Categories
Features Healthcare Lived Experience

What difference does inclusive cancer screening make?

I let the nurse persuade me to make an appointment for a check up and went along to the trans specific clinic. I live in London so actually had a choice of two trans specific clinics to go to. I think it being a trans specific clinic made it better somehow. I didn’t have that fear of being misgendered, judged or pitied. I knew that my genitals wouldn’t faze them. There is no way I would have gone to my GP surgery for a smear.

by Charlie J

If it hadn’t been for the nurse at the sexual health clinic asking me if I’d been screened for cervical cancer recently, I’d have never made the appointment and I’d never have been any wiser. But she did, I did, and I am.

It’s not that I didn’t know that I needed to get checked every three years. I did know. I knew from having three yearly checks for years, then the 3 monthly and then 6 monthly checks after they’d caught some dodgy cell changes early. My cervix was very well attended to in terms of medical checks. Until it wasn’t.

What changed? Previously checks had been grim and made me feel a bit awful, but I’d not had the same feeling of nausea at just the thought of a nurse looking at my genitals. I’d not had the same sense of shame that I began to associate with being born with the wrong genitals and reproductive system (disclaimer: not all trans people feel this way about their body, but I do and this is my story).

Given that I started suppressing my transness as a child and had a good 20 years’ experience of it before I came out, I can only assume I’d also been suppressing the dysphoria. But that’s not what’s important here. The thing is that my disgust at certain parts of my body, the nausea I felt about someone else looking at those parts of my body, was a deterrent to me getting regular cervical cancer screenings even though I’d been treated for pre-cancerous changes in the past and knew I was at higher risk than most.

So, I let the nurse persuade me to make an appointment for a check up and went along to the trans specific clinic. I live in London so actually had a choice of two trans specific clinics to go to. I think it being a trans specific clinic made it better somehow. I didn’t have that fear of being misgendered, judged or pitied. I knew that my genitals – those that have changed due to testosterone and the newly created penis – wouldn’t faze them. There is no way I would have gone to my GP surgery for a smear. My regular nurse at the surgery means well, she would have been professional. But she would most definitely have been fazed and would probably have suggested I go to a specialist clinic.

With that grim job done, I took myself off to the cinema and didn’t think about it until a few weeks later. I got a call from the receptionist from my GP surgery, something about “a bit of a mystery”. There was a letter from a cancer screening service with some results of a cervical smear on, but it hadn’t come through the usual channels. “Perhaps because you’ve got an M on your medical records” she suggested. She told me she couldn’t tell me what was on it, but I ought to call the clinic and talk to them. Funnily enough, the doctor from the clinic called me before I got chance to call her. She told me the bad news – pre-cancerous changes and an appointment needed at the hospital. But she also told me what to expect and how to contact her if I had any questions at all.

One of the worst things about this whole situation is that if it wasn’t for Covid-19 I wouldn’t even have a cervix by now. It would have been whipped out along with the other gubbins as part of stage 2 of phalloplasty. But there we are. Stuck on a waiting list, like countless others. And then for two weeks, waiting anxiously to be sent word of an appointment in a clinic that is designed for women, for an examination that I knew was going to trigger my dysphoria even further.

The invitation to my appointment arrived relatively quickly, along with it a leaflet “For women attending the colposcopy clinic”. I was tempted to get in touch to tell them they’d sent me the wrong leaflet, but didn’t because I was afraid it would impact my treatment. So it was with low expectations that I went to the appointment. Thankfully, with a supportive friend. I’d been to such an appointment many moons ago, so knew it would be grim regardless of my dysphoria. But there were so many unknowns. What if I got misgendered? What if I didn’t get misgendered, but got told I was in the wrong place and then had to explain myself to a stranger? What if the doctor or nurse treated me like some unusual specimen? And so on.

And then. It was fine. The appointment that is (the state of my cervix is a different matter, results tbc). Or at least, the colposcopy and associated biopsies weren’t much more grim than I remembered them being last time. Yes it triggered my dysphoria a bit, but it wasn’t hideous. And the reason why? Because this particular clinic has long been associated with a trans specific service, the doctor and nurse had both treated plenty of trans men and non-binary people. And they told me that, but not in a way that felt weird or uncomfortable. They knew what the challenges might be for me, knew that they might need to go slower with the process, to check in with me a bit more. Self-conscious about my “in-between surgeries” genitals, I made a comment about it and without skipping a beat the doctor asked me whether it was still the same surgical team offering phalloplasty. I wasn’t made to feel out of the ordinary or a specimen and that was a huge relief.

So there we are. An example of what trans inclusive treatment can look like, and I am thankful for that. But I shouldn’t need to be thankful for it. I shouldn’t be thankful to live in London so I have easy access to trans specific services and hospitals where those services have clearly delivered training. Trans inclusive healthcare should not be a postcode lottery. It should be a right.