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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“Be a doctor, Kacper.”

I’m six and he’s 63 and with hands carved by dirt and eyes worn and tired, he outlines a world of undeniable possibility, of hope, and ultimately, of love.

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“I was sick. Very sick. Right here.” He leads my tiny paw to his heart. “Hear that?”

A single bump pulses under my fingertips. It sounds like little metallic gears turning together yet there is no clicking or grinding. The single note is smooth, as though there is a solitary string being strum in one direction, then strum again before it can rebound.

“It is different than yours. Different than others, too.” It continues to pound gently. Neither up or down, the rhythm is consistent.

“I came to Canada for this. And from this, you came too.” I look up and notice that he’s smiling.

“You can do this, Kacper. For others. For anyone. For me again if I need it.”

I open my mouth, trying to find the words to tell him that his heart is healthy. But he instead says, “Let’s get some dinner.”

My hand moves away and we eat and I grow, I do, I feel and 15 years pass, and I’m standing in an emergency room. I’m holding the hand of a beloved. People are crying around me. A beep-beep is heard when the tears stop.

I am stoic against it all. It is my grandfather’s words that comfort me: there’s hope here. This is Canada after all. Doctors can make things better. They will respect you. They will care for you. And sickness will be cured, injuries will be mended, and life will return to normalcy again. The single pulse will become immutable in time.

A phone rings. It is my grandfather. His voice is pregnant with worry. Is everything is okay? Is everything okay?

I don’t answer, and time passes, and we find ourselves in a long line. No longer is there the careful weighing of words. Instead in a busy hospital packed with people, we have become meat-wagons preparing for a nameless butcher. A number is given to us, we’re sandwiched among others, we’re yelled at, and shuffled around.

Once it is our turn, a doctor comes in and says this is what we’re doing. Surgery, he says. It is the first thing he utters. We never learn his name.

We try to ask questions. He says he’s busy. We say we understand but… We’re cut off. He says he will be back later to answer our queries. We don’t see him again.

We bounce around from unit to unit. A procedure is done. A mistake is made. It happens, we’re told. The procedure is done again.

We’re furious. Our worries are passed off with rudeness. We’re burdening others with our concerns. We have become a burden, my father says.

Another doctor enters. He introduces himself. We ask how our beloved is doing. He mumbles something, dismisses our questions. “How are the X-rays?” “You wouldn’t understand them.” “How is the catheter?” “It’s a complicated situation.”

He then tells us that surgery is imperative. There is no alternative. We ask about the method, he tries to explain it. We don’t understand. He tells us he has explained the procedure enough and he was the doctor and twice was enough for him.

He left the room, and the power dynamic became relevant. We weren’t just nobodies; we were physical bodies too, and that’s all he could see. Flesh, muscle, and skeleton coming together in the wrong way. We were a problem, an aberration, a sickness and no more.

Perhaps it was just a bad few experiences because the next hospital met us with kindness and a handful of information. We could challenge findings. We could seek second opinions. We weren’t powerless under authority; we were guided by it, and thereby made all the more powerful.

This, I believe, is what is what it means to be a doctor. Having not only technical competence, but also competence in social perception, emotional receptivity, and cultural sensitivity.

This two-pronged approach is necessary for sickness does not simply injure a person’s physicality and rejuvenation is not just a bodily concern. Illness and healing alike involve the whole being of an individual. Both are the unwinding of that patient’s story; there is an assault on the entirety of a person. From a free individual to an anxious, dependent, often bed-ridden patient, they become an iota of what they were and what they saw themselves to be.

Doctors can help lead back to the consistency. Doing so means assessing the whole patient, not just treating them as some means to an end. This means introducing oneself when meeting a new patient, asking how the patient is feeling, ensuring that they understand the procedures, gauging one’s comfort, discussing particular findings, not talking down to an individual, consent is continually stressed, and ensuring that the complications are listed, and not simply discovered haphazardly.

That way a patient can be empowered, instead of feeling like a burden, or worse yet, a cow waiting for slaughter. This is necessary as patients are not just the sum of their sicknesses. In between the coughs and blood and diagnoses are those same stories - stories of peeing in Lake Ontario or eating ice-cream cakes at Dairy Queen or first kisses or last ones all the same - the pages are just curling in a moment of bad weather.

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