Do I still need Pap smears or pelvic exams if I’m transmasc or nonbinary—and what should I expect?

If you have a cervix, yes—Pap smears and, sometimes, pelvic exams are still recommended. These screenings aren’t about your gender identity—they’re about anatomy and risk. That said, how these procedures are done, talked about, and experienced should absolutely reflect and respect your gender.

Why these exams matter:

Pap smears check for abnormal cervical cells that could turn into cancer. These screenings have saved countless lives—and they’re still necessary for anyone with a cervix, including transmasc and nonbinary people.

• Guidelines recommend starting Pap smears at age 21 and repeating every 3–5 years depending on the results and type of test.

• Even if you’ve stopped having penetrative sex, you still need screening if you have a cervix.

• If you’ve had a total hysterectomy (removal of the cervix), you may no longer need Pap smears—ask your provider.

What can make these exams more affirming—and less traumatic:

1. Work with a provider who understands gender-affirming care.
Your provider should:

• Use your name and pronouns correctly

• Ask before touching you

• Explain what they’re doing step by step

• Check in often throughout the process
  If they don’t? You can stop the exam at any time. You can ask for a chaperone, a different provider, or schedule the visit for another day. Your autonomy is the priority.

2. Know how testosterone may affect the exam.
Testosterone can cause vaginal atrophy, which means the tissues become thinner and drier over time. This can make speculum exams more uncomfortable or even painful.

• Solutions may include using extra lube, choosing a smaller sized speculum, or applying topical estrogen (for approximately 2 weeks prior to the appointment) to ease discomfort.

• You can also ask for the exam to be done in a different position (lying on your side instead of on your back), or explore whether the new FDA approved self-swab HPV testing is available.

3. Prep emotionally—it’s okay if the appointment feels overwhelming.
For many trans and nonbinary people, pelvic exams can bring up intense dysphoria, medical trauma, or just deep discomfort with being in a gynecologic setting. That’s real.

• Bring a support person if that feels helpful.

• Practice grounding techniques before and during the visit.

• Let your provider know if you’ve had a bad experience in the past—they should respond with compassion, not judgment.

4. Don’t push yourself beyond your limits.
If you’re not ready, or you’re still searching for an affirming provider, that’s okay. Your health matters—but so does your comfort and safety. You can wait, ask for accommodations, or seek out care in a setting that makes you feel seen and respected.

Bottom line:

If you have a cervix, you likely still need Pap smears and possibly pelvic exams—even if you’re on testosterone or no longer menstruating. But these procedures must be offered in a way that centers your autonomy, your safety, and your identity.

You deserve care that affirms who you are, protects your health, and honors your right to set the terms.