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.

Appreciate our work?

Vote now! And help Rewire earn a bigger grant from CREDO:

VOTE NOW

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.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

Appreciate our work?

Vote now! And help Rewire earn a bigger grant from CREDO:

VOTE NOW

Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

News Law and Policy

Pastors Fight Illinois’ Ban on ‘Gay Conversion Therapy’

Imani Gandy

Illinois is one of a handful of states that ban so-called gay conversion therapy. Lawmakers in four states—California, Oregon, Vermont, and New Jersey—along with Washington, D.C. have passed such bans.

A group of pastors filed a lawsuit last week arguing an Illinois law that bans mental health providers from engaging in so-called gay conversion therapy unconstitutionally infringes on rights to free speech and freedom of religion.

The Illinois legislature passed the Youth Mental Health Protection Act, which went into effect on January 1. The measure bans mental health providers from engaging in sexual orientation change efforts or so-called conversion therapy with a minor.

The pastors in their lawsuit argue the enactment of the law means they are “deprived of the right to further minister to those who seek their help.”

While the pastors do not qualify as mental health providers since they are neither licensed counselors nor social workers, the pastors allege that they may be liable for consumer fraud under Section 25 of the law, which states that “no person or entity” may advertise or otherwise offer “conversion therapy” services “in a manner that represents homosexuality as a mental disease, disorder, or illness.”

Appreciate our work?

Vote now! And help Rewire earn a bigger grant from CREDO:

VOTE NOW

The pastors’ lawsuit seeks an order from a federal court in Illinois exempting pastoral counseling from the law. The pastors believe that “the law should not apply to pastoral counseling which informs counselees that homosexuality conduct is a sin and disorder from God’s plan for humanity,” according to a press release issued by the pastors’ attorneys.

Illinois is one of a handful of states that ban gay “conversion therapy.” Lawmakers in four states—California, Oregon, Vermont, and New Jersey—along with Washington, D.C. have passed such bans. None have been struck down as unconstitutional. The Supreme Court this year declined to take up a case challenging New Jersey’s “gay conversion therapy” ban on First Amendment grounds.

The pastors say the Illinois law is different. The complaint alleges that the Illinois statute is broader than those like it in other states because the prohibitions in the law is not limited to licensed counselors, but also apply to “any person or entity in the conduct of any trade or commerce,” which they claim affects clergy.

The pastors allege that the law is not limited to counseling minors but “prohibits offering such counseling services to any person, regardless of age.”

Aside from demanding protection for their own rights, the group of pastors asked the court for an order “protecting the rights of counselees in their congregations and others to receive pastoral counseling and teaching on the matters of homosexuality.”

“We are most concerned about young people who are seeking the right to choose their own identity,” the pastors’ attorney, John W. Mauck, said in a statement.

“This is an essential human right. However, this law undermines the dignity and integrity of those who choose a different path for their lives than politicians and activists prefer,” he continued.

“Gay conversion therapy” bans have gained traction after Leelah Alcorn, a transgender teenager, committed suicide following her experience with so-called conversion therapy.

Before taking her own life, Alcorn posted on Reddit that her parents had refused her request to transition to a woman.

“The[y] would only let me see biased Christian therapists, who instead of listening to my feelings would try to change me into a straight male who loved God, and I would cry after every session because I felt like it was hopeless and there was no way I would ever become a girl,” she wrote of her experience with conversion therapy.

The American Psychological Association, along with a coalition of health advocacy groups including the American Academy of Pediatrics, the American Counseling Association, and the National Association of Social Workers, have condemned “gay conversion therapy” as potentially harmful to young people “because they present the view that the sexual orientation of lesbian, gay and bisexual youth is a mental illness or disorder, and they often frame the inability to change one’s sexual orientation as a personal and moral failure.”

The White House in 2015 took a stance against so-called conversion therapy for LGBTQ youth.

Attorneys for the State of Illinois have not yet responded to the pastors’ lawsuit.

credo_rewire_vote_3

Vote for Rewire and Help Us Earn Money

Rewire is in the running for a CREDO Mobile grant. More votes for Rewire means more CREDO grant money to support our work. Please take a few seconds to help us out!

VOTE!

Thank you for supporting our work!