Clare Dimyon is a teacher, quaker, lesbian and rape survivor and was awarded an MBE for her work campaigning for LGBT rights.

She was recently in the news for quite an extraordinary reason. She wrote a letter to her hospital requesting a female clinician prior to attending a mammogram appointment, which is her legal right under the equalities act. She thought no more about it until she discovered that an anonymised version of her letter had been included in the Brighton and Sussex NHS Hospitals Trust transgender guidelines and described as “unacceptable” and “highly discriminatory”.

She very kindly spoke to us about her experience.

JL: Why is it important to you to be seen only by a female clinician for intimate procedures?

CLARE: How do I explain what it is like for your first experience of someone seeing you “down there” to be a man like the man who battered you and strangled you until you were close to death?

A mammogram of my breasts, which 'he' did not see and did not touch... so, yes, retaining consent about that is very precious indeed.

I used to be able to have cervical screening but am now 8 years adrift. I keep writing to Public Health England to tell them 1 in 4 no-shows is remarkably similar to the 1 in 5 women subjected to rape. I don’t understand why they ignore the crashingly obvious reason women might not be turning up.

After medical ‘misunderstandings’ that have destroyed what was left of my mental health - in which it is clear that medical people do not realise that the word ‘consent’ in ‘medical consent’ is the same word and concept that distinguishes sex from rape - I can no longer cope with male dentists or opticians. I just cannot cope with the physical proximity to them. I am more sensitive than I used to be and so I will invariably ask for female clinicians for any procedure or GP consultation unless it is by telephone.

This is NOT a choice - my last surgery had to be a female surgeon and a female theatre team and definitely not a single male nurse. Nobody thought I was making it up, I was hyper-vigilant throughout and I only just managed that. I waited three times as long for the surgery I should have. The surgeon & her team were fantastic and that really helped me after the previous awful experience. They healed me psychologically as well as taking care of the pesky gallbladder.

JL: Have you made similar requests when attending medical appointments in the past and how have they been met?

CLARE: Yes and it has *always* been respected because the words woman and female meant something, had an agreed meaning for all. In the last 12-18 months I have had to use language more carefully.

JL: The NHS are being advised to place patients on wards according to gender identity rather than sex. How would that affect you?

CLARE: I cannot possibly be in an NHS “female only” ward if female does not mean biological sex. I am horrified by the advice the NHS is now giving. Women who are becoming distraught about a transwoman who is biologically male on their ward are called transphobic? That is very likely to be the very accurate symptoms of rape-related post-traumatic stress.

I’m autistic - High Functioning Autism - so I have done the stats, and the sexual offending of transgender people is the same as biological males. If the NHS doesn't want to place transwomen on the male wards, then they need to provide an alternative space, but the last place any transwoman should be is on a female-only ward.

I would simply not go to the hospital even if that adversely affects my physical health.  PTS is chemical changes in the brain, and I’m sorry, with love and respect, the gender identification of a transwoman has no impact on the chemical changes in my brain. I wouldn't get distressed, I would have FLED the hospital.

JL: How did you find out that Brighton & Sussex NHS Hospital Trust had used your letters in their ‘guidelines’ document?

I was online one day and someone someone asked for a link about same sex NHS accommodation....and all of a sudden I am in the BSUH NHS Trans guidelines and face to face with my own letter. It completely omitted that the letter relates to a mammogram and therefore covered by the Equalities Act 2010.

My letter gives the public sector organisation the information it needs to manage the needs of two ‘protected characteristics’ (sex and gender reassignment) “sensitively”. As p38/9 of the BSUH Trans Guidelines clearly state (before they took the whole document down 10 Dec 2019) the Equalities Act 2010 places a special onus on public sector organisations to foster good relations between members of different ‘protected characteristics’.

Obviously the persons putting the document together didn’t understand the Equalities Act 2010 enough to understand they were actually breaking it by not only including my letter for my appointment but also editing out the term "mammogram".

JL: You were awarded an MBE for your work in the field of LGBT human rights. How did you feel having your requirement for a female clinician described as “highly discriminatory” and “unacceptable”?

CLARE: I describe PTS as like your shock absorbers are gone. It kind of landed in waves, then I kept being in disbelief, at times it felt like being kicked in the stomach and as though I was physically reeling. This is the NHS right? I come from a medical family, our lives revolved around patient needs and it was like being told I was a lesser human being.

Then the pure hilarity of it took over; I present myself for a mammogram and I make my needs known and the medic in front of me rings up the Equality DIVERSITY and like INCLUSION department to find out how to exclude a female rape survivor from treatment! And then it was back to being stunned again and thinking “How am I ever going to access medical care?" As with much of the rest of this debate I am perplexed and bewildered.

I have met trans-people in Ukraine and Poland and Moldova some from countries far to the East of Europe.  My ‘work’ was simply to inform myself and support people especially those who seemed most in need of support. I have never excluded trans-people as they are often the most in need. I’ve supported trans rights for 40 years.

JL: How do you think the NHS could better understand and provide for the specific needs of women who have survived male violence?

CLARE: Where would I start? Acknowledge the basic stats of the situation. Equality does not mean pretending the uni-directional nature of rape and other male sexual violence and abuse against women is not true. It is a mass cognitive dissonance that is really making it unsafe for female patients.

Awareness training for cervical screening providers and anyone in that sequence including receptionists; if a woman is asking obliquely for an appointment give her an appointment to discuss it.

It is a simple question of training. We have NHS training relating to the treatment of 200,000-500,000 transgender patients but ZERO about the 6.6M women and 165,000 men who have experienced sexual assault.

Everyone is gung-ho about mental health so how about not damaging it for avoidable reasons due to the mind boggling insensitivity of clinicians? I feel like we must be living in a parallel universe. It’s like they imagine women who have been subjected to sexual violence disappear and fall off the edge of the universe! But I have the parallel experience of being a lesbian and autistic at that so I just think it isn't fair.