By: Noeka Nimmervoll, Staff Writer
Content warning: References of sexual activities.
The wrinkling of paper underneath you as you sit atop the patient’s table. A cold stethoscope against your skin. The question, “are you sexually active?” These are all part of a regular doctor’s appointment, but one can be exclusionary if it’s being asked by someone who has a narrow and heteronormative understanding of sex.
In the wide spectrum of human intimacy and relationships, what counts as sexually active?
It seems the definition is different for everyone, and this reality is not reflected in a doctor’s checklist. For health-care to be truly inclusive, doctors should be more specific about what they mean when they ask, “are you sexually active?”
Doctors ask about sexual activity ultimately with the patient’s best interests in mind, but they do not make it clear how you should answer — what kind of sexual activity is being asked about? It’s important to have conversations about using condoms to prevent STIs in penetrative anal sex between men, or using dental dams when having oral sex. It is easy to withhold valuable information if you assume that your doctor is asking about penetrative vaginal-penile sex, when that doesn’t apply to you! Perhaps you are straight, but you masturbate, or you prefer fingering with your partner(s). Being honest about how you are sexually active opens up conversations about contraceptives, screening for STIs, and vaccines for HPV, among other things. Additionally, if you are showing symptoms of a yet-to-be-diagnosed condition, information about your sexual health may be the piece of information needed to understand what’s going on. However, when treated like a binary “yes or no” question, instead of a conversation, your individual identity and sexual experiences are undermined, and have the potential to prevent you from receiving quality health-care. Among the many different reasons for doctors to understand a patient’s sexual health, some are only applicable to certain types of sex. For example, the doctor might be inquiring about your sexual activity to assess which contraceptive to recommend to you — which is only applicable to certain kinds of penetrative sex. The vagueness of asking “are you sexually active?” may limit honesty between patients and healthcare professionals, and disproportionately affect marginalized communities.
Sexual health education is part of the BC school curriculum, but it is often based in heteronormative assumptions, impacting doctor-patient relationships. Everybody has their own experience with sex education, but mine memorably involved a timed game of put-the-condom-on-the-banana, and did not discuss 2SLGBTQIA+ experiences and sexual health. Personally, I got my queer sex ed from Glee and my friends, but it shouldn’t be on the individual to fill in the blanks about what a system should already be teaching. This heteronormativity that guides our sexual education is reflected in the doctor’s office by making 2SLGBTQIA+ individuals feel less visible. People who need to “come out” to their doctor must overcome more barriers, including social stigma, vulnerability, and fear around patient-doctor confidentiality, to access the same medical care as their cisgender, heterosexual peers.
I recognize that this question becomes more personal and invasive the more specific we get. But this question itself is aged and heteronormative, and it heavily excludes 2SLGBTQIA+ communities and countless people who partake in outercourse. I know it may seem like a small thing, but words matter, and they reflect the broader culture of exclusion and heteronormativity. By properly explaining the definition of sexually active, people have better opportunities to discuss and improve their sexual health.
