Screening Policies for Cervical, (Neo-)Vaginal, and Vulvar Dysplasia and Cancer

As medicine evolves, the traditional healthcare model that reflects societal binary systems is changing to become more inclusive of the transgender population. This is especially true in the field of gynecology and physicians have started to recognize the need for more research in the transgender population as it is particularly vulnerable due to healthcare disparities. Here, we conducted a literature review to help guide for gynecological cancer screening in the transgender population. We found that the transgender population is particularly at risk for infection with the human papilloma virus (HPV) and thus, should be encouraged to undergo preventative vaccination. In this chapter we will highlight screening policies in cervical cancer in the transgender male population, particularly for individuals who have not undergone gender-affirmation surgery. The rarity of vulvar and vaginal cancers in the transgender population have made it difficult to implement routine screening policies and patients should be screened on an individual basis in the presence of concerning symptoms. We also discuss screening skepticism in the transgender population and different techniques physicians can employ to improve their practice. It is our goal that through this chapter a physician can gain a deeper understanding and appreciation when caring for this unique patient population.