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Enacting power and constructing gender in cervical cancer screening encounters between transmasculine patients and health care providers.

Authors
  • Peitzmeier, Sarah M1
  • Bernstein, Ida M2
  • McDowell, Michal J3
  • Pardee, Dana J4
  • Agénor, Madina5, 6
  • Alizaga, Natalie M7, 8
  • Reisner, Sari L4, 5, 9
  • Potter, Jennifer3, 4, 10
  • 1 School of Nursing, Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA.
  • 2 Department of OB/GYN, Brown University, Providence, RI, USA.
  • 3 Harvard Medical School, Boston, MA, USA.
  • 4 Fenway Health, Boston, MA, USA.
  • 5 Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • 6 Department of Community Health, Tufts University, Medford, MA, USA.
  • 7 Center for Tobacco Control Research and Education, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA.
  • 8 Cañada College, Department of Psychology, Redwood City, CA, USA.
  • 9 Boston Children's Hospital, Boston, MA, USA.
  • 10 Beth Israel Deaconess Medical Center, Boston, MA, USA. , (Israel)
Type
Published Article
Journal
Culture, health & sexuality
Publication Date
Dec 01, 2020
Volume
22
Issue
12
Pages
1315–1332
Identifiers
DOI: 10.1080/13691058.2019.1677942
PMID: 31661659
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Transmasculine people are at risk of cervical cancer but have lower rates of cervical cancer screening than cisgender women. Disaffirmation of the patient's gender and unequal power dynamics between patient and provider during screening contribute to patient unwillingness to be screened. The mechanisms by which the balance of power may be shifted between patient and provider, and by which gender is constructed during the Pap test, are not well understood. A qualitative study using a modified grounded theory approach was undertaken to analyse patient interview and provider interview and focus group data pertaining to power and gender in the context of cervical cancer screening among transmasculine individuals. The study was conducted at an LGBTQ-focussed health centre in Boston, USA. Processes by which power is enacted included constraining or affirming patient choice, mitigating or exacerbating vulnerability, and self-advocacy. Gendering processes included naming patients and their bodies, invoking gender norms, de-gendering/re-gendering Pap tests, and othering or normalising trans bodies. The interplay between these processes promotes or constrains patient agency over body and health, impacting patient care, patient-provider interaction, and service utilisation. Understanding patient and provider roles in power and gender dynamics are critical for the provision of patient-centred care.

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