‘It will only be a little uncomfortable’: lifting the lid on the cervical screening nightmare

Dr Deborah Lee of Dr Fox Online Pharmacy also shared that sometimes the 4, 7, 8 breathing technique helps for anyone feeling anxious during the test. “Remember you are in charge, and during the procedure, if you change your mind at any time, you just say ‘stop’ and the procedure will be abandoned. You are in control.”

I have what’s known as a tilted cervix (or tilted uterus), which is actually incredibly common. This means that the cervix curves in a different direction than what is considered normal. Tilted cervixes can be anteverted or retroverted, either pointing down to the spine or pointing back towards the belly button. Cervical screenings tend to be more challenging for people with tilted cervixes, and from personal experience, I’ve found it very painful in the past. I went to my local sexual health clinic for my most recent screening, where staff specialise in gynaecological healthcare. Though the experience wasn’t without pain, it was more manageable for me.

Regular cervical screenings are vital for anyone who has a cervix. However, according to the Gov.uk website, their cervical screening IT systems are not able to include individuals registered with the NHS as male or non-binary. So, to avoid screenings being missed, the website states that the eligible patient’s GP practice or healthcare team is responsible for sending letters inviting them to attend screenings.

KP, who is non-binary and 31, said that the process for trans and non-binary patients has left them feeling discarded. “The NHS website says, “all women and people with a cervix…should be invited by letter.” I did get a letter in the post, but the letter said, “we invite women aged 25 to 64 a registered with a GP.” Receiving the letter, and effectively my identity being ignored in it, made me feel resistant to actually going. I have yet to book a test.”

“I’m not just scared of the pain, or of getting a medical professional who doesn’t understand that my vaginismus is real, but of going through a process that is misgendering and dysphoria-inducing.”

Quinn, who is now of eligible age to be invited for screening, is dreading his first smear test. He told me, “I’m still registered as female on the NHS system – I still get ‘Miss Quinn Rhodes’ on prescriptions I pick up and on letters the NHS sends me. So I’m not worried that I’ll be passed over for a cervical screening, but I am worried about how I’ll be treated when I go for an appointment. 

“I’m not just scared of the pain, or of getting a medical professional who doesn’t understand that my vaginismus is real, but of going through a process that is misgendering and dysphoria-inducing,” he explained.

“It’s not uncommon for me to be the first trans person a medical professional has had, and that shows in how they interact with me. I don’t want to have to educate the person I’m vulnerable and exposed to about how they should be treating me. I want a medical professional who understands that the vagina between my legs doesn’t make me less of a man, and I wish I could trust that I would get one.”

Karen Hobbs of gynaecological cancer charity The Eve Appeal advised that having GP staff, nurses and doctors trained so that they can deliver trauma-informed care and make their practice a clearly welcoming place for LGBTQ+ individuals would make a big difference to the experience of trans men and non-binary people could have during screening. 

She added, “Anything that can be done to make the care being given inclusive of everyone who needs a cervical screening test. It’s not about excluding anyone; it’s about including everyone who is eligible for this life-saving screening.”

But inclusion doesn’t always mean acceptance or safety. The NHS has a long way to go to ensure all of its patients, whether disabled and/or trans, or otherwise, feel listened to, cared for and respected through the screening process. So many vulnerable people have lost faith in our healthcare system due to traumatic medical experiences – it shouldn’t be on us to fix it. 

*Some names have been changed.