Scenario

Setting: Virtual Visit

PATIENT NAME: Danny Clarke

Reason for Visit: 

35-year-old trans man (assigned female at birth) is presenting to establish care by video visit and asking if he needs a pap smear. As part of your evaluation:

Assess whether a pap smear is indicated.

Use shared decision-making to develop a plan for a trauma-informed cancer screening with the patient, to be performed at a future, in-person visit. Please follow SAMHSA’s six guiding principles to a trauma­-informed approach to patient care, which include the following:

1. Safety,
2. Trustworthiness and Transparency,
3. Peer Support,
4. Collaboration and Mutuality,
5. Empowerment, Voice, and Choice, and
6. Cultural, Historical, and Gender Issues.

Make a plan to write any needed prescriptions ahead of the appointment for the pap smear. Examples of medications which may be helpful (depending on patient preference and situation) include:

• anti-anxiety medication
• topical vaginal estradiol.

Danny Clarke – Supporting Materials include a guide to taking a trauma informed physical exam and an except on Cervical Cancer in Trans Men).

SOGI:

●      Pronouns: he/him/his

●      Sex Assigned at Birth: female

_______________________________________________________________

You have 30 minutes to conduct this interview followed by verbal feedback with the SP

"Join Visit" button will appear AT the scheduled visit time. If you don't see it, be sure that the time zone in your profile matches where you are physically located.

Visit Objective

Tasks:

• Introduce self with pronouns and ask patient’s pronouns and name (“what name do you go by?”)
• Describe the recommended approach for cervical cancer screening in trans and gender diverse patients (i.e., who qualifies for screening, when, and how often)
• Used shared decision-making to plan a trauma-informed pap smear with patient
• Recognize the value of gender-affirming hormone therapy provision in the primary care setting, as it can reduce barriers for routine health screenings and primary care. 

Target Audience

Although this case may of particular interest to clinicians who perform pelvic exams as part of their practice (e.g. clinicians in Primary Care, OB/GYN, and Emergency Medicine), a trauma-informed physical exam is a valuable practice for clinicians in all disciplines of healthcare