Impact of Sex Assessment Methodology on Natal Sex-Specific Condition Data: Pap Smears and Transmen [38G]

INTRODUCTION: Most surveys use a single question to assess sex. The recommended two-step process asks two questions, sex assigned at birth and current gender identity, which better identifies gender minority populations. We use Pap smear data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine the impact of single question sex assessment on natal sex-specific condition data. METHODS: We analyzed data among people eligible for Pap smears in the 2014-2016 BRFSS (n= 294,171). In 2014-2015 “sex” was determined by interviewers' perception with “clarification if necessary;” in 2016 respondents were asked, “Are you male or female?” “Females” were asked about Paps. Transgender status was determined by asking “Do you consider yourself to be transgender?” We analyzed the “sex” and transgender status of respondents that were and were not asked about Paps using design-adjusted chi-square tests. RESULTS: Half of transmen (48.7%), compared to two-thirds (69.8%) of ciswomen, were asked whether they ever had a Pap (p-value <0.001). Sex was coded “male” for 31.8% (24.9-43.0%) of transmen. Pap data was not collected for any individuals coded as “male”. Among transmen labeled “female” there was no difference in those asked about Paps (71.4%) compared to ciswomen (69.8%, p-value=0.709). Of those who were asked, 17.5% of transmen had never had a pap compared to 6.8% of ciswomen (p-value <0.001). CONCLUSION: Transmen are less likely to be asked about, or to have had, a Pap than ciswomen. With a single sex question, surveys fail to capture natal sex-specific conditions accurately in gender minority populations.