Multiple barriers can prevent a person with a disability from receiving a cervical cancer screening, which can detect HPV. Certain types of the HPV virus can lead to the development of cervical cancer. Access barriers to important screens include environmental, psychological, and physiological deterrents. There is also the need to help the medical community realize that people with a physical disability are in fact sexually active.
A Department of Family Medicine study examined the experiences of women with disabilities receiving a clinic-based speculum exam and an at-home self-screening test. The participants, who all identified as women, reported during interviews that the test would be more comfortable and could eliminate barriers to access.
The results of their study were recently published in JAMA Network Open in a paper titled, “Cervical Cancer Screening in Women with Physical Disabilities.” The study representatives a collaboration between numerous research and clinical faculty not only in Family Medicine, but also within the department’s MDisability program; the Department of Physical Medicine & Rehabilitation; and the Lehigh Valley Health Network in Pennsylvania.
Department of Family Medicine authors include senior author Diane M. Harper, MD, MPH, MS, and co-authors Michael M. McKee, MD, MPH, Christelle El Khoury, MD, Elizabeth Haro, MPH, Martha Alves, MPH, MSW, and Emma Butcher, MPH.
Researchers recruited 56 women to take part in the study, which included qualitative and quantitative date collection, along with the testing of two types of self-sampling tests. Among participants, 49 (92.5%) described prior negative experiences with clinician-led speculum exams, with the physical environment proving a significant contributor to women with disabilities not receiving the exam. The inconvenience of going to a clinic space was also a major barrier.
One participant talked about her inability to position her body for a speculum-based exam: “Like for me, trying to get my feet in the stirrups, I can’t do that ... because my hips are going to dislocate to the side and ... my ankle in the stirrup is probably going to go out too.”
Another participant shared her experience of physical pain and humiliation during the exam and then, after receiving a positive test, her avoidance going back for follow up care because of that experience.
In contrast, all 56 participants described how self-sampling was both comfortable and convenient and eliminated barriers such as transportation difficulties, time constraints and efforts it took to arrange accommodations for their needs.
“Many women felt that using the self-sampling kits was similar to tasks they had performed before (e.g., using tampons), which made the experience feel easier and more familiar,” the authors wrote. “Interviewees also described similarities to pregnancy tests, COVID -19 tests, and home-based colon cancer screening.
“For women who already face disabling environments in their day-to-day lives, providing the option to choose when and where to screen for cervical cancer allows them control over their health,” the authors added.
Thirty-seven of the 56 participants (66.1%) also believed self-sampling would change the likelihood of obtaining on-time screening in the future. Although the remaining 19 participants stated that they would still opt for in-office examinations, they said that they would recommend the self-sampling methods to others.
The authors noted that although the self-screening option is a popular one among participants, it doesn’t negate the fact that the medical establishment does not provide culturally competent care that considers the needs of people with disabilities.
However, the authors say that what the participants shared with them is helpful in identifying barriers to equitable care and conceiving ways to mitigate those barriers.
“Eliciting interviewees’ perspectives helps us understand opportunities for education and support so that all people using self-screening devices can be used confidently,” the authors wrote. “Clinicians must provide accurate, evidence-based information to their patients regarding the role of screening, examinations in gynecologic care, as well as information about alternative forms of cervical cancer screening, to reduce barriers to on-time cervical cancer screening.”
Article Citation: Vinson, A. H., Norrid, C., Haro, E. K., Ernst, S., El Khoury, C., Alves, M. L., Kieber-Emmons, A., Kamath Mulki, A., Butcher, E. A., Kalpakjian, C., McKee, M. M., & Harper, D. M. (2025). Cervical cancer screening in women with physical disabilities. JAMA Network Open, 8(1). https://doi.org/10.1001/jamanetworkopen.2024.57290
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