Barriers to Cervical Cancer Screening among transgender men / Barreiras ao exame do Câncer do Colo do Útero entre homens transgêneros

Eloísa Sotilli Scarioti, Dulcimary Dias Bittencourt, Rita Maira Zanine


Purpose: to evaluate the barriers to cervical cancer screening among transgender men, and also to understand their experiences and preferences for cervical cancer screening. Methods: 19-item online survey structured based on the Health Belief Model, a conceptual formulation for understanding why individuals do or do not engage in health-related actions. It consists of the following dimensions: perceived susceptibility, perceived severity, perceived benefits, perceived barriers and general health motivation. Familiarity with cervical cancer, with Human Papillomavirus (HPV) and with Pap Test, being up-to-date on Pap Tests and preference for HPV self-sampling were additionally assessed. Results: 27 transgender men aged 18-51 years completed the survey. Most of them have a formal job, income up to 1 minimum wage per month, and are health-insured. The majority is single, heterossexual, and completed high school. Despite the fact that most are familiar with HPV and cervical cancer and are aware of the importance of regular Pap Tests, less than 20% are up-to-date. The barriers to cervical cancer screening may be related to discrimination, fear of invasive procedures and also the gaps in preventive health care associated with Covid-19. Only 25.9% of participants preferred HPV self-sampling over provider-collected Pap Test screening. Conclusion: most participants were not up-to-date on Pap Test screening, and refer unpleasant experiences in the past, discrimination and fear of invasive procedures. Healthcare professionals should be aware of the needs of this specific population, in order to provide better care and to  affirm the gender identity.


Cervical Cancer, HPV, Pap test, transmasculine, health behavior.

Full Text:



Coleman E, et al. Standards of Care For The Health Of Transsexual, Transgender and Gender-Nonconforming People. World Professional Association for Transgender Health. 2012. Version 7.

Goodman M, et al. Size and Distribution of Transgender and Gender Nonconforming Populations: A Narrative Review. Endocrinol Metab Clin N Am. 2019;48:303-321.

Rocon PC, et al. Dificuldades vividas por pessoas trans no acesso ao Sistema Único de Saúde. Ciência & Saúde Coletiva. 2016;21(8):2517-2525.

Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Estimativa 2020 - Incidência do Câncer no Brasil. Ministério da Saúde. 2020.

Ferlay J, et al. Global Cancer Observatory: Cancer Today. 2020. Lyon, France: International Agency for Research on Cancer. Available from:, accessed 14 Jun 2021.

Burd EM. Human Papillomavirus and Cervical Cancer. Clin. Microbiol. Rev. 2003;16(1):1-17.

Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Diretrizes Brasileiras Para Rastreamento do Câncer do Colo do Útero. Ministério da Saúde. 2016.

Peitzmeier SM, et al. Pap Test Use Is Lower Among Female-to-Male Patients Than Non-Transgender Women. Am J Prev Med. 2014;47(6):808-812.

Bethlehem J. Selection bias in web surveys. International Statistical Review. 2010;78(2):161-188.

Janz NK, Becker MH. The Health Belief Model: A Decade Later. Health Education Quarterly. 1984;11(1):1-47.

Ben-Natan M, Adir O. Screening for cervical cancer among Israeli lesbian women. International Nursing Review. 2009;56:433-441.

Seay J, et al. Understanding Transgender Men

Maza M, et al. Cervical Cancer Screening with Human Papillomavirus Self-Sampling Among Transgender Men in El Salvador. LGBT Health. 2020;7(4):174-181.

Comissão Nacional de Ética em Pesquisa. Orientações Para Procedimentos em Pesquisas com Qualquer Etapa em Ambiente Virtual. Comunicado CONEP 0019229966. Ministério da Saúde. Fevereiro de 2021.

R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2021. URL https://www.R-

Tracy JK, Schluterman NH, Greenberg DR. Understanding cervical cancer screening among lesbians: a national survey. BMC Public Health 2013;13:1-8.

Gonzales G, Henning-Smith C. Barriers to Care Among Transgender and Gender Nonconforming Adults. The Milbank Quarterly. 2017;95(4):726-748.

Tabaac AR et al. Gender Identity Disparities in Cancer Screening Behaviors. Am J Prev Med 2018;54(3):385-393.

Carrara S et al. Body construction and health itineraries: a survey among travestis and trans people in Rio de Janeiro, Brazil. Cad. Saúde Pública 2019; 35(4):1-14.

Xavier JM, Simmons R. The Washington transgender needs assessment survey, 2000. Available at: Accessed Jan 2022.

Unger CA. Care of the transgender patient: the role of the gynecologist. Am J Obstet Gynecol. 2014;16-26.

Peitzmeier SM et al. Female-to-Male Patients Have High Prevalence of Unsatisfactory Paps Compared to Non-Transgender Females: Implications for Cervical Cancer Screening. J Gen Intern Med 2014;29(5):778

D'Angelo AB et al. Health and Access to Gender-Affirming Care During COVID-19: Experiences of transmasculine individuals and men assigned female sex at birth. American Journal of Men's Health. 2021;1-11.

McGowan VJ, Lowther HJ, Meads C. Life under COVID-19 for LGBT+ people in the UK: systematic review of UK research on the impact of COVID-19 on sexual and gender minority populations. BMJ Open 2021;11:e050092. doi:10.1136/bmjopen- 2021-050092.

McDowell M et al. Cervical Cancer Screening Preferences Among Trans-Masculine Individuals: Patient-Collected Human Papillomavirus Vaginal Swabs Versus Provider-Administered Pap Tests. LGBT Health. 2017; 4(4):1-8.



  • There are currently no refbacks.