In this research deep dive, we examine the challenges that LGBTQ+ individuals may face when it comes to in-clinic cervical cancer screening. This group is underscreened at higher rates, often due to specific barriers to the speculum and clinician-collected cervical screening. Turning to solutions, we delve into data from our nationwide SELF-CERV clinical study. Our data illuminates that an at-home self-collection device like the Teal Wand^TM not only improves the cervical cancer screening experience for the LGBTQ+ population but can also help improve their screening participation toward the goal of eliminating this disease. 

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We also presented this data at the 2024 Annual American Public Health Conference. Check out our conference research poster.

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Contents: 

1. Barriers to Cervical Cancer Screening Among LGBTQ+ Individuals 
2. The LGBTQ+ Population in Teal Health’s SELF-CERV Clinical Study
3. Barriers to Cervical Cancer Screening Reported in the SELF-CERV study
4. Engaging more LGBTQ+ Individuals in Life-Saving Preventative Care with At-Home Self-Collection 
5. In the Words of Our LGBTQ+ Study Participants
6. Final Thoughts

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Barriers to Cervical Cancer Screening Among LGBTQ+ Individuals 

According to medical guidelines, all those with a cervix between the ages of 25 and 65 should engage in routine cervical cancer screening, which is the most effective way to prevent this disease. However, over 20 million people (or, 1 in 4 individuals) in the United States are behind on their routine cervical cancer screenings. Within this large underscreened group, those who identify as gay, lesbian, bisexual, pansexual, queer (or additional sexual identities, other than heterosexual) are 50% less likely to engage in routine cervical cancer screening (i.e., in-clinic speculum exams commonly referred to as a Pap smear) and are therefore at higher risk for cervical dysplasia and cervical cancer.

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The lower screening rate among LGBTQ+ individuals often stems from higher rates of sexual trauma (which can make the speculum exam feel distressing) and systemic experiences of implicit bias from healthcare providers. In one study,  87% of LGBTQ+ patients reported receiving disrespectful and biased healthcare. Additionally, among trans men, gender dysphoria related to the clinician-collected speculum exam can be especially challenging and pose a deterrent to screening. A study found that only 56% of trans men were engaged in routine cervical cancer screening compared to 72% of cisgender women, while another showed that over 90% of trans male patients preferred self-collecting to the speculum exam. As a result of these personal histories and healthcare inequities, LGBTQ+ individuals may feel hesitant to seek cervical cancer screenings in clinic settings and fall behind on life-saving preventative care. 

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Here, we explore how an at-home self-collection option – like the Teal Wand^TM – can serve as a critical option to overcome these specific barriers and engage more people of diverse sexual and gender identities in routine cervical cancer screening.  

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The LGBTQ+ Population in Teal Health’s SELF-CERV Clinical Study

Between 2023 and 2024, Teal Health conducted SELF-CERV, a clinical study consisting of 16 investigational sites across the United States. We studied the safety and efficacy of our at-home self-collection cervical cancer screening device, the Teal Wand. Participants also provided feedback on their experience and preferences around cervical cancer screening. 

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Of over 600 participants (aged 25-65, all of whom had a cervix), 13% identified as gay or lesbian (n=10), bisexual (n=42), pansexual or queer (21), or self-described (n=1). Further, 1.3% identified as genderqueer or non-conforming, 0.5% as trans men or male, and 0.2% as another gender category, which aligns with the most recent data on gender diversity in the United States. 

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Not only did we find that the LGBTQ+ group highly preferred at-home self-collection and would be more likely to engage in routine cervical cancer screening with this option, but the Teal Wand was also very safe and effective in its performance. Across the entire study, 98% of participants successfully collected a valid sample with the Teal Wand. Regarding safety, there were no serious adverse events and no device malfunctions.

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Barriers to Cervical Cancer Screening Reported in the SELF-CERV study

Reflecting other research, our SELF-CERV study found that gay, lesbian, pansexual, bisexual, or queer individuals reported increased rates of delaying or avoiding their cervical cancer screenings. Where around 29% of heterosexual participants had delayed or avoided their screening, a much larger percentage  – over 51% – of gay, lesbian, pansexual, bisexual, or queer individuals had delayed or avoided. This group often cited barriers around discomfort with the exam, trauma-related issues, or other negative experiences with speculum exams: 

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• 37% of the gay, lesbian, pansexual, bisexual, or queer participants who reported delaying cervical cancer screenings stated that this was due to being uncomfortable with the exam. 
• 21% also cited other reasons for delaying, including challenges with the speculum, and ongoing distress related to sexual trauma and PTSD. 

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In particular, delaying screening due to discomfort with the exam was much more common (almost 4x higher) among this group, compared to only 9% of heterosexual participants who reported delaying due to being uncomfortable with the exam. Breaking this down further, 30% of gay or lesbian, 19% of bisexual, and 14% of pansexual or queer participants reported delaying due to discomfort. While these barriers are relatable across demographic groups as well, we found that they were particularly pronounced among those who identified with a sexual identity other than heterosexual.

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Diving into experiences with the clinician-collected speculum-based exam among those who are gay, lesbian, pansexual, bisexual, or queer, we found that: 

• 65% of this group experienced discomfort during clinician-conducted screenings 
• 49% felt nervous
• 34% experienced pain 
• And 18% felt embarrassment

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Relatedly, some gay, lesbian, pansexual, bisexual, or queer participants also noted the clinician-collected experience felt “dehumanizing,” triggered “trauma-response,” and reported “discomfort with a male provider.” 

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Engaging more LGBTQ+ Individuals in Life-Saving Preventative Care with At-Home Self-Collection 

Turning to solutions, our SELF-CERV study found that the Teal Wand, an at-home self-collection device for cervical cancer screening, was far more favorable and could help engage more LGBTQ+ individuals in routine cervical cancer screening. Experiences with self-collection were more positive, across the board, for those who identified as gay, lesbian, pansexual, bisexual, or queer: 91% of this group felt more empowered or in control of their screening experience with self-collection, compared to only 7% who felt in control during their clinician-collection experience. 

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Breaking this down by group, we find that 100% of those who identify as gay or lesbian, 95% of those who are pansexual or queer, and 88% of those who are bisexual found their self-collection empowering and felt in control. 

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Moreover, 80% would prefer self-collection over clinician-collection if given the choice. This preference was particularly high (90%) among those who are gay or lesbian, followed by 81% of pansexual or queer individuals, and 76% of bisexual individuals.

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The preference for self-collecting translates to increased engagement in routine life-saving cervical cancer screening for this group. This is especially important, as increasing screening engagement is the most effective approach to preventing cervical cancer in adults (or detecting it before the disease advances, which improves the ability to cure the disease): 

• 96% of this group felt confident self-collecting if they could be reassured it was just as accurate as a clinician-collected speculum exam.
• Over 89% of those who identified as gay, lesbian, pansexual, bisexual, or queer indicated they would be more likely to stay up-to-date on screenings with at-home self-collection, like the Teal Wand.

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Looking closer, 100% of gay or lesbian, 91% of pansexual or queer, 86% of bisexual, and 85% of heterosexual participants would be more likely to engage in routine screening with the Teal Wand.

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This data illustrates the potential Teal Health’s approach holds for increasing screening rates and moving toward the goal of eliminating cervical cancer as a public health concern. 

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In the Words of Our LGBTQ+ Study Participants

This is what our LGBTQ+ study participants had to say about their experience using the Teal Wand: 

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“Comfortable, easy to use, no hassle, less pain and discomfort than speculum exam”

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“Could be very helpful for women with PTSD/sexual trauma that gets triggered during these exams”

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“I like that I can take my time with the self-collection because pain from Paps has been a concern I have had. With self-collection I can better manage the pain by working slowly.”

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“The privacy aspect is a big deal for me, and I have several friends who have expressed discomfort at having to be spread-eagle with their feet in stirrups.”

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“I would recommend it as a great option if you do not want to, or cannot, come in person to a clinic for a Pap. I liked the privacy and I felt empowered.”

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“I know a lot of people who are uncomfortable with pelvic exams because of dysphoria. They would be a lot more likely to do a self-test.”

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“(This gives the) option to take back agency and bodily autonomy.”

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“It was really good to be about to do the test without having to undress fully and let another person (or 3) look at my cervix. I liked the privacy and how I didn’t have to have a full speculum inserted.”

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Final Thoughts

At-home self-collection is a crucial option for helping more individuals of diverse genders and sexualities participate in routine cervical cancer screening, as it overcomes the barriers many of these individuals face around clinician collection and speculum exams. It offers increased agency, identity affirmation, privacy, and comfort, improving healthcare delivery and outcomes, which can be particularly useful and desired in these communities.

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Not only did using the Teal Wand allow for a more comfortable and empowering cervical cancer screening experience for LGBTQ+ individuals, but this group felt that they would be more likely to engage in routine screening given this option. We underscore how important it is to design cervical cancer screening with people’s experiences in mind, as these experiences translate into healthcare engagement, which can make all the difference in preventing cervical cancer and eventually eliminating this disease. 

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If you would like to dive deeper into our SELF-CERV data about how at-home self-collection can be particularly effective for the LGBTQ+ community check out this research poster we presented at the 2024 American Public Health Association Annual Conference. To share your thoughts, please reach out to us. To stay up-to-date on when you may be able to use the Teal Wand^TM for your at-home cervical cancer screening, please join our waitlist.*

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*The Teal Wand is an investigational Device and is currently under review with the US FDA

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