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Gender identity in healthcare

Posted on: Thursday, 14th July 2022 by Eluned Hughes, Head of Information and Engagement

At Jo’s, we work for women – that goes without saying – but we also recognise that not everyone with a cervix identifies as a woman. This week is Non-Binary Awareness Week, and this blog looks at the role of sample-taker and other GP staff in helping trans men and/or non-binary people with a cervix to feel welcomed and encouraged throughout their screening.

“The (cervical screening) programme is meant to prevent people from falling through the cracks. Unfortunately, if you're a transmasculine person with a cervix, unless you actively arrange and push for screening, then falling through the cracks is exactly what will happen." Laurie (he/him), who shared his story with us.

Who can go for cervical screening?

In the UK, anyone with a cervix between ages 25 and 64 is eligible for cervical screening. Women are usually born with a cervix, and some trans men and/or non-binary people also have a cervix. Some trans men and/or non-binary people may have had gender confirmation surgery that involves removing the cervix, so will no longer need screening. 

The screening process is set up to invite those who are registered as female on their NHS records. This means trans men and non-binary people registered as male who have a cervix are not routinely invited. Providing targeted information and a supportive environment can help encourage attendance. 

How can clinical and non-clinical staff help trans men and/or non-binary people feel more comfortable attending their cervical screening?

Avoid negative or inappropriate reactions

The sample taker and other healthcare staff play a key role. You may be the difference between someone feeling able to go to cervical screening or not attending. 

LGBT Foundation run a Pride in Practice programme for anyone who wants to increase their knowledge and confidence of LGBT+ inclusion at home, at work and in the community. Find out more about Pride in Practice >

Be explicitly welcoming 

Make it easy for trans and/or non-binary people to see that you recognise and welcome them. Your GP surgery or clinic could:

  • include LGBTQ or trans-specific posters in waiting and examination rooms
  • have a note addressed to trans and/or non-binary patients on the website.

Offer alternative ways to disclose

No-one should feel pressured into discussing their gender identity, but it’s important they feel supported to do so if they want to. Some people may prefer to:

  • write it down
  • have a trusted person speak on their behalf – in this case, you may need written consent from the patient. 

Avoid misgendering and using incorrect language

Misgendering is referring to someone by the wrong gender. It is disrespectful to misgender someone and can be painful for that person. Incorrect language or terminology, such as using the wrong pronouns or deadnaming (using the person’s previous or birth name), can have the same impact. In a medical setting, using someone’s dead-name on a waiting room screen or in an invite/results letter can cause real distress. Always use the patient’s used name – if you’re not certain of this, have a chat with them to confirm how they’d like to be called in.

A good way to avoid this is to ask questions about anything you are unsure of – e.g. ‘I use these pronouns [e.g. ‘she/her’]. What pronouns should I use for you?’ or ‘Remind me of your name?’. This opens up the conversation for the patient and lets them know you want to understand their gender identity. Remember, everyone makes mistakes from time to time – it’s OK to correct yourself and move on. 

It’s important to remember that, while the term ‘trans’ may be a necessary qualifier in understanding why someone needs cervical screening, many people would usually describe themselves without it – for example, as a man. Listen to what the patient tells you and mirror their language. 

Be discreet and respectful

While some people will feel comfortable having conversations about their gender in a more public space, many people will not. If you are working on the reception desk, you could simply say ‘Have you been for this test before? Do you have any questions about it?’.

If you are a sample taker and want to determine whether someone is there for cervical screening, invite them into a private space like the examination room to check in. As always, it is important to explain what happens during cervical screening before the test. 

Other barriers

It’s important to remember that trans and/or non-binary people may also experience other barriers, such as fear of results, access to the test and past trauma. As with any patient, it’s vital you recognise this and support them with each individual need.

Your impact

Accessing cervical screening in an environment where they feel safe and in control can be difficult for many people and can be exacerbated for trans men and/or non-binary people with a cervix.

By taking these steps and becoming a model for trans and/or non-binary healthcare within your GP surgery or clinic, you will be supporting someone to have an important health test, as well as making it more likely that they will come back again. This is an important step in securing a future without cervical cancer.

Want to hear about attending a cervical screening from a trans man? Seb shares his first experience of cervical screening >

Find out more about how you can improve the patient’s experience >

 

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