The morning of my most recent annual checkup, I showered, shaved and put on a fresh pair of underwear. At 22, I anticipated that the family doctor I’ve had since puberty would be giving me a Pap smear for the first time, and I wanted to feel comfortable and prepared. But once I arrived and my general practitioner cycled through her routine tasks — checking my blood pressure, weighing me, listening to my lungs crackle through her stethoscope — she instructed me to keep my underwear on. My Pap smear virginity would remain intact, she informed me. “There’s no need,” she said. “Women who have sex with women don’t need them.”
I trusted my doctor. After all, she doubles as an obstetrician half of the week, so who could know better about my vaginal health than her? But after my appointment, I sent a quick tweet about my experience, and realized she was terribly wrong. “What idiot told you that you aren’t eligible?” asked one of my followers. Another sent me a message asking if I wanted the names of alternative LGBTQ-friendly doctors in Toronto. Later, my brother’s girlfriend, who happens to work as an epidemiologist, confirmed my Twitter friends’ speculations: anyone in Ontario 21 or older who is sexually active is eligible for a Pap smear, regardless of whom they choose for sexual partners.
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Pap smears, or Papanicolaou tests, involve collecting a small sample of cells from the cervix, which are then examined under a microscope. The tests are routine screenings for symptoms of illness such as cervical and vaginal cancer. Starting in 2012, the Ontario government revised its health care guidelines to suggest that all women between the ages of 21 and 70 receive a Pap test every three years.
I’m not alone in being denied this routine procedure. According to Devon MacFarlane, director of the provincially funded LGBTQ organization Rainbow Health Ontario, the most common misconception about queer women’s health care is that they don’t need to receive Pap smears — and even more concerning, that they don’t contract sexually transmitted infections such as human papillomavirus, or HPV, which can cause cervical cancer.
That means many queer women discouraged by general practitioners from getting Pap smears. The latest data from Statistics Canada, compiled in 2008, showed that less than two-thirds of lesbians surveyed had received a Pap smear in the past three years, significantly lower than heterosexual women’s rate of 77 per cent. According to Statistics Canada the effect of this discrepancy is unknown, because there is little to no data on rates of cervical cancer in lesbians specifically versus the general population. The same data indicated that queer women were also less likely than their heterosexual counterparts to have a family doctor in the first place.
The idea that anyone with a cervix should be screened to prevent cervical cancer seems straightforward enough. But many factors play a role in keeping queer women from receiving the health care they need. For one thing, MacFarlane says, the average doctor in training in Ontario receives only five to seven hours of education in LGBTQ health care throughout their studies, allowing for misconceptions about queer and trans health care to fester and spread. At the same time, LGBTQ Ontarians may feel uncomfortable disclosing their sexual orientation to their doctors, leaving GPs unable to provide specific treatment to meet their needs.
MacFarlane stresses that sexual orientation doesn’t always determine sexual behaviour, which complicates a number of the assumptions a general practitioner might otherwise make about a patient’s screening needs. If a woman identifies as a lesbian, for instance, it doesn’t necessarily mean she hasn’t had sex with a man, or that she won’t in the future.
Joanne Woodward Fraser, senior communications adviser at the Ontario Ministry of Health, said in an email that the ministry continues to take the health needs of LGBTQ Ontarians “very seriously.” But even with its funding contributions to Rainbow Health Ontario, little government intervention has been made to address the Pap smear situation.
Instead, Rainbow Health has taken the lead on raising awareness. In association with Women’s College Hospital and Sherbourne Health Centre, it launched a Check It Out campaign last year to encourage queer women and trans men — or anyone with a cervix, as the campaign put it — to ask their doctors for Pap smears. Meanwhile, the organization lectures to medical students at the University of Toronto and the Northern Ontario School of Medicine in Thunder Bay to educate doctors in training about LGBTQ health needs. Rainbow Health also hosts a biennial conference for Ontario doctors. But, as MacFarlane says, “Doctors must be wanting and willing to attend.”
Two months have passed, and I still haven’t received my Pap smear. Though I haven’t visited my doctor since my last checkup, I imagine she is still clueless, unaware of the risks I face due to her decision not to perform one on me. Instead, I plan on heading to a hassle-free clinic, which offers free sexual health and counselling services privately and confidentially. There, I know a doctor won’t question my desire for a Pap smear — regardless of my sexual orientation.
Erica Lenti is a Toronto-based journalist who covers mental health, LGTBQ and women’s issues.