New research reveals complex barriers to cervical screening for trans men

New research in the British Journal of General Practice has revealed trans men and non-binary people with a cervix face complex personal and systemic barriers to cervical screening. Lack of information, gender dysphoria and experienced or anticipated discrimination contribute to low attendance with over a third unaware that those registered male with their GP will not be automatically invited for this potentially life-saving test. 

The research is the first piece of UK research on the perceptions of cervical screening among trans men and non binary people with a cervix. 137 participants took part in the research conducted by the Gender Identity Clinic at the Tavistock and Portman NHS Foundation Trust, 56T and Jo’s Cervical Cancer Trust.

Among those eligible for screening, just half had attended (57%) with all citing a wide range of factors impacting ability and intention to do so. These include female focused information and invitations and being discouraged or turned away. Almost all of the participants (130/133) wanted more training for healthcare professionals around supporting LGBTQ+ patients, including use of inclusive, appropriate language.

There are an estimated 300,000 people in the UK who identity as transgender. 

Cervical screening is the best protection against cervical cancer, a disease that can affect anyone with a cervix regardless of gender identity. There are many barriers to attendance including fear of results, access to the test because of physical disability, and previous trauma. However for trans men and non binary people there can be additional challenges as a result of their gender identity. Almost half (30/61) of participants of screening age (25-64), said gender identity was a reason they don’t attend. Genital dysphoria was reported by (82%). 

The cervical screening programme invites those who identify as women or female, which means trans men and/or non-binary people registered as male at their GP will usually have to request a test. Over a third (39%) were not aware of this leaving them at risk of being missed out. Only 35% saying they had sufficient information about cervical screening. 

The research highlights a number of factors that could help to increase cervical screening uptake among this group including use of TMNB-appropriate screening invitations and the option to self-sample (53%). Only 6.7% wish to attend their GP with increased access to trans-specific or trans-aware health services preferred (64%).

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.”

Three quarters (101/133) felt that cervical screening information materials should be adapted to better reflect their use by trans people. Participants wanted dedicated trans-specific resources as well as a more trans-inclusive approach to non-specialist screening resources.

Rebecca Shoosmith, Chief Executive (Acting), Jo’s Cervical Cancer Trust: “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.”

Ends

Notes to Editors

• Research was conducted between 16th August to 7th October 2019
• The paper was published in the British Journal of General Practice: https://bjgp.org/content/early/2021/01/18/BJGP.2020.0905  
• Jo’s Cervical Cancer Trust is the UK’s leading cervical cancer charity. We provide information and support to anyone affected by cervical cancer or cell changes and campaign for excellence in treatment and prevention. Our Helpline is on 0808 802 8000. www.jostrust.org.uk 
• 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. 

[1]Office for National Statistics. Gender identity update [Internet]. 2017 [cited 2020 Oct 15]. Available from: https://www.ons.gov.uk/methodology/classificationsandstandards/measuring...