used bivariate analyses to determine proportional differences between FTM and non-transgender female patients.
The researchers found that in comparison to non-transgender female patients, FTM patients were 8.3 times more likely to have an unsatisfactory Pap test (10.8% vs. 1.3%). After adjusting for age, race and BMI, this likelihood rose to more than 10 times vs. non-transgender females (adjusted OR=10.77; 95% CI, 6.83-16.83).
After the researchers adjusted for years on testosterone therapy, the association was decreased but still strong (adjusted OR=6.01; 95% CI, 3-11.5); in addition, researchers observed a link between time on testosterone and unsatisfactory Pap tests (adjusted OR=1.19; 95% CI, 1.04-1.36). FTM patients also exhibited an increased prevalence of having numerous unsatisfactory tests compared with non-transgender females, and they had longer delays to follow-up testing.
The researchers theorized that these disparities may be related to cytological changes induced by testosterone treatment or doctor–patient discomfort with Pap tests on transgender patients.
“More information is needed on the effects of testosterone on the cervix and effective cervical screening strategies that do not rely on a Pap test,” Jennifer Potter, MD, director of women’s health at Fenway Health, said in a press release. “While we wait for results of studies that address these questions, clinicians should do everything possible to increase patient comfort during the exam and alert FTM patients that repeat Pap testing may be necessary after an initial, inadequate result.”
Disclosure: The researchers report no relevant financial disclosures.