Family Doctors, STI Screening, and Shaming

Celeste Orr describes how women are treated differently than men during STI screening.

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For various reasons, I haven’t had a consistent family doctor. So, when I seek comprehensive testing for Sexually Transmitted Infections (STIs), I’m usually (sceptically) facing (and fearing) a new family doctor. But, the impending procedures aren’t what prompt my anxiety; I dread being asked certain questions.

In my experience, male family doctors usually ask me at least one of the following questions when I want STI testing: “How many men have you had sex with since your last testing for STIs, or in the last months?” “Do you have a boyfriend?” “Why are you here if you have a steady (male) partner?” For a long time I have assumed that everyone was asked (and made uncomfortable by) these questions. However, I recently started comparing my experience with those of others.

Numerous women I spoke with noted that male family doctors ask these questions more often than female family doctors. Some added that, when they (honestly or dishonestly) answered questions about the number of sexual partners they have had, the family doctor seemed dissatisfied with their answer. For example, one friend told me that the number she provided prompted the family doctor to ask if she needed help dealing with her sex addiction. Many friends and colleagues noted that the doctor’s attitude made them feel uncomfortable for having multiple partners. One doctor asked another friend of mine, who at the time was “only having sex with women,” if she still wanted STI testing, insinuating that lesbian sex is not “real” sex or she isn’t in danger of contracting an STI. Many women I spoke with were concerned that if they didn’t answer, or if they demanded reasons for, such questions, then the rest of the appointment would turn out to be more awkward than it would have been otherwise. In other words, many of us (un/truthfully) answer these sorts of questions and endure feeling shamed in order to get the services we know we need.

Max Klinger, "Shame" 1880/1903

Max Klinger, “Shame” 1880/1903

Some men who I asked about their experiences were shocked that a family doctor would need to know how many people the patient had sex with. Others had been asked how many sexual partners they had had, but didn’t feel strange answering. This is perhaps because it is often assumed that men will have multiple partners. One man noted that, when he said that he was in a monogamous, heterosexual relationship, the doctor insinuated that his female partner might not be faithful and he should definitely get tested.

Even if unintentionally, medical professionals treat people differently depending on their (suspected or confirmed) gender, dis/ability, race, ethnicity, non-/trans status, non-/intersex status, class, occupation, sexuality, weight, and age. While there is an argument to be made that doctors are trying to gauge their patients’ “at risk” status to make sure they perform all the correct procedures, STI tests don’t change according to how many sexual partners a patient has had. Nor does providing information about safer sex practices depend on knowing how many people the patient has recently had sex with. And, if these questions are medically necessary, why don’t all family doctors ask these questions of all patients consistently?

Questions about one’s sexual activity should not assume heterosexuality. Like so many other women I have spoken with, I find the question, “How many men have you slept with?” isolating. Assuming heterosexuality either coerces one to awkwardly out oneself or makes one want to lie to just get it all over with.

Equally, family doctors should not assume monogamy. Again, like so many other women I have spoken with, I find the question, “Why are you here if you have a steady partner?” isolating; it extols or presumes (successful) monogamy, incorrectly implies that having one sexual partner is a safeguard against STIs, links non-monogamy with disease, and indirectly (slut) shames the patient if she and her partner are not monogamous.

Asking a woman how many sexual partners she has had – gauging how “at risk” she is – implies that female “purity” is negated or diminished as the number of sexual partners increases. Linking a woman’s purity with how many or how few sexual partners she has (had) is a manifestation of slut shaming, a practice that men largely escape. Yet, the purity myth and slut shaming are not applied to all women in the same way. For example, women of colour, low-income or homeless women, and trans women are hypersexualized and conceptually linked with impurities and diseases. Hence, asking a woman to disclose how many partners she has had can take on racist, transphobic, and classist undertones, as well as sexist and homophobic undertones.

I cannot help but feel that the questions I have been asked about my sex life function, at least in part, to abate a family doctor’s curiosity, a curiosity that exacerbates the already inequitable power relations.

I have had some fantastic family doctors who have made me feel safe, confident, and at ease. These family doctors were capable of imparting all the information I needed and performing all the necessary procedures without knowing how many people I have had sex with. Leaving patients feeling vulnerable, exposed, and shamed is not inevitable.

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Celeste Orr is a Ph.D. Candidate at the University of Ottawa in the Institute of Feminist and Gender Studies.

2 comments

  1. When I was younger, I was asked these types of questions at every feminine exam. But in recent years, they haven’t asked me anything at all. Not if I’ve had sex, or with how many people, or what my sexual orientation is. Kinda weird.

  2. felonious grammar · · Reply

    So true.

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