Tips to support patients with extra barriers

As you know, some people can find gynae examinations uncomfortable, stressful and even traumatic.

Here are our tips on supporting your patients with their gynae health appointment:

Survivors of sexual trauma

Having an examination or cervical screening test may be a triggering experience for any patients who have experienced sexual trauma. Reminding them at the start of the appointment that they are in control of the situation, and that they can stop at any time for any reason can help them feel more at ease. Check in on them during the procedure and reassure them that they are in control of the situation and can stop if they need to. Let them know that there is no pressure to go ahead with the examination/screening at the first go, and that you can always try again at another time. Talk them through what to expect and remind them of each next step during the procedure too. Putting the speculum in themselves may help, and using the smallest size possible.

Trans men and non-binary people with gynae organs

Check with your patients what their pronouns are and ask what they prefer their genitals to be called, avoiding words like vagina/vaginal unless told otherwise. Check what gender reassignment genital surgeries your patient has had, if any. If your patient needs an examination, be aware that they may not have experienced any vaginal penetration, which includes vaginal intercourse, using sex toys or tampons, so they may find a speculum painful. Try the smallest size speculum, and make sure it is well lubricated. Some patients can feel very vulnerable during an examination or cervical screening, so throughout the appointment reminding your patient that they are in control, that they can tell you to stop or change their mind at any time, and that everything is on their terms can help balance this. Letting them know that if it is easier for them, they can help you guide in the speculum. Get informed and explicit consent, and double or triple check!

Lesbian and bi women

Your patient may have heard or seen some myths around cervical screening and may not be aware that they need screening if they haven’t had sex with men. Do check their screening history and invite them to attend if they are overdue/ haven’t yet had a screening test, and explain why it is important for them to be screened. Your patient may or may not have experienced vaginal penetration before and may find a speculum more uncomfortable during screening tests or examinations. Do use a small speculum if needed with plenty of lubrication.

Vaginal atrophy

Examination and screening tests may be more uncomfortable or even painful for women and people with vaginal atrophy. Use the smallest size speculum available and with lots of lubrication. Communication is key and encourage them to tell you if it becomes too uncomfortable or painful. Let them know they don’t have to go through with the examination/screening today and can book another appointment if needed. If that is necessary, advise them to use a vaginal moisturiser in the lead up to the appointment to make the next attempt more comfortable.

Lichen sclerosus

For some people with lichen sclerosus on their vulva, examinations and screening may be difficult. Scar tissue around the vaginal opening can make using a speculum painful or even impossible. Like with vaginal atrophy, advising them to apply vaginal moisturisers before the appointment can help. Use the smallest speculum and ensuring it is well lubricated can help ease some of the discomfort.

Physical disabilities

Your patient may not have been told that they should have a cervical screening test and may have even heard or been told that they don’t need one. Do check their screening history and invite them to attend if they are overdue/ haven’t been screened. If they are hoist dependant, they will need an examination or cervical screening test to be at a GP surgery with a hoist, do check with them what their needs are.

Learning disabilities

Your patient may need a bit more time to understand the information, so talk them through what to expect step by step and check in with them to see if they need any further explanation or support. Let them know they can have a trusted friend, family member or carer with them for the appointment or any examination/screening test if that would make them feel more comfortable and prepared (if Covid restrictions allow). Your patient may not have been told that they should have a cervical screening test and may have heard or been told that they don’t need one. Do check their screening history and invite them to attend if they are overdue/ haven’t been screened.

Signpost to more support…

Signpost people to expert sources for more support and advice – a 10-minute appointment is a very short time, and if your patient feels they need extra support, they may be tempted by Dr Google! Arm them with trusted resources of information, signpost to eveappeal.org.uk, Patient.info and NHS Choices.

The Eve Appeal also runs a specialist information service called Ask Eve. This is a nurse-led service and provides free, confidential, expert information and signposting. No question is too small or too embarrassing. It’s a taboo-free zone! They can get in touch by telephone or email: nurse@eveappeal.org.uk / freephone: 0808 802 0019.