Cervical cancer screenings prevent cancer and save lives. But for many transgender people, getting these basic screenings is fraught with anxiety and fear. Both the very real fear of disrespect and discrimination, and the dysphoria many people feel about this part of their body, make going for these tests feel anything but routine. In the National Transgender Discrimination Survey, we found that forty-eight percent of transgender men delay or avoid getting preventive care due to the fear of encountering discrimination.
It doesn’t help that, even during this Cervical Health Awareness Month, virtually everything we hear about the subject is framed in alienating gendered terms. For example, a quick survey of online articles on cervical cancer testing refer only to women and do not address the need for cervical cancer screenings among people of other genders. Any mention of trans people’s needs for cervical screenings is limited to blogs and other trans community spaces.
Fortunately, this is changing. The American Congress of Obstetricians and Gynecologists (ACOG) has specifically encouraged this kind of positive care experience in the hopes of improving preventive care for transgender and gender non-conforming people. In a statement released a year ago, ACOG addressed the health care disparities that exist for the transgender community and advocated for doctors to explicitly welcome transgender patients. Another organization that recently voiced their support for access to health care for transgender and gender non-conforming people is the American College of Nurse Midwives (ACNM). ACNM called for improved knowledge of transgender health care among providers in order to ensure access to safe, complete health care. The ACNM statement outlines the expectations of midwives when working with transgender or gender non-conforming patients and their own goals as an organization with a special emphasis on providing “welcoming and accessible” care.
The U.S. Preventive Services Task Force recommends that people with cervixes aged 21-65 should get pap smears every 3 years, or every 5 years for people over age 30 who also get an HPV test done. It’s not necessary to get a pap smear every year although national guidelines recommend an annual check-up to assess other health concerns. Anyone who has had a total hysterectomy (including removal of the cervix) should not continue to get tested. While much more research and data is needed about the needs and best preventive care practices for transgender people, we do have guidance on how these standards apply to transgender folks from the Center of Excellence for Transgender Health here.
Organizations such as ACOG, with its statement on Health Care for Transgender Individuals, as well as the ACNM, have taken important steps, but there is still much discrimination going on against transgender people in the medical world. NCTE calls on health care organizations and federal and state governments to do more to make health care environments welcoming for transgender people, especially when it comes to sexual and reproductive health.
At the national level, we urge the Department of Health and Human Services to adopt trans-inclusive nondiscrimination standards and promote cultural competence training for Title X family planning clinics and other key providers of preventive health screenings. Concrete, wide-spread institutional change is needed to provide safe, reliable access to preventive care to all people.