Cervical Cancer Screening Preferences Among Trans-Masculine Individuals: Patient-Collected Human Papillomavirus Vaginal Swabs Versus Provider-Administered Pap Tests

Abstract

Purpose: Trans-masculine (TM, i.e. persons who have a masculine spectrum gender identity but are assigned female sex at birth) individuals face disparities in cervical cancer screening rates compared to non-transgender women. Some unique barriers to screening in this population are specific to Pap tests. Introduction of self-collected frontal (i.e., vaginal) swabs for human papillomavirus (HPV) testing as a screening strategy may help to alleviate these barriers. This study elucidates cervical cancer screening preferences among TM individuals. Methods: TM individuals participated in in-depth interviews (n=31) and online surveys (n=32) to explore perceptions and experiences regarding cervical cancer screening, including the acceptability of self-collected frontal HPV swabs compared to provider-administered Pap tests. Provider-collected frontal HPV swab acceptability was also explored. Results: Most TM individuals (92% in-person and 91% online participants) preferred either the self- or provider-collected frontal HPV swab to the Pap test. Participants perceived self- and provider-collected frontal HPV swabs to be less invasive, provoke less gender discordance, and promote a greater sense of agency compared to Pap tests. However, some participants expressed concern about HPV swab accuracy and, regarding the self-collected swab, discomfort about the need to engage with genitals they may not want to acknowledge. Individuals who reported positive provider relationships found Pap tests and provider-administered frontal swabs more acceptable than those who did not. Conclusion: Frontal HPV swabs have the potential to promote regular cervical cancer screening among TM individuals and to narrow screening disparities. Work is ongoing to establish swab accuracy and develop shared decision-making tools.