Cervical Pap Tests in the Female-to-Male Transgender Population: Should the Adequacy Criteria be Revised in this Population? An Institutional Experience

Abstract Introduction It is recommended that female-to-male (FTM) transgender patients with a cervix follow the same cervical cancer screening guidelines as cisgender women. This study analyzes Pap tests, HPV results, and follow-up histology in FTM patients, and compares those results to other atrophic populations at our institution. Materials and Methods A cohort of FTM patients receiving androgen therapy was identified through our institution’s translational research database. We collected data on Pap tests, HPV results, follow-up surgical procedures, and duration of androgen therapy. ThinPrep® slides were reviewed for cellularity and cytomorphology. The results of these tests were compared to those of an atrophic control group consisting of postpartum and postmenopausal cisgender women. Results We identified 71 FTM patients with 77 Pap tests collected over six years. Pap interpretations included: negative for intraepithelial lesion (69%), atypical cells of undermined significance (5%), low grade squamous intraepithelial lesion (1%), atypical glandular cells (1%), and unsatisfactory due to inadequate cellularity (23%). Five of 27 (18.5%) HPV tests were positive. Follow-up surgical specimens did not identify high-grade lesions. Unsatisfactory rates among FTM patients differed significantly from the atrophic group (p .05). Most FTM Pap tests reviewed showed features of atrophy. Conclusions FTM patients receiving androgen have high Pap test unsatisfactory rates secondary to atrophy. Epithelial abnormality and HPV rates do not differ significantly from atrophic cisgender patients. Lower the cellularity threshold for this population to 2,000 like that of other atrophic groups should be considered.