Got a cervix? Get a Pap

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Campaign encourages lesbian, bisexual & trans people to get tested

By Jane Shulman

When was your last Pap test? According to Statistics Canada, if you are like 77 percent of heterosexual women in this country, you have had one in the past three years. But if you identify as lesbian, bisexual or you are a transgendered man, you are less likely to have had one recently.
Pap tests, which are routinely performed by family doctors, nurses and gynecologists, check the cervix for abnormal cells. The Pap test can find cell changes (caused by HPV) on your cervix. That way, cell changes can be treated before they turn into cancer. That’s why the test is common practice.
Why then, do fewer queer people have Pap tests than heterosexuals? This is a question the people at Toronto’s Sherbourne Health Centre and Planned Parenthood Toronto wanted to address after they conducted research among women who have sex with other women.
They investigated women’s needs around reproductive health, and found that an alarming number of women weren’t having Pap tests either because they didn’t know they needed them, or their health care providers told them they weren’t necessary.
A working group called the Queer Women’s Health Initiative was formed in response, and the idea for the Check It Out campaign was born. The working group soon realized that the campaign needed to include trans men, who are even less likely to have access to Pap tests but may need them just the same.           
A separate project called Check It Out Guys is running concurrently. Campaign headquarters are the websites www.check-it-out.ca and www.checkitoutguys.ca. Accessible, concise information, flashy design and eye-catching slogans like “Got a cervix? Get a Pap!” guide the reader through questions or concerns about Pap tests. Content developed with Sherbourne’s medical staff and queer and trans community members answers everything from how often to have one, to what actually happens during the procedure. Free posters, postcards and temporary tattoos are available through the websites, as well as a mass of printable information. Cheryl Dobinson, Director of Community Programming at Planned Parenthood Toronto, says she has heard too often from lesbian and bisexual women who received misinformation about Pap tests from doctors and nurses.
“Sometimes women are told that if they’re having sex with women, they don’t need Paps,” she says, “and others who know they need it are denied the test when they have asked for it.”
Dobinson says this may be a result of some health workers not knowing enough about how HPV is spread. The Check It Out site notes that HPV “is transmitted through genital skin-to-skin contact with anyone who has the virus — this includes oral sex, sex with fingers or hands, genital rubbing and vaginal sex with toys.”
“We’re targeting queer women mainly,” says Dobinson,” but there’s a piece for providers too.”
Ayden Sheim, coordinator of the trans men Pap project, agrees. He says that while trans men are the focus of Check It Out Guys, there needs to be an educational component for providers, partly to help clients trust that sensitive, informed providers are out there. “If I get to a point where I’m ready to get a Pap, that assumes that I have a provider I feel safe with,” he said. “The two pieces go hand in hand.” Pamphlets and information packages about the specific needs of queer and trans clients seeking Pap tests will soon be distributed to clinics in Ontario.
A Pap test for trans men isn’t always an easy sell, but Scheim estimates that the majority of trans men have not had a hysterectomy that would include cervix removal, so they need to have regular Pap tests. Even people who have had a hysterectomy may need a test. Working with an advisory board of trans men, the goal was to develop content for a diverse audience.
“Part of the campaign is being really honest and saying this isn’t going to be a fun experience,” he says, “but there are things we can do to make it less challenging.” Sections on the site address the emasculating feelings that a trans man may experience during a pelvic exam, or the pain of speculum insertion if a person hasn’t experienced penetration before.
“Our ability to take care of ourselves and advocate for ourselves is more advanced than the health care system is to meet our needs,” Scheim says. He stresses that people have the right to interview health care providers about their experience with specific populations. “We know the system isn’t perfect for people, but in the meantime, we should be able to take care of our own health as much as possible.”
The sites have a peer-to-peer feel about them. The people in the photos are members of Toronto’s queer communities. They are people who readers may know, or at least know of. Dobinson says this lends credibility to the sites, and to the information they provide. It’s part of the community-building piece that she says is so important to the success of a health promotion campaign.
“Sometimes non-queer health campaigns can really exclude queer women. People think that the campaigns don’t apply to them,” she observes. “Some are better at being inclusive, but there is still a place for queer women to get information that’s specific to us. We’re going to reach more queer women with information that’s directed to us.”
Official project evaluations will begin soon, but anecdotal evidence from clinics that see high volumes of queer and trans people indicate that more people are having Pap tests since the campaign’s launch.

Dobinson is a longtime queer-health advocate. She has worked on breast health campaigns and campaigns for lesbians and bisexual women, and is one of the only people in the country to have been working consistently on health promotion projects for queer women over the past several years.

She is familiar with the homophobia and heterosexism that lesbian and bisexual women may encounter from the medical system, and has heard about plenty of negative interactions with the health professionals. But she has seen positive change for queer women in recent years, too.

“As more health care providers get educated about queer women’s health and as there are more resources to use,” says Dobinson, “it dovetails with more resources to share with queer women, who are then more likely to go and get positive response.

“If those two things are happening, then I would imagine that people are more likely to go back and feel like they are going to be well cared for.”

At Planned Parenthood Toronto, where she has worked since August, Dobinson says she is “so excited to be at an organization that is making queer women and our sexual and reproductive health such a priority.”

What is a Pap test?

Information from the Check it Out website, Courtesy of Queer Women’s Health Initiative

Pap tests. No one ever looks forward to them. Many of us are not even sure what exactly they are for or if or why we need them. Below is some information on what a Pap test is all about and why you should consider getting one.

  • Your cervix is the narrow end of the uterus which has a small opening (called the os) that connects the uterus with the vagina.
  • A Pap test is a microscopic examination of cells taken from the cervix in a doctor's office or health clinic. The Pap test is usually included as a part of an overall pelvic exam, which is a complete examination of the pelvic organs (uterus, ovaries, cervix, etc.).
  • The Pap test is a screening tool for cervical cancer, which is preventable through Pap tests and treatment, where necessary.
  • The Pap test does not screen for any other forms of cancer.
  • The Pap test is not a screening test for sexually transmitted infections (STIs). While the Pap test may show that cells of the cervix have been affected by human papillomavirus (HPV), the STI that can cause the cells of the cervix to become abnormal, the Pap test does not actually test specifically for HPV or any other STIs.

Jane Shulman is the Director of Knowledge Exchange at the Canadian Women’s Health Network