Creating Inclusive, Affirming Gynecologic Cancer Care During Pride Month—and Beyond

As gynecologic oncologists and cancer care professionals, the SGO recognizes that precision in screening and diagnosis saves lives, but precision means more than applying the right tools. It means understanding who your patient is, what they need, and how systems may fail them if we aren’t paying attention. 

For transgender and nonbinary patients, routine gynecologic care is often anything but routine. Fear of discrimination, prior trauma, and lack of provider knowledge can all create barriers to timely screening and diagnosis. For many patients, these gaps directly affect outcomes. 

This Pride Month, we call on our colleagues to go beyond acknowledgment and take active steps to create clinically competent and identity-affirming spaces for trans and nonbinary patients, starting with how we approach screening and diagnosis. 

Why This Matters 

• Delayed care and missed screenings are common. Trans and nonbinary individuals are significantly less likely to access preventive gynecologic services due to stigma, prior negative experiences, and gender dysphoria related to pelvic exams. 
• Anatomy, not gender identity, determines screening needs, but identity must shape how care is delivered. Transmasculine patients who retain a uterus, cervix, or ovaries remain at risk for uterine, cervical, and ovarian cancers. A patient-centered, trauma-informed approach is essential to ensure these screenings happen in a safe and respectful way. 
• Language is care. Misgendering and inaccurate assumptions can cause psychological harm and disrupt trust. Inclusive language is clinical competency, not courtesy. 

What Clinicians Can Do

1. Use inclusive intake processes. Collect both legal name and chosen name, sex assigned at birth, and current gender identity on intake forms. Offer patients space to self-identify and ask which screenings they’d like to discuss based on their anatomy, risk factors, and preferences.
2. Normalize asking about anatomy and surgical history sensitively. Do not assume which organs a patient has. Use neutral, body-part-based language when discussing care (e.g., “patients with a cervix” instead of “women”). A simple script like, “To help guide your care, can you share if you’ve had any surgeries that affect your reproductive organs?” can go a long way.
3. Be mindful of trauma and dysphoria. Pelvic exams can be especially triggering for trans and nonbinary patients. Always explain what you’re doing and why, obtain explicit consent, and give patients control over how the exam is conducted, including options to pause or stop.
4. Update your environment. From inclusive restroom signage to LGBTQIA+ affirming posters, visible signs of safety matter. Ensure staff are trained to use correct pronouns and respectful language. Consider creating pathways for confidential patient feedback on inclusivity.
5. Stay informed. Clinical guidelines are evolving. Institutions like the World Professional Association for Transgender Health (WPATH), UCSF Transgender Care, and Fenway Health offer regularly updated clinical resources on cancer risk and screening protocols in LGBTQIA+ populations. Additionally, American Society of Clinical Oncology (ASCO) recently published a chapter titled, “Breast and Gynecologic Cancer Care for Sexual Minority Women and Transgender People,” detailing oncologic care practices for LGBTQ+ people with breast and gynecologic cancers. 

Screening Considerations by Anatomy 

Cervical Cancer: Transmasculine patients with a cervix should follow cervical cancer screening guidelines, though testosterone use may result in inadequate or uncomfortable sampling. Liquid-based cytology and HPV co-testing may improve sensitivity. Al Asante-Facey, PA-C, MBA, Associate Director of Advanced Practice Providers at Memorial Sloan Kettering Cancer Center also recommends the following: 

“Consider offering patients on testosterone 1-2 weeks of vaginal estrogen cream to make the exam more comfortable as well as increase the likelihood of an adequate pap. In patients who cannot tolerate a pelvic exam, consider using a self-collected HPV test.” 

Endometrial Cancer: Patients with a uterus who present with abnormal bleeding, especially postmenopausal or while on testosterone, should be evaluated with the same urgency and care as cisgender women. 

Ovarian Cancer: Risk remains in patients with retained ovaries, regardless of gender identity or hormone therapy status. Imaging and CA-125 testing should be offered when clinically indicated. 

Vaginal/Vulvar Cancer: Often overlooked in trans patients, especially those with a neovagina or history of gender-affirming surgery. Encourage regular self-exams and remind patients to report symptoms such as pain, bleeding, or visible changes. 

The Bottom Line 

Inclusive care is evidence-based care. When trans and nonbinary patients feel safe, seen, and respected, they are more likely to access screening, report symptoms early, and engage in follow-up. The SGO encourages health professionals to engage in Welcoming Spaces, a cultural humility training, developed in partnership with the National LGBT Cancer Network to educate health professionals on providing safe and affirming care to LGBTQ+ people with gynecologic cancer. 

Gynecologic oncologists are uniquely positioned to lead the way in improving cancer outcomes for LGBTQIA+ communities. By embedding inclusion into our clinical practice, not just during Pride Month but year-round, we reaffirm our commitment to care that is not only medically excellent, but human-centered.