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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.
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:
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.
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. We explain this process in more detail below.
In Northern Ireland, cervical screening follows a process called cytology that checks for cervical cell changes. You can read more about both processes here >
Cervical screening checks the cervix for a virus called high-risk HPV. HPV is common and is usually passed on through skin-to-skin in the genital area. This includes vaginal, anal or oral sex, as well as touching or sharing sex toys. There are different types of HPV and a few types, called high-risk HPV, can cause the cells of the cervix to change.
If you have high-risk HPV, the cervical sample will also be checked for cervical cell changes. If there are cell changes, you will be referred to colposcopy, which is a closer look at the cervix to help decide if monitoring or treatment is needed. Remember, cell changes are not cervical cancer.
Not all cell changes develop into cervical cancer but, in some cases, they may if they are not monitored or treated. Cervical cancer takes a long time to develop – on average between 5 and 20 years. It is also important to know that cervical cancer is rare.
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:
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.
You usually have to ring your GP surgery to book a cervical screening appointment. You may also be able to book an appointment online. At the moment, you should try to avoid booking an appointment in person because of coronavirus (COVID-19) and the safety measures in place.
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:
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:
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.
Some expert clinics are currently closed due to coronavirus. We will update this page as services reopen.
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.
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:
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:
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.
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.
Nat (they/them), who shared their story with us
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.
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 in England, Scotland and Wales in more detail below.
You don’t have high-risk HPV. If you live in England or Wales, your GP surgery should invite you for for cervical screening in:
If you live in Scotland, your GP surgery should invite you for cervical screening in 5 years, whatever your age.
This may seem a long way off, so it may help to put a reminder in your phone or calendar.
You have high-risk HPV, but you do not have changes to your cervical cells. We know this might sound worrying, so try to remember that having HPV doesn't mean you will definitely develop cell changes or cervical cancer.
Your GP surgery should invite you for cervical screening in 1 year to check the HPV is gone. It may help to put a reminder in your phone or calendar.
If you get an HPV result 3 times in a row, your GP surgery should refer you to colposcopy for more tests.
You have high-risk HPV and cervical cell changes, so your GP surgery should refer you to colposcopy. If you don’t get a letter inviting you to colposcopy, ask your GP surgery whether they have made the referral. Try to remember that cell changes aren't cervical cancer, and that cervical cancer itself is rare.
In a few cases, the sample taken during cervical screening can’t be properly tested. This might happen if there aren't enough cells in the sample or they can't be seen properly under a microscope. If this happens, you will be asked to book another cervical screening appointment in about 3 months.
Research has not shown that being trans and/or non-binary puts you at higher risk of developing cervical cancer. It is likely that you have the same risk as anyone with a cervix.
However, there may be inequalities in how easily you can access preventative services like cervical screening, because you will only be automatically invited if you are registered as female with a GP surgery.
Although GP surgeries are the most common clinics that provide cervical screening, in some areas sexual health clinics also offer it. You can ask your local sexual health clinic or check their website to see if they do.
In a few areas, there are also trans-specific or trans-friendly clinics that offer cervical screening, including:
Bear in mind that some clinics are currently closed due to coronavirus.
The NHS is currently trialling self-sampling to understand if it could be offered for free as part of the national Cervical Screening Programme.
Self-sampling tests are available privately for a cost. They only test for high-risk HPV, so if you have high-risk HPV, you will need to go to a GP surgery or clinic to have another cervical screening test, which will tell you if you also have cervical cell changes.
If you experience transphobia or any kind of discrimination at a GP surgery, you do not have to continue to go there. You can register at another GP surgery, go to specialist clinic, or, if you would prefer to stay with your current surgery, ask not to be seen by a specific member of staff.
You also have a right to make a complaint about a member of staff or the GP surgery as a whole. If you feel uncomfortable or unsafe making a complaint yourself, there are trans advocacy organisations who can offer you support and expert advice:
Read about making a complaint on the NHS website >
No, trans women do not have a cervix so do not need cervical screening.
If you have had gender confirmation surgery to create a neo-cervix, you may have read that you do need cervical screening. However, there is no evidence that suggests cervical screening would benefit you if you have a neo-cervix.
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.
Action for Trans* Health is an organisation which campaigns for greater access to healthcare for trans* and gender variant people. It has produced the NHS Interim Protocol Guide to explain the new protocol around gender dysphoria to service users.
A UK-wide organisation aiming to improve the lives of trans and gender non-conforming people. It hosts Tranzwiki, a directory of groups campaigning for, supporting or assisting trans and/or non-binary people.
A national charity that exists to support the needs of the diverse range of people who identify as lesbian, gay, bisexual and trans. Delivers a wide variety of services to LGBT communities.
Phone: 0345 3 30 30 30
Assists transgender people, service providers, employers and equality organisations to engage together to improve gender identity and gender reassignment equality, rights and inclusion in Scotland.
A charity that campaigns for the equality of lesbian, gay, bi and trans people across Britain, and provides information and support.
Information Freephone: 0800 050 2020
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.
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.
If you have general questions about cervical screening, our Ask the Expert service may be able to help. Submit your question confidentially to our panel of experts and get a tailored reply. All questions submitted to our panel are made anonymous.
Thank you to all the experts who checked the accuracy of this information and the volunteers who shared their personal experience to help us develop it. A special thanks to Harris, Laurie, Nat and Seb for allowing us to share their stories.
This information was developed in response to research done by Jo’s Cervical Cancer Trust in collaboration with Tavistock and Portman NHS Foundation Trust and 56 Dean Street.
We write our information based on literature searches and expert review. For more information about the references we used, please contact [email protected]