Transgender women who have undergone gender-affirming surgery to create a vagina and, in some cases, a cervix, may need to arrange regular cervical screenings. Those who have not had this surgery do not need to attend cervical cancer screenings.

If a transgender woman decides to have gender-affirming surgery, this may include the construction of a vagina, or neo-vagina, and a cervix, or neo-cervix. People may also refer to this surgery as vaginoplasty.

A transgender woman who has a neo-vagina or neo-cervix may be at risk of developing cancer in the tissue.

This article will look at the risk of a transgender woman developing cervical cancer and discuss the recommended guidelines for cervical cancer screening for transgender women.

A trangender woman wearing a bathrobe before undergoing cervical cancer screening.Share on Pinterest
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Transgender women who have not had a vaginoplasty are not at risk of developing cervical cancer.

According to the Canadian Cancer Society, there is a small chance of transgender women developing cancer if they have a neo-cervix or neo-vagina.

The most common cause of cervical cancer is the human papillomavirus (HPV). HPV is a sexually transmitted infection that spreads through vaginal, anal, or oral sex. Although HPV usually causes no symptoms, some types of HPV can develop into certain forms of cancer.

When a transgender woman undergoes a vaginoplasty, a surgeon will usually use skin from the penis to create the new vagina and cervix.

Penile skin can also contract HPV, which can lead to a transgender woman developing cancer in the neo-cervix or neo-vagina.

Cervical screenings test for the presence of HPV and precancerous cells. There is limited research available regarding the need for transgender women to undergo cervical cancer screenings.

In Canada, screening guidelines recommend that transgender women with a neo-cervix have routine cervical cancer screenings.

However, they do not recommend cervical cancer screenings for those who have undergone a vaginoplasty without the creation of a neo-cervix.

If a person is unsure whether they need to have cervical screenings, they should speak with a healthcare professional.

Little information exists regarding cervical cancer screening guidelines for transgender women. As a result, a person may wish to speak with a healthcare professional about any cancer screenings they may need.

A transgender woman should receive routine screenings after the creation of a neo-cervix.

According to the Centers for Disease Control and Prevention (CDC), healthcare professionals generally perform routine screenings for cervical cancer on cisgender females and those assigned female at birth (AFAB) when they reach the age of 21 years.

After an initial cervical cancer screening, a person should undergo screening every 3 years if the result is normal. Between the ages of 30 and 65 years, a person may have a few different screening options:

  • Pap smear only: A Pap smear checks for precancerous cells. If a person has a normal test result, they may not need another test until 3 years have passed.
  • HPV test only: If a person has a normal HPV result, they may be able to wait 5 years before their next test.
  • Both HPV and Pap smear: If both of these results are normal, the next screening does not need to take place until 5 years have passed.

After the age of 65 years, a person may not require cervical cancer screening if they have had normal results for several years.

Cervical cancer screening may be more difficult for a transgender woman. Certain healthcare professionals may not understand the risk of cervical cancer in transgender women. This can lead to people not receiving the care they need.

It is important for a person to see a healthcare professional who is educated about their healthcare requirements.

The following tools may help people find transgender-friendly doctors:

There are certain cancers that a transgender woman should receive regular screenings for.

These cancers include:

Neo-vaginal cancer

Research from 2019 notes that, although it is rare, cancer can develop in the neo-vagina. Neo-vaginal cancer can develop due to HPV.

Neo-vaginal tumors tend to develop at the back of the neo-vagina, known as the apex. The apex is the deepest part of the neo-vagina.

Researchers recommend that trans women have frequent gynecological checks. These checks can look for signs of cancer or any other health issues that might affect the neo-vagina.

Prostate cancer

A person assigned male at birth (AMAB) will generally have a prostate. If a transgender woman decides to have a vaginoplasty, this surgical procedure will not remove the prostate.

There are no specific recommendations on when to undergo prostate cancer screenings. The American Cancer Society advises people to make a joint decision with a healthcare professional on whether they should get a screening, based on their personal risk factors.

If a person chooses to have prostate cancer screenings, they only need a test every 2 years if they have a normal result. If a person has an abnormal test result, they may need to undergo yearly tests.

Researchers believe that prostate cancer may be more aggressive in transgender women who are receiving hormone replacement therapy (HRT) or have had bottom surgery. This is because the cancer develops despite low testosterone levels.

Breast cancer

Although rare, breast cancer can develop in transgender women who have not undergone any gender-affirming surgery.

The CDC notes that HRT can increase a transgender woman’s risk of developing breast cancer. The advice is for transgender women who are on HRT to undergo breast cancer screenings every other year from the age of 50 years.

If a transgender woman has undergone gender-affirming surgery that involves the creation of a neo-cervix, they have a small risk of developing cervical cancer. Cervical cancer usually occurs due to HPV, which can also affect the penile tissues that surgeons use to create the neo-cervix.

There are no specific guidelines regarding how often transgender women should undergo screenings for cervical cancer. However, experts recommend that they receive routine cervical cancer screenings.

Screening may also be advisable for other types of cancer, including prostate cancer and breast cancer. People can speak with a transgender-friendly healthcare professional about any cancer screenings they may require.