Use of “inclusive” language in medical leaflets etc

Here is the procedure for gender change in NHS England England:

pcse.england.nhs.uk/help/patient-registrations/adoption-and-gender-reassignment-processes

It does appear to be quite comprehensive at first glance although transfering cervical screening to the practice for FtM seems a bit risky. Also, prostate cancer is completely ignored.

Also, as has been noted upthread, there is no guarantee that the process is followed by all practices.

Or we be clear that health and sickness are rooted within physical bodies and humans have two sexes male and female.

*aren't considered people. Ffs

The problem with saying "women and people with xxx" is that means women are considered people as they are seperate from people with a xxx.

Health literacy is poor in most countries. Vital screen services need to do general messaging clearly. Then do specific and specialised messaging for groups that may need it.

All the nonsense about it's just more ink is pointless actually health services need more money to do specialist services.

Much of the NHS CSP professional guidance now refers to individuals with a cervix https://www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management/1-introduction-and-programme-policy

If a woman has her medical records changed to male, then the central screening database is also changed to male. She won’t be part of the call/recall system and manual arrangements must be made with the GP Practice, joint responsibility between patient and practice for invitation, result letter, communication with colposcopy if appropriate etc.
This is the programme guidance for trans gender and non binary people
https://www.gov.uk/government/publications/nhs-population-screening-information-for-transgender-people/nhs-population-screening-information-for-trans-people

Women who no longer have a cervix, and don’t require follow up for treatment are ceased by the practice using either the prior notification list or a standard form (probably both) https://www.gov.uk/government/publications/cervical-screening-removing-women-from-routine-invitations

In routine work, request forms arriving marked as male or nb mean additional checks to find out whether the medical records and screening database have been changed. Or it’s just been written on the form but no formal record changes - this makes a difference. If the records at all parts of the system don’t tally it causes problems and it’s important for the patient to get a result and any relevant treatment.

This is the current approach, but this is as a result of campaigning by women on the issue - a couple of years back that would have just read "people with a cervix" with no mention of women

Indeed. An example from 2021 from the Scottish Government/NHS Scotland -

www.heraldscotland.com/politics/19639181.snp-ministers-criticised-urging-anyone-cervix-get-smear-test/

The national radio campaign at the time referred only to 'those with a cervix'.

And of course, when all the links on the NHS Scotland website were being changed to have 'inclusive' language, it was all the conditions which affected women which were changed first, before any changes were made to any conditions which affect men.

Oh fecking Mumsnet formatting. A star to C. A star and A.

I once taught at a girls private school - academic entrance exam and everything. 100% A to C GCSE grades. Over 80% A and A.

One of my year 11s once labelled the scrotum as "cul-de-sac" in her biology mock exam.

Assuming that people know anything much is dangerous.

No. But if you haven't a clue about what a vagina is, then you really aren't going to think 'hmmm that's me' either though.

See my school friend who got an F in GCSE science.

There's an ongoing discussion about whether the age for breast screening should be brought forward to 40 from 50 in the UK. It's 40 in other countries/healthcare systems, but, in the UK, the risk-benefit assessment says it's not appropriate for the general population of women because of the radiation exposure in addition to the number of false positives and associated biopsies.

It's a different risk-benefit for women with have relevant BRCA mutations etc. and for whom screening at 40 might represent a reasonable and very different risk-benefit profile. Or, switching to additional/other imaging might be useful for the younger women, such as MRIs (too expensive/scarce for general screening use but no ionising radiation).

We use Epic. Recently seen in the WPATH files. The demographic fields are 'legal sex' 'sex assigned at birth' 'gender identity ' and 'sexual orientation'. Usually only 'legal sex' is filled out, and the patient gets to choose what with.

That's a good point about the risk of radiation exposure - the leaflet we were working on was based on an NHS England one, so I'd like to think they'd considered the relative risk before issuing the advice, but who knows these days?

Largely agree except the heightened risk might not be sufficient to justify the radiographic dosage in breast ca. screening (say).* A small increase in the number of breast cancer cases diagnosed in transwomen is a large relative increase in breast cancer risk compared to men.

Over the course of the study, 15 cases of invasive breast cancer (breast cancer that has the potential to spread to other areas of the body) were detected in 2,260 transgender women that the researchers were following. In cisgender men, over the same period of time, only 0.32 cases of breast cancer would be expected to be detected.
This is why scientists suggest transgender women are 47 times more likely to develop breast cancer. However, 15 out of 2,260 is still a very small number of cases.

https://breastcancernow.org/about-us/blogs/transgender-people-breast-cancer/

*The BMJ authors have a different perspective.
This study showed an increased risk of breast cancer in trans women compared with cisgender men, and a lower risk in trans men compared with cisgender women. In trans women, the risk of breast cancer increased during a relatively short duration of hormone treatment and the characteristics of the breast cancer resembled a more female pattern. These results suggest that breast cancer screening guidelines for cisgender people are sufficient for transgender people using hormone treatment.
Study: https://www.bmj.com/content/365/bmj.l1652

de Blok C J M, Wiepjes C M, Nota N M, van Engelen K, Adank M A, Dreijerink K M A et al. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands BMJ 2019; 365 :l1652 doi:10.1136/bmj.l1652

Absolutely agree that there is a lot to be known, not least about age-groups that might benefit from screening or whether the risk is related to the dosage of hormones or lifetime exposure to them. There are some reports of greater risk of obesity amongst transwomen so it might be useful to see if that is a helpful risk stratification.

The authors report variation in the typical hormones used, especially by transwomen. The blend of hormones has changed over the years and it's notable that some are not the standard of care offered by GIDS in the UK.

A quick scamper through the study shows they're relatively young. So, transwomen who started hormones when younger might yet develop breast cancer later on in life. As above, this might not be generalisable, depending on current standard of care in different healthcare systems.

Not sure if I've done this right: We don't know much

You really do need to rewrite rather than just gender neutralise though - for example, trans women do need to consider breast screening, as a small number of men do get breast cancer, and taking female hormones long-term raises their risk.

Also in some cases we don't know the impact of hormones - for example, screening for abdominal aortic aneurysms is only offered to men as they are at 5x the risk of women, but we don't know the impact of taking testosterone on female risk factors. The Guardian had an article about research into the effects of taking artificial hormones today if I can find it again, and how little is really known.

HCP are able to share relevant clinical information with other HCP without patient permission.

They may also share in other circumstances, such as safeguarding or to prevent a crime.

I'm not a lawyer. Just like whoever wrote that, I guess.

To be fair to them, they're in a specialty area where we have significant staff shortages so probably too busy to take much time to think about it critically.

My GP practice (Scotland) put out an appeal for patients to turn up for routine screening for a variety of health conditions, not including prostate checks. First up, cervical screening - see picture. I emailed them and said I was bothered by the lack of straightforward language and how that would affect those with learning disabilities or those for whom English wasn’t their first language. They were understanding and promised to change it on the website!

From joes cervical cancer survey below

Half of women don’t know what the cervix is

Fri, 09/06/2017 - 14:47

Cervical Screening Awareness Week taking place from 12-18 June
Almost half of women (44.2%)[1] are unaware of what the cervix is, unable to correctly identify it as the neck of the womb (uterus). One in six could also not name a single function of the cervix with less than half (41.40%) aware that it connects the womb to the vagina and only one in three knowing that it provides a seal to hold the baby in when pregnant.

Jo’s Cervical Cancer Trust is releasing these new statistics at the start of Cervical Screening Awareness Week (12-18 June) to encourage women to talk about and protect their cervical health.

So excluding the word woman does really matter

The NHS already translates leaflets into a huge number of languages, it would surely be a good use of Stonewall or mermaids money to fund the translation of a gender neutral one, for those who need it.

The rest of us can carry on as normal, as affected as we are by the Cantonese/Urdu/Spanish versions.

It would be interesting to know if gender neutral rewording happened in all languages or just the English one!

It's not liable for criminal prosecution unless they actually have a GRC. So the GRC is relevant whether known about or not.

https://www.gov.uk/government/publications/the-gender-recognition-disclosure-of-information-england-order-2022-equality-impact-assessment/the-gender-recognition-disclosure-of-information-england-order-2022-equality-impact-assessment

The law had to be amended just to do the GIDs research, but that amendment only applied to paediatric patients.

https://www.nhsggc.org.uk/media/258438/sharing-trans-information-doc.pdf

The NHS records transgender status in private medical records, so I don't think this applies. They just record gender and transgender status - the GRC doesn't come into it. You may well know better.