Health screenings are an essential part of maintaining your health as an LBT+ woman or non-binary person, and yet, our community is far less likely to be recommended for screenings, or receive them, than cis and/or heterosexual women. Lesbian and bi women are ten times less likely to have had a cervical screening in the past three years than heterosexual women. One study from LGBT Foundation even found that 51% of lesbian and bi women of an eligible age had either never had a test, or hadn’t had one within the recommended timescales

So what health screenings are there? And when and where should you be getting them?

COVID NOTE - during the coronavirus crisis there has been some interruption to health screenings, but it’s vital that LBT+ women and non-binary folk continue to attend tests and screenings where they are available. If you have any questions or concerns about COVID safety, then you can contact your clinic, hospital, or practitioner and ask what precautions are being taken to prevent the spread. 

Pap test

The pap test, also known as cervical screening or smear test, is a medical checkup where cells are extracted from your cervix (the opening from your womb to your vagina) and tested for abnormalities. 

It’s a misconception that the pap test is a cancer screening, it actually exists to prevent cancer. Extracted cells are tested for the presence of certain strains of a virus called human papillomavirus (HPV). If these are found, then the cells are checked for abnormalities that could potentially become cancerous.

If abnormal cells are found then they are removed in another procedure, preventing them from becoming cervical cancer. 

99.7% of all cervical cancers are caused by HPV. If you want to learn more about HPV, then check out our fact sheet.

Who needs pap tests?

In short, anyone with a cervix! This means lesbians, bi women, non-binary folks and some trans men. Trans men who have had a total hysterectomy to remove the womb and cervix don’t need a pap test, but those who haven’t yet had this part of gender affirmation surgery still require testing.

Myths about pap tests for LBT+ women and NB folk 

Women who have sex with women don’t need pap tests - This is completely untrue. Worryingly, there are many cases of women who have sex with women being told by medical professionals they don’t need a pap test, but lesbians, bi women, and nonbinary folk can still catch HPV and still develop abnormal cells. Once again, if you have a cervix, you need a pap test.

Trans men don’t need pap tests - Also completely untrue. Trans men with a cervix need pap tests.

An abnormal cell result means you have cancer - Nope! If your result comes back for abnormal cells, this means that they may potentially develop into cancer, but the test is looking for pre-cancerous cells. 

The test is embarrassing - Yes it can be a little embarrassing to get undressed and let someone you don’t know take a look at your vagina and cervix, but it’s important to remember that these are trained medical professionals who see hundreds, or probably thousands of vaginas every year. The test itself should be conducted professionally and with dignity.

You don’t need the test if you’ve had the HPV vaccine - While the HPV vaccine does provide a good degree of protection against the potential development of cervical cancer, it’s important to continue to go for your pap tests regardless, as the protection is not 100%.

How often should I get a pap test?

People with a cervix aged 25 - 49 will be invited for a pap test every three years. Those aged 50 - 64 every five years and those over 65 will only be invited if one of their last three tests was abnormal.

People under 25 aren’t invited for screenings because cervical cancer is very rare in young people, and abnormalities in the cervical cells in this age group often correct with no intervention.

What happens in a pap test?

Pap tests are very quick (5-10 minutes), and shouldn’t be painful. They are usually conducted by a doctor or nurse who identifies as a woman, but you can ask for someone who identifies as a man to perform the exam if this makes you more comfortable.

  • You’ll be asked to undress from the waist down behind a screen and be provided with a sheet
  • Next, you’ll be asked to lie down on a bed, with knees bent and apart, feet together.
  • The doctor will then insert a smooth, tube-shaped tool called a speculum into your vagina. They might use some lubricant for your comfort.
  • The speculum is then “opened” so that the nurse or doctor can see your cervix
  • A small sample of cells is then collected from your cervix with a soft brush.
  • After the speculum is removed you can then stand up and get dressed.

Note: you may experience some bleeding afterwards so try not to wear light coloured materials and if you wish, bring a sanitary pad or panty liner with you.

This video from the NHS outlines what will happen during your appointment:

IMPORTANT NOTE - If you don’t regularly have penetrative sex, you might find a smaller speculum more comfortable. If you’re in pain, ask your nurse or doctor if they can use the smaller size.

Pap tests during Covid

Some scheduled pap tests have been delayed during lockdowns, it’s vital to attend a test if you’re still invited. Most tests that don’t go ahead are due to missed appointments or cancellations. 

There have been calls for “self-sampling” at-home kits to be distributed for people with cervixes to conduct their own tests at home, but the effectiveness of these kinds of tests hasn’t yet been concluded. 

How you should be treated

LBT+ women and non-binary folk are entitled to dignified treatment that meets their needs and respects their identity. It’s the duty of every medical professional to abide by this. 

  • You should not be asked any inappropriate questions or be treated with disrespect.
  • Your sexuality or gender identity should not be assumed by the medical practitioner (assumed heteronormativity).
  • Any lesbophobia, transphobia, or biphobia is completely unacceptable.
  • Your right to have a pap test should not be called into question: “why are you here?”

Trans people and pap tests

Trans men may prefer to have their pap tests conducted in a place that provides trans-specific care. There are many charities and organisations that offer trans-specific tests and treatment, such as 56 Dean St or CliniQ.

Breast Cancer Screening

Screening for breast cancer is a vital part of maintaining any LBT+ woman or non-binary person’s health as studies suggest that they are more likely than cis or het women to be at risk of developing breast cancer (risks of cancer in general are almost 1% higher in lesbians than straight women).

In spite of this increased risk, some studies suggest that LBT+ women and non-binary people are less likely to be screened for breast cancer.

What is a breast cancer screening?

Screenings use an X-ray process known as a mammogram to find lumps that are too small to feel. This allows cancers to be found early, and be more easily treated. 

Who should have a breast cancer screening?

Anyone with breasts should have a breast cancer screening. This means LB+ women and non-binary people, trans men who haven’t had top surgery, and also trans women who have been using hormone therapy. 

Breast Cancer screening myths for LBT+ women and non-binary people

If you’re queer, you don’t need a breast cancer screening - Completely untrue. In fact, as mentioned above, LBT+ women and non-binary folk can be at a higher risk of developing breast cancer, and therefore screenings are vital.

Lesbians are at lower risk of breast cancer - Definitely false. Lesbians are at higher risk of cancer, and the causes of cancer, such as diabetes, smoking, binge drinking, and obesity. Screenings are very important.

Trans women don’t need breast cancer screenings - It’s a common misconception, but trans women who are on long term hormonal treatment are at an increased risk of developing breast cancer. Trans women between the ages of 50-70 should be routinely invited for screenings.

It’s a painful procedure - During the mammogram the breasts are compressed by a plastic plate to flatten them, and this can be a little uncomfortable, but the discomfort is over quickly as the test is quick.

How often should I get a screening?

Screenings are offered to people who need them every three years, and usually between the ages of 50 to 70. However, if you’re at a high risk of breast cancer (for instance, you have a family history), then your tests might begin at 30 and may include an annual MRI scan.

To be invited for screenings you should be registered with a GP.

What happens at a breast cancer screening?

Screenings happen at special clinics or breast screenings units and are conducted by a specialist called a mammographer who usually identifies as a woman, but you can ask for someone who identifies as a man to perform the exam if this makes you more comfortable.

  • First, you’ll be asked some questions about whether you’ve had any breast problems and check your details.
  • You’ll then be asked to undress to the waist
  • Your breasts will then be placed on the mammogram machine and compressed slightly using a plastic plate (this helps make sure the x-ray image is clear).
  • Two x-rays will be taken of each breast. While this happens the mammographer will pop behind a screen.
  • It only takes a few minutes before you can then redress and be on your way.

How should I be treated?

Many LBT+ women and non-binary people forgo screenings for fear of having a negative experience with healthcare workers or based on previous negative experiences they’ve had in other healthcare settings. 

At a breast cancer screening:

  • You should not be asked any inappropriate questions or be treated with disrespect.
  • Your body should not be shamed or insulted in any way
  • Your sexuality or gender identity should not be assumed by the medical practitioner (assumed heteronormativity).
  • Any lesbophobia, transphobia, or biphobia is completely unacceptable.
  • Your right to have a screening should not be called into question: “why are you here?”

What Next?

Support services

Switchboard - The UK's longest running LGBTQ+ helpline, staffed by queer volunteers. Contact on 0300 330 0630, via email at [email protected] or via webchat here.

LGBT Foundation - Charity for all LGBTQ+ people based in Manchester. Offers advice, support and information via its helpline on 0345 3 30 30 30.