For Cervical Cancer Prevention Week, Gay Star News reached out to a leading London doctor to answer everything you need to know about cervical cancer.
Cervical cancer is cancer of the cervix – the part between the lower end of the uterus and the entrance of the vagina. The main cause for cervical cancer is the virus HPV which is very common.
There are diverse types of strains HPV. While they are mostly harmless, a few strains could potentially lead to cervical cancer.
There are usually no symptoms in early stages and when symptoms are present, they are wide and non-specific.
They can include spotting, bleeding during/after intercourse, dyspareunia (pain during intercourse), post-menopausal bleeding, unusual vaginal discharge.
You should seek medical advice as soon as possible if you spot any symptoms even if you’ve recently had a screening.
There is unfortunately no way so far to eradicate the risk of HPV. Fortunately, most people will NOT develop cervical cancer.
Although, anyone with a cervix who has started to be sexually active can catch it, the risk of developing an HPV infection increases the earlier you start having regular sex and the more sexual partners you have.
In the past 10 years, the HPV vaccine has been offered to girls aged 12 and 13 in the UK. But the vaccine does not provide a complete protection against cervical cancer as the vaccine is only able to immunize against a few strains of the virus.
There are some ways to reduce the risk of HPV.
The vaccination reduces the risk of cervical cancer as the vaccines include the HPV 16 and HPV 18, which are responsible for most of cervical cancers.
However, the vaccination does not cover all the harmful types of HPV and the screening is still essential regardless of if someone is vaccinated.
Using condoms during sex (which provide protection against other sexually transmitted disease), can reduce the risk of HPV infection but not totally as the virus spreads via intimate contact as well.
The virus can be transmitted by sharing sex toys, so reduce the risk by cleaning them properly.
You can reduce your chances of getting cervical cancer by not smoking. The progression of the acquired HPV infection into cervical cancer
increases with smoking habits.
The best way to protect yourself from cervical cancer is by attending the cervical screening for early detection and early treatment.
Trans men, who have had a total hysterectomy, do not need to have cervical cancer. But trans men, who have retained their cervix and are registered with their GP as female, will receive invitation in accordance with the national cervical cancer screening.
Trans men, who have retained their cervix and registered with their GP as men, will not receive automatic invitations. But they are still at risk and are eligible for screening. They should discuss having regular smear tests with their GP.
Unfortunately, many studies have show trans people get less frequent smear tests.
Other studies have shown that many LGBTI people with a uterus also get tested far less than straight people. A 2014 survey found that 20% of lesbian, bisexual and queer women in Sydney, Australia had never had a Pap test.
How regularly should people have a smear test?
In the UK, the NHS offers a screening for all women. Between the ages of 25 and 50 years old, the screening is every 3 years. Between the age of 50 to 64 years, every 5 years. Outsides these ranges, people should discuss any concerns with a GP.
All cisgender women should be screened as per national cervical cancer screening program as there is a risk for the HPV to be transmitted between partners, regardless of their sex.
What happens in these screenings?
During the cervical screening, the nurse/doctor uses a speculum to see the cervix clearly then gently scrapes the surface of the cervix with a soft brush to get cells sample. It is a very simple procedure and last only a couple of minutes.
The sample will be then sent to the lab where they will examine it under microscopy.
What happens next if your test comes back positive?
An abnormal test does not mean you have cancer, but it can be early stage of alteration in cells.
Depending on the results of the test, the doctor will send cells from inside the cervix for further testing. Or a the doctor will send the person for a colposcopy.
A colposcopy, which is a more accurate examination of the cervix, is a simple procedure for diagnosis. During this procedure, the clinician may be able to immediately remove the abnormal cells or may take a biopsy to confirm the diagnosis.
Sometimes tests come back inadequate for testing as not enough cervical cells were present for the microscopic examination. The patient will then get a recall and will repeat the smear test. But that should happen no less than 3 months after the initial test (time for the cells at the surface of the cervix to regenerate after a smear test).
Trans men and ‘unsatisfactory smear tests’
Studies have shown trans men are more likely to have unsatisfactory smear tests results and have to retest. The study showed that long-term testosterone therapy administered intramuscularly (IM) induces vaginal and cervical atrophy. This can alter the smear test results.
The atrophy makes also the examination more difficult due to the discomfort during the passage of the speculum.
Bad experiences can increase the number of attending and non-attending patients for retest. In addition, the medical team should focus on minimizing the discomfort with for example smaller speculum or lubricant.
Dr Nagete Boukhezra is a General Practitioner at the Private GP, London Doctors Clinic.