“I keep getting smear test letters — last time it went really badly, and I’m not sure I even need one”

Inclusive care starts with the basics: use the person’s name and pronouns, correct the record, and acknowledge past harm. Anyone with a cervix aged 25–64 who has ever been sexually active should be offered cervical screening, whatever their gender or partners’ gender; trans men and non-binary people registered as male are not invited automatically, so practices must recall them manually. Testosterone can cause vaginal atrophy, making examination uncomfortable; a short course of vaginal oestrogen beforehand may help (discuss with the patient and gender service), along with a smaller speculum, self-insertion, a chosen clinician and an explicit right to stop. Postcoital bleeding is a symptom, not a screening question: examine the cervix, test for STIs, and refer on a suspected cancer pathway if the cervix looks suspicious. Testosterone is not a contraceptive and is teratogenic; offer progestogen-only methods, IUDs and condoms. From August 2026, HPV self-sampling kits are being offered to some under-screened people in England, but self-sampling is not suitable when there are symptoms.