Healthcare access, cervical cancer screening, and urogenital health among masculine-presenting people assigned female at birth in Thailand: The HAFFU Project

Globally, masculine-presenting people assigned female at birth (AFAB), including transgender men, nonbinary people, and butch or otherwise masculine-presenting women, participate in cervical cancer screening less often than cisgender women. Thailand offers an important setting to examine whether the comparatively high social visibility of gender diversity translates into equitable healthcare access. Published evidence addressing cervical screening, broader healthcare access, and urogenital health in this population remains sparse in Thailand and Southeast Asia. This qualitative study conducted focused semi-structured interviews with 19 masculine-presenting AFAB participants aged 28–65 years in Bangkok, Thailand. Thematic analysis followed a six-stage framework. We conducted primary coding on the original Thai-language data, including the coding framework, candidate themes, discrepant cases, and final conceptual model. Interpretation was guided primarily by health-services frameworks. Seven themes were identified: generally accepting clinical encounters complicated by administrative misgendering; fear of pain and embodied exposure; symptom-contingent care and low perceived risk; financial and coverage barriers; self-management and reliance on peer or social-media information; preferences for more affirming clinic design; and low spontaneous reporting of urogenital symptoms with severity-gated disclosure. Participants also described a possible masculinity/body-concealment gradient, with greater avoidance among those least willing to expose their bodies. These findings informed a proposed Quiet Avoidance Model. Relatively accepting clinical encounters did not by themselves translate into equitable preventive-care access. Screening avoidance was associated more strongly with fear, low perceived risk, administrative mismatch, and financial barriers than with overt discrimination. Participant-informed clinic modifications, human papillomavirus (HPV) self-sampling options, and verified gender-inclusive outreach may provide more approachable routes to screening and follow-up. Thailand’s inclusion of gender-affirming hormone services in the Universal Coverage Scheme is an encouraging policy development, although equitable access will require broader service availability and alignment across coverage schemes.