Past last updated May 2021

New research reveals barriers to smear test uptake among trans men and non-binary people

An overhead photo of the vaginal speculum, white napkin, medicine gloves and spatula. The medical plactic tool for holding open the vagina during medical investigation. Feminine woman health diagnosis

Anticipated discrimination, gender dysphoria, and lack of information are among reasons trans men and non-binary people with a cervix are not attending their smear test, finds new research by Gender Identity Clinic at the Tavistock and Portman NHS Foundation Trust, 56T, and Jo’s Cervical Cancer Trust.

The research, published in the British Journal of General Practice this week and conducted between 16th August-7th October 2019, investigated the perceptions of cervical screening among 137 trans men and non-binary people with a cervix, and found that only half of those eligible for screening (57%) attended their appointment. It is the first piece of research of its kind.

Over a third of respondents (39%) were unaware that those registered as male with the GP will not be routinely invited to attend their screening, while only 48 of 137 (35%) felt that they had sufficient information about the test and what it might mean for them. However, those who were eligible for the test did feel better informed, with 34 out of 64 (53%) feeling they had adequate information versus 14 out of 73 (19%) who were too young for the test.

“I had met two health professionals…who expressed strong moral objections to the existence of transgender people, and refused to treat me and recommended religion as conversion treatment”

Having a male gender marker was identified as a barrier to accessing screening, making it more difficult for participants to access the automatic invitation and follow-up system (call and recall) and their test results. “The NHS refused to give me my results as they were under a male gender marker,” said one study respondent. Nine participants reported that they had been discouraged from getting a smear test due to their gender identity, while one person was turned away entirely.

Anticipated and experienced stigma or discrimination was a theme among reasons for non-attendance, which the study authors identify as a major barrier to accessing this essential care. One respondent said: “I had met two health professionals…who expressed strong moral objections to the existence of transgender people, and refused to treat me and recommended religion as conversion treatment. I was scared I might encounter someone with a similar mindset who would use a screening as a chance to assault me.”

Almost half (30 of 61) of participants above screening age chose not to attend screening because of their gender identity, giving reasons such as not wanting to associate with or think about certain parts of their body, fears of being asked difficult questions, and concerns about how others might react to their gender identity.

Almost all of the participants wanted more training for healthcare professionals around supporting LGBTQ+ patients, including use of inclusive, appropriate language

Dr Alison Berner, Lead Author and Doctor at the Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust said: “Facilitating cervical screening for trans and non-binary people requires a multi-pronged approach, involving improved clinical and awareness training for providers, more welcoming and inclusive clinical environments, invitations and information, and embracing new testing methods such as self-taken swabs.”

Almost all of the participants (130 of 133) wanted more training for healthcare professionals around supporting LGBTQ+ patients, including use of inclusive, appropriate language. Most respondents (86 out of 134; 64%) said that they would prefer to attend their screening at a trans-specific health clinic — something they reported put them at ease and made the process easier and less dysphoric. One participant said: “Being a trans clinic, I could ignore my mind and get on with it, knowing they weren’t down there out of curiosity, but just doing their job.”

Having the option to self-sample, versus having a clinician carry out the test, could be another way to improve uptake of cervical screening among trans men and non-binary people. More than half of respondents (71 out of 134) said that they would prefer this option, despite some expressing concern about their own ability to self-sample and whether the test would be accurate. Many who preferred self-sampling cited the privacy it afforded as a reason why.

“Just as cervical cancer does not discriminate, cervical screening shouldn’t either”

Cervical screening is the best protection against cervical cancer, a disease that can affect anyone with a cervix regardless of gender identity. There are several barriers to attendance for anyone with a cervix, including previous trauma and physical access to the test, but this research demonstrates that trans men and non-binary people experience additional challenges due to their gender identity. It is estimated that 300,000 people in the UK identify as transgender.1

Rebecca Shoosmith, Chief Executive (Acting), Jo’s Cervical Cancer Trust, said: “Accessing cervical screening can be difficult for many people. This can be exacerbated for trans men and/or non-binary people with a cervix who face many barriers to accessing routine cervical screening, as well as discrimination because of their gender identity. Just as cervical cancer does not discriminate, cervical screening shouldn’t either.”

The full paper can be accessed here: https://doi.org/10.3399/BJGP.2020.0905
 
 
Jo’s Cervical Cancer Trust is the UK’s leading cervical cancer charity. They provide information and support to anyone affected by cervical cancer or cell changes and campaign for excellence in treatment and prevention. Their helpline is on 0808 802 8000

The Tavistock and Portman NHS Foundation Trust is a specialist mental health trust with a focus on training and education alongside a full range of mental health services and psychological therapies for children and their families, young people and adults, as well as specialist gender services for both child and young people and adults.
 
 
Featured image is an overhead shot of the equipment needed to undertake a smear test: plastic gloves, a speculum, and a spatula. All the items aside from the speculum, which is made of plastic and clear, are varying shades of blue against a pale and bright blue background
 
Page last updated May 2021

Anticipated discrimination, gender dysphoria, and lack of information are among reasons trans men and non-binary people with a cervix are not attending their smear test, finds new research by Gender Identity Clinic at the Tavistock and Portman NHS Foundation Trust, 56T, and Jo’s Cervical Cancer Trust.

The research, published in the British Journal of General Practice this week and conducted between 16th August-7th October 2019, investigated the perceptions of cervical screening among 137 trans men and non-binary people with a cervix, and found that only half of those eligible for screening (57%) attended their appointment. It is the first piece of research of its kind.

Over a third of respondents (39%) were unaware that those registered as male with the GP will not be routinely invited to attend their screening, while only 48 of 137 (35%) felt that they had sufficient information about the test and what it might mean for them. However, those who were eligible for the test did feel better informed, with 34 out of 64 (53%) feeling they had adequate information versus 14 out of 73 (19%) who were too young for the test.

“I had met two health professionals…who expressed strong moral objections to the existence of transgender people, and refused to treat me and recommended religion as conversion treatment”

Having a male gender marker was identified as a barrier to accessing screening, making it more difficult for participants to access the automatic invitation and follow-up system (call and recall) and their test results. “The NHS refused to give me my results as they were under a male gender marker,” said one study respondent. Nine participants reported that they had been discouraged from getting a smear test due to their gender identity, while one person was turned away entirely.

Anticipated and experienced stigma or discrimination was a theme among reasons for non-attendance, which the study authors identify as a major barrier to accessing this essential care. One respondent said: “I had met two health professionals…who expressed strong moral objections to the existence of transgender people, and refused to treat me and recommended religion as conversion treatment. I was scared I might encounter someone with a similar mindset who would use a screening as a chance to assault me.”

Almost half (30 of 61) of participants above screening age chose not to attend screening because of their gender identity, giving reasons such as not wanting to associate with or think about certain parts of their body, fears of being asked difficult questions, and concerns about how others might react to their gender identity.

Almost all of the participants wanted more training for healthcare professionals around supporting LGBTQ+ patients, including use of inclusive, appropriate language

Dr Alison Berner, Lead Author and Doctor at the Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust said: “Facilitating cervical screening for trans and non-binary people requires a multi-pronged approach, involving improved clinical and awareness training for providers, more welcoming and inclusive clinical environments, invitations and information, and embracing new testing methods such as self-taken swabs.”

Almost all of the participants (130 of 133) wanted more training for healthcare professionals around supporting LGBTQ+ patients, including use of inclusive, appropriate language. Most respondents (86 out of 134; 64%) said that they would prefer to attend their screening at a trans-specific health clinic — something they reported put them at ease and made the process easier and less dysphoric. One participant said: “Being a trans clinic, I could ignore my mind and get on with it, knowing they weren’t down there out of curiosity, but just doing their job.”

Having the option to self-sample, versus having a clinician carry out the test, could be another way to improve uptake of cervical screening among trans men and non-binary people. More than half of respondents (71 out of 134) said that they would prefer this option, despite some expressing concern about their own ability to self-sample and whether the test would be accurate. Many who preferred self-sampling cited the privacy it afforded as a reason why.

“Just as cervical cancer does not discriminate, cervical screening shouldn’t either”

Cervical screening is the best protection against cervical cancer, a disease that can affect anyone with a cervix regardless of gender identity. There are several barriers to attendance for anyone with a cervix, including previous trauma and physical access to the test, but this research demonstrates that trans men and non-binary people experience additional challenges due to their gender identity. It is estimated that 300,000 people in the UK identify as transgender.1

Rebecca Shoosmith, Chief Executive (Acting), Jo’s Cervical Cancer Trust, said: “Accessing cervical screening can be difficult for many people. This can be exacerbated for trans men and/or non-binary people with a cervix who face many barriers to accessing routine cervical screening, as well as discrimination because of their gender identity. Just as cervical cancer does not discriminate, cervical screening shouldn’t either.”

The full paper can be accessed here: https://doi.org/10.3399/BJGP.2020.0905
 
 
Jo’s Cervical Cancer Trust is the UK’s leading cervical cancer charity. They provide information and support to anyone affected by cervical cancer or cell changes and campaign for excellence in treatment and prevention. Their helpline is on 0808 802 8000

The Tavistock and Portman NHS Foundation Trust is a specialist mental health trust with a focus on training and education alongside a full range of mental health services and psychological therapies for children and their families, young people and adults, as well as specialist gender services for both child and young people and adults.
 
 
Featured image is an overhead shot of the equipment needed to undertake a smear test: plastic gloves, a speculum, and a spatula. All the items aside from the speculum, which is made of plastic and clear, are varying shades of blue against a pale and bright blue background
 
Page last updated May 2021

Monica Karpinski

Founder & Editor, The Femedic

Monica is the Founder and Editor of The Femedic. Against a journalism background and after years of leading content marketing projects in the healthcare space, it became clear that health information out there for women simply wasn’t good enough. No-one had bothered to look deeper into the ways women were searching for information, or consider the depth of what they actually needed to know. Instead of waiting for the perfect publication to approach her, she created The Femedic.

Monica has been named one of The Drum’s 50 under 30 for influential women in digital 2018 and was shortlisted for Female Entrepreneur of the Year in the 2018 British Business awards. She speaks and writes widely on gender and health inequality.

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References

  1. Office for National Statistics, Gender identity update, ONS website, 2017 [online] [accessed 19 May 2021]