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Staff training on trans health needed to improve cervical screening uptake, study says

by Jess Hacker
19 May 2021

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Practices should work with trans-specific sexual health services and staff should receive trans awareness training, a study has recommended after finding just 7% of trans men and non-binary people preferred seeing a GP for their cervical screening.

The study, published by the British Journal for General Practice (BJGP) (17 May), found that by comparison nearly two-thirds (64%) preferred to attend a trans-specific clinic for a screening.

The authors said that although such specialist clinics are set to increase, they are currently limited to ‘major cities’, and GPs should be aware of their closest service.

‘Though the authors encourage expansion of such services, they would also welcome initiatives to educate and train GPs and practice nurses in how to approach cervical screening sensitively with trans men and non-binary (TMNB) people,’ it said.

The recommendation comes after the authors found more than half (54%) of TMNB people assigned female at birth who did not attend their cervical screening cited disclosing that they are trans as a reason.

The study also found that 56% of patients who had not attended their screening cited how others might react as a factor.

The authors – who interviewed 137 TMNB people at an NHS gender identity clinic (GIC) and NHS sexual health service – found that many participants wanted dedicated trans-specific resources as well as a more inclusive approach generally, and that they felt these should also contain information for professionals caring for trans patients.

Similarly, practices should ensure GPs, receptionists and admin staff can receive trans awareness training, the study said.

Gender markers on digital systems

Several participants also reported that gender markers on practice’s systems acted as barriers to screening.

The study said that this meant patients were excluded from routine call and recall programmes, and had trouble accessing results.

Currently, professionals taking screening samples must inform the laboratory to return results to their practice as opposed to the NHS screening service, it added.

It said: ‘The lack of access to standard processes and safeguards could be argued to be systemic discrimination, and places the burden on patients and GPs.’

One respondent said that the ‘NHS refused to give me my results as they were under a male gender marker’, while a second reported difficulties booking in and expressed concerns that some receptionists ‘don’t understand’.

Meanwhile, nine participants said they had been discouraged from attending their screening because of their gender identity.

The authors called for policymakers to make better provision for these patients to access ‘the full infrastructure of the screening service, perhaps with the use of a ‘body organ checklist’ (where organs that each patient possesses that are recommended to be screened are recorded), which would also allow patients to opt out of reminders they find triggering’.

Creating a register

The study said that it is recommended that TMNB people undertake cervical screening with the same frequency as cisgender women (women who are not transgender), as not all TMNB people will have had surgery to remove the cervix.

However, the study found that more than three-quarters (79%) of participants said they have not attended a screening because they do not ‘associate with/like thinking about that part of the body’.

It said that GPs should ask trans men and non-binary people if they would like to be included on a reminder register, adding that they should recognise not all may wish to be.

This comes after the NHS Confederation’s LGBTQ+ Leaders Network called for staff to be ‘confident and competent’ in collecting data about patients’ gender identity or sexual orientation to better understand issues facing local LGBTQ+ communities.