LGBTQIA+ Cervical Cancer

March 29, 2023

SWEDISH LGBTQIA HEALTH TEAM

[7 MIN READ]

Anyone with a cervix can get cervical cancer.
Regular screenings that include both Pap and HPV tests effectively detect cervical cancer in its earliest stages when treatment is most likely to have a positive outcome.
Swedish is committed to providing safe, compassionate, high-quality care to everyone, regardless of gender identity, gender expression or sexual orientation.

Let’s be honest. Even when we know it’s time to schedule a Pap test, most of us put it off as long as possible. And yet, when combined with human papillomavirus (HPV) testing, Pap tests are one of the most effective screening tools for cervical cancer. So why do so many people – especially members of the LGBTQIA+ community – regularly skip their regular pelvic exam?

We spoke with Vinny Fox (they/he), senior program coordinator for LGBTQIA+ education and team lead of the LGBTQI+ Program at Swedish, about the challenges LGBTQIA+ persons often face getting recommended health screenings. Here’s what they shared.

“Cervical cancer has traditionally been seen as a health issue for cisgender women. But that’s not an accurate depiction,” says Vinny. “Anyone with a cervix can get cervical cancer.”

Cervical cancer is the growth of abnormal tissue that starts in the cervix. Its leading cause is HPV, which can be passed from one person to another during intimate or sexual contact.

The American Cancer Society estimates more than 4,300 people will die from cervical cancer this year and almost 14,000 new cases will be diagnosed. Experts agree the best way to reduce those numbers is regular screening and getting the HPV vaccine. But for many LGBTQIA+ patients, a visit to the doctor’s office leads to so much physical, mental and emotional distress they avoid making an appointment at all costs despite any added cancer risk delay may cause.

Screening saves lives

Screening for cervical cancer includes a Pap test and an HPV test. Both require a pelvic examination using an instrument called a speculum to complete the screening. Screening is beneficial because it can detect HPV and changes to your cervical cells before cancer develops beyond its earliest stages. When cancer is detected and treated early, it increases the possibility of a positive outcome.

Pap test

During a Pap test, your physician uses a speculum and a small brush to collect a sample of cells from your cervix. The cells are then sent to a lab where they are inspected for abnormalities that indicate further testing is needed to rule out cancer. The test may cause some discomfort – similar to menstrual cramps – but it should not be overly painful.

Communicate openly and honestly with your provider about any concerns you have throughout your visit. It will help them know how to adjust their approach and improve their ability to provide the care and support you need.

Human papillomavirus (HPV) test

The procedure for an HPV test is similar to a Pap test. If you do both screenings at the same time, it's called co-testing. HPV screening detects the type of HPV that can lead to cervical cancer. Although you may feel some discomfort during the procedure, there are no known risks.

Recommended screening schedule

In most cases, Swedish follows the current guidelines from the United States Preventive Services Task Force (USPSTF). However, everyone is different and the timing could change depending on your unique health needs. Talk to your care provider to determine the screening schedule that’s best for you.

In general:

If you are younger than 21 years old, routine screening is not recommended.
If you are between the ages of 21 – 29, you should have a Pap test every three years.
If you are between the ages of 30 – 65, you should have a Pap test every five years and an HPV co-test every five years.
If you are over 65, screening may not be needed if you’ve had normal test results for the past 10 years. Talk to your physician to determine what’s best for you.

Barriers to care

Why do so many members of the LGBTQIA+ community avoid their screenings? Reasons vary widely from person to person, according to Vinny.

“For things like cervical cancer screening, our lesbian population, our trans men and non-binary populations have extremely low participation rates because of the trauma of going into a doctor’s office to get that kind of screening. From a transgender perspective, you are not a woman, but you do have female reproductive organs. You're going to go to the doctor and the entire time you’re there, you're continually hearing ‘women’s exam’ or ‘women’s health’,” Vinny explains. “It’s a lot of women-centered language – especially if you go to an OB/GYN office, which can be a very alienating experience for transgender men and non-binary people.”

Provider training seldom includes information on providing affirming, supportive care that’s sensitive to the needs of the LGBTQIA+ community. This lack of knowledge in caregivers contributes to the problem, according to Vinny.

“There isn’t knowledge about how to approach that kind of screening in a way that is comforting and non-triggering. It makes the entire experience so traumatic that the risk of getting cancer is less scary than having to go and have a pelvic examination,” says Vinny.

“Add on to that a lot of transgender and non-binary people have issues with dysphoria, especially around their body. So, you’re not only in an uncovered position – and anybody who’s ever had a Pap smear knows that is not a comfortable place to be – then add on to that a layer of dysphoria of having to have that part of your body that you are not necessarily comfortable with be thoroughly examined. You are in a very vulnerable position,” they explain.

According to the American Association for Cancer Research, other issues include:

Fear of mistreatment or discrimination
Lack of insurance or denial of coverage
Anti-LGBTQIA+ bias
Lack of legal protections
Negative past experiences

Compassionate, comprehensive care for everyone

“At Swedish, we believe everyone deserves high quality, compassionate care, regardless of gender identity, sexual orientation or gender expression,” says Vinny.

Some of the ways we deliver on that belief is through these programs at Swedish:

The LGBTQI+ Program offers training for providers to help them better understand the historical context, terminology and language specific to transgender and gender diverse patient care. More than 60 clinicians have completed non-clinical transgender health training and are listed as gender-affirming clinicians.

Health Care Navigation Services provide access to gender affirming services, treatments and providers. It helps patients receive the care they need and identify available resources to improve their quality of life.

The Patient and Family Advisory Council was created to improve communication between patients, their families and their care providers. Monthly meetings offer the opportunity to discuss patient needs and explore solutions to improve access to care.

There’s always a stop button

A vital component of improving screening rates in the LGBTQIA+ community is an atmosphere of inclusivity, says Vinny. “We strive to create a safe space that makes everyone under our care feel respected and welcome. And we welcome input that helps us make that happen. The patient has every right at any time to say, ‘No, I do not feel comfortable.’ They can ask to have an advocate in the room. They can bring someone with them. They can always ask for the clinic manager if they feel like they have been mistreated, misgendered or harassed,” explains Vinny.

“If at any time you are uncomfortable, you can say ‘Stop.’ You can ask for an advocate, you can ask for a chaperone. We can step out of the room for a minute if you need something. If I say something that – intentionally or unintentionally – makes you uncomfortable, you can tell me,” says Vinny. “Patients need to know that they have that right to speak up. If they’re uncomfortable, there’s always a stop button.”

Learn more and find a provider

Regardless of gender identity, gender expression or sexual orientation, Swedish is committed to making sure every patient gets the care they need. Learn more about LGBTQIA+ care at Swedish.

Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction, and follow up as needed. If you need to find a provider, you can use our provider directory.

Join our Patient and Family Advisory Council.