Gynecologic Care for Transgender Individuals

Care for transgender, nonbinary & gender nonconforming patients at a glance

• At University of Colorado OB/GYN, we understand that transgender, nonbinary and gender-nonconforming patients face significant barriers to receiving medical care.
• We strive to provide open, culturally competent gynecologic care to those in need of an affirming environment regardless of gender identity.
• Transgender, nonbinary and gender-nonconforming patients who have retained reproductive organs such as the cervix require routine gynecological care.
• Cervical cancer screenings (Pap smears), contraception and sexually transmitted infection testing are essential to the sexual health and wellness of all individuals requiring gynecologic care, regardless of gender or sexuality.
• In addition to offering gynecologic surgery, we also provide care for the management of pelvic pain and other gynecological conditions, including ovarian cysts, endometriosis, vaginitis, abnormal uterine bleeding, and fertility preservation.

Care for transgender & gender nonconforming individuals

Transgender and gender-nonconforming individuals require reproductive healthcare. Depending on health history, surgical history and goals, a gynecologist may be best suited to provide reproductive health exams and screenings.

A transgender individual who has retained the cervix, uterus, one or both fallopian tubes and/or ovaries requires routine gynecologic care. A transgender individual who has had genital surgery may need specialized gynecological care. All patients with breast tissue should be screened for breast cancer with regular clinical breast exams and mammography.

University of Colorado OB-GYN offers the following services to all transgender individuals:

• Contraception management.
• Sexually transmitted infection (STI) testing and treatment.
• Evaluation & management of pelvic pain, pain during intercourse, abnormal menstrual bleeding and other complex reproductive health conditions.
• Cervical cancer screening (Pap smear).
• Breast cancer screening.
• Fertility preservation counseling with referral to specialists as needed.
• Gender affirming hysterectomy with or without oophorectomy (removal of the ovaries).

Exams & preventive screening

The needs of transgender individuals vary based on whether they have received hormone treatments, had gender-affirming surgeries or have specific personal health goals. Many transgender men still require cervical cancer screening, STI testing and other preventive measures. If possible, patients should discuss potential needs and healthcare concerns with a trusted care provider.

Pelvic exams

Periodic pelvic exams are necessary to screen for reproductive cancers, to perform Pap smears, and to identify abnormalities or signs of infection. Patients who believe they may be pregnant or wish to become pregnant may also require a pelvic exam.

Birth control management

Testosterone therapy alone does not eliminate the possibility of pregnancy. Trans men who have penile-vaginal sexual intercourse should use birth control to prevent unwanted pregnancy. Some patients may opt for hormonal contraceptive methods available by prescription from an OB-GYN.

Breast cancer screening (mammography)

Transgender men who have not had a mastectomy are at normal risk of developing breast cancer.  Transgender women are also at risk, though the overall risk is likely low. Transgender men and transgender women with breast tissue should follow the same breast cancer screening intervals that cisgender women follow.

Cervical cancer screening

Any individual who has a cervix is at risk of developing cervical cancer. Transgender men are statistically less likely to be current on their cervical cancer screening than cisgender women and are 10 times more likely to receive unsatisfactory smear results.

The American Society of Colposcopy and Cervical Pathology (ASCCP) advises that transgender men should follow the same cervical cancer screening intervals and recommendations that cisgender women follow. Although pelvic exams are generally required for Pap smears, our goal is to ease any anxiety or discomfort with the pelvic examination.

Transgender women who have received a vaginoplasty do not need Pap smears, as they are not at risk for vaginal or cervical cancers. Vaginal exams, however, may be indicated to screen for sexually transmitted infections and to address certain pelvic issues after vaginoplasty.

Gender affirming hysterectomy considerations for transgender men

Hysterectomy, the removal of the uterus, effectively ends menstruation. Similarly, an oophorectomy (removal of the ovaries) eliminates the body’s primary estrogen producing organ. Hysterectomy and salpingectomy (removal of the fallopian tubes) with or without oophorectomy can be considered after 12 months of continuous testosterone therapy for transgender men who desire gender affirming surgery. Some patients may opt to keep their ovaries for fertility preservation purposes.

Fertility & pregnancy considerations

Transgender men who have not had a hysterectomy can still become pregnant, even those who have consistently used testosterone therapy. Patients seeking to become pregnant naturally may want to work with an OB-GYN to stop testosterone treatments and to undergo preconception counseling.

Other patients may consider fertility preservation prior to transitioning. University of Colorado offers transgender patients fertility counseling prior to gender affirmation surgery to review available fertility preservation options.

UCHealth Integrated Transgender Program

UCHealth boasts a team of specialists dedicated to transgender and gender diverse patients. From primary medical care to surgical procedures to hormone therapy, we offer patients a range of services and can arrange for patients to see multiple providers in just one visit. UCHealth offers patients the following services:

• Primary medical care.
• Endocrinology and hormone therapy.
• Gynecologic care and surgery.
• Mental health care.
• Urology/urologic surgery.
• Facial plastic surgery/laryngology.
• Reconstructive and aesthetic procedures.

Consultations with additional specialties in other fields, including reproductive endocrinology, infectious diseases and neurology, are also available to patients.
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