I don’t want what I want: The battle for a cervical smear test

This is Laurie.

Laurie wants to look and act like a man and be fully recognised as a man in law.

This is Laurie
Photo – https://www.bbc.com/news/health-56942480Laur

Catering to Laurie’s wishes, the health service recorded her sex as male. Therefore she was not contacted to undertake a cervical smear test. This would appear to be the desired end-game for someone who has gone to lengths medically, surgically, socially and legally be recognised as a man despite being in fact a female.

However, Laurie feels cheated

The cervical smear test reminder is a service provided to women to improve early detection of cervical cancer. Males don’t have a cervix and therefore do not develop cervical cancer. Therefore they are not called up for a test. Reminders are sent out centrally, but for some individual cases the GP will manage the reminder.

Laurie has placed herself in a special category where she would be required to schedule her own smears. Personally I use a calendar reminder, and my GP also nudges me every couple of years. No one loves a speculum up in their vagina, but needs must.

However Laurie still wishes to be entitled to regular smear test reminders. Laurie tells us that the process of organising her own smear reminder is both “exhausting” for herself and “It also puts a lot of extra work on to the GPs, who are already pretty stretched.” My GP uses a software application for all my notes and the reminder comes up automatically. Even when GPs used paper files and no automated call register, my mother’s generation managed to receive regular tests.

I remember my mother talking about it. The trepidation of going in, the relief of a gentle hand or the discomfort of a clumsy procedure. Seb, also a trans-identified female, notes “wasn’t as terrifying as I was expecting”. This is a common experience among women. Since these tests became routine, women sit in waiting rooms fiddling with their hands, and they breathe a sign of relief when they walk out the door. Done for another 2 years.

Laurie wants to be a man, with all the attendant social interactions, but also she wants to be treated like a woman when it suits her. Now that she has what she wants (to be a man), does she still want it?

Special arrangements are needed for men like Laurie

It is always interesting to me how women’s problems become material concerns when voiced by a man. Cervical screening is is at best a chore, and at worst quite an invasive and uncomfortable way to find out you might die quite soon.

“The sample taker and reception staff have a really important role in creating a safe and supportive environment for trans men and/or non-binary people with a cervix,” says Rebecca Shoosmith. Yes Rebecca, for women also. Indeed, far all of us be-cervixed individuals. So the NHS are looking at discreet at-home kits. Quite how the girlfriend, hubby or sister would be better than a trained doctor is a baffling question. But we must keep trying to make Laurie and Seb happy.

Now that men are talking, we’re listening.

Statistics and exaggerations

40% of trans-identified females have never had a cervical smear test. Compared to only 21% of the general population of women in the UK.

One of these numbers is not like the others. The 21% of women comes from official government-collected data made available by the NHS.

The 40% comes from a survey conducted by the Tavistock Gender Identity Clinic. Dr Alison Berner interviewed 137 trans people. Half of these (68.5) were eligible for a cervical smear, and of this half, 40% (27.4) had never been screened.

27.4 trans-identified females had not undertaken to get a smear test. “Many had missed appointments because they were fearful about disclosing their gender identity and of how others might react.”.

They fear being exposed, because they are living under a pretence.

They have convinced the medical establishment, and society at large, to take them at their word. When they fear exposure, this has somehow become a public health issue rather than an issue of personal integrity.

Access for all? Solving the intractable puzzle of inviting trans men for screening

Laurie describes accessing a smear test as coming up against a “brick wall”. However she seems to be raging against the machine for nothing.

Gov.uk advises that they are aware trans-identified females are a special case, and have created a process to handle them.

Trans men (assigned female at birth) do not receive invitations if registered as male with their GP, but are still entitled to screening if they have a cervix.

Current cervical screening IT systems are not able to include individuals registered with the NHS as ‘male’. Also, current registration systems are unable to record the gender category of ‘non-binary’. In these circumstances, the GP practice or a healthcare team managing gender reassignment should send screening invitation.


Not everyone with a cervix is a woman, however he is a female

The language used in this section of gov.uk is absurd. “Women and people with a cervix”, “[HPV] Vaccinated women and people with a cervix”. The advice information on reducing cervical screening inequalities for trans people includes the heading not everyone with a cervix is a woman. Perhaps that is semantics, but everyone with a cervix is a female.

Far from being excluded and put-down, Laurie and Seb need only snap their fingers for the kind of recognition that other women dream of.

This post is a response to this article published by the bbc.com on 18 May 2021. https://www.bbc.com/news/health-56942480

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