Gynecologists are asked to provide routine gynecologic care for female-to-male transsexuals or to address their gynecologic problems, such as chronic pelvic pain, dysmenorrhea, pelvic mass, or cancer. Some transsexuals will consult a gynecologist for benign gynecologic conditions, such as pelvic pain or leiomyomata, even after testosterone injections have begun. Hysterectomy with bilateral salpingo-oophorectomy, known as Full or Total Hysterectomy, is the most definitive treatment for many gynecologic symptoms for those transsexual men who do not desire fertility. However the debate remained as to whether trans men should continue to have annual Pap exams after completing Total Hysterectomy.
"It's tough to get cervical cancer without a cervix," said Dr. David Chelmow, a professor of obstetrics and gynecology at Virginia Commonwealth University Medical Center. And just as tough to get ovarian or uterine cancer without ovaries or uterus.
Most professional groups including the American Cancer Society, the American College of Obstetricians and Gynecologists (ACOG), and the U.S. Preventive Services Task Force, a government-backed panel, agree that it is unnecessary for most female-bodied people who have had a total hysterectomy to be given an intravaginal exam for non-cancerous reasons. It continues to be highly recommended that annual STD and HIV testing be conducted for sexually active persons regardless of gender identity or sexual practices, more often if non-monogamous.
Although an annual Pap test was once the standard of care, the previously named three groups now recommend that most people with natal female reproductive organs only get tested every three to five years, and that they delay their first test until 21 years of age. An annual health assessment that includes external assessment of pelvic health and STI testing continues to be recommended.
A note about male-to-female transsexuals:
Gynecological exams are to be provided for trans women who have completed genital reconstruction and breast cancer exams for all trans women estrogen hormone treatment, as demonstrated by a news release from American College of Obstetricians and Gynecologists dated November 21, 2011: Ob-Gyns: Prepare to Treat Transgender Patients
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