While many of us don’t get excited for a trip to the gynecologist's office, for transgender men, these visits arrive with their own slew of difficulties. Many providers are inexperienced in care for trans patients, the experience may trigger dysphoria, and there’s always the fear of outright transphobia. In the face of these barriers, gynecological care continues to be vital to the health of trans men who have not undergone gender-affirming surgery, also known as “bottom surgery.” 

There’s a severe deficit in research conducted on the health of trans and non-binary people, particularly as it relates to vaginal and breast health. Not only do trans men require gynecological care, but there are certain vaginal issues that they are at increased risk of facing. 

Vaginal Atrophy

Transmasc individuals may experience vaginal atrophy (atrophic vaginitis) as a result of taking testosterone or “T.” Vaginal atrophy in trans men is believed to be a result of lower levels of estradiol (estrogen) production from taking T. Atrophy has several uncomfortable symptoms, including an increased occurrence of bacterial vaginosis (BV), vaginal dryness, and bleeding or pain during penetrative sex, which occurs as a result of thinning vaginal walls. Dryness, bleeding, and pain have often been treated with lubrication and/or topical estrogen. These treatment options are, however, not clinically proven for trans men specifically.

Infection

Outside of as a symptom of atrophy, trans men have been found to have a higher predisposition to BV in general, with a study finding higher bacterial diversity than cis women, which may explain the higher BV rates. Similarly, trans men are at an increased risk of UTIs because the urethra is estrogen-responsive. 

Pregnancy

Even if a trans man has been taking T for a prolonged period, and has irregular or no period as a result, they are still at risk of becoming pregnant if they are vaginally receiving penetrative sex with a person who produces sperm. While taking T may make it more difficult to become pregnant, it is by no means a form of contraception, and cannot effectively prevent pregnancy. Testosterone should be stopped immediately if you become pregnant, as it has been shown to cause birth defects. Notify your provider immediately if you are on T and find out you’re pregnant. 

Cancer

It is still essential to receive routine vaginal examinations, such as pap smears and pelvic exams, as a trans man. All people with vaginas, cervixes, and uteruses are at risk of developing cancer in the respective regions. These examinations can be triggering for trans men, whether because they are emotionally triggering due to past traumas, or because of dysphoria. For this reason, be sure to, when it is safe to do so, ask your provider if they offer sedation for pelvic exams. 

Lastly, finding the right provider is essential to receiving equitable vaginal care that is receptive to your unique needs as a trans man. If you’re stuck on where to start when seeking a queer-friendly provider, check out our article on the subject.