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.