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How to support trans men and non-binary patients with cervical screening |
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Jo ’ s Cervical Cancer Trust offers a guide to practice nurses ’ role in helping trans men and non-binary people through screening |
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We know how much cervical screening – a test that prevents up to 75 % of cervical cancer cases – has been impacted by the pandemic . In your practice it may have been much harder to provide your usual service because of changing national or local guidance , on top of staff sickness or redeployment . For many patients , the pandemic has added an extra layer of diffi culty to attending a cervical screening appointment . Yet , long before coronavirus , some groups already faced signifi cant challenges around accessing screening – among those groups are trans men and non-binary people with a cervix . On top of the common barriers faced by the wider eligible population , for these people the test might present greater diffi culty for reasons related to their gender identity . Here , we discuss the factors specifi c to these patients .
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Processes and disclosure The invitation to cervical screening can itself be a stumbling block . Only those registered with their GP as female are automatically invited by the call and recall system , meaning trans men and non-binary people with a cervix who are registered as male either have to request a test or be offered one . Disclosure of a trans or non-binary identity can be diffi cult . It can trigger distressing feelings or dysphoria for that person , in addition to the fear of potential repercussions – for example , transphobia or discrimination .
Practice nurses can help overcome these factors by engaging in an understanding and supportive way , and establishing a different process that works for each patient . Creating a safe environment throughout the practice , in which someone feels comfortable to be open and honest , is crucial .
Everyone in the practice , clinical or non-clinical , can help in this respect . Here are some key tips for doing this :
Avoid assumptions about gender identity based on visual factors .
Offer alternative ways to disclose identity , such as in writing , or having a trusted person speak on the patient ’ s behalf .
Be discreet and respectful . If you want to check whether a person is attending for cervical screening , you could use phrases like ‘ We have you booked in for a cervical screening appointment . Is that right ?’
Have a conversation about confi dentiality ; reassure them that medical records are not discussed with anybody else .
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Consider how you can make it clear your practice is a safe and inclusive environment ( such as by using rainbow lanyards or posters referencing LGBT + inclusive healthcare ).
Language matters A positive experience at one healthcare appointment , such as cervical screening , can encourage positive health-seeking behaviour in the future . Below are some simple language choices and tips you can use to help trans and non-binary people feel welcomed , included and understood :
Agree on the language you ’ ll use before the test starts – you can ask how they would like their body parts referred to . Ask questions if you are unsure , such as ‘ What is your gender ?’ or ‘ What pronouns should I use for you ?’ Asking questions is a great way to show that you want to understand and recognise somebody ’ s gender identity .
Listen to your patient , and mirror their language – ‘ trans ’ may be a necessary qualifi er in terms of why someone needs cervical screening , but if the patient refers to themselves as ‘ a man ’ then you can refl ect this .
Try to avoid assumptions about issues like sexual partners . Trans and non-binary people can have any sexual orientation .
If you , or other staff in your practice don ’ t feel confi dent in supporting trans and non-binary people , look to the LGBT Foundation ’ s ‘ Pride in Practice ’ programme , which can help increase your knowledge and confi dence of LGBT + inclusion .
Physical changes If your patient is taking testosterone , there are physical changes that may make cervical screening less comfortable . Vaginal atrophy is a common side-effect and can make speculum insertion painful . It may help to offer a smaller speculum size , extra lubrication or topical oestrogen , as a cream or a tablet , if it ’ s acceptable to your patient .
It ’ s diffi cult to overstate the importance of the relationship between sample taker and patient . Your actions and words could be the difference between someone feeling able to have their test and not . By taking these steps you will be supporting someone to have this important health test , as well as making it more likely they will come back again .
Jo ’ s Cervical Cancer Trust website has more information , as well as a glossary and signposting , and on the Nursing in Practice site , Seb Daniel explores the challenges of accessing cervical screening as a trans man ( see Resources ).
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Resources Jo ’ s Cervical Cancer Trust website . jostrust . org . uk LGBT Foundation , Pride in
Practice : bit . ly / 3wzb0YL Seb Daniel ’ s Nursing in Practice blog : bit . ly / 3fndOm1
Cervical Screening Awareness Week takes place from June 14-20 , 2021
Imogen Pinnell Health information manager at Jo ’ s Cervical Cancer Trust
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ALAMY |
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nursinginpractice . com Summer 2021 |