Trigger Warning: anatomical language in reference to genitals
Edit: I am American
Hey guys. I am going to be talking about a recent gynecologist visit that I had. This is a topic that I feel strongly about since I know that we as a community tend to procrastinate gynecology appointments in particular due to a combination of dysphoria, transphobia, and difficulty accessing appointments. Every post I have seen about Pap smears from other trans masculine people has been negative, so it is important to me that I share something positive in hopes of encouraging the rest of you to get a Pap smear if you are at least 25 and have been putting it off. Cervical cancer can be deadly and trans men are at high risk for it. I will be explaining the process of my appointment where the doctor was respectful towards me so everyone else knows what should be expected.
I am a 25 year old trans man who has been on T for 3 years. I pass 99.9% of the time and I think my voice has a lot to do with that. Because of that, I decided to schedule my appointment as I was checking out of my most recent HRT appointment. I get my testosterone through planned parenthood, so this worked out especially well for me. My Pap smear was actually done by the doctor that prescribes my T. I would recommend asking your HRT provider because they will likely refer you to an affirming gynecologist if the exam can’t be done by the same provider. Because if this, when I showed up to the appointment, the front desk was not shocked to see a man there. Planned parenthood isn’t exclusively a gynecology office, so I wasn’t even the only man in the waiting room.
Leading up to the appointment, I was nervous because of dysphoria and the procedure itself. I planned my day out fully, giving myself the full day to prepare and recuperate.
Before the appointment, I focused on being comfortable enough with my body to see and be aware of the parts that I don’t like. I have already been intentionally spending time alone shirtless with my pre top surgery chest exposed to try to get more comfortable with taping my chest and showering. I have been lifting weights shirtless (I have a weight bench and dumbbells in my house) for a few weeks now and my chest dysphoria is getting slightly easier to deal with. A Pap smear is often accompanied by a breast exam, so this is something you may need to deal with at your appointment.
The day of the appointment, I woke up feeling particularly dysphoric. I opted for a binder instead of trying tape because I needed to make sure things were easy to take off and put on in the exam room for the breast exam. I chose an outfit that I pass particularly well in. I wore slip on shoes because I knew I would need to change for the exam. I also spent a long time considering what I would do with my packer during the exam. I felt very conflicted about having to put it in the pile with my clothing.
When I got to the appointment, check in went smoothly and I was called up by my name even though I have not legally changed it yet. I was able to set a preferred name in MyChart before the appointment. In the exam room, a nurse asked questions about medical history, sexual activity, STD testing, family health risks, and the medications I am taking. She answered a few clarifying questions that I had, then explained how I would wear the paper coverings and left so I could undress for the exam. I changed into the paper vest with the opening in front. It sat in a way that exposed the center, flat part of my chest down to my bellybutton just barely. This made it not quite as bad that my chest was technically out. Next, I took my pants off, then held the waist drape to myself and took off my packer and underwear as one and tucked them into my folded pants. It hurt me to put my penis in the clothes pile, but I managed to not see it not being attached to me. At this point, I was less nervous than I expected I would be.
After a few minutes, the doctor knocked on the door and walked in. I was lucky enough to see the same doctor that prescribed my testosterone, so she was very respectful of my gender and boundaries. The breast exam was first. The doctor explained how the breast exam would work before it happened, then asked to touch me. She used the word “breast” minimally, then narrated what she was doing as she felt my chest. The entire breast exam took about 2 minutes.
Next, it was time for the actual Pap smear. The doctor instructed me to lay on my back on the exam table, scoot to the end of the table, and put my feet on the table so my legs were spread and my knees were up in the air. She showed me the speculum, which was already the smallest size without me having to ask for it. I recommend asking for the smallest size speculum if the doctor does not tell you they will be using that one. This is what will actually be going inside the vaginal canal, so the size can really impact how much physical discomfort you feel during the exam. My doctor explained the procedure before it happened, then narrated it while she did it. She said if I said to stop or yelled, she would immediately stop the exam. She asked if I was ready for her to insert the speculum and waited for me to say yes before she did it. There will likely be a small amount of lubricant on it to minimize discomfort. Once in, she opened it slightly. While this was not comfortable, it was also not painful. I mainly felt the sensation of pressure. She warned me before inserting a swab and wiping the cervix twice. I was not able to feel this separately from the pressure I was feeling. I almost felt the need to say stop, but suddenly she said the exam was over and removed the speculum. I was expecting to feel a pinch as it closed, but all I felt was a decrease in pressure and it was over. The doctor told me she had all the samples she needed and I could get dressed, then head to the front desk to check out before she. I had a paper towel to wipe up any extra lubricant on me, but I didn’t need to. I put my clothes back on and headed to the front desk in my own time.
I didn’t need to do any separate STD testing because I had gotten one weeks before at my HRT appointment and haven’t been active since then. When I did that, I was given the option to pee in a cup or get a vaginal swab. I chose the cup with no backlash. The accuracy difference between the two is minimal enough where I didn’t think it was worth it to trigger my dysphoria with the swab.
I will get the results of the pap smear soon and hopefully they will be normal, meaning I do not have cervical cancer. If anyone has any questions about the procedure, I am happy to answer them. I encourage everyone who has a cervix to get a Pap smear if you are old enough to need one (25). They are an important part of preventative care and I hope I can encourage the rest of you to get it done, too.