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.