Working with patients who face specific barriers

People of diverse sexualities and genders (LGBTQI+)

Find information and resources on how to engage patients of diverse sexualities and genders backgrounds in cervical screening.

Resources

For patients

You can provide these resources to patients to help them before, during and post screening. See the full resource library.

    Before screening appointment

    During screening appointment

    Post screening appointment

    For healthcare providers

    Watch our case study video on overcoming the LGBTIQ+ barriers.

    Considerations

    LGBTIQ+ people experience higher rates of discrimination and poorer health outcomes than other Australians. They may be less likely to have  regular Cervical Screening Tests than heterosexual people. This is particularly the case for people who have never had sex with men.

    Transgender men who have a cervix are also at risk of cervical cancer. They are less likely to have regular Cervical Screening Tests than the general population, and more likely to have an unsatisfactory result. They are also less likely to be offered screening by healthcare providers.

    Barriers

    There are general barriers that people face in participating in cervical screening. People who identify as lesbian, bisexual or are same-sex attracted, and people who identify as transgender and have a cervix can face extra barriers relating to:

    • misconceptions that they are not at risk of cervical cancer (i.e. belief that cervical screening is not necessary)
    • misconceptions by healthcare providers that they are not at risk of cervical cancer (i.e. incorrectly advising patients not to participate in screening).
    • misconceptions that HPV is only spread through heterosexual intercourse (i.e. incorrect belief that women who have not had sex with men are not at risk of cervical cancer).
    • discrimination and social stigma
    • fear of negative attitudes of healthcare providers
    • high levels of psychological distress, experiences of trauma and abuse
    • lack of understanding by healthcare providers about sexual and gender diversity
    • heterosexual assumptions by healthcare providers
    • difficulty finding a suitable healthcare provider (i.e. accepting, empathetic, non- judgemental)
    • previous negative experiences with healthcare providers/healthcare services
    • reluctance to disclose sexual orientation or identity
    • potential distress for transgender patients caused by the conflict between their sex assigned at birth (i.e. female) and their gender identify (i.e. male)
    • transgender men with a cervix may find speculum examinations painful.

    Ways to engage

    Strategy

    Detail

    Staff training
    • Encourage all health service staff to undertake lesbian, gay, bisexual, transgender, and intersex (LGBTIQ)-specific cultural sensitivity training.

    Appropriate communication
    • Offer self-collection as a more comfortable and acceptable screening option.
    • When discussing cervical screening with patients, the healthcare provider should employ a non-judgmental and open-minded approach (e.g. avoid the assumption that everyone is heterosexual).
    • Use terminology that encompasses all sexual orientations (e.g. asking about a patient’s partner/significant other instead of their husband), and acknowledging the patient’s same-sex partner and including them in conversations.
    • Advise lesbian, bisexual and same-sex attracted women, and transgender men who have a cervix, that they are at risk of cervical cancer and recommend that screening is appropriate for them.
    • When communicating with patients, reflect their use of language and self-identification. If in doubt, ask what terms they prefer.
    • Use gender-neutral language on intake forms and give patients ample choice when documenting next of kin, relationship status and sexual orientation.

    Avoid making assumptions
    • If a female patient identifies a female partner, do not assume she has never had a male sexual partner or been pregnant.

    Supportive environment
    • Provide a safe, supportive, sensitive and welcoming environment for the LGBTIQ+ community.
    • Make the waiting room welcoming, with posters and resources for the LGBTIQ+ community.
    • Prominently display your health service’s policy of non-discrimination and confidentiality.
    • Signal your health service’s willingness to provide quality services to all patients and your openness to disclosures about sexuality (e.g. through messages on your website).

    Choice of cervical screening collection method
    • Offer the choice of either self-collection or clinician-collection screening options.
    • Explain the pros and cons of each option, including follow-up requirements if HPV is detected on a self-collected vaginal sample.
    • Consider offering home-based self-collection (e.g. via a telehealth consultation) where appropriate.
    • If clinician-collection is chosen some of the below points may assist.
      • Some patients may prefer to insert their own speculum, and it can be helpful to offer this option.
      • Providing instructions on calming and deep breathing techniques can also help the patient to relax.
      • A prescription of vaginal oestrogen cream before the appointment can decrease pain or discomfort for post-menopausal patients.
      • Provide a mirror in case the patient wants to view their own cervix.
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