Masculine-presenting people assigned female at birth in Thailand participate in cervical cancer screening less often than cisgender women, and a new qualitative study offers a detailed account of why. The research, part of the HAFFU Project published in BMC Public Health, is based on focused semi-structured interviews with 19 participants aged 28 to 65 years in Bangkok, including transgender men, nonbinary people, and butch or otherwise masculine-presenting women. The authors analyzed the original Thai-language data through a six-stage thematic framework and interpreted the results primarily through health-services frameworks.
The interviews revealed seven themes. Clinical encounters were generally described as accepting, yet administrative misgendering complicated them. Participants reported fear of pain and embodied exposure, sought care only when symptoms appeared, and perceived their risk of cervical cancer as low. Financial barriers and gaps in insurance coverage added further obstacles. Many relied on self-management and on information from peers or social media rather than on health services. Participants also expressed preferences for more affirming clinic design, and they disclosed urogenital symptoms spontaneously only rarely, often gating disclosure by severity.
A striking pattern was what the researchers describe as a possible masculinity and body-concealment gradient: avoidance appeared greater among those least willing to expose their bodies during examination. These findings informed a proposed Quiet Avoidance Model, in which screening is quietly avoided even when interactions with providers are not overtly hostile. The authors conclude that relatively accepting clinical encounters did not by themselves translate into equitable preventive-care access, and that avoidance was associated more strongly with fear, low perceived risk, administrative mismatch, and financial barriers than with overt discrimination.
The study points to practical routes forward. Participant-informed clinic modifications, human papillomavirus self-sampling options, and verified gender-inclusive outreach may make screening and follow-up more approachable. Thailand’s inclusion of gender-affirming hormone services in its Universal Coverage Scheme is described as an encouraging policy development, although the authors note that equitable access will require broader service availability and alignment across coverage schemes. Because this was a qualitative study of 19 participants in Bangkok, the findings describe experiences and proposed models rather than measured prevalence, and the published version is an early, citable accepted manuscript subject to further edits.
Subject of Research: Barriers to cervical cancer screening and healthcare access among masculine-presenting people assigned female at birth in Thailand
Article Title: Healthcare access, cervical cancer screening, and urogenital health among masculine-presenting people assigned female at birth in Thailand: The HAFFU Project
Article References: Winaitammakul, R., Piñol Rovira, M., & Saraluck, A. (2026). Healthcare access, cervical cancer screening, and urogenital health among masculine-presenting people assigned female at birth in Thailand: The HAFFU Project. BMC Public Health. https://doi.org/10.1186/s12889-026-30038-z
Image Credits: AI Generated
DOI: 10.1186/s12889-026-30038-z
Keywords: cervical cancer screening, transgender health, Thailand, healthcare access, qualitative research, HPV self-sampling, urogenital health, gender-affirming care, health equity, BMC Public Health, Healthcare, access
News Source: Nathaniel Bowman. (October 30, 2026). Research report: Healthcare access, cervical cancer screening, and urogenital health among masculine-presenting people assigned female at birth in Thailand: The HAFFU Project. Scienmag.
