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."

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

@ancientgran

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?

I think there may be a spot of narrow focus going on. You are assuming that an apparent male being called in for an abnormal smear result could only happen if the male was actually female.

But it could also happen if there was a paperwork error.

My guess is the latter happens (or at least, used to happen) far more often, and in more circumstances than just cervical smears, so based on their own experience staff would rationally first assume an error rather than a trans man with a female body and a male sex marker.

In an upcoming episode of SVU - Special Snoflake.

@LittleMysSister

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?

I assume because they see quite a few mentally unwell patients in A&E and if a man told you he was pregnant you’d probably put him in the mentally unwell category rather than the woman who’s gone to extreme lengths to hide that they’re a woman but has somehow also managed to get themselves pregnant and not notice it for quite a long period category.

TheRebelle - even after he'd told them he was trans though?

I'd have thought since he told them he was trans and especially because he himself knew he was pregnant, they would have taken it seriously. I'd understand more if the patient hadn't known they were pregnant.

I guess he obviously hadn't engaged with medical care throughout the pregnancy for him to not realise himself he was in labour? For him to even go to A&E reporting 'abdominal pain' must mean he didn't realise what was happening. Which seems mad given he knew he was pregnant.

Why would he say he was trans....at that point he should have told them very loudly that he was a she, female and had a positive pregnancy test. If he said anything else, its not the fault of medical staff.

I assume because they see quite a few mentally unwell patients in A&E and if a man told you he was pregnant you’d probably put him in the mentally unwell category

I don’t know if this would have been the case at the hospital, but ‘trans man’ is sometimes misunderstood, and even then gender fluidity and non binary identities make it increasingly difficult to establish sex by simply learning somebody’s gender identity.

This highlights the bizarre mental health conundrum that many trans people have to live with, and probably should have had therapy for, rather than live a life of pretence with everyone humouring them.

Having female genitalia and pretending to be a man is ultimately a lie. To pretend otherwise only works on a surface level and doesn't change DNA, cells, tissues and systems.

@ManifestDestinee

Why would he say he was trans....at that point he should have told them very loudly that he was a she, female and had a positive pregnancy test. If he said anything else, its not the fault of medical staff.

I do think he should have been understood if he genuinely explained he was trans and definitely pregnant.

Especially since he had been on hormones etc which are medically prescribed. Medical staff are aware of this kind of treatment. They know what trans is.

I'm more wondering how clearly he actually made the point that he was trans and pregnant, and why he'd not accessed medical care himself related to his pregnancy given he'd had a positive test, which may have prevented this incident from happening.

It says he stopped his hormones due to lack of insurance - maybe lack of insurance is a greater factor in this sad loss than the fact that he's trans. Did he not seek medical care due to lack of insurance, given that he knew he was pregnant?

@merrymouse

I assume because they see quite a few mentally unwell patients in A&E and if a man told you he was pregnant you’d probably put him in the mentally unwell category

I don’t know if this would have been the case at the hospital, but ‘trans man’ is sometimes misunderstood, and even then gender fluidity and non binary identities make it increasingly difficult to establish sex by simply learning somebody’s gender identity.

I guess the fact that you can refer to yourself as 'trans' without having had any surgeries/hormones creates a huge grey area for medical professionals. That's very true.

Not just without any surgeries or hormones - you can refer to yourself as trans and present as your biological sex, so a female person can identify as a trans woman. It’s an entirely subjective concept from which it is impossible to definitively infer sex.

As on other threads TRAs repeatedly chant 'what harm does it do to use preferred pronouns?' I'm going to ask what harm does it do Jamie, if Jamie's correct sex is recorded in a medical document, on a computer, in a doctor's office in s remote location - especially if it ultimately means Jamie gets their smear invite and appropriate healthcare?

This is fuck all to do with NHS failure, this is a failure of grown adults to acknowledge the effects of their material, unchangeable reality. And I'd go so far as to say that IS a mental issue.

People have far more upsetting conditions than biological sex recorded in their medical records.

Because NHS staff are so underworked they have time to try and work out if a patient isn't the sex they claim to be, and aren't dealing with anything urgent that might distract them ...

Really, is it so hard to understand that sometimes you have to take just a little responsibility for yourself? Maybe not hide essential information from the people looking after you, and expect them to ferret it out?

@Blibbyblobby I want you to write the screenplay of that movie! The Scan a medical mystery thriller.

Many people with hidden disabilities and medical conditions that may mean ending up in A&E, possibly in no state to explain with a medical team needing key information, carry cards or wear medical alert jewelry. With electronic medical information it also makes sense to have clear flags on a file for patients where a medic needs key info on sight every time they open it. There is however the concern around being 'outed'.

This is why I really wonder how 'kind' it really is to support the idea that sex ever changes from a fixed state and that this is an essential part of supporting a person properly in their gender identity. There are times when being clear about sex really does matter.

It's just utterly absurd that everyone else in the world is supposed to ties themselves in knots so a very small group of people can live out this pretence.

And why did it become necessary anyway? What you might call "old-style" trans people appeared to manage without feeling the need to create this drama. I had a chat with a trans woman on Twitter who said she insisted on her medical history being accurately recorded because she'd sooner be "outed than dead".

Even if people don't want "conversion therapy" surely there's a role for therapy in preparing people for their new lives and how to navigate the world with some degree of honesty.

@merrymouse

People have far more upsetting conditions than biological sex recorded in their medical records.

Quite, couldn’t agree more.

When I read quotes like this:

“You know animals can be almost as interesting and diverse as people... Many species are able to change their physical sex...” (from a Huffpost article on LGBetc people at work - no it’s not from 1996) I realise why some unthinking people are confused...

Oh the Huffpost. Many species of creature are capable of incredible physical feats. For example, cheetahs can run at 80km an hour. I can't and I will never be able to do so!

Just believe in yourself! 🏃‍♀️ 🐅

The other species arguments are just ridiculous.

When a clownfish changes sex it does it spontaneously and functionally, because it’s in its dna to do that. Likewise a snail is both sexes at once because that’s it’s biology.

What that has to with pretending or faking it that you have biology you don’t have, i have no idea.

It’s like saying a bird can fly, so I can fly if I have some fake wings surgically attached and jump off a building with a parachute.

Clownfish can breathe underwater and have a typical lifespan in the wild of 6-10 years.

Very different species from humans, really.