5 Tips For Going to the Gynecologist as a Trans or Non-Binary Person

Nobody really likes going to the gynecologist, but for most cisgender women, these necessary doctor’s visits are a mere annoyance. That’s not the case for many trans men, transmascs, and non-binary folks. For them, a trip to the gynecologist isn’t just uncomfortable - it can trigger gender dysphoria, an extreme dissatisfaction with their gender assigned at birth that impairs their mental health.

According to Dr. Ashley Brandt, a board certified OBGYN and the Medical Director of the Transgender Medicine and Surgery Program at Tower Health in Pennsylvania, for many trans men, trans masc folks and non-binary people, the experience is so distressing that it induces anxiety or panic attacks.

Gender dysphoria manifests differently for each person, so there is no universal experience of the condition. Some trans men, transmascs and non-binary people experience an intense feeling that their body is “wrong” because it doesn’t match their gender. Some may be repulsed by their genitalia and secondary sex characteristics, while others may just dislike them. Others may be fine with their genitalia and secondary sex characteristics in some circumstances, like sexual activity with their partner, but not others, like a medical appointment.

The distress surrounding gynecological care has a major impact on how people in these communities perceive this care - and whether they receive it at all. One study published in the medical journal Obstetrics & Gynecology found that more than 90% of trans men surveyed felt anxious about receiving gynecological care because of their gender identity. Their anxiety isn’t unfounded. The same study revealed that 59% of participants were misgendered at the gynecologist’s office and a whopping 70% had to educate their own doctors about trans healthcare.

Because of the distress gynecological appointments can cause, research suggests that more than 50% of trans men actively avoid seeing a gynecologist. According to the American College of Obstetricians and Gynecologists (ACOG), regular gynecological exams are crucial for early detection of common conditions like pelvic inflammatory disease (PID), sexually transmitted infections (STIs), ovarian cysts, HPV (human papillomavirus), and gynecological cancers; trans men, transmascs, and non-binary folks are at risk when they skip these appointments.

Although going to the gynecologist may never be a totally comfortable experience for trans men, transmascs, and non-binary folks, Brandt shared some things that gynecologists and patients can do to make their gynecological care as tolerable as possible.

Read: 5 Transgender Issues That Affect Us All

See a Trans-Friendly Gynecologist

Dr. Brandt said that the first step in making your experience at the gynecologist better is finding providers that are well versed in caring for gender diverse individuals. “All too often, gender diverse patients must educate providers on gender-affirming health care. This is not acceptable," Dr. Brandt said. "The focus of the visit should never be a patient’s trans-ness or gender diversity. The goal of the visit should be ‘what health care needs does this patient have and how can we work together to optimize their overall health?’”

Trans-informed and trans-affirming providers are adept at a gender-neutral approach to care, which may include using gender-inclusive language, asking about pronouns, and not using common anatomical terms that may trigger dysphoria. They already understand the unique challenges trans men, transmascs, and non-binary folks face at the gynecologist’s office, and they’re prepared with solutions.

Brandt suggested searching the World Professional Association for Transgender Health or the Gay and Lesbian Medical Association websites, which have comprehensive lists of providers organized by location and specialty. MyTransHealth and OutCare also have searchable databases of trans-affirming medical providers, including gynecologists.

If you can’t find a provider in your area on those sites, talk to the schedulers at local OB-GYN practices and ask whether the providers “frequently see gender diverse patients.” Find their websites, and see if there’s any information about LGBTQIA+ health or trans healthcare. Check out providers’ bios to see if they mention LGBTQIA+ health or state that they’re a trans-affirming provider. If there’s no information on the site about serving LGBTQIA+ patients, it might be a sign that the practice isn’t trans-informed or trans-affirming.

If you’re already seeing a gynecologist semi-regularly and you like them, you can try coming out to them and gauging their reaction. Most medical offices now have patient portals where you can send a secure, private message to your provider, so you can just send a message. That way, if they react poorly, you’re not there seeing their reaction in real time, and you know you need a new provider.

Read: Reproductive Healthcare for Trans People

Talk About Terminology

When it comes to the language used in the appointment, Dr. Brandt says that a good, trans-informed and affirming provider will start with gender-neutral language.

“If I need to know details about a patient’s menstrual cycle, which is considered a gendered term, I will instead inquire about the frequency of their monthly bleeding [and] how many absorbent products they use during this time,” Brandt explained. “If a patient is more comfortable saying the terms menstrual cycle, periods, or tampons, I will adjust my terminology to match the patient’s.”

Often, gynecologists who’ve worked with trans and non-binary patients before will ask about your language preferences at the beginning of the appointment. If they don’t and it’s really important to you that you don’t hear gendered language, be sure to say that as soon as they enter the room.

Some trans men, transmascs, and non-binary folks use terms like “front hole” instead of vagina, “external/internal reproductive organs” instead of vulva, uterus, and ovaries, “T-dick” instead of clitoris, and “chest” or “moobs” instead of breasts. Talking about the terms you prefer to use can be a big dysphoria trigger, so make sure you have support before and after the appointment. If you’re concerned that you won’t be able to have the conversation face to face, send a message before your appointment and make sure the gynecologist has read it before you start talking.

Read: 7 Best Sex Toys for FTM Transgender People With Bottom Growth

Ask What Absolutely Needs to Happen at the Appointment

Depending on the reason for your appointment, you might be able to skip the more dysphoria-triggering procedures, like a pelvic or breast exam. You might not even have to undress and wear a gown. According to the ACOG, even your annual exam doesn’t always require a physical examination. Your gynecologist will assess whether they need to physically examine you during your appointment based on what you discuss.

Before your appointment, you can message your gynecologist about what you want to discuss during your appointment and ask whether they think a physical exam will be necessary. In that message, you can make it clear that you’d prefer to avoid exams that might trigger dysphoria if at all possible. Brandt said she always gives her patients the choice to opt out of a physical exam during early appointments so they can build trust.

If you know ahead of time that you’ll need a physical exam, talk to your therapist, trans or non-binary friends, and your support people about how you can reduce the dysphoria around these exams or, at the very least, manage the dysphoria as it arises.

“Communication between the patient and the provider about what makes the patient comfortable is key,” Dr. Brandt said.

She added that many trans-informed and affirming gynecologists are prepared to adjust the exam to make it more comfortable. For example, they might let you insert the speculum yourself, start with a smaller speculum, do a digital exam rather than using a speculum, let you self-swab for STI testing, use a topical anesthetic so you feel less of what’s going on during the exam, or offer you an anti-anxiety medication before the appointment. If there are things that might help you feel better – like listening to music during the appointment or having a support person there - be sure to discuss this with your gynecologist before the exam. They’ll probably be happy to accommodate.

Advocate for Yourself

Your voice is the most powerful tool you have during any kind of medical appointment. Yes, they’re the doctor and you’re the patient, but that doesn’t mean you have to just nod, smile and follow “doctor’s orders.”

“Health care providers are here to help you, and we don’t want to exacerbate feelings which could result in you not seeking care in the future… It is crucial for patients to be honest about what makes them uncomfortable,” Dr. Brandt said.

Before the appointment, take some time to reflect on the boundaries you want to hold during the appointment and how you’ll communicate those with your gynecologist. Write down any questions you have and bring them with you so you don’t forget them. Take some time to reflect on what kind of recommendations would make you uncomfortable as well. For example, maybe taking hormonal birth control to prevent pregnancy or regulate your menstrual cycle triggers dysphoria. Do some research on alternate birth control solutions, like the ParaGard IUD, and practice what you’ll say to the gynecologist if they suggest hormonal birth control.

Unfortunately, trans-informed and affirming gynecologists can still make pronoun and deadname mistakes - as well as ignorant or insensitive comments - because they’re humans. So, practice responses for situations that might come up until they’re second nature, just in case.

Taking the time to reflect on all this and plan your responses takes a lot of emotional energy, but it will be so worth it once you’re actually in the appointment.

Get Support During the Appointment

It may seem weird to have someone in the room with you during a gynecological appointment, but Dr. Brandt says it can actually be really helpful, especially if you need to have a physical exam. “The person can help serve as an advocate and as someone who is familiar to make the appointment less daunting.”

They can distract you from what’s going on during the exam so you don’t have to focus on the anxiety and dysphoria that might come up, and talk you through the appointment. Perhaps the most important reason to have a support person in the room with you, though, is so they can take on some of the emotional labor of advocating for you. When you’re super uncomfortable, it’s really hard to remember things you wanted to bring up in the appointment and questions you wanted to ask. It’s also hard to speak up when something’s bothering you. Your support person can be your backup voice during the appointment so you don’t have to marshall your energy to speak up or ask questions.

If you have an affirming friend or family member who’ll go to the appointment with you, that’s great! If you don’t have someone in your life you’re comfortable with bringing, that doesn’t mean you can’t have support during your appointment. Many medical practices have patient advocates on staff – professionals who are trained in providing support during sensitive appointments. If the practice you’re seeing doesn’t offer patient advocates, you can reach out to the Patient Advocate Foundation to connect with services in your area.

As a trans man, transmasc or non-binary person, going to the gynecologist will probably be at least a bit uncomfortable, even if you find a provider who’s an expert in gender diverse care and follow all these recommendations. But, at the very least, these tips will help you be better prepared and, just maybe, make you feel a little better.