Going to the Gynecologist as a Nonbinary Person

TL;DR: it’s important to prevent a variety of health issues, and it’s important to start going early. According to the American College of Obstetrics and Gynecology, the first visit to the gynecologist should take place between 13-15 years old. Gynecologist can provide many important services that can help our overall health, including:

• Pregnancy care: going to an OB/GYN or alternative healthcare provider (midwife) is an important step during pregnancy, to maintain help for both the pregnant person and the fetus in utero
• Screening for breast cancer: about 266,400 total people are diagnosed with breast cancer every year in the US, according to the CDC. Regular examination or self-examination of the breast tissue can help identify anything that’s abnormal.
• Screening for cervical cancer: Pap smears, recommended after age 21, involve taking a sample of cells from the cervix, and screening for either human papilloma virus (HPV) and/or cervical cancer.
• Birth control options: if preventing pregnancy is a goal for you, a gynecologist can help discuss birth control options that might be right for you. This could include things like hormonal contraceptives, implanted devices like IUDs, or use of physical barriers like condoms. For folks taking testosterone, this may not be adequate to prevent ovulation or pregnancy, and additional measures may be required.
• Infection testing: gynecologists can screen for urinary tract infections (UTIs) and a variety of sexually transmitted infections to keep you and your partner(s) healthy and safe. Gynecologists can also administer preventative vaccines, like for HPV.
• Surgery: gender affirming hysterectomy, with or without removal of ovaries, can be performed by a specialized gynecologist.

Current recommendations for frequency are annual wellness exams, but there isn’t a specified frequency for pelvic exams for those without a history of gynecological conditions, pregnancy, or symptoms. If you have symptoms like abnormal bleeding or discharge, pelvic pain or pain during sex, it’s definitely worth a visit for your health.

How’s your environment?

It's all well and good that gynecologists can help us with our health, but the reality is many gynecological practices cater to cisgender people. It’s hard to want to receive care in an environment where you don’t feel seen as a person. This can show up in a lot of ways, from the language on the intake paperwork, to the floral and feminine artwork on the walls, and gendered bathrooms. It should feel like a “structurally affirming environment”, and if it doesn’t, it will probably be hard to be comfortable receiving care and establishing a rapport with a provider. 

So when you arrive at the gynecologist’s office, take note of how it makes you feel. Is it safe, supportive and welcoming? Can you establish your pronouns, and does the intake form have language that feels right for you? How about signage? If it doesn’t, consider if this clinic is the right fit for you, and check out the resources at the bottom of the page to find care that may be a better fit for you.

Access to care

Access to care that creates a friendly and welcoming environment for transgender and non-binary people can be really hard to find. “Nearly one-quarter of transgender and nonbinary individuals report avoiding seeking healthcare due to fear of being mistreated due to their gender… In addition, nearly 50% of transgender and nonbinary people are survivors of sexual abuse or assault, which may contribute to fear in seeking sexual and reproductive healthcare.” 

This can create significant barriers to care that cisgender individuals may not face. Finding a gynecologist who specializes in providing care to transgender and non-binary folks is ideal, however, this may not be available in your geographic area. Check out the resources at the bottom of this article to help locate a specialized provider near you.

How to set your boundaries

We’d hope that providers are always using an inclusive, trauma-informed approach when providing exams, but sometimes it’s helpful to speak up about what you need. Here are a few ways to set your boundaries so your provider knows how to best support you.

Communicate 

Ask clearly what will happen during the exam, and have a way to make the exam stop if you get uncomfortable.

Language matters 

Establish which terms you’d like your provider to use for your anatomy.

Maximize your support

If having a support person present during your visit feels helpful to you, ensure that you can do this.

Medications 

If you experience significant gender dysphoria or anxiety, ask your provider about medications prior to your visit that may be helpful.

Ask Questions 

Don’t be afraid to ask all the questions you need to in order to feel comfortable during your visit

Resources

While finding care can feel daunting, there’s many resources available to help you find care that fits your needs. 

• World Professional Association for Transgender Health (WPATH) is an non-profit organization of healthcare professionals with members devoted to providing high quality care, internationally, for all genders. Using the WPATH provider directory can help you locate several types of providers near you, including gynecologists.
• MyTransHealth is a US-based provider directory within major metropolitan cities to help find care
• The LGBTQ+ Healthcare Directory, organized by the GLMA– Health Professionals Advancing LGBTQ+ Equality, features US and Canadian providers

It may be a process of trial and effort to find a provider where you can establish trust, rapport and who can respect your boundaries. As frustrating as it can be to find care that feels right for you, it’s worth the effort. Gynecological care is so important for overall health.