Cervical screening for LGBT+ patients
Have I got a cervix?
The cervix is inside the body at the top of the vagina, which joins to the bottom of the womb. People who were assigned female at birth usually have a cervix. If you have had gender confirmation surgery, you may not have a cervix. It is best to check with the healthcare team who did the treatment if you are not sure.
What is cervical screening?
Cervical screening is a free health test that helps prevent cervical cancer. Everyone with a cervix between age 25 and 64 has a right to go for cervical screening. It is your choice whether you want to go.
Do trans patients need cervical screening?
Currently, in most surgeries, only people who are registered as female are automatically invited for cervical screening. At BHWC, we have a process in place whereby all our trans patients are assessed for suitability and will be invited if you still have a cervix intact. If you prefer, there is also an expert clinic, Clinic T, that offers cervical screening. Clinic T is a Trans and Non-binary friendly Sexual Health and Contraception service. We offer testing and treatment for STIs, support to those on prescribed hormone treatments, help with bleeding control and contraception, cervical cytology, vaccination, social support and signposting to local partner support organisations. http://brightonsexualhealth.com/service/clinic-t/
Testosterone replacement therapy (TRT)
If you use testosterone, it may cause some changes that make cervical screening more uncomfortable or painful due to less natural lubrication. But there are things that can help; you can ask for a smaller speculum size or for more lubrication. You may want to talk with the nurse about using topical oestrogen, if this is acceptable for you. It is usually given as a cream or slow-dissolving tablets that are used a couple of weeks before the appointment to help treat TRT changes. Sometimes the nurse isn’t able to view the cervix because of changes due to TRT or because it is in a slightly different position. If this happens, they may suggest you go to colposcopy instead. This is a clinic in a hospital where a doctor can take a closer look at the cervix.
Do lesbian and bisexual women need cervical screening?
Anyone with a cervix (aged 25 to 64) is eligible to attend cervical screening. Yet, as well as dealing with common barriers for not attending cervical screening, LGB women sadly face the myth that they don’t need to attend cervical screening, caused by common misconceptions, and lack of understanding around HPV and how cervical cancer develops. Research from the LGBT Foundation has shown that 40.5% of LGB women of screening age have incorrectly been told they do not need to attend because of their sexual orientation. This has had a lasting impact of declining smear test attendance in the LGB community.
Human papillomavirus (HPV)
HPV is a really common virus that 80% of us will get at one point in our lives. It can be passed on between women, even if neither of them has ever had sexual contact with a man. This is because HPV is spread by skin-to-skin contact in the genital area, which can include sexual touching, sharing sex toys, oral sex and penetrative sex. Sometimes people are told not to have a smear test due to the common misconception that LGB women can’t get HPV. If you have a cervix and have been told you can’t have one because of your sexual orientation, you can speak to your GP surgery about your experience and to book a smear test. You can usually find contact details on their website. You can also request for someone else to take your smear test.
Anxiety about going to the doctor
For some LGBT+ patients, going to the doctors can cause anxiety. People are routinely asked standard questions by doctors, which may lead to them having to disclose their sexual orientation each time. For instance, being asked about whether you are sexually active, whether you use birth control and if there is a possibility that you may be pregnant. All of these queries, invariably, can lead to a discussion about sexual orientation that may be unwanted.
If this is your experience, please know you do not have to answer these questions. If your sexual orientation is not something you want to talk about, it may be helpful to pre-plan your answers.
“My partner and I were able to book our screenings within a few days of each other, with hers being a few days before mine. She was able to talk to the nurse about my appointment and let her know that I was worried.”
Some people experience a feeling of unease or distress (dysphoria) related to their body, which makes cervical screening particularly difficult for them. If you know or worry this might happen for you, there are some things that may help you feel more in control of the situation:
Ask for the door to be locked or unlocked. No one will interrupt your appointment or come into the room without permission, but you may feel more confident and at ease if the door is physically locked. Or you might find comfort in it being unlocked. Whichever you prefer, let the nurse know.
Ask if you can bring a larger covering for the lower half of your body. Although you will get a paper sheet to cover up, you may be more comfortable choosing something that makes you feel less exposed.
Ask to insert the speculum yourself. You may feel more comfortable interacting with certain parts of your body yourself.
Bring a phone or tablet and headphones. You may prefer to concentrate on something other than the test, so playing music, watching a video or reading something can help distract you.
Think about whether medicine would help. If you are very anxious, a doctor can sometimes prescribe one-off anti-anxiety medicine. This may make the test seem more manageable, but it is important to discuss whether this is the right choice for you.
Remember that you are in control.
You can say stop at any time. You may find it helpful to agree on a different word or physical signal, such as a hand gesture, that will let your nurse know to stop. You can also tell them how much or as little you want to know about what is happening during the test – and you can ask for them to say nothing about it.
“It’s worth explaining any concerns you have to your nurse prior to the screening. I thought my test would literally be one of the worst experiences of my life, but my nurse was so kind and understanding.”
Know your limits. It is important to remember that if you feel distressed, in pain or unsafe at any point, you can pause or stop cervical screening. This is true whether you need a short time to process what’s happening, or you would prefer not to have the test at all.
It is absolutely fine if you can’t have cervical screening during your first appointment. You can always try again on another day, at a different clinic, or possibly with another nurse. Be patient and gentle with yourself and remember that the priority is your health and wellbeing. The nurse is not there to judge and should be respectful of your emotional need to move forwards at your own pace.
“I don’t want to talk about it a lot and prefer to speed through. During the test, I was on my phone the whole time to distract myself. I should’ve brought headphones so I could’ve watched a video.”