Trans and non-binary people’s experiences of accessing and attending cervical screening in the North of England

Transgender people face discrimination and inequality in various areas of life, including within healthcare. A key health disparity is the limited uptake of cervical screening compared to cisgender women. A scoping review highlighted the paucity of research in this area. Therefore, the aim of this thesis was to undertake an in-depth, qualitative study to explore transgender men and non-binary peoples (trans+) experiences of cervical screening to develop recommendations to improve experiences of this service.
15 trans+ people shared their experiences of cervical screening in a semi-structured interview (10), or an online, asynchronous focus group (5) conducted between November 2022-March 2023. Participants were recruited through purposive and snowball sampling using various social media and LGBTQ+ newsletters. Inclusion criteria were being trans+, aged 25 or over, having or previously having a cervix, and living in the North of England. Participants were aged between 25-45, and the majority (13/15) had a disability, and were mostly (13/15) white British.
Data were analysed using reflexive thematic analysis, through which four themes were developed that explore various barriers and facilitators to attending cervical screening. For example, in cases where health professionals were not sensitive and respectful, trans+ participants reported more negative experiences, such as heightened physical pain and gender dysphoria, compared with then health professionals were knowledgeable and reassuring. Further, trans+ people shared complexities of deciding whether to attend cervical screening. These decisions were shaped by previous experiences of health services, concerns about heightened gender dysphoria or pain, and the potential emotional impacts of cervical screening.
The findings had multiple implications for practice, policy and future research to improve cervical screening for trans+ people. For example, trans+ people value being given choice in cervical screening, and shared what they would like health professionals to know about their identities and health needs.