Motivators and Barriers to Accessing Sexual Health Care Services for Transgender/Genderqueer Individuals Assigned Female Sex at Birth

Abstract

Purpose: Individuals who were assigned female sex at birth (AFAB) but do not conform to the gender binary (i.e., transgender/genderqueer) often do not seek out necessary sexual health care, including Papanicolaou (Pap) tests, placing them at heightened risk of cervical cancer. Despite growing awareness, scant research has focused on the sexual health care experiences of this population in Midwestern and rural states. Methods: We used two approaches to develop a more detailed understanding of factors that determine sexual health care use. Seventeen transgender/genderqueer AFAB individuals completed a quantitative knowledge survey then participated in a semistructured qualitative interview to further elaborate their experiences with sexual health care services as well as the motivators and barriers related to accessing the health care system. We produced descriptive summaries of quantitative data and conducted a thematic analysis of interview transcripts. Results: The sample was mostly young adults, of whom nearly all were white and 65% self-identified as transgender men. Participants displayed good knowledge about human papillomavirus (HPV) and Pap tests; however, 41% rated themselves as “unaware” and 59% rated themselves as “aware but not well informed” about HPV. Fifty-nine percent had ever obtained a Pap test. We identified one facilitating factor (health care provider's role and relationship) and three inhibiting factors (availability of competent care; distress about seeking sexual health care; health care setting characteristics) related to obtaining Pap tests. Conclusion: As this study was conducted in the U.S. Midwest, findings extend the geographic scope of existing knowledge and may inform future risk reduction interventions and clinical practice.

Bridging Barriers to Cervical Cancer Screening in Transgender Men: A Scoping Review

“…The qualitative results demonstrated that no single participant perceived themselves as "aware and well-informed" regarding HPV and cervical cancer, but quantitative survey results suggested high levels of knowledge and awareness regarding HPV (Harb et al, 2019). For instance, 100% of the participants were aware of facts about infection-that HPV could cause cervical cancer, that condoms did not prevent infection, that infection can be asymptomatic, and that routine CCS is necessary regardless of HPV vaccination status (Harb et al, 2019). But, survey questions regarding guidelines for CCS, (i.e., age for first screening and frequency for routine testing) were often answered incorrectly (Harb, et al, 2019).…”

“…Interestingly, a mixed methods study identified contradictions in the knowledge levels of TM. The qualitative results demonstrated that no single participant perceived themselves as "aware and well-informed" regarding HPV and cervical cancer, but quantitative survey results suggested high levels of knowledge and awareness regarding HPV (Harb et al, 2019). For instance, 100% of the participants were aware of facts about infection-that HPV could cause cervical cancer, that condoms did not prevent infection, that infection can be asymptomatic, and that routine CCS is necessary regardless of HPV vaccination status (Harb et al, 2019).…”

“…Eight studies explored the perceptions, knowledge, and/ or health behaviors of TM in the context of cervical cancer prevention and/or risk (Agénor et al, 2016;Dutton et al, 2008;Harb et al, 2019;Johnson et al, 2016a;Peitzmeier et al, 2017;Rahman et al, 2019;Seay et al, 2017;Semlyen & Kunasegaran, 2016b). In studies focused on perceptions of CCS, TM acknowledged CCS as important (Dutton et al, 2008), as necessary (Agénor et al, 2016;Seay et al, 2017), and as an effective means of preventing serious consequences (Peitzmeier et al, 2017).…”

“…For instance, 100% of the participants were aware of facts about infection-that HPV could cause cervical cancer, that condoms did not prevent infection, that infection can be asymptomatic, and that routine CCS is necessary regardless of HPV vaccination status (Harb et al, 2019). But, survey questions regarding guidelines for CCS, (i.e., age for first screening and frequency for routine testing) were often answered incorrectly (Harb, et al, 2019). In contrast, participants in other research were rated as knowledgeable regarding current screening guidelines (Johnson et al, 2016a).…”

“…These studies and epidemiological results support the need for targeted interventions to promote regular screening in the TM population. Many TM are not receiving the same gynecological care set out in the guidelines for cisgender women, putting them at undue increased risk of developing cancer (Dutton et al, 2008;Harb et al, 2019).…”