Trans man and cervical screening "confusion"

[SpittinKitten]

Saw this earlier and thought it worth sharing...

www.bbc.co.uk/news/uk-england-humber-58515769

A transgender man has said confusion over his gender caused a delay in receiving a hospital appointment after an abnormal cervical screening result.

Jamie, 29, from Hull, began his medical transition aged 18, but opted to retain his cervix.

When referred to hospital after the screening, it was questioned why a man needed an appointment, he said.

The NHS group responsible for screenings said it was sorry to hear about Jamie's recent experience.

Jamie said the nurse who referred him to hospital following the check in late 2020 wrote an accompanying paragraph explaining he was trans.

"I think the hospital had said 'Why have you sent us this guy?' and she said 'Haven't you read the paragraph that came with it? This is a trans man, he still has a vagina, he needs screening'.

"It had to go through multiple managers to accept and understand it," he said.

Jamie said the confusion over his gender led to a three-month wait for results - not the usual two weeks.

His results came back negative, despite the delay in receiving the appointment.

The Hull Clinical Commissioning Group (CCG), which is responsible for cervical screening, said while it could not comment on individual cases it was sorry to hear about Jamie's experience and thanked him for bringing it to their attention.

"Trans men who still have a cervix should have cervical screening to help prevent cervical cancer," the CCG said.

"They may need to ask their GP practice for an appointment and ask that their preferences are recorded in their notes."

However, NHS guidance says a trans man registered with a GP as male will not usually receive automatic invitations.

Only women aged over 25 are automatically sent reminders to book an appointment.

Jamie said his case highlighted the issue that trans men and non-binary individuals who have a cervix were not routinely called for screening.

"There is no notification to tell me I need a screening, so it's something I need to manage myself," Jamie said.

He said because screening was normally done every three years "it's really easy to forget".

"That's why women are sent letters," he said.

"Everyone that needs a screening needs that reminder and that will prompt more people to go."

Imogen Pinnell, from charity Jo's Cervical Cancer Trust, said there was a need for healthcare professionals to be better educated about the issue "so they are able to better support transgender and non-binary people with a cervix".

"Because so often the experience someone has at an appointment will be what determines if they go back in future", she added.

'Could save your life'
Public Health England said it had worked closely with the LGBT community to produce a guide to help trans people understand what screening is available.

"We have promoted the guide to LGBT groups to help trans people access the most appropriate screening for them," they added.

Jamie said he wanted screening invitations to be sent to everyone who required them.

"No-one is going to say cervical screening is nice, and there is that extra layer of why it is uncomfortable for a trans person.

"But, for a few minutes of being uncomfortable, that could save your life."

---

Quite a bit to unpick here- the whole situation is a heck of a mess, isn't it?

Obviously shouldn't be necessary in my book because people would be OK with medics having a clear record of their sex and being open about that, but many aren't

Personally I would view this as a firm of self harm/ self sabotage

Withholding your sex in a medical situation could lead to death. Someone reluctant to do this, is actively choosing to hurt themselves. This isn't an informed person making an informed choice aviut what course of treatment they accept ir turn down. This is someone preventing themselves from even getting the information to make an informed choice.

When the NHS facilitates this policy, it directs the risk of potential harm to both the patient and their own staff. It does not pass a risk assessment.
For that reason I'm surprised their insurers and the NHS workers unions are ok with it.

Maybe the fact that a nurse had referred her was a clue, maybe the note from the nurse explaining the situation was a clue, maybe the telephone conversation with the nurse was a clue. They didn't need to be the second coming of Sherlock Holmes to work it out.

I work in a job that requires clear communication. I learned early on that leaving "clues" (or in my case, the various factors that are relevant) and leaving it to my audience to work out the conclusion I wanted them to draw is pointless and ineffective.

Just tell them what they need to know about people in a standard way that can apply to everyone equally: the sex of the body and whether there is cross gender presentation, the latter to make it clear the sex is correct if it seems initially mismatched to the presentation.

In a world where stating the obvious is a hate crime - would YOU want to be the nurse who ‘assumed’ that a person presenting themselves as a gyne clinic was a woman and asked when their last period was, were they having any discharge, etc...?

To be taken for a male (or to be told this because the alternative is to be labelled a bigot) is surely (on a cosmetic level - because biology can kill as this case highlights) the target?

We need to be grown ups here.

You know what, the NHS doesn't care about people as individuals, not at a public health system level anyway. Yes your local NHS workers will care about you, but activities like routine screening are often organised from regional data centres in any case.

In which case, I would be on the system as [female], [my age], and then other identifying details like name and address etc.

For some people who are 'oh so very clever' about this, and all of the 'how hard can it be?!' arguments, they should really understand that public health DOESN'T really see you as an individual. You're a number, a member of a population, for whom health issues are addressed at least initially, at a population level. Same with covid vaccinations for example. We were called for those in age order. Thank goodness people aren't widely identifying as different ages at the moment - that would have messed the Covid vaccine programme right up.

A public health screening system such as this (which is a marvellous, invaluable asset to have as a nation) doesn't cater for individual 'special' circumstances. And where there really are special cases, such as people who have learning disabilities, or who don't speak good English (or Welsh), then additional resources should go there.

Anyone who is capable of making a case for their 'gender-specialness' is perfectly capable of speaking with their GP surgery to ensure that they are in the right place in the system I am sure.

Imogen Pinnell, from charity Jo's Cervical Cancer Trust, said there was a need for healthcare professionals to be better educated about the issue "so they are able to better support transgender and non-binary people with a cervix".

Chateau Margaux from charity Sex is a Health Matter said there was a need for trans people to be better educated about the issue "so they are able to understand the difference between sex and gender and the link between their natal sex and their health risks.'

So we have to be oh-so-careful to make sure someone is identified by their chosen gender until they change the rules and want sex to be relevant and then we have to read their minds?

The other thing that strikes me about this is that what the OP is describing can be seen as just part of the poor healthcare that women are routinely subject to.

But instead of joining the fight for better healthcare for all women they make it all about them and their specialness.

@Cbtb

The nhs has got a lot wrong when it comes to trans. I don’t think the recording of people with a grc with their new gender is the nhs fault tho, that’s legislation. Trans People who have not got a grc usually have the name on the notes changed and a explanation of which gender is preferred when addressing them. With grc it’s different - like adoption - and we don’t have a choice - they get a new nhs number so a whole new set of records (it’s the same process as for adopted kids, which I also think is stupid as well,- have a shit start in life and then maybe have a medical issue because you are adopted and we don’t know your medical hx). It’s a legal fiction creating a whole new person so there is nothing the nhs can do

They don't even have to have a GRC. They can just inform the practice. This line in the PCSE guidance doesn't make much sense to me:

GP practice creates new patient record using new details, and transfers all previous medical information from the original medical record. Any information relating to the patient’s previous identity should not be included in the new record.

Previous identity? Does that mean just their name? So if they have scans and X-rays on file which include the patient's name, someone has to tippex it out?

It does also say that: If the gender is being re-assigned from female to male, screening will become the responsibility of the practice

So all you need is someone who is very busy spending time erasing all evidence of the fact that you're someone with a female body and they forget to tick the box that says actually you still need cervical screening. It's a nonsense.

@Cbtb

The nhs has got a lot wrong when it comes to trans. I don’t think the recording of people with a grc with their new gender is the nhs fault tho, that’s legislation. Trans People who have not got a grc usually have the name on the notes changed and a explanation of which gender is preferred when addressing them. With grc it’s different - like adoption - and we don’t have a choice - they get a new nhs number so a whole new set of records (it’s the same process as for adopted kids, which I also think is stupid as well,- have a shit start in life and then maybe have a medical issue because you are adopted and we don’t know your medical hx). It’s a legal fiction creating a whole new person so there is nothing the nhs can do

Both of these approaches seem mad to me. Why did anybody ever think it was a good idea to delete medical history on adoption or getting a GRC? If a young child had asthma and medically verified allergies before adoption, they will still be there after adoption. The child might have had a head injury or issues arising from a difficult pregnancy or birth, and those won't magically disappear either. A transwoman who had high blood pressure before transition will still have it after getting a GRC. And as this thread demonstrates, a transman with a cervix will still need smear tests.

I don't know anything about database design but I can imagine that the NHS database is huge, old and clunky. When this issue first arose some years ago, the obvious thing to do would have been to add another field for gender identity but leave natal sex as first recorded. Is it possible the database just couldn't be altered in that fundamental way so they decided to change the label on the 'sex' field to 'gender'?

If you want all markers of your sex removed from your files it should be up to you to sort out stuff like this.

The NHS has far more things on it's plate than to tie themselves in knots because people have decided their potentially hurt feelings are more important than medical procedures to save their lives. They are far too busy to tiptoe around people trying to acknowledge gender but also sex, oh but not sex because otherwise they're targeted for bigotry, but the procedure is about your sex, but oh we can't mention your sex, what a mess!!

Have both sex and (optional) gender by all means, but sticking your fingers in your ear going lalalalala then having a massive whine because you didn't get the message is not the fault of the messenger, it's yours.

This article also unfortunately shows yet again that it can be very difficult to do right for doing wrong, and either way the NHS risks ending up with negative publicity in a sad face news story.

where there really are special cases, such as people who have learning disabilities, or who don't speak good English (or Welsh), then additional resources should go there.

Agreed in spades, @VerveClique!

@Whatwouldscullydo

Obviously shouldn't be necessary in my book because people would be OK with medics having a clear record of their sex and being open about that, but many aren't

Personally I would view this as a firm of self harm/ self sabotage

Withholding your sex in a medical situation could lead to death. Someone reluctant to do this, is actively choosing to hurt themselves. This isn't an informed person making an informed choice aviut what course of treatment they accept ir turn down. This is someone preventing themselves from even getting the information to make an informed choice.

I agree. It worries me a lot that so often the co-morbidities are airbrushed out as transition is sold as solving all pre-existing problems and trauma.

@VerveClique

You know what, the NHS doesn't care about people as individuals, not at a public health system level anyway. Yes your local NHS workers will care about you, but activities like routine screening are often organised from regional data centres in any case.

In which case, I would be on the system as [female], [my age], and then other identifying details like name and address etc.

For some people who are 'oh so very clever' about this, and all of the 'how hard can it be?!' arguments, they should really understand that public health DOESN'T really see you as an individual. You're a number, a member of a population, for whom health issues are addressed at least initially, at a population level. Same with covid vaccinations for example. We were called for those in age order. Thank goodness people aren't widely identifying as different ages at the moment - that would have messed the Covid vaccine programme right up.

A public health screening system such as this (which is a marvellous, invaluable asset to have as a nation) doesn't cater for individual 'special' circumstances. And where there really are special cases, such as people who have learning disabilities, or who don't speak good English (or Welsh), then additional resources should go there.

Anyone who is capable of making a case for their 'gender-specialness' is perfectly capable of speaking with their GP surgery to ensure that they are in the right place in the system I am sure.

I'm rapidly losing patience with people who are determined to bend the rest of the world to their distorted view of reality, rather than accept reality themselves. By any measure, when you step back and look at the situation objectively, it's utterly fucked up. And in too many cases, transition doesn't even resolve the dysphoria (see: the growing number of detransitioners; increased risk of suicide post-transition).

There is no value judgement in recording sex accurately. It is a simple biological fact and, as this story shows, crucial to receiving the right kind of healthcare.

But as I say, I'm losing patience. Play stupid games, win stupid prizes.

Yeah the baroness did a webinar about this as well

And paediatric. Consultants spoke up about how dangerous it was for kids

The person/ child they were before were gone

Children lost. A route for trafficking.

Will try and find it it brought up things I never would have thought about. But the consultants saw it in real life

Safeguarding again

I just don't understand how this even gets into the media.

Surely if you're a trans man but have retained your cervix, you could comprehend why there is confusion around this kind of thing if you are listed as male on your medical records? It's not outrageous that something like this would happen to you.

To me, this is something you would be aware of as a trans person and would need to keep on top of. Either that, or leave your medical record registered as your birth sex.

To quote @VeryLongBeeeeep There is no value judgement in recording sex accurately. It is a simple biological fact and, as this story shows, crucial to receiving the right kind of healthcare.

Exactly. It would be equivalent to recording a person’s weight incorrectly. Sure it might save them some awkwardness and uncomfortable feelings, but would be incredibly dangerous when a doctor is calculating how much anaesthetic or blood-thinner to give them.

The argument from the TRAs though is that sex is a spectrum and all very complicated, trans men are men and to call them anything else is discrimination …. Except when medically relevant, then suddenly it’s okay to say what you see, suddenly it is okay to say having a cervix is not something men have, suddenly your innate biological sex is important and to recognise this person (who yesterday would have had you disciplined for calling them a woman) as a man and therefore not a “cervix-haver” is also discrimination.

@TatoAndBeans

To quote *@VeryLongBeeeeep* There is no value judgement in recording sex accurately. It is a simple biological fact and, as this story shows, crucial to receiving the right kind of healthcare.

Exactly. It would be equivalent to recording a person’s weight incorrectly. Sure it might save them some awkwardness and uncomfortable feelings, but would be incredibly dangerous when a doctor is calculating how much anaesthetic or blood-thinner to give them.

The argument from the TRAs though is that sex is a spectrum and all very complicated, trans men are men and to call them anything else is discrimination …. Except when medically relevant, then suddenly it’s okay to say what you see, suddenly it is okay to say having a cervix is not something men have, suddenly your innate biological sex is important and to recognise this person (who yesterday would have had you disciplined for calling them a woman) as a man and therefore not a “cervix-haver” is also discrimination.

This is the problem though, I saw on twitter over the weekend someone say that the word 'biological' is transphobic language?

Many trans activists don't seem to believe that 'biological reality' is a thing at all.

I am guessing maybe their ultimate goal would be for every citizen to be invited to every screening, and you just go to those that are relevant for you?

@LittleMysSister

I just don't understand how this even gets into the media.

Surely if you're a trans man but have retained your cervix, you could comprehend why there is confusion around this kind of thing if you are listed as male on your medical records? It's not outrageous that something like this would happen to you.

To me, this is something you would be aware of as a trans person and would need to keep on top of. Either that, or leave your medical record registered as your birth sex.

That would be a good explanation for getting screened but he had been screened and referred for follow up as abnormal cells. If he had abnormal cells on cervix then what does it matter what he is recorded as?

Mind you I shouldn't be surprised as when a doctor was taking my medical history I mentioned a condition my paternal grandmother had that could be relevant. Doctor stared at me and explained that grandmothers were female so couldn't be paternal. I told them that I had two grandmothers, my mother's mother who was my maternal grandmother and my father's mother who was my paternal grandmother. My notes were snapped shut and doctor left without speaking to me. Makes you wonder what they learn at medical school.

"It had to go through multiple managers to accept and understand it," he said

Anyone else struggling with this one? I know some people like to pretend that we all have no idea that trans people are trans, but we all know that't not true. This individual, turning up to a cervical screening appointment, is extremely unlikely to look so male that multiple medical professionals are unable to work out why they might be there.

That would be a good explanation for getting screened but he had been screened and referred for follow up as abnormal cells. If he had abnormal cells on cervix then what does it matter what he is recorded as?

Good point, I guess there is more room for assuming it's a mistake along the way if a patient is recorded as male though?

In medical scenarios it surely makes sense to use sex at birth on records as that is all that's relevant to whatever screenings people need to be offered and presumably is also highly relevant to whatever treatment people are receiving in relation to their transition.

@ManifestDestinee

"It had to go through multiple managers to accept and understand it," he said

Anyone else struggling with this one? I know some people like to pretend that we all have no idea that trans people are trans, but we all know that't not true. This individual, turning up to a cervical screening appointment, is extremely unlikely to look so male that multiple medical professionals are unable to work out why they might be there.

I don't know about this one. Transmen on testosterone will have facial hair which they are very likely to grow into a beard/moustache and they may have rather a pumped up physique. Some may have a receding hairline and a big 'beer' belly as testosterone has induced pattern 'male' baldness and changed where fat is stored on the body. Not all men are tall. Their voices will be deeper than women's voices typically are.

This superficial confusion can have devastating effects. metro.co.uk/2019/05/20/pregnant-transgender-mans-baby-died-because-nurse-didnt-realize-he-was-in-labor-9613972/ In this very sad case from the US, a 32yo transman went to the emergency room with severe stomach pains. The medical notes said male so when the transman tried to explain about having a positive test on a pregnancy test the triage nurse doesn't seem to have grasped the full implications. Hours went by before anybody put two and two together and tragically by the time medical staff realised the patient was in labour it was too late to save the baby, who was stillborn. Had the patient arrived with the same symptoms but with 'F' on the notes, triage would probably have identified an urgent need for ultrasound at the point of admission and the outcome might have been different.

I am guessing maybe their ultimate goal would be for every citizen to be invited to every screening, and you just go to those that are relevant for you?

I am sure some of them think exactly that.

Yet in a brave new world where sex isn't (ahem) "assigned at birth" and people are just people, how would one know what is relevant? In place of "sex assignment" would everybody for a periodic "body analysis" to see what they've got?

"Hmmmm ok, looks like there's a cervix in there, that's an ovary, that's a uterus...amazing how often we find those three together...nope to penis, nope to Adam's apple, do you know I've never seen an Adam's apple and a uterus in the same person...weird huh? OK, so your upper body strength is in the lower quartile, I suggest if you decide to play rugby you join the low-strength league but it's up to you obviously, we do see a lot of top quartile athletes in the lower leagues now, well I guess who can blame them eh? Haha....."

"Can you come back same time next week for the results of the hormone assessment? Oh your partner has their hobby that night and isn't prepared to change it? I hope you don't mind me being a bit nosy but does they happen to have a penis? It's just I've noticed it's more common for people with uteruses to fit around people with penises than the other way round. Might be an interesting topic for a sociologist to research, except of course how would they know who has what? Maybe someone could run a small survey or something."

"Oh, your partner gets to set the dates because they has a more important job? I can see the sense in that. Although a weird thing is, I hear that about penis people a lot as well....huh, I guess just another of those mysteries we'll never explain eh?"

It's one of the three fundamental flaws in gender ideology...the whole thing of "cervix-haver", "sex-is-a-spectrum-not-a-binary" etc only works so long as everyone does actually know what's physically normal for each sex underneath the rhetoric.

It's very like the teenagers who decry their parents humdrum work and money-based priorities while happily eating the food and using the housing their parents are working to pay for.

Hopefully, they will eventually inch their way through the painful path of logic and tell us that "all we need to do is record something about the physical body type, nothing to do with sex being real, nothing to do with anyone's gender, just a practical note...ha, take that GC people!"

And we will chuckle behind our hand and say "Oh gosh, well you do seem to have solved that GC objection to gender, that is us told! I guess we will just have to live with a world where people's personality is not related to their body type."

This superficial confusion can have devastating effects. metro.co.uk/2019/05/20/pregnant-transgender-mans-baby-died-because-nurse-didnt-realize-he-was-in-labor-9613972/ In this very sad case from the US, a 32yo transman went to the emergency room with severe stomach pains. The medical notes said male so when the transman tried to explain about having a positive test on a pregnancy test the triage nurse doesn't seem to have grasped the full implications. Hours went by before anybody put two and two together and tragically by the time medical staff realised the patient was in labour it was too late to save the baby, who was stillborn. Had the patient arrived with the same symptoms but with 'F' on the notes, triage would probably have identified an urgent need for ultrasound at the point of admission and the outcome might have been different.

I just can't understand how this happened when he told them he was trans and also that he had was pregnant!? I guess he didn't realise he was in labour himself, despite knowing he was pregnant?