Cervical screening for trans men and/or non-binary people

Self-care note: This page talks about cervical screening and genitals. If you find this distressing or triggering, remember to take it at your own pace – you may prefer to read small sections, wait until you feel ready to read it all, or choose not to read it at all. At the bottom of the page there is a section on getting support that may be helpful.

January 2024 — Please be aware that as of December 2023, the screening programme in Northern Ireland has switched to using HPV primary screening. This page is currently undergoing review, but the information below regarding England, Scotland and Wales remains valid.

This information is for trans men and/or non-binary people, but may be useful for anyone interested or wanting to offer support. It explains the process of going to a cervical screening (smear test) appointment and aims to offer support with any challenges you may face.

On this page:

• Have I got a cervix? >
• What is cervical screening? >
• Will I be invited for cervical screening? >
• Booking your appointment >
• During your appointment >
• After your appointment and getting results >
• FAQs >
• Getting support >

Have I got a cervix?

The cervix is inside the body at the top of the vagina, which joins to the bottom of the womb. People who were assigned female at birth usually have a cervix. 

If you have had gender confirmation surgery or previous treatment, such as a hysterectomy, you may not have a cervix. It is best to check with the healthcare team who did the treatment if you are not sure. 

What is cervical screening? 

Cervical screening is a free health test that helps prevent cervical cancer. Everyone with a cervix between age 25 and 64 has a right to go for cervical screening. It is your choice whether you want to go. 

In England, Scotland and Wales, cervical screening follows a process called HPV primary testing or HPV primary screening.

In Northern Ireland, cervical screening follows a process called cytology that checks for cervical cell changes. You can read more about both processes here >

Will I be invited for cervical screening?

Currently, only people who are registered as female with their GP surgery or clinic are automatically invited for cervical screening. 

If you are registered as male, aged between 25 and 64, and want to go for cervical screening, you can:

• ask your GP surgery to send you invites directly – they may be able to add a reminder to your medical record
• put a reminder in your phone or calendar to ask for an appointment every 3 or 5 years, depending on your age and where you live.

There are also expert clinics, including some trans-led clinics, that offer cervical screening. Although these clinics can’t invite you automatically, you can book an appointment with one. 

Read about expert clinics >

Booking your appointment

You usually have to ring your GP surgery to book a cervical screening appointment. You may also be able to book an appointment online. 

Telling GP surgery staff you are trans and/or non-binary

If you are registered as male at a GP surgery and they do not know you have a cervix, it is possible that the person you speak with may be confused or have questions about your request to book a cervical screening appointment. Equally, if you are a non-masculine non-binary person, you may be misgendered and talked to as a woman. 

You have a right to privacy and you do not have to disclose that you are trans and/or non-binary to anyone. However, if you feel comfortable letting someone at your GP surgery know, they may be better able to support you as an individual and avoid situations that may be distressing for you. You could:

• Identify a member of staff that you feel comfortable with. This might be reception staff or clinical staff, such as a doctor or nurse, who you have seen before. It might feel easier to tell them privately or, even if they do not formally know, they may already have an innate understanding of who you are and how best to support you.  
• Ask a trusted person to speak to your GP surgery on your behalf. You may need to provide verbal or written permission for this. 
• Write it down, either in an email before your appointment or to hand over at the surgery. This may feel easier than speaking it out loud. You could also include any important information, like your pronouns or language you would prefer the reception staff or your nurse to avoid.
• Share our information for professionals or the NHS guide to screening for trans people with your GP surgery. You could suggest that you and a nurse or another member of staff discuss it together.

Taking control of your appointment

Making decisions about how you want your appointment to go can help you feel more in control. It can also help avoid situations that could be triggering for you. Here are some examples that may help:

• Ask for a phone or video appointment with the nurse before your cervical screening appointment. If you don’t know them, this will give you a chance to introduce yourself and talk as much or little as you’d like about your gender identity, preferred language, and so on.
• Ask if you can bring a trusted person. Having a partner or friend with you at any point before, during or after the appointment may help you feel more comfortable about the test itself, talking with the nurse, and managing any triggers. 
• Ask to book a longer appointment. This allows you extra breathing space, as well as time to talk or ask questions, before and after the test. It means you can take the appointment at a pace that is more comfortable for you.
• Ask for an appointment with a nurse of a particular gender. Be aware that this may not always be an option if all nurses at your GP surgery are the same gender.

Expert clinics

There are clinics specialising in trans healthcare that offer cervical screening. Some are trans-led and all offer a safe, confidential space to have your appointment and discuss any worries. Many of these clinics are in major cities, so we know it may not be possible for you to visit one. We hope the other tips on this page will help if this is the case. 

• 56T at 56 Dean Street in London >
• The Butterfly Clinic in Liverpool >
• Clinic T in Brighton >
• CliniQ in London >
• My Body Back in London >
• My Body Back in Glasgow >

During your appointment

At the start of your appointment, the nurse should explain the test and answer any questions you have. This is a good opportunity to talk about language preferences for body parts, whether you want the nurse to explain each step or would prefer not to focus on the test, and what you will do or say if you need to pause or stop. The nurse may also be able to suggest ways to make the test better for you. 

After this, the nurse will give you a private space to undress from the waist down, usually behind a curtain. You can tell them whether you would prefer the door to be locked or unlocked. 

You will be given a clean, paper sheet to cover yourself. The nurse will use a speculum – a tube that is usually plastic – to gently open the vagina. They then use a small, soft brush to take a sample of cells from the cervix. The test itself usually takes no more than a minute.

Dysphoria 

Some people experience a feeling of unease or distress (dysphoria) related to their body, which makes cervical screening particularly difficult for them. If you know or worry this might happen for you, there are some things that may help you feel more in control of the situation:

• Ask for the door to be locked or unlocked. No one will interrupt your appointment or come into the room without permission, but you may feel more confident and at ease if the door is physically locked. Or you might find comfort in it being unlocked. Whichever you prefer, let the nurse know.
• Ask if you can bring a larger covering for the lower half of your body. Although you will get a paper sheet to cover up, you may be more comfortable choosing something that makes you feel less exposed. 
• Ask to insert the speculum yourself. You may feel more comfortable interacting with certain parts of your body yourself. 
• Bring a phone or tablet and headphones. You may prefer to concentrate on something other than the test, so playing music, watching a video or reading something can help distract you. 
• Think about whether medicine would help. If you are very anxious, a doctor can sometimes prescribe one-off anti-anxiety medicine. This may make the test seem more manageable, but it is important to discuss whether this is the right choice for you. 
• Remember that you are in control. You can say stop at any time. You may find it helpful to agree on a different word or physical signal, such as a hand gesture, that will let your nurse know to stop. You can also tell them how much or as little you want to know about what is happening during the test – and you can ask for them to say nothing about it. 

Testosterone replacement therapy (TRT)

If you use testosterone, it may cause some changes that make cervical screening more uncomfortable or painful due to less natural lubrication. But there are things that can help:

• Ask for a smaller speculum size. 
• Ask for more lubrication.

You may want to talk with the nurse about using topical oestrogen, if this is acceptable for you. It is usually given as a cream or slow-dissolving tablets that are used a couple of weeks before the appointment to help treat TRT changes.

Sometimes the nurse isn’t able to view the cervix because of changes due to TRT or because it is in a slightly different position. If this happens, they may suggest you go to colposcopy instead. This is a clinic in a hospital where a doctor can take a closer look at the cervix. 

Know your limits

It is important to remember that if you feel distressed, in pain or unsafe at any point, you can pause or stop cervical screening. This is true whether you need a short time to process what’s happening, or you would prefer not to have the test at all.  

It is absolutely fine if you can’t have cervical screening during your first appointment. You can always try again on another day, at a different clinic, or possibly with another nurse. Be patient and gentle with yourself, and remember that the priority is your health and wellbeing. The nurse is not there to judge, and should be respectful of your emotional need to move forwards at your own pace.

After your cervical screening appointment

Your feelings about cervical screening, or the impact the appointment has on you, probably won’t begin and end in the examination room. After your appointment, it’s important to practice self-care and seek any support you need. You may want to plan something that feels particularly affirming straight afterwards.

Getting your cervical screening results

You should get your cervical screening results within 4 weeks after the test. Your GP surgery is responsible for send them to you. You may want to check the address the results are being sent to, as well as the name being used on the letter. If you want to make any changes, you can let the GP surgery know. 

If you have not heard from your GP surgery within 4 weeks, you may want to contact them to ask when you can expect your results. 

Many people feel anxious while waiting for cervical screening results, so you are not alone if you feel that way. It may help to remember that most people have clear results and will not need another appointment for 3 or 5 years. We explain the results you might get in more detail below.

Read more about cervical screening results across the UK >

Cervical screening FAQs

Where to get support

There are lots of organisations dedicated to supporting trans and/or non-binary people. While they may not be able to provide specific information about cervical screening or other aspects of cervical health, they can offer support around disclosure, dysphoria and more.

Find more support organisations using Tranzwiki >

How we can help

We know that cervical screening isn't easy for everyone. If you are worried about anything before, during or after the test, we are here to support you with your questions or by talking the process through on 0808 802 8000. 

Check our Helpline opening hours >

We also have a welcoming community in our online Forum, including an LGBTQ thread, where you can get and give support. There are lots of conversations about cervical screening, so you can choose to read existing threads or post your own messages. 

Join our Forum >