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Provision of cervical screening for transmasculine patients: a review of clinical and programmatic guidelines
  1. Emily Jay Nicholls1,2,
  2. Catherine R McGowan1,3,
  3. Sam Miles1,
  4. Louisa Baxter4,
  5. Laura Dix1,
  6. Sebastian Rowlands5,
  7. Daniel McCartney6,
  8. Cicely Marston1
  1. 1 Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
  2. 2 Institute for Global Health, University College London, London, UK
  3. 3 Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  4. 4 Medical Specialties Unit, Médecins Sans Frontières, Barcelona, Spain
  5. 5 Frontline AIDS, Hove, East Sussex, UK
  6. 6 Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, London, UK
  1. Correspondence to Dr Catherine R McGowan, Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London WC1H 9SH, UK; Catherine.McGowan{at}


Background Most cervical cancer can be prevented through routine screening. Disparities in uptake of routine screening therefore translate into disparities in cervical cancer incidence and outcomes. Transmasculine people including transgender men experience multiple barriers to cervical screening and their uptake of screening is low compared with cisgender women. Comprehensive evidence-based guidelines are needed to improve cervical screening for this group.

Methods We searched for and synthesised clinical and programmatic guidelines for the provision of cervical screening for transmasculine patients.

Findings The guidelines offer recommendations addressing: (1) reception, check-in and clinic facilities; (2) patient data and invitation to screening; (3) improving inclusion in screening programmes; and (4) sexual history taking, language and identity. Guidelines offer strategies for alleviating physical and psychological discomfort during cervical screening and recommendations on what to do if the screening procedure cannot be completed. Most of the guidelines were from and for high-income countries.

Discussion The evidence base is limited, but existing guidelines provide recommendations to ensure life-saving screening services are available to all who need them. We were only able to identify one set of guidelines for a middle-income country, and none for low-income countries. We encourage the involvement of transmasculine people in the development of future guidelines.

  • sexually transmitted diseases
  • Early detection of cancer
  • Health Services Accessibility

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  • Contributors EJN: Conceptualisation, formal analysis, investigation, writing – original draft, writing – review and editing. CRM: Conceptualisation, methodology, writing – original draft, writing – review and editing, supervision. SM: Formal analysis, writing – original draft. LB: Validation, writing – original draft. LD: Project administration, supervision, writing – original draft. SR: Writing – original draft. DM: Writing – original draft, funding acquisition. CM: Conceptualisation, writing – original draft, writing – review and editing, funding acquisition.

  • Funding This project was funded with UK aid (Grant number 3 00 055–105) from the UK government (FCDO) as part of the ACCESS Consortium led by the International Planned Parenthood Federation.

  • Disclaimer The views expressed do not necessarily reflect the UK government’s official policies or that of all consortium partners.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.