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  • Writer's picturequeerhellth

Case #7

I’ve never enjoyed going to the doctor. Ironic, considering I dedicate hours every night to my molecular biology and clinical anatomy studies as part of what will ultimately be a decade’s worth of medical training.

Revealing intimate details about our bodies, lifestyle and identity can be intimidating for anybody. It’s an especially fraught experience for non-heteronormative people, who often experience substandard quality of care and health outcomes compared to other patient groups.

Earlier this year, I visited my university clinic to have an immunization form filled out as part of graduate school entrance requirements. That appointment was my first after recognizing and accepting myself as an aromantic asexual person.

The experience was jarring. As the physician went through my form, I asked her about the human papilloma virus vaccine. I hadn’t yet received that vaccine series and had read it was most effective for girls and women through age 26.

“Actually, it’s most effective before you’ve had sexual intercourse,” the physician told me. “But it’s too late for that now, so don’t worry about it.”

I froze. She’d already moved on, collating my scattered immunization records while I pondered what to say. I was 21 years old. She hadn’t asked any questions about my sexual history. What she did do was make an assumption that made me deeply uncomfortable, plus give me a reassurance I hadn’t asked for.

Was it my age that spurred the assumption? Something about my appearance? I was unsure, and even more uncertain of how she’d react if I told her about my asexuality. So I said nothing.

A 2014 survey of 86 asexual-identified people found asexual individuals have a distrust of the medical community, anticipating negative responses or dismissal from their providers upon disclosure of their asexuality. This is unsurprising, given reports of health care providers invalidating asexuality and framing it as a symptom of mental health issues. Asexual people have been told their orientation is a byproduct of trauma or a biological dysfunction. Some have been subject to corrective therapy, during which they were prescribed drugs like Viagra and told to “have sex until you like it.”

To be clear, not all asexual people are sex-averse. Some do have sex for a variety of reasons, perhaps because they are in a relationship with someone who isn’t asexual, or they simply enjoy it; asexuality refers to a lack of sexual attraction to others — or highly circumstantial and rare attraction in the case of demi- and gray-asexuals — not an inability to experience arousal. Some asexual people used to have sex and stopped when they realized that they had no interest in it; others have never had sex at all.

In health care settings, providers are responsible for understanding these nuances and working with each patient individually to meet their needs. Pressuring patients to conform to an arbitrary standard of how much sex they “should” be having is a grotesque abuse of the trust between patient and provider. It reinforces the damaging perspective that asexual people are broken and may lead to them participating in sex they do not want in an attempt to fix themselves.

The minimal visibility that the asexual community has almost invariably consists of cisgender, white and nondisabled individuals. Asexual people who are neurodivergent, experiencing mental health issues, who have disabilities, who are transgender or nonbinary, and people of color are all incredibly likely to be pathologized.

Part of the problem is the pervasive stigma against asexuality. It was only recognized as distinct from hypoactive sexual desire disorder in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, published in 2013. Comprehensive education during medical training is needed to combat the stigma and ensure that health care providers have the knowledge, skills and attitudes to properly care for asexual patients.

Unfortunately, gender and sexual minority education in medical school is lacking. A search of the Association of American Medical Colleges website provides only a few search results, which mention asexuality without further explanation. A survey of American medical students revealed that most of the sexual health education they received was in endocrinology and sexually transmitted infections.

Although curricula differ among schools, the overarching focus on preventing unwanted pregnancy and disease is founded in the notion of compulsory sexuality. It’s undeniably important material to learn, but the scope is too limited to prepare future physicians to serve increasingly diverse patient populations. Asexuality needs to be integrated into gender and sexual diversity coursework, and early clinical exposure should be provided through standardized patient encounters.

There is a serious lack of academic scholarship pertaining specifically to asexuality. What are the unique health needs of the asexual community? Are there differences in health outcomes? Which health services do asexual people use most frequently? What about barriers to health care access? These questions merely scratch the surface of information necessary to characterize a patient population, the issues that population is facing, and how best to address its members. We don’t know the answers because the data doesn’t currently exist.

Gaps in education and research are compromising the medical care that asexual people receive. They are deterring us from being honest with our providers or from accessing medical services entirely. We should feel able to freely discuss our sexuality in health care settings without the fear that providers won’t listen, will weaponize an aspect of our identity to explain the cause of our asexuality, or try to force corrective therapy upon us.

One of the very first things medical students promise during our training is to do no harm.

Stigmatizing asexuality dishonors that promise. The doctor’s office is often the most vulnerable setting for asexual people, and health care providers have an obligation to offer us competent care sensitive to our background and identity.

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