Cervical screening is an invaluable resource for early identification and treatment of cervical cancer, preventing at least 2000 deaths in the UK each year. However, trans men and non-binary people with cervixes may face obstacles accessing screenings that cisgender women do not.
This is where people like Dr Alison Mary Berner have been working to identify the barriers to the trans community, and figure out what has to change in order to overcome them. Dr Berner, an oncologist, cancer researcher, and gender identity specialist, has been part of pioneering research to assess the attitudes of trans people towards cervical screening. The results of the research suggest that cervical screening uptake for trans people with cervixes is substantially lower than cisgender women.
It is recommended that trans men and non-binary people with cervixes go for screening at the same rate and within the same age range as cisgender women. However, the cervical screening process in the UK is set up so that women aged over twenty-five are automatically sent an invite. This means that people with cervixes who have a male gender marker on their medical records may be filtered out of the system, or that medical labs may throw away samples marked as male. These are not insurmountable problems, but they are compounded by a lack of education and understanding in primary care. For instance, if GPs do not know about the need for trans people with cervixes to continue accessing screening they may not leave notes on their medical record to ensure appointments are made.
There are also problems in the way that information around cervical screening is largely centred on cis women. This can lead to trans men and non-binary people feeling excluded or being confused as to whether the screening is for them. A similar lack of awareness around the polarising effect of gendered language affects the practice of the professionals who conduct the examinations. Some trans people are afraid to attend screenings because they anticipate discrimination, misgendering, or gender dysphoria. Dr Berner has suggested that this could be remedied with simple interventions to reduce discomfort. Specialist services for trans cervical screening, like the No Barriers Cervical Screening Project in London, or Clinic T in Brighton, already make arrangements like scheduling additional appointment time, using inclusive language, and offering muscle relaxants to reduce the invasiveness of the procedure. But these don’t have to be limited to trans-specific services, and the majority of adjustments can be accomplished by improving education around the needs of trans and non-binary people.
Although the duty of care lies with the medical establishment, it can be useful to know what you need to do to ensure your own health. If you are concerned that you will not be called for screening, or you have been called for screening but you have concerns about attending, talk to your GP and explain your needs. Even if they aren’t well-informed, you might be able to get notes added to your medical file to help ensure you are treated the way you want to be. There are resources online that offer straightforward guidance around screening for both trans people with cervixes and medical professionals. If you have friends and other contacts in the community who you think might be missed for screening, it’s worth getting in touch with them or sharing these resources.
Ultimately, making sure that everyone is well-informed and able to communicate their needs around screening benefits everyone, across all genders. Trans and non-binary people are not uniquely affected by the problems of the cervical screening system. Women born without cervixes, who have had hysterectomies, or who are otherwise not eligible for cervical screening may feel alienated by their default inclusion in the scheme; likewise, not all women who need cervical screening will be comfortable with the process purely by merit of being cisgender. By advocating for better trans-inclusivity in access to cervical screening, we can develop a service that is sensitive to a broad variety of experiences and needs.