Sexual health and health screening

Warning this section will use sexual references and anatomical terms for the body.

Transgender and non-binary people, like everyone else should go for their screening. Anyone with a cervix, breast tissue, prostate etc should all be invited for their cancer screening still as they are still at risk. As far as I’m aware, there is a gap in the technology and when someone changes their gender they are lost in the system and not recalled for their screening. So, as healthcare professionals we should be providing all the health advice and information to enable our patients to make informed decisions about their testing. Discussions should also take place with screening services to inform them that this patient is transgender and should be on the recall system still to prevent any rejections in samples once taken.

There is a myth that transgender men can not get pregnant as they are on testosterone and menstruation is delayed or stopped. However, if a transgender man is having sexual intercourse with a cis-gender man there could be a risk of pregnancy there. It’s important that you sensitively approach this conversation with the patient to assess the risk and potential need for contraception use to prevent an unwanted pregnancy. Along side this, please be mindful that some transgender men want to get pregnant. They want that opportunity to become a parent one day. If this is the case, there are a few things people need to be informed about:

  1. Before any trans non-binary person starts hormones, this conversation should be happening. As a healthcare professional, we should be referring to fertility services to have their eggs / sperm kept for future use if they would potentially like to start a family one day. If this is done before hormone treatments, this will avoid unwanted side effects from stopping their hormones later down the line to do this.
  2. To do this, a trans / non-binary person must not be on hormone therapy such as testosterone / HRT. This is due to hormones affecting fertility on long term use of these hormones. They can have the option of attempting to do this later on once they have started hormones, however, they will need to stop taking all hormones and allow fertility to return for this to happen. This can cause huge distress to someone as a result, but also their fertility may be affected later on and they may not be able to start a family as they wished.
  3. If a transgender / non-binary person is about to undergo gender surgery, the surgeon may be able to take samples from the ovaries and sperm for them during this procedure and this should be discussed with the surgeons at the time of assessment.
  4. Give your patient all the resources and time to think about their decision so that they can make a fully informed decision – document this in their notes.

Like I said at the beginning, all people need sexual health screening if they are having any form of sexual contact. This does not have to be full penetrative sex between a penis and a vagina. This goes for all people regardless of sexuality and gender and includes all forms of sexual contact (between any gender) such as (list not limited to):

  1. Close body rubbing
  2. Anal sex / rimming
  3. Oral sex
  4. Use of sex toys / objects between partners (such as lesbian relationships) – If two people share a sex toy without cleaning between or condom change they are at risk of sexual infection

This should be managed sensitively, using gender neural wording and terms if you can without causing offence to the patient. To help manage this you could ask the person what they call their genitals, if there’s any wording they would like you to use when explaining how to take a test for example. So, I had a transgender man for sexual health screening, and I had to explain to that person how to insert their swab to take the test. However, he didn’t mind me using the anatomical terms for the areas. Within documentation, we have to use correct terminology to ensure an accurate assessment and make it clear to the reader what swabs were done where and that this persons preferred names for these areas are such and such. This then gives other health care professionals advice if they should treat this patient next time and save the whole conversation happening again. As healthcare professionals we have to use correct terminology and go by biological sex sometimes, but we can do that alongside maintaining someones dignity without making our patient feel uncomfortable. Most transgender / non-binary people would rather you included them and asked them rather than assume and get things wrong.