February 16, 2013

IconComing out to doctors: is it good for our (sexual) health?

The speculum and I have become so well acquainted of late that I have considered adding it to my list of sexual partners.

It is not, however, the speculum, the swabs, or the undignified feet-on-stirrups position that has caused me the most discomfort on these occasions; It is the health professionals’ assumption that I am straight.

Awkward conversations at the Sexual Health Clinic

The first encounter went like this:

Doctor: “Any pain during sex?”

Me: “No.”

Doctor: “Any bleeding before or after sex?”

Me: “No.” (by this point I even felt that I was somehow deceiving the doctor into thinking that I was straight)

Doctor: “What contraception are you on?”

Me: “Er, none; I’m gay.”

Doctor: “Oh right…”

To my shame, the second encounter with a different doctor went like this:

Doctor: “Are you sexually active?”

Me: “I’m gay, does that count?”

In this instance, I wanted to pre-empt any heterosexual-exclusive questions that would lead me down the path the first doctor squeezed me down. Better to get it over with.

The problem was that I needed to communicate that, yes, I am sexually active, but please don’t ask me questions about penises because my answers will inevitably mislead you. So, I’m going to throw in that I’m gay, even though you didn’t ask, to save us both some embarrassment.

Third encounter with yet another doctor:

Doctor: “Do you have a long-term sexual partner?”

Me: “Yes, I have a female partner.” (By now, I was becoming a pro)

Doctor: “Are you having penetrative sex?” (Translation: what is it that lesbians do in bed?)

Invisibility of lesbian and bisexual women in the NHS

I have come out to four doctors, two nurses, one sexual health worker, and one machine in recent months and only one asked me what my sexuality is; it was the machine.

Doctors failed to acknowledge my ‘coming out’ and often quickly changed the subject. I might as well have told them that I was a unicorn.

Their response reminded me of something Leonard Woolf’s mother said about The Well Of Loneliness: “Until I read this book, I did not know that such things went on at all. I do not think they do. I have never heard of such things.”

It is one thing to assume a patient is straight (in this case, the doctor is hedging their bets, plumping for straight simply because it is statistically more probable.)

It is quite another to render a minority group invisible simply because you have not even entertained the possibility of their existence. I believe that, in my case, it was the latter. I felt like The Invisible Woman rather than the four-leaf clover.

Institutionalised exclusion of lesbians and bisexual women

I am not alone in highlighting the invisibility of lesbians and bisexual women within sexual health services. A report commissioned by the NHS Cervical Screening
Programme in 2009 states:

The Health Protection Agency does not routinely collect data on lesbian and bisexual women… neither the National Strategy for Sexual Health and HIV (DH, 2001) or the recent update (IAG, 2008) includes reference to lesbian or bisexual women.

Re-thinking the risks of STIs and cervical cancer

Some writers claim that the idea that lesbians and bisexual women are at a lower risk of contracting STIs is chiefly the result of their exclusion from sexual health research.

The dearth of data in this area means that doctors just don’t know and are likely to misinform their patients about the risks of STIs and cervical cancer (the report even featured lesbians whose doctors denied them cervical screening because they considered it unnecessary).

This inaccurate perception of risk, added to other barriers to healthcare, such as heterosexual assumptions, mean that lesbians and bisexual women were ten times less likely than heterosexual women to have had a cervical screening in the past three years.

Ironically, the greatest risk factor for cervical cancer is not sex with men, but not being screened.

The NHS needs to honour their duty of advancing equality of opportunity for lesbians and bisexual women; our health is at stake.



4 Responses to Coming out to doctors: is it good for our (sexual) health?

  1. AJ says:

    I’ve had similar experiences at the sexual health clinic. I find it surprising that heterosexuality is assumed in a sexual health clinic of all places!

  2. Gabs says:

    I know how you feel i have a disability and just because i am incapable of walking that makes me straight well no disability doesn’t just covers the able-bodied straight community. so many doctors have asked about male partners and so have ignored me for just being female in general what is the world coming to.

  3. christine Sowden says:

    I remember the first time the doctor asked me those questions and it killed me not to tell her. I kept asking myself why she just assumed I was straight. I think the medical association and health care facilities have a responsibility to change the questions that doctors ask and train doctors not to assume anything. Ask questions that open up dialogue not ones that push us further back into a closet we worked so hard to come out of. Fortunately times are changing and as an adult I don’t worry about what anyone thinks. I just hope our younger generation has the courage to come right out with it. If they won’t take the initiative, then we will blaze the trail until they catch up.

  4. j t says:

    Its so awkward once they have already made the assumption to find the best way/time fot correcting them. My partner is a dr herself and thankfully had oodles of communication training, learning to never assume anything. She finds it amazing how many of her colleagues fail to transfer that thought away from patients and into general life-she had to correct ‘boyfriend’ to ‘girlfriend’ on far too many occassions.