Should You Provide Sexuality Education to Your Patients?

Photo credit: Eva Blue

Photo credit: Eva Blue

It is a rare thing these days to receive comprehensive sex education from a health care practitioner. When it is offered, it’s typically limited to the health of sex organs. However, as Melanie Davis explains in the following article, sex and sexuality go beyond the biological. Crucial aspects of sexuality that influence one’s individual choices are often overlooked by health care providers- such as one’s degree of autonomy as well as knowledge about safer sex tools.

The article speaks to health care providers and offers concrete examples of how sexual health envelops aspects about identity, relationships, and intimacy- all of which impact a person’s overall health.

This article was originally published here.

BY MELANIE DAVIS, PhD | MelanieDavisPhD.com

Physician involvement in sexuality education began in 1904, when dermatologist Prince Morrow, MD published Social Diseases and Marriage. His goal was to protect women whose husbands were bringing home sexually transmitted infections (then called venereal disease) from sex workers.

Sexuality education and medicine became more enmeshed when other physicians and the American Purity Alliance joined Morrow’s work to reduce STIs as a way to promote sexual morality. Today, healthcare providers don’t usually discuss sexual morality with patients, but you are an important source of information about sexuality.

Sexuality education is a lifelong process of acquiring information and forming attitudes, beliefs, and values about identity, relationships, and intimacy. Sexual health and decision making are critical aspects of sexuality education, and you may have more opportunities to educate patients than you may realize.

The Breadth of Patient Sexuality

If you limit your exam room consultation to discussions of the function and health of sexual organs only, you risk missing out on information that could have an impact on a patient’s sexual health and overall wellness. There are five categories of sexuality that comprise every person’s sexual being:

  • Sensuality = awareness, acceptance and enjoyment of our own or others’ bodies.
  • Intimacy = the degree to which we express and have a need for closeness with another person.
  • Sexual identity = how we perceive ourselves as sexual beings in terms of sex, gender, orientation, expression.
  • Sexual health and reproduction = attitudes and behaviors toward our health and the potential consequences of vaginal, oral, and anal intercourse.
  • Sexualization = using sex or sexuality to influence, manipulate, or control others.

The area of sexuality in which healthcare providers address most often is sexual health and reproduction for two reasons: 1) It is where most acute medical issues fall, and 2) There are fewer gray areas that can be time-consuming to discuss. However, the other areas of sexuality are less concrete but equally important to discuss, as these examples illustrate:

  • Patients may avoid sexual intercourse or masturbation because they believe genitals are ugly or shameful.
  • Patients may not experience sexual pleasure because they don’t understand their sexual anatomy or the sexual response cycle.
  • A partner’s turn-ons may hurt your patient emotionally or physically.
  • A patient may be struggling with gender identity or sexual sexual identity.
  • A patient may be too embarrassed to disclose sexual coercion/abuse.
  • Research shows that patients often fear being judged by their providers or being embarrassed, so they may not bring up their concerns. Be sure to open the door to conversations about sexuality — One quick way to begin is to ask, “If there were anything you would change about your sex life?”

Contact me if you’re interested in learning more about essential, yet easy educational conversations you can have with patients about sexuality.

melanie_davisMELANIE DAVIS, PHD, consults with individuals and couples to help them build sexual knowledge, comfort, and pleasure through the New Jersey Center for Sexual Wellness. Through her firm Honest Exchange LLC, she provides professional development in sexuality. She’s a popular speaker on self-esteem and body image, and the sexual impact of cancer, menopause and aging. She’s an AASECT-Certified Sexuality Educator. On Twitter @DrMelanieDavis

Monogamous? This STI Doesn’t Care

From the award winning documentary, "Under Our Skin" (2009)

From the award winning documentary, “Under Our Skin” (2009)

New research published this year suggests that Lyme disease may be sexually transmitted between humans. These new findings could fundamentally change the way we think about STIs.

The study (headed by microbiologist Marianne Middelveen and an international team of medical researchers) is the first to officially investigate sexual transmission between partners. However, it has been suggested for over a decade that Lyme disease could transmit sexually. The bacteria that causes Lyme is a type of spirochete which is related to the same cork-screw shaped bacteria of syphilis.

“It would certainly explains why the disease is so common,” Dr. Raphael Stricker, one of the researchers of the study stated. According to the CDC, there are 300,000 new cases of Lyme each year and this rate is rapidly increasing making it one of the most urgent epidemics today.

In this article, Melissa White interviews Lyme literate doctors who have recommended patients to use condoms to prevent transmission. She also reached out to people living with Lyme who believe they have transmitted the infection to their sex partner and who wish that their doctors informed them earlier about this possible risk.

This post was originally published on The Good Men Project

BY MELISSA WHITE | LuckyBloke.com

If there were a new sexually transmitted infection (STI, aka STD) on the rise –-say, one that was an unexpected concern, especially to monogamous couples– when would you want to know about it?

Say, when it’s a scientifically proven possibility with mounting evidence –even if it took three to five years before it could be officially confirmed?

And when would you expect government and medical organizations such as the Centers for Disease Control and Prevention (CDC) and the Infectious Diseases Society of America (IDSA) to share this information with you? At what point does a serious potential threat warrant disclosure?

Finally, to what extent and at what point should doctors inform patients? When does it become their responsibility to do so?

It’s important to note that this potential new STD may initially be transmitted even without sexual contact. Your partner may pick it up from a tick in the woods –or be born carrying it. And while currently a “silent” epidemic, the numbers of cases have been climbing so rapidly that it won’t be kept under the radar for much longer.

Perhaps most alarming is the lack of a reliable test or conclusive go-to cure for this infection. Also, with over 300,000 new cases a year in the United States alone, a global epidemic is perhaps already underway.

In fact, leading researchers are likening it to the HIV/AIDS epidemic of the 1980s, due to similar rapidly rising infection rates, as well as a widespread lack of comprehensive testing and treatment. Many conclude that a majority of those infected do not get properly diagnosed until years after contracting it, when chronic stages have already set in.

The infection gains traction in the body in much the same way syphilis does. Also, like syphilis, the symptoms of the infection are so varied that it has been called “the great imitator”, making it perhaps the most complicated, multilayered infectious disease today. Some researchers, such as Dr. Raphael Stricker, are proposing a nationwide HIV-style “Manhattan Project” in which a uniform standard of testing is established and long-term treatment is the norm.

Commonly known as Lyme disease (aka Borrelia burgdorferi), you might assume this potential sexually transmitted infection (STI) can only afflict those bitten by a tick. Sadly, it may be time to ditch that notion. Emerging information indicates that, if you are having unprotected sex at all –even in a monogamous relationship– you’re at risk of infection.

Lyme symptoms have often been dismissed as stress or aging. They include fatigue, joint pains, muscle aches, headaches and flu-like symptoms. However, left untreated, the infection can travel to the nervous system, dwell in your tissue, and mimic chronic illnesses such as arthritis, paralysis, epilepsy or even Alzheimer’s disease. In fact, the International Lyme and Associated Diseases Society (ILADS) suggests that Lyme should be considered in diagnoses of chronic fatigue syndrome, fibromyalgia, multiple sclerosis, Lou Gehrig’s disease, Parkinson’s disease and many other multi-system illnesses.

The work of Lyme-aware healthcare providers is being hampered by faulty testing and an outdated treatment protocol. As if that wasn’t enough, these professionals are also up against a medical community and agencies that seem rather averse to examining the rise of Lyme infection, with many institutional leaders clinging to the dangerous, antiquated notion that chronic Lyme doesn’t even exist. The status quo is making it incredibly difficult for severely ill patients to receive the treatment they desperately need.

I’ve interviewed many leading Lyme literate doctors and researchers, including microbiologist Marianne Middelveen and internist Raphael Stricker. Both are involved with the most recent study investigating Lyme as an STI.

For practitioners like Dr. Christine Green on the boards of ILADS and LymeDisease.org, it is important to assume patients wish to be fully informed:

I inform my patients that it is possible Lyme disease could be sexually transmitted as the bacteria has been found in sexual fluids. But I inform them that proving transmission has not been done, possibly because it is not sexually transmitted or possibly because those studies are expensive, controversial or/and we do not have an agreed upon test that confirms active Lyme.

On the other hand, I have been shocked to learn that it’s common practice to not discuss new research findings about Lyme in order to avoid fear and recrimination. Until more large-scale peer reviewed studies are published, some doctors simply disregard the latest findings.

Unfortunately, despite mounting evidence seen by doctors in their own practices, even leading Lyme organizations are hesitant to suggest barrier methods as a precaution.

Yet all of the above offers merely a glimpse of just how difficult it is to battle Lyme disease. People living with Lyme often have to navigate medical settings in which
mainstream doctors subscribe to the myth that Lyme is “hard to catch, easy to treat”.

Those affected are forced to do their own research. According to ILADS, the average Lyme patient sees five doctors within 2 years before being properly diagnosed. The CDC surveillance criteria used for diagnosis of Lyme are so insensitive that they miss more than half of patients with the tick borne illness.

After watching Under Our Skin (2009), an award winning documentary investigating Lyme as one of the most serious,controversial modern-day epidemics, I recognized that the stories of people living with Lyme need to be more widely shared. I have now heard from hundreds of people around the world living with chronic Lyme.

Most have been misdiagnosed due to false negative Elisa testing or doctors simply not considering Lyme. Many don’t recall a tick bite or telltale bullseye rash (in fact, the ILADS reports that fewer than 50% of Lyme patients recall being bitten by a tick); also, many are convinced they’ve transmitted the infection to their sexual partner or vice versa.

Joanne, who travels to Belgium from the Netherlands to see her doctor, strongly feels she transmitted the infection to her partner and expressed relief that her doctor informed her about this mode of transmission:

I am personally really glad my doctor said it is likely to be an STD. Because of this I had my boyfriend tested right away when I found out I had Lyme. He’s now also receiving treatment and is recovering much faster. With Lyme, the earlier you discover it, the better your chances of recovery, so no, I wouldn’t wait.

Barbara* has a story like so many Americans. Her infection wasn’t detected until many years after transmission:

I may have sustained a tick bite in 2008, but the circumstances were such that I brushed the incident off. I never had a bullseye rash. Lyme wasn’t identified until 2014 (after a year trying to find a diagnosis that explained my symptoms). Although Lyme crossed my mind my initial test was negative. My treatment might have been completely different if I had known and understood what IS NOT KNOWN about Lyme. I might have sought aggressive treatment for the tick bite, not ignored it. I might have been able to protect my husband who now also has Lyme.

Desi lives in Europe, and like Joanne, travels to Belgium to meet with her physician:

There are too many people with Lyme at the moment, it cannot only come from a tick bite anymore. Whole families are infected with Lyme. Including my family and my husband. I have Lyme. My husband never had a tick bite but had a positive test. He also has Lyme disease because of me. I think every practitioner has to tell their patients it’s sexually transmitted, there needs to be more information told about it.

According to Dr. Stricker and Ms. Middelveen, researchers of the 2014 study on Lyme as an STD, it was suggested over a decade ago already that Lyme disease could be sexually transmitted because the Lyme bacteria, called a spirochete, shows activity similar to the syphilis spirochete. Yet not until 2014 did research findings compellingly suggest this type of transmission may be possible in humans.

“It would certainly explain why the disease is so common,” Dr. Stricker stated in our phone interview. “This is a big game changer”, Stricker said. “It would mean we should no longer think of Lyme based on geographical high risk zones.”

Just this week, a woman diagnosed with genital ulceration was linked to Lyme disease for the first time. Based on a recently released abstract, it is now a possibility that women with Lyme are being misdiagnosed with genital herpes.

In our interview, Dr. Sticker said a more comprehensive study of sexual transmission of Lyme disease is currently underway. He is hopeful this will offer more conclusive results regarding how this epidemic is spreading at such a rapid rate.

Given all the uncertainties with Lyme, prevention is more important than ever. We know condoms will be the most effective way to protect against its spread as an STI. Drawing from what people living with Lyme have voiced, my personal opinion is that if there is any chance whatsoever that Lyme could be sexually transmitted –and the evidence is rapidly increasing– more people need to be made aware of this possibility.

Everyone has the right to choose how they protect themselves and their partners. This is not about inciting panic or stigma. It is about encouraging an up-to-date public discussion regarding Lyme. It’s about allowing people an informed choice. And finally, for safer sex educators, it’s about informing people on how they can enjoy sex and remain infection free, and for those who are infected, how to best protect their partners.

*Some names are changed, at patient request, to protect privacy.

Warts and Worries. What To Do?

Photo credit: Jamelah E.

Photo credit: Jamelah E.

If you were recently exposed to genital warts would you know what to do? Do you know what to ask your doctor? What tests and treatments are available? Are genital warts curable?

As part of their weekly Q&A series, the CSPH (the Center for Sexual Pleasure and Health) explains what to do if you think you’ve been exposed to genital warts, a common sexually transmitted infection caused by the human papillomavirus (HPV). HPV is so common, it has been called the “common cold” of STIs in the United States.

According to the CDC, the United States is facing an HPV epidemic, in which 50% of sexually active adults carry some form of HPV without any symptoms. Yet not enough people know what is HPV, what are it’s sympotoms (if any!), and how it can be treated and prevented.

In this post, the CSPH explains that:

  • About one person in 10 will have genital warts at some time in their life.
  • Because genital warts spreads by skin-to-skin contact rather than an exchange of bodily fluids, condoms are not 100% effective at preventing transmission.
  • Unlike many STIs which can be diagnosed with a simple blood test, genital warts are detected primarily through visual inspection. However, not everyone shows symptoms.
  • About two-thirds of people who are exposed to active genital warts will develop them, usually within three to six months after contact.
  • You can reduce the risk of HPV with consistent use of sex dams and condoms, creative outercourse that doesn’t put you in direct contact with genitals (dry humping, vibrator play, etc.), and regular STI testing to keep your status up-to-date.
  • Still confused about testing? Check out our post about when to get tested for STIs.

This post was originally published on the CSPH

BY THE CSPH | theCSPH.org

Image from the CSPH

Image from the CSPH

Each week, The CSPH answers questions asked on our site and through social media outlets like Twitter, Tumblr, and Facebook. This week’s question is:

Hi! I just recently found out that I was exposed to genital warts and might have it, though I am currently not showing any symptoms. I have a pap smear coming up at the beginning of August and I plan to bring up my concerns then (while abstaining from sex until then). Do you think that they’ll be able to test me although I don’t have any symptoms, only reasonable concern?

Genital warts is a common sexually transmitted infection caused by the human papillomavirus (HPV), which is spread by skin-to-skin contact rather than an exchange of bodily fluids. About one person in 10 will have genital warts at some time in their life. Unfortunately, this sneaky virus can be passed along even if you use a condom—for example, if your genitals touch during foreplay, or if your partner masturbates before fondling your naughty bits. Condom use is still recommended, as safer sex practices can significantly decrease risk, but it should be remembered that barrier methods are not a genital force field.

While HPV is a family of viruses often linked to cervical cancer, the particular strains that cause genital warts are different and distinct. With more than 100 permutations, the volume and variety of HPV could rival Nicki Minaj’s wig collection. Most genital warts, however, are caused by HPV types 6 and 11, which are lower risk but highly contagious. About two-thirds of people who are exposed to active genital warts will develop them, usually within three to six months after contact.

Thanks to high school health class, some people might associate genital warts with magnified images of mutant cauliflower, but in most cases these warts are inconspicuous, subtle, and benign. They can be flesh-toned or gray, raised or flat, singular or in clusters. For vulva-owners, these growths tend to appear on the vagina or cervix or around the labia majora, anus, or inner thighs. A pelvic exam is often necessary for diagnosis, since warts do not usually cause pain or discharge and can reside internally. Genital warts in penis-owners may surface on the shaft, scrotum, testicles, anus, or general groin area.

Unlike HIV and syphilis which can be diagnosed with a simple blood test, genital warts are detected primarily through visual inspection. No lab results can indicate the presence or absence of HPV 6 or 11 before genital warts appear. Once a skin growth is present, a biopsy may be required for confirmation since smaller warts can be difficult to distinguish from normal genital bumps or ingrown pubic hair.

Although there is an HPV test on the market, it was designed to detect high-risk, pre-cancerous strains of the virus (types 16 and 18) in women over thirty. Similarly, a pap smear would not reveal whether or not someone has genital warts. Due to a lack of effective screening and testing, it is hard to know if you or a potential partner might have this contagious, but harmless, skin condition; an estimated 50% of sexually active adults carry some form of HPV without any symptoms.

Fortunately, the Gardasil vaccine can protect against the HPV strains responsible for 90% of genital warts, in addition to the high-risk types associated with 75% of cervical cancers. No longer restricted to empowered women and girls who engage in radical activities like playing drums, skateboarding, or living in designer lofts, this vaccine is now available to members of all sexes and genders. While there are risks and benefits associated with Gardasil (or any vaccine), the recommended age of inoculation is 11 or 12, or prior to becoming sexually active.

The CDC recommends that vulva-owners ages 13 through 26 get HPV vaccine if they have not received any or all of the three doses when they were younger. Likewise, CDC recommends the vaccine for penis-owners aged 13 through 21 years if they have not been received it already.

If you happen to have genital warts, there are several treatment options available, including podophyllin solution, cryosurgery (freezing), and electrocaudery (burning). You can also wait and give the warts some time to disappear on their own; within three months, 20 to 30 percent of all cases of non-cervical warts usually clear up without medical intervention.

When genital warts are treated, symptoms often resolve within one to nine months. Although the virus is most easily spread when active warts are present, you may still be contagious following treatment or removal, especially during the six months immediately afterwards. If you have been with your current partner since a few weeks before the genital warts appeared, more than likely your partner has already been exposed to the virus and abstaining would not prevent an outbreak. However, before engaging with new partners, it would be important to discuss the risk of viral transmission (in addition to what turns you on!), and to use condoms until everyone is comfortable with the potential consequences.

Unfortunately, there is no way for your doctor to conclusively diagnose you with genital warts unless physical symptoms are present. However, it’s wonderful that you’re being responsible in the meantime by abstaining from sex and initiating dialogue on these important issues. Through consistent use of barrier methods, creative outercourse (dry humping, vibrator play, etc.), open communication, and annual exams with a qualified healthcare provider, you can take several proactive measures to help reduce your risk of genital warts and other STIs, while enjoying safe and sexy pleasure adventures.

Special note: Human papilloma virus (HPV), the underlying agent that causes genital warts, actually has over 100 strands, about forty of which can lead to genital warts. Other strains of HPV can also lead to cell division, which may be responsible for a number of throat, genital, cervical, and anal cancers. According to the CDC, nearly all sexually active adults will get at least one strain of HPV at some point in their life; however, when we state the “one person in ten” statistic, we were referring to having genital warts specifically.

condom ad condoms too loose

csphThe CENTER for SEXUAL PLEASURE and HEALTH (The CSPH) is designed to provide adults with a safe, physical space to learn about sexual pleasure, health, and advocacy issues. Led by highly respected founder and director, Megan Andelloux, The CSPH is a sexuality training and education organization that works to reduce sexual shame, fight misinformation, & advance the sexuality field.

Disabled People Need Sexual Health Care Too

Image by Maria Iliou. From the Disabled Artist Guild.

Image by Maria Iliou. From the Disabled Artist Guild.

BY ROBIN MANDELL | ReadySexyAble.com

Most safer sex guides take it for granted that all of us are going to have the manual dexterity (ability to move our hands) to unwrap and use a condom, that getting STI testing is as easy as booking (and keeping) an appointment at a free or low-cost sexual health clinic, and that communicating with a partner about safer sex is as easy as having a few face-to-face conversations about it. For those of us who have any sort of physical, cognitive, or psychological disability, these and other “basic” safer sex strategies may not be so easy.

It doesn’t help that disabled people are assumed to be nonsexual, or to have more important things to worry about than the “luxury” of sexual feelings or a sexual relationship, or any number of other myths about sex and disability all of which miss the mark in one way or another.

People with disabilities who are sexually active, or planning to be sexually active, need to practice safer sex, and get regular sexual healthcare, just like anyone else.

A Quick Overview of Safer Sex

If you’re disabled, know that you have the right to whatever expression of your sexuality you want to have, and you have the right to be safe when expressing your sexual self, both alone and with partners.

Safer sex is about taking care of your sexual health, and protecting yourself from sexually transmitted infections (STIs). Preventing unwanted pregnancy is known as birth control, not safer sex, but it’s still part of your sexual healthcare if pregnancy is something that can happen to you or someone you’re sexually involved with.

Safer sex includes using barriers (such as condoms or dental dams) for genital contact with a partner, and getting regular sexual healthcare, including STI testing.

Let’s look at a few considerations around safer sex specific to being someone who has any kind of disability. You can get more safer sex info by reading through the other articles on this site.

Sexual Health Care

Most sexual health services aren’t set up to meet the needs of disabled people. In the U.S., many providers don’t get training in working with patients who have disabilities. Coupled with assumptions about disability and sex, this can lead to you not getting the sexual healthcare you need. That might be a healthcare provider who doesn’t ask you about sex, or asks in such a way that assumes you’re not having it.

Or, it means examination tables that don’t accommodate people whose bodies don’t move in the ways expected for traditional exams. This includes staff unable, unwilling, or untrained to assist with positioning your body on the table.

Or, it means reams of forms to fill out, and informational pamphlets and brochures that are only available in print.

Even one step into a building- or doorways that are too narrow- can keep you from seeing a healthcare provider of your choosing.

Healthcare providers aren’t immune to the myths about disabled people and sex, which can result in them assuming their disabled patients aren’t having sex and consequently not asking questions about sexual health, evaluating someone’s need for birth control or STI testing, or even conducting routine genital exams.

Sometimes healthcare providers can fall into the trap of thinking that any problem a patient presents with is related to their disability; or, it may be assumed that what would be a problem for some people (such as fertility problems or the need for frequent STI testing)) will not be a priority or even a problem for disabled people.

Steps you can take to get the sexual healthcare you need if you have a disability:

  • Look for a sex-positive healthcare provider.
  • Find a provider who can meet your disability needs. Members of the Gimp Girl community have put together this list of accessible gynecologists. The list is short, but can give you an idea of what sorts of accommodations you can ask for, and expect, from any private medical practice or clinic.
  • Be prepared to ask for the sexual healthcare you need. Sadly, preparing yourself might also include being ready to fend off judgment, condescension or surprise.If your provider doesn’t bring up sex, you can. You can ask for STI testing, or to discuss birth control options.
  • Be sure when you’re discussing birth control, or if you are being treated for an STI, that the treatment won’t interfere with any medication you take and that any possible side effects won’t trigger physical or psychological symptoms of your disability.

Some assumptions you might encounter:

  • “Oh, I guess we don’t have to talk about birth control, do we?” Quickly followed by the next question in the provider’s list.

Possible response: “Yes, actually, I do need to talk about that. I’ve been wondering what method would be easiest to use considering the problems I have with my hands.”

  • “Is there someone who can help you with your birth control pills?”

Possible Response: “No, I want to keep that private. Maybe I need a different kind that will be easier for me to use on my own.”

  • “I know it’s hard for us to do a pelvic exam on you. Let’s skip it this year.”

Possible Response: “I know it’s hard to examine me, but with what I told you about my sexual history, is a pelvic exam advisable medically? I don’t want to skip any steps I need for my health.”

Sometimes, if the provider assumes the answer to a question, like that you don’t need to have birth control, or of course you’re not sexually active so there’s no need to talk about that and they can move right along with the questions, their words are accompanied by nervous laughter. You might want to drop through a hole in the floor when hearing that, but just because they’re nervous doesn’t mean you have to be. As disabled people, we’re often encouraged to help people feel less nervous around us. This is your healthcare provider, though; it’s their job to meet your healthcare needs and to deal with whatever feelings they have around doing that on their own time. So, just take a deep breath and set them straight about what you need from them.

Once you’ve found a provider you’re able to work with, talk with them to make sure you’re getting the best care you can. The following resources might help you and them. (Unfortunately, most of the writing and research on this topic has been geared towards patients who have what medical people have defined as female genitals. If you don’t have a vagina/vulva, your healthcare needs will be different but your provider can still work with you to find creative solutions to disability-related problems that might come up during examinations.)

Table Manners and Beyond: The Gynecological Exam for Women with Developmental Disabilities and Other Functional Limitation, and Reproductive Health Care Experiences of Women With Physical Disabilities: A Qualitative Study are both resources you and your provider can read through together to help problem-solve any accessibility challenges you’re having with your healthcare.

Accessing Safer Sex Supplies

Transportation problems, inaccessible buildings, worries about being judged, or lack of trusted help can keep you from getting safer sex supplies. Perhaps you’re in a wheelchair and need to ask a store employee to reach your preferred pack of condoms. Or maybe you have a visual impairment and need to ask for help reading the wide variety of lube bottles. Being in these situations may make you feel vulnerable to being asked intrusive questions or judgmental comments. Considering that people ask visibly disabled strangers how they have sex, these fears aren’t unfounded. How can you get supplies while maintaining self-respect and privacy?

Many resource centres on college campuses and sexual or reproductive health clinics provide free condoms. If you get your healthcare needs taken care of at a private practice, and you have a good rapport with your provider, consider asking them if they can obtain condoms, gloves, or other safer sex supplies for you.

You also might consider asking a trusted friend to pick supplies up for you- they can find somewhere that offers them for free so no one has to pay -and handing them over when you see each other.

Many reputable suppliers also sell safer sex supplies online at decent prices and provide clear , detailed information on what you’re buying.

Communication

Do you have the words to talk about sex, and about your body? A lot of us, whether we’re disabled or not, don’t grow up learning the right words for our body parts, or clearly understanding how our bodies work.

When you’re talking to someone you are (or want to be) having sex with, making sure you can communicate accurately and clearly is important. You can’t consent to take part in a sexual activity if you can’t understand your partner, or if they can’t understand you. It’s hard to agree on safer sex practices if, say, one or both partners are unable to speak clearly, are hard of hearing or deaf, or has trouble paying attention to written or spoken words for more than a moment.

You and your partner might want to have a few ways you communicate with each other about sex, both when you’re discussing it and when you’re doing it.

Your communication toolbox can include talking or signing, gesturing, writing notes back and forth, or any other way you can both understand each other. If verbal communication is difficult, or doesn’t happen at all, you’ll want to agree ahead of time on how you’ll communicate things during sex like “I need more lube” or “let’s get the dental dam.”

If talking and writing are both difficult, you might try reading through safer sex information together, and using words or body language (such as nodding your head, shrugging, looking confused, and so on) to indicate when you’ve read something you want to start doing, or that you want to learn more about.

If you use any assistive or augmentative communication devices, you might find the following list of sexual vocabulary words and phrases useful. These can also help you when you’re communicating with a healthcare provider or caregiver.

A Word On Coercion

Disabled people are at an increased risk of experiencing sexual assault. Sometimes that abuse can take the form of sexual coercion, someone talking you into sex you don’t want to have, or attempting to convince you to ditch the safer sex practices you’ve made it clear you want to use. Some people with disabilities are told—sometimes by partners, sometimes by family or friends–that they should be grateful for any sexual attention they get even if it’s not precisely what they want or need.

I call BS on that!

If someone is trying to talk or force you into sex that isn’t safe for you in any way, and they’re trying to use your disability (or anything else) to convince you, that’s just not okay. A person’s disability is no excuse for abuse.

More Resources on Sex and Disability

The following are some sex-and-disability resources that you may find useful:

ROBIN MANDELL is a healthy sexuality and disability rights advocate based in the Washington D.C. area.
She holds a Bachelor’s degree in Women’s Studies from Queen’s University in Canada and a Professional Writing Certificate from Washington State University. Over the years, Robin has amassed extensive experience working with people at vulnerable times of their lives, both as a crisis hotline worker and a sexuality and relationships education advocate with Scarleteen.  Robin has discovered over the years that disability issues receive significantly less attention in academia and social justice movements than they’re due. She has developed a passion for starting dialogues on sex, disability and accessibility, and has come to the realization that, as much as she just wants to be like everybody else, she can use her visible reality as a blind woman to start these dialogues. Robin blogs on disabilities, sexualities, and the connections between them at ReadySexyAble.com and has published articles on various sexuality and sexual health topics at Scarleteen and Fearless press.

How to Talk with Your Doctor About Sex

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BY MELANIE DAVIS, PhD | MelanieDavisPhD.com

Chances are, you haven’t talked to your doctor about sex lately, but you should: your sexual orientation, gender identity, relationships, body image, and sexual activities can all affect your physical and emotional health.

Physicians rarely bring up sex during office visits, other than to ask a basic question or two. They are focused on diagnosing and treating problems that have an immediate impact on your health, and many sexuality topics are out of their area of expertise and comfort.

Another issue is that physicians, like everyone else, act in accordance with their perceptions and assumptions. Your provider may assume you have all the information you need; that you either aren’t at risk for sexually transmitted infection or unintended pregnancy; that you know how to protect yourself; or that your levels of sexual function and pleasure are acceptable to you.

When it comes to talking about sex, you may need to take the lead. Don’t be embarrassed – if you can discuss your indigestion and bowel habits with your doctor, you can discuss sex! Here are some tips to get started:

• Don’t wait until your doctor is ready to leave the room before you bring up a sexual concern. Mention your question or concern at the start of your visit, in case the doctor needs to look at a specific part of your body to answer the question.

• Consider booking a second visit. Doctors have little time to spend with each patient, so they focus on acute health issues. Sexual concerns often take longer to discuss. To ensure that all of your concerns are addressed, schedule a visit specifically related to your sexual questions and concerns. If it’s an urgent matter, let the doctor know at the first visit.

• Acknowledge that sexuality may be a difficult topic to discuss, but it’s important to you. If your doctor can’t give you useful answers or seems judgmental, find another doctor. Urologists treat male sexual concerns; gynecologists treat female sexual concerns.

• Ask your doctor to alert you to possible sexual side effects of medications, treatments, and surgeries.

• Be honest about the sexual activities you participate in, so your sexual health risks can be appropriately assessed and you can be tested and treated for sexually transmitted infection (STI) or unintended pregnancy. People of any orientation may enjoy oral sex, body rubbing, anal sex, mutual masturbation, etc., so a discussion of your sexual activities will not reveal your orientation unless you choose to disclose it.

• Ask about sexual activities that may affect pre-existing medical conditions. If you have circulatory problems, being tied up could be risky. If you have heart problems, physically stressful sex may need to be modified. If you have blood-clotting issues, you may need to avoid activities that could break the skin. If you have multiple partners, you are at higher risk for STIs. If your doctor can’t suggest satisfying modifications, seek out a sexuality educator or occupational therapist who can help you find ways to enjoy your favorite activities.

• If you have psychological and relationship concerns, consider seeing a sex therapist. If you need information and practical solutions/skills, see a sexuality. You can find certified sex therapists and sexuality educators at www.AASECT.org

 

melanie_davisMELANIE DAVIS, PHD, consults with individuals and couples to help them build sexual knowledge, comfort, and pleasure through the New Jersey Center for Sexual Wellness. Through her firm Honest Exchange LLC, she provides professional development in sexuality. She’s a popular speaker on self-esteem and body image, and the sexual impact of cancer, menopause and aging. She’s an AASECT-Certified Sexuality Educator. On Twitter @DrMelanieDavis