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Processing invitations, samples and results for trans men and/or non-binary people

The LGBT Foundation. 

The information on this page is for clinical staff who work with trans men and/or non-binary people. It may also be useful for reception staff.

It aims to explain differences and potential difficulties in getting a cervical screening sample from a trans man and/or non-binary person tested, and ways to overcome this. 

See all our resources on this topic >

On this page:

Want to know more about the language we use on this page? Visit our glossary >

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

Accessing cervical screening in an environment where they feel safe and in control can be difficult for many people. This can be exacerbated for trans men and/or non-binary people with a cervix who face additional barriers to accessing routine cervical screening, as well as discrimination because of their gender identity. 

Invitations and sample processing are extra, significant barriers to a trans man and/or non-binary person accessing the test. The process is set up to recognise only those who identify as women or female, which means trans men and/or non-binary people can easily miss out, even if they disclose their sex assigned at birth. 

Read about other barriers that trans men and/or non-binary face >

Cervical screening invitations

Only people who are registered as female with a GP surgery are invited for cervical screening via the national call and recall system. 

Trans men and/or non-binary people registered as female

A trans man and/or non-binary person who has a cervix and is registered as a female will automatically be included in the national Cervical Screening Programme. This means they will be invited for screening at appropriate intervals, unless they choose to opt out of the programme in accordance with national guidance.

Trans men and/or non-binary people registered as male

A trans man and/or non-binary person who has a cervix and is registered as a male will not be automatically invited for cervical screening by the national Cervical Screening Programme. 

The GP surgery or clinic will need to invite or support these patients to attend at appropriate intervals: 

  • Most GP surgeries will be able to add a reminder to the patient’s medical record, with the patient’s permission. You can then use this as a prompt to invite the patient for cervical screening at appropriate intervals.
  • Some sexual health clinics offering cervical screening may not be able to add a reminder. In this case, you may want to suggest that the patient puts a reminder in their phone or calendar, as they might have to remember to book an appointment themselves. 

Although the patient can request cervical screening at appropriate intervals, this places responsibility on an individual who may already struggle with these appointments and therefore may be less likely to book one.  

Trans men and/or non-binary people who have had a hysterectomy

Some trans men and/or non-binary people may have had a hysterectomy or another treatment that removes the cervix. In this case, they should not be invited for cervical screening. 

If they have had the treatment because of cervical cancer, they may need vault smears as part of their follow up. This is where a sample of cells is taken from the vagina for testing. The information on this page and within this section on supporting a trans man and/or non-binary person through a gynaecological test is relevant for that process too. 

Making sure the sample is processed

If your patient is registered as a male and their cervical screening sample is not clearly labelled, it is likely the lab will reject the sample as an error. This means that your patient would need to have another cervical screening test in about 3 months which may cause further unnecessary distress. It is important to ensure the sample is processed when it is sent to the lab.  

Labelling the sample

There is currently no national guidance about requirements for submitting a cervical screening sample from a trans man and/or non-binary person to the laboratory for testing.

Ideally, you should include that the sample is from a trans man and/or non-binary person with a cervix in the clinical details section of the cervical screening request form. However, as long as it is clearly included somewhere on the form, there should not be any problem for the lab. 

Contacting the laboratory

It may be useful to contact the lab ahead of time and let them know a sample marked as male will be sent for testing. The results of these samples will need to be returned to the GP surgery or clinic, rather than the call and recall system. 

Remember that many labs receive thousands of samples each day, so it may be difficult for them to find a specific sample unless it is very clearly labelled. 

If a sample is rejected, contact the lab as soon as you become aware. They may still be in a position to retrieve and test it.

Communicating results

The sample taker and GP surgery or clinic is responsible for communicating cervical screening results to a trans man and/or non-binary patient. In England, Scotland and Wales, this includes:

  • inviting back in 3 or 5 years, depending on age and location, if the results don’t show high-risk HPV 
  • inviting back in 1 year if the results show high-risk HPV without cell changes
  • arranging a referral to colposcopy if the results show high-risk HPV and cell changes. 

In Northern Ireland, this includes inviting back in 3 or 5 years, depending on age, if results don't show cell changes, or arranging a referral to colposcopy if they do.

Read more about HPV primary screening and cytology >

Confirming the postal address and name

It is essential that you confirm the address where results should be sent. If results are automatically sent to the patient’s home address, this could cause problems if they are not out as trans and/or non-binary to those they live with. 

At the same time, confirm the name the patient would like the letter addressed to. They may be using a different name at home or the name you have on the system may be outdated. By doing this, you are avoiding unintentionally outing someone or potentially putting them in danger. 

Next steps and further support

It is worth talking with your practice manager, colleagues and the local laboratory to put a system in place to ensure samples from trans men and/or non-binary patients are processed correctly. Doing this will mean you are providing a better experience for your patients and avoiding unnecessary repeat tests, which means they are more likely to return for cervical screening and seek support from you in future.

  • Cervical screening: cervical sample taker training – Topic 4: equality of access to cervical screening. Explains the current cervical screening system and how to overcome inequalities for certain communications, including trans men. Read this resource > 
  • Cervical Screening Wales Sample Taker Reference Guide. Contains information, advice and guidance to assist sample takers, including about processing samples for trans men. Read this resource >

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.

References

  • Berner, AM, et al (2020) A Survey of Attitudes to Cervical Cancer Screening in Trans Men and Non-binary People in the UK. Manuscript under review.
  • Connolly, D., Hughes, X. and Berner, AM. (2020). Barriers and facilitators to cervical cancer screening among transgender men and non-binary people with a cervix: A systematic narrative review. Preventative Medicine. 135.
  • Public Health England (2020). Cervical screening: cervical sample taker training. Web: www.gov.uk/government/publications/cervical-screening-cervical-sample-taker-training. Accessed August 2020. 
  • Cervical Screening Wales, Public Health Wales and Royal College of Nursing (2020). Cervical Screening Wales Sample Taker Reference Guide.

We write our information based on literature searches and expert review. For more information about the references we used, please contact [email protected]

Read more about how we research and write our information >

Barriers to cervical screening >

Understand the challenges your patients may face and get tips to support them.

I have the same risk of getting cervical cancer as anyone else with a cervix, but can’t get the same access to services because of my gender identity.
Read Laurie's story
Date last updated: 
07 Sep 2020
Date due for review: 
01 Sep 2023
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