Uptake, experiences and barriers to cervical screening for trans and non‐binary people in Aotearoa New Zealand

Abstract

Background Little is known about experiences and barriers for trans and non‐binary (TGNB) people eligible for cervical screening in Aotearoa New Zealand. Aims To identify uptake, barriers and reasons for delaying cervical cancer screening among TGNB people in Aotearoa. Materials and Methods The 2018 Counting Ourselves data on TGNB people assigned female at birth aged 20–69 years who had ever had sex, were analysed to report on experiences of those who were eligible for cervical screening (n = 318). Participants answered questions about whether they had taken part in cervical screening and reasons behind any delays in receiving the test. Results Trans men were more likely than non‐binary participants to report that they did not require cervical screening or were unsure if they needed it. For those who had delayed cervical screening, 30% did so due to feeling worried about how they would be treated as a trans or non‐binary person and 35% due to another reason. Other reasons for delay related to general and gender‐related discomfort, previous traumatic experiences, anxiety or fear of the test and pain. Material barriers to access included cost and lack of information. Conclusions The current cervical screening program in Aotearoa does not consider the needs of TGNB people, leading to delayed and reduced uptake of cervical screening. Health providers require education on the reasons TGNB people delay or avoid cervical screening in order to provide appropriate information and affirmative healthcare environments. The human papillomavirus self‐swab may address some of the existing barriers.

Transgender and non‐binary peoples experiences of cervical cancer screening: A scoping review

“…Of the 23 papers, 17 were research studies, 11 of which were qualitative (Agénor et al, 2016;Bernstein et al, 2017;Carroll et al, 2023;Dutton et al, 2008;Gibson et al, 2021;Johnson et al, 2016Johnson et al, , 2020Kerr et al, 2020;McDowell et al, 2017;Peitzmeier et al, 2017Peitzmeier et al, , 2019, two mixed-methods (Berner, Connolly, et al, 2021a;Potter et al, 2015) and four quantitative (Harb et al, 2019;Roznovjak et al, 2023;Seay et al, 2017;Shires et al, 2019). Three of the papers were literature review articles (Connolly et al, 2020;Dhillon et al, 2020;Gatos, 2018), two were recorded conference presentations (Berner et al, 2021c;Berner, Connolly, et al, 2021b) and one was a conference abstract (Semlyen & Kunasegaran, 2016).…”

“…TMNB patients with sexual trauma often reported negative experiences including distress, a loss of control and PTSD-like symptoms during CCS (Bernstein et al, 2017). Some TMNB also shared that sexual trauma prevented them from attending screening due to fear surrounding the invasive nature of the procedure (Carroll et al, 2023). Additionally, many participants discussed worries of being touched by a stranger or being ignored if they needed the procedure to stop (Bernstein et al, 2017).…”

“…Gender dysphoria, which refers to the distress caused by the incongruence between gender identity and sex assigned at birth (Johnson et al, 2016), was consistently discussed across the literature and was reported as one of the primary reasons for delaying or avoiding cervical screening (Carroll et al, 2023;Roznovjak et al, 2023).…”

“…For example, in Aotearoa, 30% of those who delayed screening did so due to worries of how they would be treated by HCPs (Carroll et al, 2023). This theme discusses how HCPs can impact TMNB experiences of CCS, both positively and negatively.…”

“…In contrast, some TMNB report negative experiences caused by a lack of sensitivity towards, and education on, trans issues among HCPs (Carroll et al, 2023;Peitzmeier et al, 2017). For example, some participants reported being referred to by their deadname in a waiting room (Dhillon et al, 2020), which can exacerbate the distress already felt by being the only masculine-presenting person in a room full of cis women.…”