Ensuring sexual health services are safe and welcoming for the trans community   

This Sexual Health Week we want to amplify the voices of those who face barriers as well as those who are working tirelessly to break barriers. In this blog, Aben Ripley from LGBT Foundation highlights some of the particular barriers that are faced by people with trans* and non-binary identities and signposts to some inclusive resources and services.  

Working in LGBT+ sexual health as a demi-ace/aro, bi & trans-non-binary person has been an eye-opening experience, to say the least. It’s a dream job and I absolutely love the diversity of conversations that we get to have. Sadly, I am often unsettled by the state of mistrust and apprehension that trans populations express around sexual health services.  

My job at LGBT Foundation focuses on engaging Greater Manchester residents to reflect on their sexual wellbeing and promote advice and services that suit their needs. It can often feel like an uphill battle or that we’re finding people ‘too late’. The complex outcomes for many of having to self-educate alongside overcoming shame and stigma are always going to be multifaceted.  

The reality is that our greatest ally is time, but we need to use it wisely and amplify the great work that’s already happening.

We can’t rely on people’s needs guiding them to the right service, that a trans flag on a leaflet or having a non-gendered waiting room is enough. The trust of the trans community is earnt, not bought, and we do that by centring those who have been marginalised and creating services that are safe for them, not simply “friendly”. 

Some truly incredible work is being done by organisations to tackle the information and confidence barriers that often prevent the community from engaging with support and advice around sexual wellbeing. Here are a few of my favourites that I hope will inspire you too… 

• Resources: I heartily recommend a browse of THT’s sexual health resources for trans and non-binary people, by and for the community. 
    
• Services: 56 Dean Street offer a wonderful example of what a ‘dedicated space’ and care can look like for trans and non-binary sexual health. (Head to the bottom of this article for some Northern services who are also doing a great job!) 
   
• Education: Brook is doing incredible work in education “from planning to policy to delivery”, including free training for professionals working with young people. 

If you’re a trans or non-binary person who’s worried about accessing a sexual health clinic, check out local services to see if they have a specific trans clinic you might be more comfortable in. In the areas we work these are Onyx (Manchester, the Northern) and Butterfly (Liverpool, Axess).  

Breaking barriers 

At LGBT Foundation, the Sexual Health team work hard to empower people to take control of their sexual wellbeing, no matter their sexuality or sexual practices. As with many other sexual health issues, the biggest challenge is reaching those who don’t know what is available to them. For those with trans identities, the problem becomes more nuanced as many are under the impression that a service doesn’t include, or will exclude, them.  

That’s hard to address because it’s not going to be fixed by adding more services; it comes from a belief system that we need to break down. We have great tools in our arsenal – condoms, PrEP, contraception – but lots of the people who could benefit from them are being left out of the conversation! LGB+ women and non-binary identities are well known as being an afterthought or tacked-on consideration when it comes to sexual health messaging.  

We need to remember that:

• Not all trans women have sex with ‘men who have sex with men’ 
• People who give birth aren’t always mothers 
• Non-binary people aren’t one homogenous group 
• Trans masculine people can’t be invited to cervical screenings addressed to “women” in writing or via literature targeting “females” 
• Contraceptives aren’t only used to prevent pregnancy 
• And (surprise!) queer sex and sexual health needs don’t fit into neat boxes 

Misinformed generalisations and assumptions from professionals mean that the needs of an incredibly rich and diverse community are best catered to when they present in a way that is expected, or easy. Rather, we need to promote a culture where we are able to prioritise discussion of sexual behaviours, rather than aligning these with heteronormative and conventional ideologies. 

Just because you know who they are doesn’t mean you know what body parts they have, how they use them, or who they’re using them with.

When accessing contraceptive services, I was most memorably asked if I “have a boyfriend”. I was stunned as this could never be an effective way of finding out if someone is having sex that will get them pregnant. Even asking this of a cisgender heterosexual woman won’t give you a helpful answer.  

Having a male partner isn’t the be-all and end-all of reproductive sex!

Only when we’re able to have appropriate, unbiased and candid discussions about the sex we are, and are not, having, will we see progression that benefits everyone. Services should strive to look at as many aspects of marginalisation as possible and how for those with multiple marginalised identities this means experiencing overlapping systems of oppression at the same time (and as a result, the barriers this creates).  

It won’t be an overnight win, but with strong, intentional and community-informed education and representation for people of all ages, I am very confident we will get there.  

BUT for now, for those in the North-West who are struggling, or would prefer gender-informed support, we recommend the following clinics that have been designed to support trans and non-binary people with a range of sexual health and wellbeing services:  

If would like to talk to a member of LGBT Foundation’s Sexual Health Team about sex, sexuality or anything linking to your sexual health & wellbeing; you can get in touch with us via the Advice Referral Form on our website!

*In this blog I have used the word ‘trans’ very generically to capture trans, non-binary and gender divergent experiences. This is inclusive of anyone who does not identify with the gender they were assigned at birth, some or all of the time. Please note that not all people whose experiences come under this umbrella will identify as ‘transgender’. For all other terms that may require definition, I have included links to resources where you can deepen your understanding.