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Transgender Health — DFSRH MCQ

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EasyTransgender HealthDFSRH

A 30-year-old transgender man attends an English sexual and reproductive health service. He has retained his cervix and has not undergone hysterectomy. His cervical screening sample at age 25 was negative for high-risk human papillomavirus. He is registered as male with his GP and has received no further invitation. He has used testosterone for 4 years and reports vaginal dryness and marked discomfort during a previous speculum examination. He has no abnormal bleeding, discharge, pelvic pain or postcoital bleeding and is willing to undergo screening if discomfort can be minimised. Which is the most appropriate plan?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Arrange screening now with a smaller speculum and additional lubricant, notify the laboratory, and establish practice-based result and failsafe arrangements

Explanation lettering: D = shown as B · E = shown as C · C = shown as D · B = shown as E

He remains eligible for cervical screening because he is aged 25–64 and retains a cervix. His negative screen was 5 years ago, so screening is now due under the current English programme. Testosterone use and amenorrhoea do not remove the risk associated with retaining a cervix. Long-term testosterone may cause vaginal atrophy, making speculum examination painful. A smaller speculum and additional lubricant are appropriate initial adjustments; topical vaginal oestrogen can also be discussed if necessary and acceptable to the patient. Because he is registered as male, he will not be managed automatically through the national call-and-recall pathway. The laboratory should be notified so that the sample is not rejected or misrouted, and the practice or clinic must communicate the result and provide local recall and failsafe follow-up. A fails because standard instrumentation disregards his previous discomfort and national call-and-recall cannot be relied upon for a male-coded record. C is incorrect because stopping testosterone is not required and would not restore automatic recall while he remains registered as male. D is inappropriate because asymptomatic atrophy does not itself require colposcopy; referral is determined by screening findings or clinical suspicion. E incorrectly treats amenorrhoea and a previous negative HPV result as reasons to cease screening despite retention of the cervix.

Reference: Cervical screening: programme overview (18 May 2026) — https://www.gov.uk/guidance/cervical-screening-programme-overview NHS Cervical Screening Programme – Good practice guidance for sample takers (9 July 2025) — https://www.gov.uk/government/publications/nhs-cervical-screening-programme-good-practice-guidance-for-sample-takers/nhs-cervical-screening-programme-good-practice-guidance-for-sample-takers