As mentioned in my previous article,eople with internal and/external reproductive organs that are associated with the female sex but do not identify as a cisgender female have been found to receive suboptimal health care compared to their cisgender counterparts. I am committed to highlighting this topic to further the education and awareness within the healthcare community.
These disparities have been attributed to misconceptions about the care these patients need and mistrust that these patients have developed in the healthcare system. I, unfortunately, have had many interactions with patients who have told me stories that have supported this research and it has made me sad because I believe that we all are entitled to live our best and healthiest lives. Specifically, when it comes to the organs that I treat as an OB/GYN, I believe that it is important anyone who has these organs have all of their needs and concerns treated! If I see someone who has organs that I don’t specialize in, it’s also equally important to me to support them in finding trustworthy care.
One topic of concern that is near and dear to me is pap testing. The pap smear is just a part of the pelvic exam that occurs during a well woman visit. The pap smear is used to screen for cervical cancer. Cervical cancer is often linked with HPV (human papillomavirus), which is sexually transmitted. It has been taught (I remember being taught this in medical school and residency) that the sexual transmission of HPV involved penetrative (sometimes thought of as heterosexual) sex, but that is not true.
HPV can be transmitted through other sexual acts and so people who have vaginas and cervixes can spread HPV, and therefore cervical cancer risk, to other people who have those same organs. In my experience, I have met many people who have identified as lesbian or bisexual who have not had a pap smear or have not had them in regular intervals because they were told that they did not need them because they were not having penetrative sex.
Unfortunately, this is not just an anecdotal finding, but has also been found in research on the topic. By not getting this screening, these patients are at higher risk of going undetected with precancerous cells on their cervixes.
There is also another issue when it comes to screening some of these patients for cervical cancer and other conditions that require a pelvic exam. If these patients are not having penetrative sex or have never had it before, there is concern about causing discomfort or pain during the exam. I am always focused on making my patients feel as comfortable as possible during the exam.
That is why, it’s important for there to be an open dialogue about everything that is going to happen during the visit. Also, I personally ask about the concerns a patient might have before the exam. There should be no fear about expressing the concerns you have about what is happening when it comes to an exam. This is your appointment. This is your body. Also, if you have had a bad experience with a pelvic exam before and you are scared about having it done again, discuss that with your doc.
Ask your doctor if there are ways that the exam could be less uncomfortable. We will always try our best to accommodate you. And one of my favorite things to tell my patients is, you can always tap out at any point of the exam. If things are too uncomfortable or painful, let your doc know that you don’t want to continue. You didn’t waste anyone’s time and you should not feel embarrassed. Your comfort is our first priority.
Another topic that is near and dear to me is family planning in this community. I have often been the first medical provider that has asked a person who is not cisgender and/or heterosexual about their plans for starting a family. Usually this question is met with a sigh of relief and a “thank you.” Unfortunately, many people resort to trying to figure things out on their own, online. Part of my job is to help figure the whole pregnancy thing out with my patients.
These days, we have many different ways that we can make that happen. It is important that we all have that conversation (if your doctor doesn’t initiate it, then you can), in order to help you start a family, if that is what you desire. My professional society, The American College of Obstetricians and Gynecologists, agrees with me on this one too!
It seems that we are all trying to become better in the way we take care of each other in our country. That should extend to all people – and that should extend to medicine.