#thetimeisnow

Seriously, can we scrap the term “sexually active?” How clinical language can lead to disparities in sexual healthcare for the LGBTQ2S+ community

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Graphic by Sukaina Imam

By: Julia Healy

“Sexually active” is an awkward phrase that many of us only hear in the doctor’s office. It is used in an attempt to bridge the intimate world of sex with the clinical and professional world of medicine, which is not an inherently harmful goal.

What is harmful is that whether or not one is sexually active is often the only question concerning sexual health that is asked during a doctor’s visit. And more often than not the answer is confined to heteronormative, penis-in-vagina penetrative sex between a cis man and a cis woman.

I recently had a negative experience that sums up how the use of this clinical language can lead to misunderstandings and humiliating experiences for LGBTQ2S+ individuals like myself. After having a bizarre 25-day period, I decided to go to the doctor.  He told me that a wide variety of problems could have caused this problem. He then referred me to an ultrasound clinic for testing.

At the clinic, I filled out my paperwork and waivers. One form asked if I was sexually active and left no space to elaborate.  I had to think about how to answer; I had had sex before, but it was with another woman, so what was this form actually asking about? Possibility of pregnancy? Exposure to STIs?

I decided to check ‘yes’ since I do consider myself to be sexually active and my doctor had mentioned that an STI could be a contributor to my problem.

Once I was inside the ultrasound room, lying on a table in a hospital gown, the technician noted that I was sexually active.  She then muttered under her breath that I would need to be to to get a transvaginal ultrasound, while picking up a large internal ultrasound wand.

Not having known that being sexually active in a heteronormative sense was a prerequisite to the procedure, I decided that now was a good time to clarify. I tried to phrase my predicament as delicately as possible, so I emphasised that I had never had penetrative sex before.

The technician became very frustrated and started to interrogate me, demanding me to explain.

I thought that a medical professional who specialized in sexual healthcare would understand my phrasing. I thought that she would at least consider that different people have different types of sex.

Instead I was there, lying half-naked on a table, being yelled at by somebody who did not seem to consider sexual differences. Humiliated, I said in a very small voice, “well… I’m a lesbian.”

The technician’s demeanor instantly changed. She became less aggressive and seemed embarrassed. She left and brought back new paperwork for me and indicated that I should write that I was not sexually active and that I did not consent to the tests that I had previously consented to.

I went home frustrated about being yelled at and ultimately denied the testing that was recommended by my doctor. I decided to follow up with the clinic and while the receptionist was sympathetic and said that they would follow up with the technician, they also defended the clinic’s position by saying, that I was technically a virgin and that I shouldn’t have indicated otherwise.

This entire situation was incredibly uncomfortable for me and it could have been avoided if only the original paperwork had been clear in its questions. If I had space to elaborate on my sexual experiences in the paperwork, I would have and would have spared myself from the frustration of the technician. If I had known that penetrative sex was a prerequisite to the test, I would not have signed the consent form.

However, even with these language changes, the clinic’s penetrative sex requirement is an inappropriate policy. Everyone with a vagina should have access to reliable ultrasound tests regardless of sexual activity.  Smaller ultrasound probes that can be used with less discomfort do exist, but unfortunately, not many ultrasound clinics use them. In my city of 600,000 people, you can only gain access to a smaller probe by going to the hospital.

When discussing barriers that lie between the LGBTQ2S+ community and healthcare, it’s not just about blatantly bigoted “bad apples” who refuse to treat queer patients.  Barriers are deeply ingrained in the language that is used and assumptions that are made about a patient’s experience.

Barriers include failing to take LGBTQ2S+ experiences into account when designing medical procedures and failing to provide access medical equipment that works for all bodies, regardless of previous sexual activity.  Barriers also arise when medical staff are ill-informed about the language that groups use to describe themselves and their experiences, and when this language is challenged in a hostile way.

Sexual health is incredibly important. However, encouraging people to  take control of their sexual health only does so much if one’s identity and experiences are not incorporated into our healthcare systems.

 

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