Commentary Sexual Health

Exam Rooms and Bedrooms: Navigating Queer Sexual Health

Taja Lindley

People are having all kinds of sex, regardless of how they identify their orientation; we need a health-care system that is prepared to address everyone’s questions, issues, and concerns about sex, sexuality, and sexual and reproductive health.

This piece is published in collaboration with Echoing Ida, a Strong Families project.

I’ve been giving praises for Obamacare, because for the first time in two years I have health insurance. I celebrated on January 2 with a long-overdue pap smear and sexually transmitted infection (STI) roundup.

Everything was going well, until the awkward moment I told my doctor that I’m queer.

Yes, I have sex with women.

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It wasn’t awkward for me to share that information. It was awkward to have to repeatedly ask the same questions over and over again because my health-care provider wouldn’t acknowledge my questions with direct answers.

In the exam room, I asked the nurse practitioner about STI risk and transmission. I had specific concerns about herpes and human papillomavirus (HPV). I kept emphasizing that I have sex with women and she kept not answering my questions, dodging them, and responding without directly taking on what I asked her. She went into a spiel about shame and stigma—told me not to worry about potentially contracting herpes or HPV because they’re prevalent infections and the hardest part of dealing with those infections would be the shame and stigma that accompany them, not the infection itself. While I appreciated a conversation about reducing shame and stigma, that didn’t answer my questions. I was asking about the science, the transmission. What does HPV transmission and risk look like for women who have sex with women? How risky is my sexual activity? How reliable is the herpes test? Can I get the lay of the land, the overview of STI transmission and risk for women who have sex with women? What should I be concerned about? How do I navigate safe sex? I didn’t want to ask Google, WebMD or the CDC—I wanted to get the nitty gritty in that room. Having waited two hours to get that 15-minute exam, I planned to leave with all of my questions answered.

After a lot of back and forth, the nurse practitioner finally admitted she did not know much about the subject as it relates to women who have sex with women, and directed me to another staff member who could answer my questions. Thankfully, the next health-care provider I spoke with gave me all of the information I was looking for.

But my frustration lingered as I questioned why I had to go through all of that to get some answers. I wondered why she took so long to admit that she did not feel equipped to answer my questions. Did her need to be the expert get in the way? I also thought about her other patients who may not be as persistent and demanding as I was—how would they get the information they need? Perhaps the most disturbing aspect of all this was that it occurred in a progressive, gay-friendly health clinic where I assumed everyone would have answers to my questions, and referrals for such basic inquiries would not be necessary. Surely I’m not the only woman who has sex with women who has sought their care.

Queer sexuality is not a specialty in reproductive health care. And as this recent case of woman-to-woman transmission of HIV confirmed by the CDC reveals, health-care providers need to tell their patients about the risks associated with all sex. 

Indeed, people are having all kinds of sex, regardless of how they identify their orientation; we need a health-care system that is prepared to address everyone’s questions, issues, and concerns about sex, sexuality, and sexual and reproductive health. Unfortunately, sex education and sexual health services remain within a hetero-normative context. This must change.

With the roll-out of Obamacare, thousands of previously uninsured LGBTQ folks who haven’t seen a health-care provider in years are navigating plans, finding providers, and likely going through this same trial and error that I did to find someone who gets them. Thankfully, there are resources to aid in this journey, and yet the exam room isn’t the only place where the conversation is awkward and where their questions will be sometimes avoided.

When I used to identify as straight and had sex with men, life seemed so much simpler. No condom? No sex. My mother, a registered nurse who gave birth to me at age 19 and raised me on her own, had the birds and the bees talk with me when I was in the second grade. We covered anatomy, intercourse, and the process of pregnancy and birth. And while I thank her for the early crash-course in sex education, its focus on pregnancy left out a whole lot of other information—like STI risk through other sexual activity beyond intercourse. She probably focused on pregnancy because she was concerned about me becoming a young mom too, but good intentions aside, there was a gap in my sex ed that was not filled by the public education system in metro Atlanta.

As I navigated the waters of sexual health as a straight woman, I found information relatively easy to find and health-care providers ready with answers to my questions. Public materials and ads about safe sex were everywhere—for straight people. I saw a few about men who have sex with men, but absolutely nothing about women who have sex with other women. So in 2010, when I had my first sexual experience with a woman, I was ill-equipped to have conversations around safe sex and put that into practice. My sex ed didn’t prepare me for this part of my sexual expression, and my mother didn’t anticipate her daughter being queer. (I’ll save my coming out story for another article.) So what’s a queer girl to do?

I tried to figure it out on my own. As a queer woman, I have been having the most unprotected sex I have ever had in my life. With pregnancy off the table and HIV reportedly being low risk, finger cots and dental dams were infrequently and inconsistently used. If conversations about sexual health and history happened at all, it’d be a conversation after we’ve already had sex. I became less diligent about testing and annual pap exams, and not too long after “coming out” I lost my health insurance.

Late last year I started dating a woman who is really passionate about LGBTQ sexual and reproductive health. During one of our late-night sexy calls, she interrupted to ask me about my sexual health and history and to share hers. This was the first time in my queer life that another woman initiated this conversation with me.

She was diligent about her own testing and wanted to make sure I got tested before getting intimate. We ended up becoming intimate before we shared our results and we chose to have protected sex, using dental dams and finger cots, until my results came in. My conversation with her and the open enrollment of Obamacare gave me a sense of urgency for applying for health insurance and making my doctor appointments. Although we are no longer dating, I appreciated that we had open, clear, and consistent communication about our sexual health and history, before and during our time of intimacy. It was not an experience I was used to as a queer woman. But it’s worth getting used to.

In fact, I am inspired to have more frank and candid conversations with my partners about our sexual health, history, and practices like I did when I was sleeping with men. I’m also feeling inspired to have these conversations with my queer girlfriends, sharing what I learned in my last gynecological visit, swapping stories and information, and making sure we’re all having safe and pleasurable sex. And yet it’s not all on us. As more of us get health care, we must demand that our providers are meeting our needs, in every context.

These frank conversations, in both exam rooms and bedrooms, will ensure folks ain’t out here groping in the dark.

Roundups Law and Policy

Gavel Drop: Republicans Can’t Help But Play Politics With the Judiciary

Jessica Mason Pieklo & Imani Gandy

Republicans have a good grip on the courts and are fighting hard to keep it that way.

Welcome to Gavel Drop, our roundup of legal news, headlines, and head-shaking moments in the courts.

Linda Greenhouse has another don’t-miss column in the New York Times on how the GOP outsourced the judicial nomination process to the National Rifle Association.

Meanwhile, Dahlia Lithwick has this smart piece on how we know the U.S. Supreme Court is the biggest election issue this year: The Republicans refuse to talk about it.

The American Academy of Pediatrics is urging doctors to fill in the blanks left by “abstinence-centric” sex education and talk to their young patients about issues including sexual consent and gender identity.

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Good news from Alaska, where the state’s supreme court struck down its parental notification law.

Bad news from Virginia, though, where the supreme court struck down Democratic Gov. Terry McAuliffe’s executive order restoring voting rights to more than 200,000 felons.

Wisconsin Gov. Scott Walker (R) will leave behind one of the most politicized state supreme courts in modern history.

Turns out all those health gadgets and apps leave their users vulnerable to inadvertently disclosing private health data.

Julie Rovner breaks down the strategies anti-choice advocates are considering after their Supreme Court loss in Whole Woman’s Health v. Hellerstedt.   

Finally, Becca Andrews at Mother Jones writes that Texas intends to keep passing abortion restrictions based on junk science, despite its loss in Whole Woman’s Health.

Culture & Conversation Human Rights

Let’s Stop Conflating Self-Care and Actual Care

Katie Klabusich

It's time for a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities.

As a chronically ill, chronically poor person, I have feelings about when, why, and how the phrase “self-care” is invoked. When International Self-Care Day came to my attention, I realized that while I laud the effort to prevent some of the 16 million people the World Health Organization reports die prematurely every year from noncommunicable diseases, the American notion of self-care—ironically—needs some work.

I propose a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities. How we think about what constitutes vital versus optional care affects whether/when we do those things we should for our health and well-being. Some of what we have come to designate as self-care—getting sufficient sleep, treating chronic illness, allowing ourselves needed sick days—shouldn’t be seen as optional; our culture should prioritize these things rather than praising us when we scrape by without them.

International Self-Care Day began in China, and it has spread over the past few years to include other countries and an effort seeking official recognition at the United Nations of July 24 (get it? 7/24: 24 hours a day, 7 days a week) as an important advocacy day. The online academic journal SelfCare calls its namesake “a very broad concept” that by definition varies from person to person.

“Self-care means different things to different people: to the person with a headache it might mean a buying a tablet, but to the person with a chronic illness it can mean every element of self-management that takes place outside the doctor’s office,” according to SelfCare. “[I]n the broadest sense of the term, self-care is a philosophy that transcends national boundaries and the healthcare systems which they contain.”

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In short, self-care was never intended to be the health version of duct tape—a way to patch ourselves up when we’re in pieces from the outrageous demands of our work-centric society. It’s supposed to be part of our preventive care plan alongside working out, eating right, getting enough sleep, and/or other activities that are important for our personalized needs.

The notion of self-care has gotten a recent visibility boost as those of us who work in human rights and/or are activists encourage each other publicly to recharge. Most of the people I know who remind themselves and those in our movements to take time off do so to combat the productivity anxiety embedded in our work. We’re underpaid and overworked, but still feel guilty taking a break or, worse, spending money on ourselves when it could go to something movement- or bill-related.

The guilt is intensified by our capitalist system having infected the self-care philosophy, much as it seems to have infected everything else. Our bootstrap, do-it-yourself culture demands we work to the point of exhaustion—some of us because it’s the only way to almost make ends meet and others because putting work/career first is expected and applauded. Our previous president called it “uniquely American” that someone at his Omaha, Nebraska, event promoting “reform” of (aka cuts to) Social Security worked three jobs.

“Uniquely American, isn’t it?” he said. “I mean, that is fantastic that you’re doing that. (Applause.) Get any sleep? (Laughter.)”

The audience was applauding working hours that are disastrous for health and well-being, laughing at sleep as though our bodies don’t require it to function properly. Bush actually nailed it: Throughout our country, we hold Who Worked the Most Hours This Week competitions and attempt to one-up the people at the coffee shop, bar, gym, or book club with what we accomplished. We have reached a point where we consider getting more than five or six hours of sleep a night to be “self-care” even though it should simply be part of regular care.

Most of us know intuitively that, in general, we don’t take good enough care of ourselves on a day-to-day basis. This isn’t something that just happened; it’s a function of our work culture. Don’t let the statistic that we work on average 34.4 hours per week fool you—that includes people working part time by choice or necessity, which distorts the reality for those of us who work full time. (Full time is defined by the Internal Revenue Service as 30 or more hours per week.) Gallup’s annual Work and Education Survey conducted in 2014 found that 39 percent of us work 50 or more hours per week. Only 8 percent of us on average work less than 40 hours per week. Millennials are projected to enjoy a lifetime of multiple jobs or a full-time job with one or more side hustles via the “gig economy.”

Despite worker productivity skyrocketing during the past 40 years, we don’t work fewer hours or make more money once cost of living is factored in. As Gillian White outlined at the Atlantic last year, despite politicians and “job creators” blaming financial crises for wage stagnation, it’s more about priorities:

Though productivity (defined as the output of goods and services per hours worked) grew by about 74 percent between 1973 and 2013, compensation for workers grew at a much slower rate of only 9 percent during the same time period, according to data from the Economic Policy Institute.

It’s no wonder we don’t sleep. The Centers for Disease Control and Prevention (CDC) has been sounding the alarm for some time. The American Academy of Sleep Medicine and the Sleep Research Society recommend people between 18 and 60 years old get seven or more hours sleep each night “to promote optimal health and well-being.” The CDC website has an entire section under the heading “Insufficient Sleep Is a Public Health Problem,” outlining statistics and negative outcomes from our inability to find time to tend to this most basic need.

We also don’t get to the doctor when we should for preventive care. Roughly half of us, according to the CDC, never visit a primary care or family physician for an annual check-up. We go in when we are sick, but not to have screenings and discuss a basic wellness plan. And rarely do those of us who do go tell our doctors about all of our symptoms.

I recently had my first really wonderful check-up with a new primary care physician who made a point of asking about all the “little things” leading her to encourage me to consider further diagnosis for fibromyalgia. I started crying in her office, relieved that someone had finally listened and at the idea that my headaches, difficulty sleeping, recovering from illness, exhaustion, and pain might have an actual source.

Considering our deeply-ingrained priority problems, it’s no wonder that when I post on social media that I’ve taken a sick day—a concept I’ve struggled with after 20 years of working multiple jobs, often more than 80 hours a week trying to make ends meet—people applaud me for “doing self-care.” Calling my sick day “self-care” tells me that the commenter sees my post-traumatic stress disorder or depression as something I could work through if I so chose, amplifying the stigma I’m pushing back on by owning that a mental illness is an appropriate reason to take off work. And it’s not the commenter’s fault; the notion that working constantly is a virtue is so pervasive, it affects all of us.

Things in addition to sick days and sleep that I’ve had to learn are not engaging in self-care: going to the doctor, eating, taking my meds, going to therapy, turning off my computer after a 12-hour day, drinking enough water, writing, and traveling for work. Because it’s so important, I’m going to say it separately: Preventive health care—Pap smears, check-ups, cancer screenings, follow-ups—is not self-care. We do extras and nice things for ourselves to prevent burnout, not as bandaids to put ourselves back together when we break down. You can’t bandaid over skipping doctors appointments, not sleeping, and working your body until it’s a breath away from collapsing. If you’re already at that point, you need straight-up care.

Plenty of activities are self-care! My absolutely not comprehensive personal list includes: brunch with friends, adult coloring (especially the swear word books and glitter pens), soy wax with essential oils, painting my toenails, reading a book that’s not for review, a glass of wine with dinner, ice cream, spending time outside, last-minute dinner with my boyfriend, the puzzle app on my iPad, Netflix, participating in Caturday, and alone time.

My someday self-care wish list includes things like vacation, concerts, the theater, regular massages, visiting my nieces, decent wine, the occasional dinner out, and so very, very many books. A lot of what constitutes self-care is rather expensive (think weekly pedicures, spa days, and hobbies with gear and/or outfit requirements)—which leads to the privilege of getting to call any part of one’s routine self-care in the first place.

It would serve us well to consciously add an intersectional view to our enthusiasm for self-care when encouraging others to engage in activities that may be out of reach financially, may disregard disability, or may not be right for them for a variety of other reasons, including compounded oppression and violence, which affects women of color differently.

Over the past year I’ve noticed a spike in articles on how much of the emotional labor burden women carry—at the Toast, the Atlantic, Slate, the Guardian, and the Huffington Post. This category of labor disproportionately affects women of color. As Minaa B described at the Huffington Post last month:

I hear the term self-care a lot and often it is defined as practicing yoga, journaling, speaking positive affirmations and meditation. I agree that those are successful and inspiring forms of self-care, but what we often don’t hear people talking about is self-care at the intersection of race and trauma, social justice and most importantly, the unawareness of repressed emotional issues that make us victims of our past.

The often-quoted Audre Lorde wrote in A Burst of Light: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

While her words ring true for me, they are certainly more weighted and applicable for those who don’t share my white and cisgender privilege. As covered at Ravishly, the Feminist Wire, Blavity, the Root, and the Crunk Feminist Collective recently, self-care for Black women will always have different expressions and roots than for white women.

But as we continue to talk about self-care, we need to be clear about the difference between self-care and actual care and work to bring the necessities of life within reach for everyone. Actual care should not have to be optional. It should be a priority in our culture so that it can be a priority in all our lives.