As Cervical Cancer Prevention Week comes to an end, Sam Hope reflects on how the campaigning often neglects groups who may be particularly at risk
Content note for discussion of sexual trauma
Cervical Cancer Prevention week is important and necessary, but as a trans person I found myself becoming increasingly distressed and anxious at the messages on my timeline. The ubiquitous use of terms like “women’s health” and “ladygarden” hammered their way into my head, reminding me of how very paradoxical is the co-existence of my slight beard, my flat chest, my cervix, and the “Mr” on my bank account.
I kept hearing that the reason some of us don’t get smear tests is because we’re worried about what our front bottom looks or smells like. Oh, if only that were the real worry! And the solution? Wear a skirt and you will feel much more comfortable. Sure, yeah, that would really help me feel much better. Butch lesbians and transmasc folks breathe a collective sigh at advice like this.
I keep telling myself nobody means any harm by this. These are innocent blunders in a world that has a long way to go on some minority issues. I remind myself most of the people who need smears are heterosexual women. Trans people with a cervix are a pretty small minority. Maybe we don’t really matter?
Sometimes it seems the very existence of trans people is inconvenient to feminism and the needs of cis women. But that’s when the pain really kicks in, because transphobic feminism keeps telling me (cis) women cannot afford to acknowledge my existence, and in the end I need to exist and be healthy. Just like everyone else!
I swallowed and swallowed but my feelings would not stay down, and despite my undying gratitude to that one woman friend who talked in her post about “people with a cervix”, too many posts just rolled out the cissexist and heterosexist tropes, and I realised this was having a major psychological impact on me, and not in a good way.
And that was when I realised I had been silencing myself all week, and that the only thing to do was write about it, in the hopes of a little bit of compassion and understanding from those who I know meant no harm but may have perpetuated some unhelpful stuff anyway.
Sometimes it seems, our very existence is inconvenient to feminism and the needs of cis women
So let’s talk about the real reasons people don’t go for smear tests, and why the conversation we have around this really matters. Meanwhile, see Lee Hurley’s piece on the same subject and for an example of some generic advice that’s useful and not cissexist, check out this tweet from MacMillan Cancer info on Twitter.
Because I’m sure I’m not the only cervix owner who, for many of the reasons listed below, is avoiding going for a smear and was anything but encouraged by last week’s campaigning.
If you’re read as lesbian, as I was for much of my life, healthcare professionals might decide you don’t need a smear. Many lesbians and bisexual women have been told they don’t need smear tests due to the assumption that women who aren’t sexually active with men are in a lower risk category. This simply is not true. Presumably, this myth also extends to trans folks who are assumed to only be sexually active with women.
There are many false assumptions around this. The main being that a person’s primary relationship tells you anything about how many male partners they have or have not been with, and that the gender of their primary or other partners tells you anything about the manner of sex, the associated risks, or indeed what actual genitals are involved. Another being that cis women cannot transmit HPV, the virus that causes cervical cancer, to one another. In actual fact, they very much can.
Even if you do get notifications about a smear test, fear of discrimination can keep you from going. For me, the worry was always that I didn’t want a cis guy doing the procedure, but at the same time I feared a woman being uncomfortable with me if she read me as either a lesbian or a trans guy. Homophobia and transphobia can make some healthcare workers insensitive, uncomfortable, and even not too careful. My advice on this would be to make sure you get the test from a clinic where you feel safe with a worker you have met, rather than avoiding them entirely.
There are many reasons why someone who has been raped or sexually abused would feel uncomfortable about getting a smear test. Sadly, the reassuring posts floating around my timeline this last week really did not address this. In fact, they made an issue of what many of us would see as very trivial things. As one friend said “I really hadn’t thought about worrying what my vulva looks like, but I will now”.
A trauma -informed approach to helping someone through getting a smear is rarely spoken about or advertised. Trauma from rape or sexual abuse can be severe enough to be considered a disabling condition. People not getting smear tests because of trauma is a disability access issue, pure and simple, and more needs to be done to ensure access.
Homophobia and transphobia can make healthcare workers insensitive, uncomfortable, and even not too careful
But what has this to do with trans people or cissexism? Simple: trans men are more at risk of sexual abuse than cis women (1 in 2 as opposed to 1 in 4). Similar to other marginalised minority groups like autistic people, trans people, whether assigned male or female at birth, are in a higher risk category for childhood sexual abuse, according to multiple studies. This is understood to be because perpetrators find it easier to groom children who are socially marginalised, as children who struggle to conform to social norms often are. They are also at risk of sexual assault as adults, including corrective rape.
So, afab trans people are more likely to need that trauma-informed approach to cervical cancer prevention. Alongside a higher risk of trauma and the additional impact of minority stress trans people are considered at higher risk of cancer due to increased smoking and other stress-related lifestyle factors.
Many trans people and some people who don’t necessarily describe themselves as trans experience gender dysphoria. Gender dysphoria comes in (at least) two flavours – one is discomfort with certain body parts themselves – as if the brain is wired up for a different configuration of body that the one you got. In a non-sexist or cissexist utopia, many trans people would still need to change their bodies’ configurations.
But the second kind of dysphoria is a more insidious kind, and it’s the result of the gendering of body parts. And it’s every bit as powerful.
If you think of gender as all the social apparatus we build up around biological sex, then at some point the penny drops – we place a huge amount of social importance on the shape of people’s genitals, and think that these should dictate a person’s social identity. We even have a linguistic code (pronouns) to socially acknowledge what shape we think someone’s bits are. And we have all sorts of gender coding that has nothing to do with biology – pronouns are not biological facts, the term “ladygarden” is not a technical term, and the colour pink smeared all over the Cervical Cancer Prevention Week’s advertising is nothing more than a gender convention.
Biological sex has been so gendered for so long people just cannot see where biology ends and social convention begins. So they believe all the gendering of issues like cervical cancer is totally justified, and trans people are making a fuss about nothing.
Worse, they render AFAB (assigned female at birth) trans people completely invisible, and attribute any concern or dissent about this issue to trans women. Transphobes concoct ridiculous stories about trans women demanding smear tests for the sake of political correctness, and the story goes viral, while the actual issue stays hidden. This harms all trans people, but in different ways.
In reality, when you change your gender marker on the NHS system if you’re AFAB you stop getting the smear test notifications you may still need, and if you’re AMAB you start getting them. Trans women aren’t demanding anything, they are just being badly served by a simplistic computer system that genders what tests people need. A simple check box system – needs smear (some AFAB trans peeps), needs mammogram (trans women and some AFAB trans peeps), needs prostate checking (yep, trans women stop getting notification for these even though they still need them), etc. Check out this useful trans people’s NHS guide for screening programmes for good information about navigating this issue.
When people shout about the cissexism of people talking about cervical cancer as a “woman’s issue” this isn’t about trans women primarily. Although some careless language does exclude trans women from the term “woman”, trans women are not the only women who do not have a cervix. Meanwhile trans guys exist, non-binary trans people exist, and many of us do have a cervix.
When we see and hear people repeatedly allocating social gender to our body parts, it has a profound psychological effect. It perpetuates the idea that we are trapped in the apparatus of gender by our bodies. It also increases our discomfort with parts of our body we may not want to surgically remove. The essence of cissexism is the idea that the configuration of our private parts says something fundamental about who we should be in society, and how we should be addressed and grouped.
Transphobes concoct ridiculous stories about trans women demanding smear tests for the sake of political correctness, and the story goes viral, while the actual issue stays hidden
Most of all, it makes us about as likely to go for a smear test as swim in shark infested waters. Cissexism is putting our lives at risk.
As with pretty much everything else in this world, an intersectional approach that is more understanding of and empathic toward diversity will reach those marginalised people who are most put off by the generalised information that is currently going around.
It isn’t enough to say “women” are not going for their smear tests. Which people are not going exactly? Disabled people, used to having so few of their access needs met and many of them stigmatised? Black people, put off by the tiresome trope that all pussies are pink, or by everyday racism? Lesbians? Trans guys and non-binary people?
Maybe we don’t need to be constantly pushed aside by generalised campaigning that always centres cishet able white women. Maybe a more diverse message would reach the people most at risk.
Follow Sam on Twitter (@Sam_R_Hope)