what gynae inequities do LGBTQ+ communities experience?

Last week, a het cis friend asked me to explain why LGBTQ+ people were at a disadvantage with gynae healthcare. I gave some examples from the project and described how we’re exploring the lived experiences of the group members and researching the collection as a way to explore these inequities further. I told them that we’re doing it in the hope of raising awareness and gaining better representation.

Our conversation made me realise that it might be a good idea to give a written overview on this project blog about some of the things we’ve been talking about and/or experiencing.

What do we mean when we talk about LGBTQ+ inequities in gynaecological healthcare?

As the group has discussed at length, the barriers they face—particularly around gynaecological healthcare—are challenging, systemic, and measurable. These inequities don’t just impact access; they directly affect health outcomes, with preventable conditions diagnosed later and treated less effectively.

History of inequity

For some LGBTQ+ people including those in our group, healthcare is often an uneasy space. From GP waiting rooms to specialist clinics, the system is still largely built on heteronormative and cisnormative assumptions. For example, many services are branded as “women’s health,” instantly alienating trans men and non-binary people who also need cervical, menstrual, or reproductive care. We’ve heard many stories in the group around this, especially issues with representation and appropriate language use.

The group also described how stigma and discrimination, whether overt or subtle, also plays a big role. In order to anticipate negative reactions, many LGBTQ+ people avoid healthcare altogether. Group members kindly shared experiences of providers who lacked training in LGBTQ+ health and/or relied on outdated assumptions. For example, some lesbian and bisexual women are still wrongly told that they don’t need cervical screening if they don’t have sex with men.

Cervical screening in focus

Cervical cancer screening is one of the clearest examples of inequity and was one of my main motivations for starting this project. About 72% of those invited in the UK to attend cervical screenings go ahead and have it done. But the numbers drop significantly for LGBTQ+ groups. For example:

• Administrative systems often prevent trans and non-binary people from even being invited for cervical screenings if their GP record lists them as male, while experiences of dysphoria, stigma, and fear of rejection make attendance harder still. One of our group members who identifies as a stealth trans man has told us his own story of this very experience.

• 15% of lesbian and bisexual women over 25 have never had a cervical screening test, compared to 7% of all women in that age group.

• In one northwest study, 37% of lesbian and bisexual women reported being told they didn’t need a test because of their sexual orientation, and 14% were actively refused or discouraged by a healthcare professional.

Other everyday barriers

The issues faced by members of the group extend beyond cervical cancer prevention. LGBTQ+ people face inequities in fertility care, menstrual health, treatment of chronic gynaecological conditions, and even access to routine GP services.

• The TransActual Trans Lives Survey (2021) found that 14% of respondents had been refused GP care at least once because they were trans, while 57% avoided going to the doctor when unwell.

• In Pride in Practice’s LGBTQ+ Patient Experience Survey (2021) by the LGBT Foundation, 25% of trans people experienced discrimination from their GP compared with 12% of cisgender people.

When LGBTQ+ people avoid care because of fear or past trauma, conditions go undetected. Pain, endometriosis, or PCOS may be dismissed. Cancers are diagnosed later. People experience poor mental health. The inequities are not just about access.

Intersectional inequities

Through our research and conversations, I’ve been more conscious how LGBTQ+ people of colour, migrants, disabled people, and those living in poverty face multiple, intersecting barriers. For example, in Scotland (23/24), screening uptake in the most deprived communities is 56.5%, compared to 67.7% in the least deprived.

Towards inclusive care

We’re hoping to raise awareness to inspire change. NHS guidance is clear: anyone with a cervix should be offered cervical screening, regardless of gender identity (NHS guidance). Some clinics and practices are beginning to adopt trauma-informed, inclusive models, and initiatives like Pride in Practice are equipping GPs with better training. There will soon be self-sampling HPV tests available, which could make screening less invasive and more accessible.

But systemic reform is needed—IT systems that send screening invites based on anatomy not gender markers; mandatory LGBTQ+ health training for providers; funding that recognises LGBTQ+ family structures; and, crucially, services that actively welcome people who have long been made to feel invisible.

Why our work matters

The inequities LGBTQ+ people face in gynaecological healthcare aren’t just statistics—they’re stories of people who avoid the GP, who feel unsafe in clinics, who are denied preventive care. Addressing them isn’t about special treatment; it’s about ensuring that no one is excluded from the right to health because of who they are. This project evidences this and more.

Until our healthcare systems reflect the diversity of the people they serve, inequities will persist. Breaking that cycle starts with visibility, data, and—most importantly—listening to LGBTQ+ voices. That’s what we’re hoping to achieve through LGBTQ+ gynae stories.

Image below: Examples of Sir William Fergusson's vaginal speculum. Wellcome Collection.

This participatory research and socially engaged project is being delivered in collaboration with the Wellcome Collection.