Mum didn’t tell me what a Pap smear was until I was in my fourth year of high school.
We were in my childhood bedroom at the time, which is tucked away in the bowels of our old house. My brothers were in the kitchen cooking something garlicky, my dad was picking Grandma’s scripts up from the pharmacist, and our next-door neighbours were taking the bins out. No-one, really, could hear us at all — but still we conversed in hushed voices, as if I was learning about some shameful family secret instead of an important medical procedure.
Here, I use the term ‘learning’ loosely. I didn’t actually learn what the Pap smear tested for that night, nor what it was supposed to prevent — and the awkwardness that stunted me and Mum’s conversations tainted my Catholic school’s PDHPE classrooms in the same way. The only information I felt I concretely knew (or could ask about) was when I needed to get tested for whatever this malignant ‘thing’ was. From this reply (“having sexual relations”), I scrounged together the understanding that the risk of ‘it’ would only emerge once I started engaging in relations that fit my Mum’s definition of sex. I didn’t discount that the screening was important — I just didn’t think that it’d apply to me.
This misconception is one of many factors impeding queer people’s participation in cervical cancer screening (previously known as the Pap test), which is notably lower for lesbians, non-binary people, and transgender men than it is for cisgender women. La Trobe University’s 2019 ‘Private Lives’ survey found that 58% of eligible LGBTQ+ Australians had accessed a Cervical Screening Test within the previous two years as opposed to 68% of the eligible Australian population in 2022. Asexual respondents were the least likely to be screened (there was not enough data to garner a statistic), and the participation of transgender men in the procedure was as low as 39%. This number resembles the 37% of trans people who avoid accessing any healthcare services because they fear being discriminated against (37%).
It’s not difficult to come up with reasons why these inequities persist. The shame that has traditionally shrouded discussions of non-male bodies has continually debilitated necessary conversations about the medical procedures that affect them and insulates said procedures from important reform. Cervical cancer screening campaigns, for example, propagate this belief of the test being ‘women’s business’ by being exclusively located in female public toilets and doused in pink and purple. While this messaging does suggest to cisgender women that they are expected to get screened, it inadvertently excludes trans, lesbian, and genderqueer people that diverge from this ‘feminine’ patient prototype from the same encouragement. When compounded by the cryptic name of the screening form used up until 2017 (‘Pap smear’) and the lack of adequate sexual health education in schools and (some) homes, it’s no surprise that misconceptions like “you don’t need to get screened if you’ve only slept with women” are affecting the participation rates of queer people. The lack of these should-be-public resources also disproportionately impacts Indigenous Australians, for whom the mortality rate of cervical cancer was three times higher than non-Indigenous Australians in 2021.
The difficulty of finding a healthcare provider in Sydney that both anticipates LGBTQ+ patients and is knowledgeable about the factors affecting their participation in intimate and relatively invasive procedures exacerbates this inaccessibility for the trans community. A 2019 study of 537 trans and gender-diverse Australians found that 51 percent of transgender men had never had a cervical test suggested to them before, let alone offered adjustments to the test’s traditional application. This, when combined with the doubt that community-specific issues such as gender dysphoria will be taken seriously by providers (especially those reticent to use trans-inclusive language), greatly impacts the community’s incentivisation to participate in cervical cancer screening.
If you’re a queer person in Sydney who is eligible for a Cervical Screening Test but hesitant about the screening process itself, you can ask your doctor about self-collection! This alternative method of screening allows you to collect the cell samples yourself in a private area of the doctor’s office.
If you’d like to locate a healthcare provider that is familiar with LGBTQ+ patients but aren’t aware of any near you, ACON’s website has a list of queer-friendly GPs that will ensure you are treated with knowledgeable and appropriate care.
DID YOU KNOW?
Cervical cancer is almost exclusively caused by infection with HPV (human papillomavirus), which is a very common viral STI. High-risk strains of this virus produce abnormal cells in the cervix, which usually take fifteen to twenty years to develop into cancer if they’re left untreated. The Pap smear (which isn’t used anymore) tests for these abnormal cells, while the new Cervical Screening Test checks for infection with HPV. They both work by inserting a speculum into the vagina and using a small brush to take cells from the cervix.
If you’re over 24, have a cervix and have recently been sexually active with anyone of any gender, you should get tested. It doesn’t matter whether you’re vaccinated or not; there are lots of different HPV strains that the vaccine doesn’t protect you against.
If you’re not comfortable with the idea of a doctor administering the test, you can opt to do it yourself! Ask your doctor about self-collection. ACON also has a comprehensive list of queer-friendly doctors per suburb if you’re concerned about that.
