Your Doctor Needs To Know

In 2016, when I was 40 freaking years old and a divorced mother of three, I had a doctor tell me I should not consent to having barrier-free sex with anyone who didn’t have to pay to get rid of me [cringe]. She said this to me as we were wrapping up my annual exam and my semiannual STI panel, during which I’d mentioned having made the decision to stop using barriers with a sexual partner of mine. I spent about five seconds in a state of speechlessness and then asked her if she was open to some feedback on that opinion. She indicated she was, which was fortunate, because she was going to hear what I had to say regardless of her willingness.

I reminded my doctor that this particular partner already had someone he’d have to pay to get rid of, (this means “married to” in case you’re not following), and that I didn’t think I’d ever be in that position again with anyone. I told her that I saw her bit of unsolicited advice as incredibly mononormative and as such, it didn’t apply to me. Additionally, I wasn’t simply consenting to this: I wanted it. Oh wonder of wonders . . . it’s not always some guy pressuring some gal into ditching condoms *eye roll.* I went on to inform her I intended to continue to decide whether or not to use barriers with folks based on my comfort level with their sexual practices and that I may do so with more than one person at a time.

I wanted the ability to be transparent about that with her so I could receive the best medical care for my situation.

To her credit, she was quick to reconsider what she’d said and apologize. She also thanked me for calling her out on it. Her acceptance of my assertions and validation of my concerns meant I retained her as my primary care physician for as long as she practiced at my clinic. Had she not, I would have found someone else to provide my medical care.

After all, doctors are service providers, and if I don’t like how they treat me I will find someone who is a better fit.

When I started seeing a therapist a couple years ago, I told him I was non-monogamous, queer, and identified as non-binary in terms of gender. I also told him I needed a therapist who was not only tolerant of those things, but supportive and encouraging. I didn’t see a productive future in therapy with anyone I’d have to talk into accepting me. He, too, thanked me for that direct assertion. This was important to me because it empowered me to hold him accountable for anything that did not feel supportive in that regard. Therapists, too, are service providers.

In the greater non-monogamous community, I witness a lot of fear around being “out” in society. Some of this is a fear of rejection by family, friends, or social communities. Others risk losing their children in adversarial custody battles, or their jobs under morality clauses. But I see this fear leading to remaining closeted with medical providers, and that means folks aren’t receiving the best care for their lifestyles.

It’s important to remember your doctor cannot report any details of your care to your employer or ex-spouse, they can’t gossip about you around town, and it’s in your best interest to be completely honest with them about all aspects of your life.

I recently read a post from a woman who asked her primary care doctor several times about birth control options after her IUD was removed. Her doctor dismissed the questions because her husband had had a vasectomy! It was that post that inspired me to write this blog. Non-monogamous folks sometimes resist being transparent even in safe spaces because the judgement of mononormative folks can feel so very defeating. But I’ve got news for you about your board certified care providers: they aren’t better than you just because they have a certain degree. Nothing about their certifications qualify them to levy moral judgement against you and let it affect their treatment of you. They probably have more education in certain areas, sure . . . but you’re the expert on you. 

You wouldn’t take your car in for routine maintenance but withhold that it’s been making a funny sound when you get over 50mph. You wouldn’t hire a nanny to watch your children and keep it a secret that one of them is allergic to bees. You can’t expect anyone to provide services to the best of their ability when they’re missing pertinent information.

A good doctor will listen to you when you tell them about you, and then they’ll treat you based on the information you give them without shame of any kind. But remember: in the absence of information, all they have are assumptions, so you need to do your part and be forthcoming. 

So how do you go about moving from a fear of stigma to advocating for yourself with medical professionals?

  • Interview your medical professionals prior to enlisting their services; this could be a phone call, an email, or a quick chat before your exam. I like to keep my clothes on with new doctors until we’ve had a chance to meet fully clothed; I don’t find meeting new people in a paper gown to be a best practice. I have yet to meet a doctor who did not respect me for this practice.
  • Familiarize yourself with privacy laws in your country, (HIPAA in the US, PIPEDA in Canada, etc.). In the US, I haven’t been able to legally access the medical records of my children since they reached the age of 12, and that is exactly as it should be. 
  • Develop a sense of entitlement when it comes to the quality of your care. You are a consumer whose money is just as valuable whether it comes from an employer funded health insurance company or a government funded one. Your socioeconomic status does not mean you deserve substandard care or consideration of your situation. 
  • If necessary, fake it ‘til you make it. There is no greater boost to confidence than a positive lived experience. If you cannot summon a feeling of entitlement to good medical care, act like you do and see what happens.

Your medical staff rely on your trust in them to provide you with the best possible care – if they betray that trust, they deserve to hear about it from you. It might feel intimidating to bring something to their attention that made you feel invalidated, unsafe, or not listened to, but a good provider will be grateful for the education and correct course.

And if your doctor (or therapist, or nurse, or anyone in your chain of medical care) intentionally attempts to make you feel bad for sharing pertinent information with them? Get mad about it! Report them to whatever board is responsible for overseeing their license and find someone else to take care of you, because you’re worth that.

Look, the thing I want you to most take away from this blog is this: you deserve the best possible care for your life. You’re also the only one who can seek out the right people for the job . . . so that means you’re in charge. You are. So act like it. 

**Caveat: this blog is written from the perspective of a US citizen and some of the information is specific to that locale. 

Photo by Hush Naidoo on Unsplash

Guest Blog: Great Sexpectations

Many assume non-monogamy is all about the sex. So much so, non-mono folks often avoid bringing it up as an aspect of relationships. But guess what? You should talk about sex!

This isn’t going to be a clinic on how to have safer sex because: 

1) I am not a sexual health professional

2) Everyone’s risk profiles are different

My main goal here is to help you foster autonomy and agency with some tips and tricks I’ve found useful. Ask yourself these questions to get a solid grasp on what your risk profile is:

  • Do you have specific concerns around contracting or transmitting certain STIs? 
  • Do you have a comprehensive understanding of STIs, their risks to you, and access to testing/treatment?
  • What are possible gaps in your knowledge with regard to sexual health?
  • Is pregnancy a concern? 
  • Do you have mental, physical, and/or emotional concerns?

Next up, you need to find a partner(s) who is interested in sexual activity with you. This is on you. Good luck!

After you have your profile/risk matrix figured out and a willing participant, it’s time to talk about sex. Everyone does this differently. HOWEVER, and I cannot stress this enough, EVERYONE needs to have some sort of conversation about sexual health with those they want to have sexy times with. I don’t care if it’s an old fuck buddy you’re revisiting after some time, a one night stand, or the first time in a long running relationship: TALK. And you know what? If you or your partner only want to say “I do what I want and that’s all you need to know?” Cool. At least the other person can consent (or not) to that level of information and plan accordingly.

Many often talk about “best practices” when it comes to safer sex. Having this conversation is a “best practice” as it helps cover so many bases. While not all encompassing, here is a list of things people might consider sharing with potential partners as well as asking of them:

The frequency with which you tend to add new sexual partners

Find that balance between too specific and exaggeration. Specifically vague, if you will. For instance, I share that I may add up to [X] sexual partners in a year. Most years are less, but I’ve also had a year with [Y]. If I deviate a lot from my norm on a regular basis, that is a change I update my partners on. 

How quickly you are likely to become sexual with a new interest

Are you a fan of one night stands? Are you demisexual and tend to take awhile? I share that my norm is getting to know someone for a few weeks first, but I am not opposed to something happening right away. 

What you consider to be sex

Do you only consider genital to genital penetration to be sex? Unpack that. Sex comes in many forms (heh heh) so you should consider including things such as oral, anal, manual stimulation of genitals, etc.

How frequently you screen for STIs

The CDC recommends sexually active people get tested at least once a year. Personally, I get tested twice a year plus as necessary should an exposure present itself. A friendly reminder: testing by proxy is NOT effective.

What you test for

Don’t say “everything” because essentially no one is tested for everything. Penises can’t currently be tested for HPV. HSV strains are more prevalent than most realize and most doctors won’t test without symptoms . . . and so on. 

What your general attitude towards STIs are 

This can really vary. Some people are very accepting of risks since most STIs are easily curable while others may struggle with any exposure. This is good information to know about the person you’re having sex with.

Any past or current positive test results

Catch something 20 years ago that was cured and has no lingering impact? Not necessary to bring up. (But maybe you can bring it up to gauge how accepting someone is of folks having had an STI.) Last test was reactive to something, you treated it, but haven’t had a non-reactive test to confirm? Share that. FYI, terms like “clean” and “dirty” have fallen out of favor due to their problematic nature. Having what’s essentially a crotch cold doesn’t make one dirty. Please consider using positive/negative or reactive/non-reactive.

How you’re managing any current STIs

Have something like HSV-2 or HIV? Share how you are addressing it and what that means. There have been some amazing advancements in treatments. I learned in just the last couple of years that HIV can now become undetectable with proper treatment which means it can’t be transmitted sexually.

What your barrier (condoms, dams, gloves, etc) use looks like

Do you use condoms? Dams? Gloves? Only for penetration or oral as well? For all sexual contact? I’ve met a lot of people who aren’t aware that STIs and pregnancy can occur with just pre-cum. If you’re someone who goes completely barrier free with others, it’s good to share your approach with this, such as if you only do that with one person or are open to it with multiple people and how you make that decision. 

Keep in mind while having this conversation, your other partners’ private information, (such as their STI status or who they have sex with), is NOT yours to share without their consent.

It would benefit all involved if you had these conversations prior to someone new catching your attention.

There are a number of reasons I prefer a more comprehensive conversation when it comes to safer sex and the practices of folks I have sex with. More than anything, it helps me preserve my autonomy and doesn’t infringe on the agency of others to give myself an illusion of safety; boundaries vs rules, if you will. It lays out my risk profile, gathers information about theirs, and allows each of us to decide if and how to move forward. 

Another thing I find valuable about sharing a complete version of my risk matrixes and decision making processes is that it removes the need for a “heads up” any time a new sexual partner is added because we know how each other operates. Any deviation from it would be shareable, of course. But in the absence of those changes, we have all the information we need. Feeling entitled to more is a super common expectation of non-monogamous people, particularly those new to it. If your partner is non-monogamous and enjoys sex, assume they’re going to be having sex with other people. Do the work beforehand. 

Following these steps will help you form a more complete approach to sexual health. It sets well-informed expectations for yourself and potential partners, facilitates productive communication, fosters personal agency and informed consent. It peels away the ownership and entitlement many feel toward the private information of others.

For a more complete understanding of your sexual health, I recommend seeking guidance from a local clinic that specializes in the sexual and reproductive health realm (e.g. Planned Parenthood) or sites like Scarleteen. Yes, that site is geared toward teens. However, most of our readers are from the US and our sexual education here is generally hot garbage. You can and should also speak with your primary care physician, but I highly recommend including the others as I’ve experienced and heard about too many problematic PCPs.

Since mid 2016, Adam (he/him) has been an educator and presenter in the ENM community. He realized he was polyamorous in high school and has practiced various forms of non-monogamy ever since. With a primary goal of normalizing a variety of relationship structures, he shows up as his authentic self: an egalitarian polyamorist who practices relationship anarchy.

Header Photo by Christin Hume on Unsplash; bio photo by Rusty