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.

What Makes Someone A Slut?

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Slut. It’s a loaded word. What does it mean? When does someone qualify as a slut? Renowned sex educator, Megan Andelloux, shares how she handles the question in workshops: “What Makes Someone a Slut?”

Don’t miss her tips on steps you can take when you hear someone called a “slut”. Key points:

  • It’s ambiguous. There is no single definition. Different people have different ideas of what “slut” means.
  • Due to differing definitions, any number of situations can lead to a woman being labeled “slut”.
  • Some women are reclaiming the word in an empowering way.
  • Most importantly- call people out when they use the slut word. Ask them what they mean.

BY MEGAN ANDELLOUX | ohMegan.com

megan_andellouxMEGAN ANDELLOUX is a Clinical Sexologist and certified Sexuality Educator, listed on Wikipedia as one of the top sexuality educators in America, her innovative education programs, writing, social media presence, and ambitious speaking schedule has made her one of America’s most recognized and sought-after experts in the growing field of sexual pleasure, health, and politics.
Follow Megan on twitter @HiOhMegan

What Is It Like to be Tested? STI/STD Testing in 5 Simple Steps

Easy-button

With all the stigma and fear surrounding sexually transmitted infections (STIs), going out of your way to specifically get tested can seem like a burden. According to the CDC, less than half of Americans ranging from 18 to 44 years old have never EVER been tested for STIs. This is a serious obstacle that cannot be overlooked when talking about sexual health.

Jenelle Marie, founder of The STD Project, takes on this social fear of getting clinically tested by demonstrating just how easy (and shame free!) it really is. She walks us through her real-life experience of going to the clinic (with her boyfriend):

Here are key points to learn from her STI testing experience:

  • Health practitioners don’t test for all STIs. You need to ask for specific test to be done, particularly for those which do not always show symptoms, like HPV, Gonorrhea and Syphilis.
  • STD testing is available for free!
  • Test results are strictly confidential. In most states, once you are 13 years old, you can get tested without a guardian’s involvement. The clinic cannot share your identity and results with anyone.
  • Depending on the STI, you may be asked to give a blood sample and a urine sample.
  • No single procedure or test will detect all STIs.
  • Getting tested is simple, quick (depending if it’s walk-in or appointment) and the trained staff do not make moral judgement on your sexual behavior.

This article was originally published here.

BY JENELLE MARIE | theSTDProject.com

Are you wondering what it’s like to be tested for STIs/STDs?

 Step One: Decide whether to schedule an appointment or go on a ‘walk-in’ day (wait is usually much longer, so patience is a virtue should you choose the latter) – I made an appointment as I have little patience 🙂

Step Two: Fill out some paperwork (this is the government we’re talking about) – HIV testing is the only test they can do completely anonymously (if they do rapid-tests onsite) where they do not require a name (they give you a number) or a lot of other information – this health department did their HIV tests on-site (which means results in 15 minutes), but I was also testing for 3 other STDs, so the paperwork was still required.

For those clinics that do not have rapid-tests, HIV tests will only be confidential. Confidential testing means you must fill out your name and birthday and answer questions about your sexual experiences. This DOES NOT mean they will call your parents or your partners and tell them your test results – test results are strictly confidential. The health department asks that you tell all future partners but does not make you retro-actively tell people, because, presumably, you wouldn’t have known you were positive for an STD until now.

Also, it is very important you answer the questionnaire with complete honesty – depending on the type of sexual activities in which you engage, they may do STD testing for additional types of STDs or they may test different areas of your body for STDs – chlamydia and gonorrhea can both be in the throat or anus, for example.

Lastly, the women my boyfriend and I met made no assumptions or judgments about the types of activities we enjoy – they simply share the risks and make sure you’re safe in all directions (your mind is whirling now, I’m sure). 🙂

Step Three: When your name gets called, a nurse takes you back, asks some additional questions, sometimes does a little preventative counseling and starts the tests by giving you a finger prick.

The finger prick begins the rapid blood test for HIV which is complete 15 minutes later.

Next, a traditional blood sample is taken from your arm for Syphilis testing. The Syphilis is sent to a lab and results are available 7 business days later along with your Chlamydia and Gonorrhea test results.

Step Four: Pee on your hand while attempting to pee into an impossibly small cup for Chlamydia and Gonorrhea testing (you do this in a private bathroom, so no one has to watch you wonder whether to pull up your pants with pee on your fingers or waddle over to the sink for washing – pants still at your ankles).

Important to note: the longer you hold your pee, the better – anything over not having urinated in an hour should be good.

The nurse said chlamydia and gonorrhea bacteria flush out and are harder to detect when having urinated recently; however, after a longer duration of time, they come back again.

Unfortunately, peeing profusely will not make your STD go away. Dang it!

Step Five: Meet the nurse back in the testing room, get your HIV results, and your FREE CONDOMS!!!! YEY!!!

Who doesn’t love free condoms?!?!

I say, you might as well go get STD tested just for the free condoms!!! (I’ll say anything – obviously – to convince you STD testing is totally harmless and will make you feel much much better!)

condom ad condoms too tight

1533882_446848112083407_2051712922_n THE STD PROJECT is a multi-award-winning independent website and progressive movement eradicating STD stigma by facilitating and encouraging awareness, education, and acceptance through story-telling and resource recommendations. Fearlessly led by Founder, Jenelle Marie, The STD Project is committed to modern-day sexual health and prevention by advocating for conscientious and informed decisions. Find them on twitter @theSTDProject

How to Tell a Sex Partner I Have an STD

Photographer Caralin Walsh

Photographer Caralin Walsh

A prerequisite to loving, healthy sexual partnership is trust and honesty. Thus, it is important for you and your sex partner to talk about your STI history and status (if one of you don’t know your status, why not get tested together?).

Initiating disclosure can feel worrisome. How can you avoid rejection? Jenelle Marie of The STD Project offers her approach and shares experiences from others.

There are effective ways to disclose. Here are main aspects of Jenelle’s approach:

  • Do it face-to-face.
  • Honest information is key. Share the facts and contextualize them with a positive attitude.
  • Give the other person time to digest the information.
  • The person’s decision to end the relationship due to an STI is not about you. Don’t take it personally.

The original article was published here.

BY JENELLE MARIE | theSTDProject.com

So, you have an STD.

You might even being learning to live with yourself by now (you certainly should be, but I know this takes oodles and oodles of time) and you might have finally resolved to regard the experience as a phenomenal learning opportunity – one you wish you wouldn’t have had to learn first hand, sure, but a learning opportunity nonetheless.

Consequently, you’ve started to date! Cheers!

Or maybe someone came on to you while you were dutifully trying to swear off relationships for the rest of your life?!?!

Either way, the time has come to have ‘the talk’. NO ONE wants to have the talk with anyone EVER, but you must have it if you’re ever to develop a loving, healthy relationship with someone again – at least enough to get in the sack with them that is!

It may shock you, but sex is still fantastic with an STD.

Do your best not to worry too much about that right now, I’ll get you there.

Anyhow, now what? What in the world are you going to say to the potential love of your life to get them to not run for the hills?!!?!

Well, I’m sure there are many ways to go about telling someone you have an STD, however, not all of them will help you keep the other individual.

Albeit, what I’m about to share is certainly not a guaranteed method, by any means; it’s just what I think works best. I’ve had quite a bit of luck in this approach; I’ve been married, I’ve had great long-term relationships, and I’ve never lost a partner simply because of my STD. So, in some ways, I’m proof there’s a good way to do this kind of thing. Others tend to agree and I talk about their perspectives in depth here.

In the end, only you will know what works best for you, but in the meantime, you can try this approach on for size until you do.

No Text Messages, Emails, or Singing Telegrams

First of all, it is my belief that any mode of telling someone you have an STD other than face-to-face is bad form and would give that potential someone all the more reason to say, ‘thanks, but no thanks.’

I know, it would be so much easier to have Barney show up at their door singing about loving people despite their differences, STDs are ok, just love one another, etc., etc….

But, this is one conversation where today’s ingenious and creative technological approaches just won’t cut it. Besides, even though the conversation is tougher/more embarrassing in person, it provides you an opportunity to gauge their initial reactions and it allows them to see how sincere you are.

All in all, in-person is a win-win.

However, and this is a very big however, where you tell someone you have an STD is just as important as how. What I mean is, the place you choose to sit someone down to have this conversation should be fairly neutral and a calm atmosphere.

At the bar, while babysitting your best-friend’s two year old, or at Starbucks are all HORRIBLE ideas.

In my experience, I’ve made a special trip over to the individual’s home while they were alone and not in a hurry with the pretense of, ‘Hey, can I drop by for a few minutes, I’d like to chat with you about something?’

Telling someone in the comfort of their own home or in private serves two purposes. It allows the person an opportunity to react how they would naturally without being influenced by on-lookers or having to ‘put on airs’. And, this leaves the individual in a comfortable environment to ask as many questions as they like or to do their own private research without pressure, which, leads me to my next point.

Be Honest, Positive, & Resourceful

In sharing your status, it’s incredibly important you’re as honest as possible.

I’ve always shared how long I have had genital herpes, how I got it (or, at least what I know about how I got it), what I’ve learned from the experience, how hard it’s been at times, and what it means for my health. Many times, I’ve told my story in tears – not with the intent of playing the sympathy card (although, I’m sure it could have been perceived that way) – because, quite honestly, it’s an embarrassing and scary conversation to have and re-telling my story generally re-surfaces some old emotions. Regardless, I think that is all O.K. because it’s honest.

From there, I share the facts and figures and let them ask whatever questions they’d like to know. I give them the information I know, what herpes does and doesn’t mean for me, and the very realistic truth that an STD has been manageable for me and has not hindered anything in my life. I have passed my STD on to others, understandably – not all of my partners have contracted it (quite a few have not) – and the risk is still very real.

I also share with them some of the resources I’ve used to gather my information. Letting the person know there’s a lot of information on the web and encouraging them to do some research on their own is always great. This let’s the individual know you respect their opinion and that this kind of decision takes some thorough consideration.

Then, I leave.

Often, I’ve shared my story and then said something along the lines of, ‘I know this is a lot to take in, and I’m not expecting a reaction or response immediately – no matter where you want to go from here, I respect that entirely, of course. Do some research, and then let’s talk about how you feel when you’re ready.’

Give Them Time

Everyone is different.

Some people have responded immediately with an incredibly surprising, ‘You mean, that’s all you had to tell me? So what? This doesn’t change how I feel about you.’ Others have needed more time to digest, to come back and ask me questions, and then to digest some more. Because of the taboo nature of STDs, it’s hard to decipher how anyone will react.

As a result, it’s nice to let them know they can have as much time as they need.

In the end, some people may choose not to continue the relationship.

This is an understandable reaction even though it will probably break your heart.

Consider yourself lucky to know why they do not want to go further. You could probably care less about the silver-lining to all of this when your heart is broken…. But remember, most people never know why a person stops calling them or chooses to see other people; they are stuck analyzing everything they did and wondering if it was their looks, their personality, their family, etc.

Should someone choose to end the relationship as a result of your STD, know it actually has nothing to do with you. They were scared – rightfully so – and the relationship had not developed enough for them to be willing to take the risk. Sucks, yes, but it’s not the end of your dating career and it means you’re still awesome despite your STD.

Believe me, it’s true. 🙂

And, for those of you who like bullet points, here’s the abridged version of how to tell someone you have an STD:

– Tell them in-person while in a calm and quiet environment – their home could be a good choice
– Be honest about your experiences, be positive about yourself and your STD, let them ask questions, share the facts and figures, and point out some good resources
– Let the person have some alone time to do their own research and to decide how they would like to proceed.
– Don’t take their decision personally

If All Else Fails…

Should you be in a situation where you have already put a person at risk and you cannot bring yourself to discuss your STD face-to-face, should you feel telling the person would put your safety at risk, or for any other reason you are not able to have a conversation directly, there are a handful of websites designed to notify partners of your STD for you and anonymously.

These are great sites designed for those in fear of judgement but wanting as much as possible to do the right thing.

In fact, the guys at Don’tSpreadIt.com, in particular, are on The STD Project’s facebook page and I’ve chatted with them frequently – they’d love for you to take a gander at their site! 😉

1533882_446848112083407_2051712922_n THE STD PROJECT is a multi-award-winning independent website and progressive movement eradicating STD stigma by facilitating and encouraging awareness, education, and acceptance through story-telling and resource recommendations. Fearlessly led by Founder, Jenelle Marie, The STD Project is committed to modern-day sexual health and prevention by advocating for conscientious and informed decisions. Find them on twitter @theSTDProject