Medical Care Shouldn’t Require Magic Words

*sigh*  This article link has been sitting in my bookmarks page for over half a year, but I hadn’t managed to post it yet because reading the article infuriated me so much that I couldn’t come up with anything constructive to blog about it in context.  But here goes.

“‘Magic Words’ Required at the Catholic STI Clinic” comes from the backlogged files of Carnal Nation and is a serious indictment of religious-based medical organizations.  I try not to hate on the religious sector of the country, despite a generally acknowledged antagonism between religious doctrine (not just Christian, but most religions) and my sex-positive morality, because I find that most people subscribing to religious beliefs do not advocate for the kinds of practices that I find abominable.  Most religious people are wonderful, friendly, and caring.

BUT religious institutions I often have a much bigger problem with.  In this particular article. Megan Andelloux, a sex educator and certified sexologist, volunteered for perhaps the least pleasant of all volunteer opportunities- to be a dummy for clinicians to practice giving gyno exams.  During the course of this volunteer experience, one of the doctors asks a fair question:

“…while a brave soul slides on a fresh pair of gloves to conduct the second exam, I hear a question asked by one of the other professionals. “At what point do you take a Pap smear?” The veteran facilitator’s shoulders subtly raise and she quietly answers, “This is a Catholic-based hospital.”

This is, of course, not a satisfactory answer to Andelloux, so later in the workshop, she returns to the clinician’s question.

“You mentioned that this was a Catholic teaching hospital when someone asked about performing a Pap smear. What exactly does that mean?”

She looks slightly defeated by my question…..  “This STI unit is funded by a Catholic hospital. Therefore, we don’t conduct Pap smears because that type of testing doesn’t fall in line with family values and abstinence only until marriage.” The room goes dead silent. She said it, and in doing so, messed up everyone’s head. We’re all thinking, “This is an STI clinic, a medical group that tests for Gonorrhea and Chlamydia, treats herpes and genital warts, but does not conduct Pap smears because they believe it goes against their religion (and therefore the hospital’s) values?!”

Andelloux uncovers through this conversation a series of problems with a medical system that does not adequately separate religious doctrine from medical practice and care.  Not only do STI clinicians there not do pap smear exams to test for cervical cancer, they do not even INFORM their patients that they are not running these tests.  Moreover, the same clinic refuses to administer birth control for the use of pregnancy prevention, even though that is one of the chief roles of an STI and sexual health facility.

Now I acknowledge that every person is entitled to their own religious beliefs, and that includes the desire to abstain from sex until marriage.  But when an institution imposes these beliefs on patients, who may or may not know:

1. What risks they run and thus, need to be tested for
2. What medical care they are entitled to

then the institution is engaging in medical negligence.  When a patient may contract HPV and not know it or be forced to abort or carry to term an unintended pregnancy because she could not access adequate medical treatment and care, it is no longer a question of religious morals, but of medical obligation to provide the services that would prevent these things from happening.

This whole practice stinks of the debate raised by Pharmacists for Life around 2008, when some pharmacies began refusing to fill birth

Is this offensive? Good- it should be.

control prescriptions or take orders for Plan B medication.  I was similarly outraged then, especially as the daughter of a pharmacist (raised Catholic, nonetheless!) who has gone to all lengths to ensure than his patients are safely treated with the medication that will protect their health and wellbeing.  It is NOT the prerogative of any medical professional- be they a doctor, nurse, pharmacist, or surgeon, to use morality to justify the refusal of medical care to a patient…

See, and there I go ranting again.  There are just so many things wrong with this picture.  The founding fathers saw fit to be clear about the separation of church and state in our constitution, and I believe that applies not only to government and schools, but to all civil institutions, including hospitals and pharmacies.  I want to see a world where, at the very least, getting tested at a clinic or filling a prescription for plan B will be about the patients needs and not the desires of the doctor.

Trans-initiative

Now that the first of my group of friends have officially settled down and started having kids, I’ve begun thinking more about the obstacles faced not only by younger LGBT people, but by their parents as they try to navigate an intolerant and often resource-deprived world for their LGBT kids.

A couple of months ago, I stumbled upon Gender Spectrum, a support, counseling, and education community for parents ofgenderqueer/trans/questioning kids.  They host a conference every year on the subject, as well as offering online resources for parents to peruse.  This is a very good start, but it’s shortcoming lies in the same place that most LGBT services fail- they only offer information to parents who ACTIVELY seek it out.  In today’s world, 99% of the time, a parent-to-be is more concerned about a myriad of other issues- prenatal vitamins, getting a bedroom prepared for the baby, regular sonograms and checkups, the pain of delivery, etc- that gender identity issues are not something they plan to self-educate about.    Reasonable?  Yes.  Problematic when the doctor tells you that your baby has ambiguous genitalia and will operate to “repair” your baby’s equiptment and you haven’t read a thing about the subject.  MAJORLY.

There are so many aspects of maternal health and preparation that have become rote in today’s society; mothers read “What to Expect When You’re Expecting,” take lamaze classes, and learn about how to feed and care for their child.  Wouldn’t it make sense to start gender counseling at this critical stage?  Perhaps it’s a sensitive issue to broach- no one wants to believe their child will turn out “abnormal,” but with widespread educational programs aimed at eradicating stereotypes and educating parents, the ideas of normal/abnormal should slowly dissolve, right?

I’d love to hear some other takes on this idea, but also please use this space if you have other resources to share with LGBT people and their parents about these tough issues.

(In other news, I’m off to Kenya in T- 3 days!  Hopefully I’ll get one more post in before then, but otherwise, I’ll see you in 4 months!)

A Transperson Walked into a Doctor’s Office…

This really is the beginning of a bad joke. For those of us privileged enough to have been born with a body that matches our internal gender identity, it’s hard to comprehend the difficulties that many trans and transitioning people must go through in order to align their physical and mental genders.  For those who choose to transition, there are hormones, surgeries, and legal battles to fight, visits to psychologists and extensive, rigorous hurdles to simply being given the medical o-k to have any sex-reassignment operations.

For those who choose not to transition (0r not to do so fully with the actual reassignment surgery), there are intense more intense legal issues, social misunderstanding, and terrible discrimination in the healthcare system.  Because of the deep-seated prejudice and lack of understanding that most Americans have for the needs and complications associated with translife, many doctors simply have no idea how to care for transpeople.  Not only do they lack a personal familiarity with the issue of transgenderism, but their training in medical school was largely centered around a binary understanding of gender and before many of the latest medical breakthroughs in sex-reassignment were made.  On top of that, many people are simply repulsed by anything non-normative and deny transpeople care because of their prejudice.  A really good article about that here.

As the article explains, there are two types of transgender specialties in the medical field: transitioning health care(hormones, surgeries, counceling, etc. aimed at helping a person change their bi0logical sex) and care of non-normative bodies (people with either ambigious genetalia/ intersex persons, people who are using hormones but don’t intend to fully transition, and so on).

On of the greatest misconceptions about transpeople is the understanding that you cannot be trans unless you have or intend to undergo sexual reassignment surgery.  As I have said before, this is clearly not true.  There are many people out there who identify as trans who are very comfortable simply cross-dressing, or only undergoing chest surgery, without the genetalia to match.  And there’s nothing wrong with that.

This article, “The Operative Word” does a good job unpacking some of the assumptions about transpeople and surgery.  I highly suggest you read it.

And to wrap up, this is a lovely interview with a transman from Boston, where he explores the way perspective and emotions change as one transitions from female to male.

Stay queer, cool kids.

Doctor, Doctor…I Got A Bad Case of Lovin’ You

Did you ever “play doctor” when you were a kid?  Ever get caught?

I love this exchange between a mother and her doctor published by Carnal Nation about young kids’ sexuality.

The door was closed.
Did you knock?
No. She’s never closed her door before.
Oh. I guess the closed door meant something to her.
They jumped when I walked in.
Well, you interrupted them.
They looked guilty.
Since your attitude was that you “caught” them, I guess they felt “caught.

The full exchange is here: http://carnalnation.com/content/58503/98/catching-your-kid-playing-doctor

The brilliant thing about this conversation is the way it puts kids behavior into a conscious context.  5 year olds know things.  They learn and understand the world based on millions of sources of input, including TV, advertising, conversation they overhear from parents (and their parents’ friends!), and through playmates.  Children do not remain blank slates forever, and parents do not selectively insert ideas and practices into their absorbent brains as they so choose.

So it’s perfectly normal that children play doctor, that they are curious about social rules that have been instilled in them without any explanation.  ”No, don’t touch Jimmy there.”  Well, why not? “Because he’s a boy, and we don’t touch little boys there.”

Face it, parents are really bad at giving explanation for these seemingly senseless social rules that they inflict on their children, so their kids are bound to utilize their own means for understanding them.  Well, if doctors can look and touch little boys there, maybe I just have to be a doctor and I’ll figure out what’s so weird about that. The game is a research method- a tool for understanding biological and social ideas that are very difficult and awkward to spell out to a small child.

Playing doctor might be sexual…and it might not be.  The curiosity of young children knows no bounds, and maybe discoveries from playing doctor lead to other “socially unsavory” games like playing “married,” yet once again, this isn’t always a bad thing.  If children are able to explore their own bodies and sexualities when they are young and in a safe place, without the shame of embarrassment or the need to hide their practices, they’ll grow into healthier functioning adults.

And that’s a pretty good prescription for a 5 yr. old, isn’t it?

Use a Vibrator, Live Longer!

Well, not really…

An interesting study done by Indiana University students found that using a vibrator is closely correlated with better sexual functioning and being proactive towards ones sexual health.  Respondents who said they used a vibrator regularly scored higher in many areas of sexual function, including ease of orgasm, desire, level of arousal.  And this will make health care providers smile-  Vibrator users were significantly more likely to have had a gynecological or testicular exam during the past year.  Full article here: http://newsinfo.iu.edu/news/page/normal/10877.html

Now I love sexology studies and all that they provide to enlighten us about human sexual behavior and health, but one thing a study like this can’t do is confirm causality.  For instance, vibrator use and getting an OB/GYN exam are correlated according to the statistics gathered in this IU study, but why?

Here’s my sex-positive hypothesis:

People who are comfortable enough with their own sexual agency and their desired to go out and buy a vibrator are also probably more aware of their own sexual health issues.  They probably pay more attention to their bodies and notice when something goes wrong.  People who use vibrators have acknowledged that they are sexual beings and thus have a more positive outlook on sexual health and the necessity of gynecology work.

On the level of basic sexual functioning, I think the connection is even easier to make.  Healthcare providers across the country have been suggesting vibrators as a safe, non-invasive way of treating sexual dysfunctions for years.   Vibrators teach your body how to respond.  So people who use a vibrator, either on their own or with their partner, know what their body does and how it reacts to all sorts of stimuli, making it easier for them to simply relax and enjoy sex.   And these statistics and associations apply to men (who use vibrators much more often than societal convention would have you believe) as well as women!

The Problem With Doctors

As the daughter of a nurse midwife and a pharmacist, you could say I live in a “medically privileged household.” My parents can treat burns, diagnose tonsillitis, prescribe antibiotics, and generally serve all medical needs short of major surgery.  But even in my modern, medically-knowledgeable family, there were giant holes in the information I received about sex, sexuality, and identity.  And despite my mother’s 25 years as a nurse-midwife, working tirelessly to help women understand their bodies and how to care for themselves, she was frustrated by her inability to help when I told her that sex was painful and unpleasant for me.  She referred me to a sex therapist, scheduled me an appointment at her old practice, the Midwife Center (which is one of the last accredited outposts of holistic health in the US), and did everything she could to help me.  Considering how progressive and proactive a stance my mother took still without result, you can only imagine how such a story unfolds elsewhere.

The problem for me, it turns out, wasn’t just physical- retroverted cervix aside…- it was also mental.  My pain derived both from internal mental pressure (to orgasm, to enjoy sex, to NOT BE SUPER AWKWARD- which failed **I will note that my mother DID address this!) and from a lack of sexual attraction to my partners.  Medical doctors and therapists had both asked me “Well, are you aroused?  Is entry painful? et. al., but they were unable to tease apart the psychological constructs of romantic attraction from sexual attraction.  Because, hell, I wanted to have sex- just…not with men, it seems.  Anyway, point being that the people I asked weren’t able to help me because they didn’t have the background in the mental and emotional aspects of sexuality and identity- they only have the medical.

One word I’ll toss around a lot in this article (and blog in general) is sex positivity.  Carnal Nation’s Carol Queen wrote a wonderful article, “Elements of Sex-Positivity,” on what exactly this means, but in essence, sex positivity is a lot like how it sounds: positive enforcement of safe, consensual exploration of sex.  Sex positivity is about open-mindedness.

Sex positivity means you acknowledge that sex is, or could be under the right circumstances, a positive, healthy force in anyone’s life… even if it isn’t right now. Those circumstances may not be the same for everyone (though some may be universal, like consent), but they include things like access to information, support, condoms (if relevant), a loving (or at least friendly) partner, healing from past negative sexual experiences like rape or abuse, privacy, enhanced self-esteem, etc.

Unfortunately, most doctors don’t get this lecture in med school.  They can tell us about STDs and how conception occurs; they can detail fetal development and diagram our anatomical anomalies, but they can’t explain the way our bodies react to things our minds find arousing.  Doctors are completely in the dark when it comes to our body-mind interaction and the complexities of gender and attraction.

Another fantastic Carnal Nation article gives A Sex Prescription for Doctors, because as it stands now, the medical profession is ill-equipped to handle the multitude of ways we think and feel about sex.

..There are about a jillion physicians who don’t know the first thing about sexual products, masturbation, the clitoris, what the foreskin would do for a man’s sexual pleasure if it weren’t removed by circumcision, what sexual effects hormone replacement therapy is likely to create in a menopausal woman (or the effects of hormones in a transgendered man), and all the other tens of thousands of sex or gender questions people might have for their physicians.

In terms of sexual behavior, teens and even adults have become their own teachers.  They have jumped into uncharted waters to explore because society has refused to give them real, comprehensive, sex-positive guidelines.  Can you imagine how a story like mine might have differed if our gynecologists, instead of asking if we were using birth control, started by asking if we were ENJOYING sex?  And god forbid, if we actually had the relationship with our medical care providers that a conversation as such would seem normal!

When I hit puberty, my PCP recommended an inane book akin to those used for middle school health classes- I was nearly in tears.  I couldn’t verbalize how insulting, how demeaning her suggestion felt to me.  It seemed as if she was telling me that I didn’t know my own body.  I’d had the lectures on hormones and secondary-sex characteristics.  I understood my body, but I had NO IDEA what to do with it.  And frankly, I don’t think my doctor knew either- if she did, she certainly wouldn’t tell me.

This going-in-blind model, created by a lack of health care provider knowledge and patient-doctor dialogue, instills constant guilt in teenagers- guilt they often carry into adulthood.  Now that’s hardly the model we want for a well-adjusted, sex-positive society!

And the story only gets worse as we begin to touch the tougher questions, those that approach before we become teens, before we begin to think for ourselves.  Issues of gender identity often arise as early as 3-4 yrs. old.  If a preschool boy insists on wearing dresses and playing with dolls, what will a doctor tell the parents to do?  Most, even in today’s relatively progressive society, will tell them to put him in overalls and take the dolls away.  They don’t have comprehensive training in these issues.  They simply know what seems normal or abnormal to their sociological paradigm, and that’s no basis for a medical or psychological decision at all.

The Edge DC wrote a piece recently called “When is Too Early to Change Genders?” which puts this struggle into perspective, especially considering the harassment, disrespect, and often familial disapproval that transgendered teens are subjected to.  On top of that, most health care providers have little, if any experience dealing with transgendered and/or transitioning kids, much less with gender non-conforming kids (outside of the gender binary completely) who may be feeling (but unable to express) states of being which English hasn’t even termed yet.  How can responsible caregivers diagnose and help kids and teens who understand their gender in a way science and medicine haven’t caught up with yet?

The only effort I’ve seen so far made towards rectifying these problems has been through the National Sex Forum and the Institute for Advanced Study of Human Sexuality’s SAR series.  SARs, or Sexual Attitude Restructuring program, is described by one of its leaders Amy Marsh as “an immersion course designed for sexologists and other helping professionals. The idea is to leave your comfort zone, discover your buttons, process all kinds of things you’d never thought you’d see or even hear about, and come out the other side with a better understanding of the really enormous range of human sexual behavior”

SARs run through the gamut of sex-related materials, from porn to erotic fiction to Good Morning America investigative specials.  Though amazing for their focus, the extent to which SARs cover issues of gender identity and expression however, is limited (probably because they’re two separate things, duh), and I don’t know of any professional organizations or workshops which do.  Of course, my knowledge in this area is, again, sorely lacking. I apologize to any trans readers out there- I suck at finding gender identity information.  Boo.

My mother, in talking to me about my blog, said “It’s crazy how your generation knows more about these issues than people who’ve been having sex for way longer.”  And that is both true and unfortunate.  Overall, despite the success and growing scale of SARs, the medical world (and society in general) still has a lot to learn if they want to help a new, younger, more open generation deal with their sexual and developmental health.