Don't you just love a lecture? I thoroughly enjoy being preached to, especially when my feet are in cold metal stirrups and someone is probing my lady goods with lubed-up latex-covered digits. I've got a dollar if you can name a time you've felt more vulnerable than having a medical professional ask how many people you've let touch your nether regions while s/he simultaneously gives a look of disapproval... all while scraping your cervix. Lying on my back in a paper gown isn't on my list of Top Five Times You Should Disapprove Of My Lifestyle.
I have great respect for medical professionals who work constantly to protect our health and treat our ailments — especially those of the sexual variety. However, one theme I've noticed in my ten years as a recipient of reproductive health care is how medical advice can come across as criticism, and how quickly a patient can shut down once s/he feels judged. I've heard many a story about patients who have had serious questions or concerns about their health, but for one reason or another felt intimidated by or uncomfortable with their provider, thus creating a barrier to receiving the care and information they needed.
Providers do this day in and day out, so it's not that they are maliciously condemning our lifestyles. Jonanne, an Advanced Nurse Practitioner (APN), explains, "We hear so much in this business, most of it ceases to surprise us. But once in awhile you hear that one story that really takes you aback. It doesn't mean we are judging some one's character, but more trying to figure out a plan of action. If you have behavior A, how can I explain solution B so that it's meaningful to you?"
In the world of sexual health, that slight pause or uncomfortable reaction, whether real or perceived, could cause a patient to withhold information they fear might garner further awkwardness. Stigma surrounding sexually transmitted infections (STIs) can present a specific barrier to communication between patient and provider.
Ashley, 27, considers herself well-informed and sexually healthy. When she was diagnosed with herpes two years ago, she was alarmed by the insensitivity of her health care provider. "I took the sexual health classes, I had the parents who were cool with condoms. I know how to protect myself, but it still happened. The icing on the cake after an already humiliating experience was that I had a clinician who tried to make jokes, and asked if I 'drank a lot.' I assumed she was insinuating I was a party girl who bed-hopped around town, and that this is what happens to girls like that. I was so angry, I didn't even tell her I'd been... sexually assaulted when I traveled abroad. [That] is important information she should have known, but I just wanted to get my prescription and get out of there."
Trent, 20, has health professionals for parents, but still feared their reaction to his STI. "When I started having a weird discharge from my penis after a sexual encounter, I went to a local clinic. I was diagnosed with Gonorrhea, and I couldn't believe it happened to me since I use condoms all the time. I've never had sex without a condom, and this made me feel dirty. I was too embarrassed to tell [my parents] right away, but when I eventually talked to them, they were more concerned that I got treatment and proper care."
Laura, 31, found out she had HPV after an abnormal pap smear. "I'm very honest with all my providers because I figure they've heard it all, so what does it matter how many people I've slept with? When I asked [the clinician] when I contracted the virus, he looked at my chart and commented, 'It's hard to tell, you've been sexually active with X people this year alone,' before quickly leaving the room. It was a punch in the face. My doctor basically called me a slut, right there in the exam room."
"I got genital warts when I was 16," reports Al, 29. "I got the warts removed, but my doctor told me I'd have the virus forever. He emphasized how young I was, while I sat there with my pants down, and it felt like I was being told I ruined my life. I went through high school and college having a regular sex life, and I didn't tell anyone about my sexual history. If my doctor could make me feel like shit about it, girls probably would too. Weird reactions from someone who has your health in their hands is intimidating, embarrassing and caused a lot of shame for me. I finally told a serious partner who is now my wife, and I... feel really guilty about how many people I could have passed this to."
Kim Rice, Sexual Health Educator at McKinley Health Center and Certified Sexual Health Counselor, takes an interactive approach when addressing sensitive issues like STIs and sexual behavior. "I try to remember that clients are nervous and are sharing things with me that are deeply personal. Validating the client's concerns is a big part of my interactions with them. I also recognize openly with the client that they have questions because we don't provide adequate sexuality education in this country, so their questions make sense. Validation, empathy and compassion are probably what I try to do most."
Thanks to many thorough health campaigns, and the work of organizations and individuals in our community, we know that condom use, monogamy, periodic (or complete) abstinence, routine testing, and partner communication all decrease our risk of contracting STIs. Still, we get them. So how can we work with medical professionals to make sure we stay as safe as possible, but still feel comfortable seeking the care we need should something happen?
Professionals like Rice work to equip us with the information we need. "I approach my work from not only a sex positive perspective but a strengths framework too. It's a partnership. I build on the healthy behaviors the client is already engaging in, while offering ideas to help them be even more sexually healthy — whether that means with birth control, condom use, increased communication, or testing. I offer ideas and information; the client chooses what's best for them."
When it comes to STIs, the risk is real, but we can each think of a million reasons why we're not the ones who have to worry about it. Add in the perceived stigma of sexual behavior in our culture, and the fear of actually talking to a provider or our partners, and we have a guaranteed recipe for the continued perpetuation of sexually transmitted infections. As Dr. Trupin said in her article last month, "Remember, always be specific in all your requests to your doctor and ask tons of questions to be sure you are getting the proper care and treatment."
If you've had a bad experience before, or know someone who has, don't be dissuaded from demanding the care you deserve. The American Social Health Association has some great tips for talking to a provider about sexual health and risks. Also, there are several ways to report dissatisfaction with your medical experience, depending on the severity of the issue. Yes, it might be annoying, but it could clue the clinician in to a better way of providing service, or stop a provider from making additional mistakes. Jonanne, the APN agrees. "What works with one patient might not work for the next. It's a dream come true when someone says, 'I'm not comfortable answering that,' or 'So you are telling me...?' It helps me understand how they communicate, which is great when you only have a few minutes with them."
To learn more about specific STIs, or to find a testing center near you, go here.