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Laurie shares his story of attending cervical screening and talks about how supportive healthcare professionals can really make a difference.
I’m 33 years old, and I started my transition in my early 20’s, so I have been having regular cervical screening for a few years now.
As part of my transition, my GP changed my NHS number to a new one, so my gender marker could be changed to male on the computer. I believe this was done with the best of intentions, but if I'd been asked I probably wouldn't have changed it, as it had all my old medical records on it and would have meant I could easily access services relevant to the anatomy I still have. As a side effect of this administrative change I was taken off the cervical screening programme.
I rang up and asked the screening service if I could be re-included, but was told their computer system couldn't accommodate men on it. I pointed out that I still have a cervix and need to have screening, but was told that it wasn’t possible to change the computer system, which was incredibly frustrating. I tried to challenge this but in the end it took more emotional energy and time than I was able to give, so I gave up.
As I don’t get the usual reminders in the post, I have to remember myself to book in for regular cervical screening. My partner is female, so when she gets a reminder it reminds me too. My practice nurse and I have developed a good relationship over a number of years, and we’ve worked out a system of sorts. She will do the test, then phone the lab to make sure they know to test my sample, as she knows that other samples have been thrown out because they think it’s an error when they arrive with a man's name on. She then looks up the results separately a few weeks later, and phones me to let me know. It’s a very convoluted process which relies on both of us being fairly motivated and proactive.
When it’s time for my test, I ask at reception to book the appointment. This process is fine now, but initially it was difficult and frustrating. I’ve had to be persistent. Sometimes people can initially be quite insensitive and sometimes obstructive, for example I've had receptionists refuse to make appointments for me in the past because they think they know my anatomy better than I do, or they’ve announced what my appointment was for loudly to the rest of the waiting room. If I run into issues, I’m lucky that I know how the health system works and am happy to persist until I get the problem sorted. Many people don’t feel able to be so vocal, which I completely understand. I worry that they just give up and don't get the healthcare they need.
Luckily for me, I don’t find the test itself painful, I understand the process and what to expect. My practice nurse had never really dealt with trans people before me, we learnt about these things together. She’s been great – very open-minded and proactive. She is non-judgemental and tries her best for me – if there’s a problem, she’ll say ‘well, we’ll just have to figure it out’ and then we do. Good members of staff really make all the difference. We’ve made it work, but it’s a source of anxiety that she could go and get a job elsewhere, then I’ve got to do it all again with someone else who might not be as helpful. I have had experiences with primary care staff who have been obstructive and unkind, and it can be really hard to get these people to help me.
I feel that me being trans sometimes makes the nurses anxious. Once, after the test as I was putting my trainers back on a nurse told me that "it wasn’t as bad as I thought it would be"…I was the one who had the test! I feel that I often have to manage the worries and concerns of healthcare staff, when I should be able to just be the patient.
My nurse uses an appropriately-sized speculum, she doesn’t go bigger than necessary. She doesn’t really refer to my genitals much, and will instead say things like ‘drop your knees a bit’, 'bit cold coming up, sorry' – it isn't totally necessary to talk specifically about vaginas when doing smear tests for the most part. She’ll be clear with what's happening, what clothes I need to take off, she gives me some paper to cover up with, puts the curtain around whilst I'm getting dressed and undressed - but these are all things that you'd do for anyone having a smear test, it's nothing special.
I have a medical background, so I'm at an advantage when it comes to understanding the system and what tests I'm supposed to have and when, and I have a good grasp of how important screening is whilst I still have the relevant anatomy. I still need cervical screening, just like anybody else with a cervix.
I feel worried that other people who aren’t in the same position as me could fall through the cracks and be a sitting duck for something bad happening to them. The whole point of a screening programme is to prevent people getting missed, but unfortunately if you're a transmasculine person with a cervix then, unless you actively arrange and push for screening yourself, falling through the cracks is exactly what can happen.