His Cervix, Her Prostate

This is a piece that I originally wrote back in August 2013, on my old website.

Recently a colleague (Ivy Branin ND of Simplicity Health wrote me, asking for help in wording a post she had written regarding cervical cancer. A commenter had posted:

…. not all people with a cervix are women. If you are talking about biological processes, this is more closely aligned with sex and so you’d be talking about females (who are not all women).

It appeared that the commenter was referring to transgender and non-gender conforming individuals, and suggesting that she use the word “female” to refer to “people with a cervix, who were not women”. The question was, as this the correct terminology? If not, what was the correct terminology, and how did she going about finding it?

(Note: a cervix is not a process, except perhaps in a very mystical sense.)

Keeping communication clear, sensitive, and accurate

One of the issues in transgender healthcare is describing needed reproductive health care in a way that is in integrity with an individual’s gender identity. At the same time, the language needs to be clear and readily understood, so that the reader knows what they do (or do not) need to do to stay safe and healthy.

Unfortunately, we don’t yet have a consensus on how to clearly refer to someone’s biological/natal sex as opposed to their gender identity. In popular usage, female overlaps with woman. Ditto for male and man. For those whose gender identity doesn’t mesh with their biology, this can lead to a lot of confusion when these terms are used to describe who should seek what type of healthcare exams. It can also lead to being invalidated in their gender identity. This alone is enough to cause many transgender and gender non-conforming individuals to avoid needed healthcare.

“Females with a cervix should get a pap smear.”

“I have a cervix, but I’m not female. I’m a guy. I don’t get exams meant for women.”

(Do not try to convince this individual that he should use the word female to describe himself. This goes for using the word male to describe those who identify as female.)

And, as there is no Central Transgender Language Committee (at least not one that is commonly recognized), there is not one place to go to to discover what terminology is in common use.

So what did I do to help my colleague?

The language needs to fit with the gender identity of the person you are addressing.

If the person identifies as female, whatever she has in her body is hers. It’s her prostate or her penis. If the person identifies as male, it’s his cervix and his uterus.

How do transgender and gender non-conforming individuals refer to themselves?

I’ve never heard someone who identifies as male say, “Well, I’m female, but I identify as a man.” This is true even if they still have breasts, uterus, vagina and so forth. They are not female. They will tell you this.

Similarly, I’ve never heard someone who identifies as female state, “Oh, I’m male, but I identify as a woman.”

Genderqueer individuals will use differing terms for themselves, and you should go along with what ze tell you they use. They will explain to you that they do not identify as (solely) male, or female, or even either.

Sometimes I hear people describe themselves as “male bodied” or “female bodied”. But if they have had surgeries or hormones, those descriptions will change to reflect their bodily changes. Someone who identifies as female and has breasts, a vagina anda prostate is not going to describe herself as “male-bodied”. She still, however, needs her prostate examined.

Genderqueer and gender non-conforming people will differ in how they refer to themselves.
(Intersex individuals have challenges of their own. Genitalia, chromosomes, reproductive organs and gender idenity do not all line up in these individuals, and our language and society really do not have categories for them.)

Check a reputable and updated reference site for current usage.

One site I consulted was was the (excellent) Center for Excellence in Transgender Health at http://www.transhealth.ucsf.edu/trans?page=lib-providers. It confirmed that most transgender or gender non-conforming individuals use the words “male” or “female” to talk about their gender identities. So using that word to signify “biological processes” would not work.

Style guides won’t necessarily have the latest cutting edge terminology that is used at your local transyouth poetry slam. They will however let you know what language is polite (or isn’t) and is in use by most of the population.

Figure out who your audience is, and what you need to say.

In most cases a need for gender-inclusive langage will arise when you need to address healthcare that is involves genitalia, reproductive organs, or reproductive hormones. In thise you need to make it plain that the audience includes those who have those genitalia, organs or hormones – regardless of their gender identity.

If you are mainly addressing the transgender and gender non-conforming communities, you may want to stick to such constructions as as “all individuals with a cervix” or “transwomen who have a prostate”. This can get fairly unwieldy, admittedly. If writing more than a brief paragraph this way, consider doing the usual introductory paragraph explanation: “While in this article I refer to transmen, this advice refers to all gender non-conforming individuals who have a cervix, regardless of their gender identification and regardless of whether or not they have engaged in any medical or surgical transition.”

If you are writing a general-audience article, then you may not want to (for instance) replace every use of the word man with “individuals who have a prostate, regardless of gender identity”. Instead, consider putting a sentence near the start and the end that says something like, “While I use the terms men and males in this article, the advice is intended for anyone who has a prostate, regardless of whether they identify as male or not”.

Stay respectful and do what you can

Language can wound and it can heal. And it changes. Acknowledge what you don’t know, and that you may not have covered all cases.