Talking about sexual health can be scary for anyone — it can feel isolating and intimidating because we’re not taught how to talk about our sexual bodies in an affirming and positive way. But especially for queer folks, navigating the blurred world of sexual health can be all too overwhelming to even delve into. Most LGBTQ people can recall at least one experience with a doctor that went horribly and left them feeling exposed, not taken care of, or completely disregarded. As harmful as these medical experiences are for queer and trans folks, we can’t let them deter us from reaching out for resources and help when we need it.
Especially when it comes to our sexual health.
There are so many health care practitioners who are making a genuine effort to provide not only LGBTQ accepting care but LGBTQ affirming care — meaning that we can find our identities and realities reflected to us with careful intention in the intake forms, the questions we are asked about our bodies, and the resources provided to us during a visit. Planned Parenthood NYC is one of those places and I wanted to speak with their Director of Quality Management & Director of Transgender Health Services, Kate Steinle, about how they got there and what steps they are continuing to take to ensure a safe environment for all LGBTQ people.
GO Magazine: What barriers specifically do lesbian, queer and bisexual women face when it comes to accessing sexual health resources?
Kate Steinle: The LGBTQ community, in general, can face many barriers when it comes to accessing high-quality health care. These include: lower rates of health insurance due to unemployment or underemployment, being more likely to delay care or not receive care due to costs, discrimination and negative experiences with providers, few culturally competent providers especially in areas outside of metropolitan centers, and a lack of comprehensive sex ed pertaining to queer sexuality.
GO: What stigmas do you see lesbian, queer and bisexual women struggling with at health clinics?
KS: Often, health intake forms do not ask questions in a way that adequately access a patient’s risk factors. There are still some clinics that believe they are asking a complete sexual health history by asking, “do you have sex with men, women, or both?” That’s so incomplete!
What information are you getting from the answer to that question? Do you have any idea what genitals that partner has? No! Do you have any idea what type of sex those bodies are having? No! Do you have any idea how many partners that patient has? No!
In our health center, we ask very direct questions about the body parts of partners and what type of sex the patient is having in order to assess risk for pregnancy and risk of STI transmission. This is the only way that we can offer counseling that is specific to the patients’ needs.
Also, a medical provider who does not ask the right questions may assume that a queer cis woman is not at risk for pregnancy, and therefore bypass birth control counseling and leave the patient at risk for unintended pregnancy.
GO: There’s often a myth that people with vulvas having sex with other people with vulvas can’t get STIs or are at a lower risk. How can we break down that myth so people can prioritize their sexual health?
KS: It is important for people to be educated on the real risks of STI transmission associated with all different types of sexual practices so that they can make informed decisions. This goes for medical providers keeping themselves up to date on studies about the prevalence of STIs in certain populations and how to appropriately screen their patients given the patient’s risk factors and the type of sex they are having. Many clinics just do vaginal swabs for STIs, without even considering or offering other sites of testing. What happens if the patient is having receptive anal sex or performing unprotected oral sex?
It is a myth both among many medical providers and among many patients that people with vulvas having sex solely with other people with vulvas are at a very low risk of STI transmission. While this is true for some types of sex and some types of STIs, there is still a real risk for transmission of STIs for this population. Fluid exchange can happen vaginally, rectally, orally – and with it, the risk of chlamydia, gonorrhea, HIV, trichomoniasis. Genital to genital skin contact can carry the risk of herpes, HPV, syphilis. Oral to genital or rectal skin can carry the risk of herpes, syphilis, and possibly some other STIs.
The reality is that patients want to be asked questions that pertain to their lives and their risk factors. But we need to do this in a respectful way. We need to create a welcoming and non-judgmental environment with our updated health intake forms, with our cultural humility/competency training for all health center staff, with our continued training of medical providers. Only then will we create an atmosphere where the patient feels they can share their full self and be given the most appropriate and accurate care and counseling.
GO: What advice would you give to queer women who are struggling to find an LGBTQ affirming health provider?
KS: To find an LGBTQ-friendly provider, you can check this list of providers provided by the GLMA: Health Professionals Advancing LGBT Equality (GLMA). You can also look on the NYC Health Map: www.nyc.gov/lgbtqhealth/ or for trans patients: www.MyTranshealth.com
Use your community, friends, social networks to discuss which providers people have felt comfortable with, which ones they have had problems with. You can learn more about queer health here and if you think you’ve been the victim of discrimination in health care, contact your local ACLU chapter.
GO: What do queer women need to know about PrEP and PEP?
KS: HIV transmission is a risk between all partners who are fluid bonded. For people with vulvas having sex with other people with vulvas, this can happen through fingering/fisting, oral sex, and sharing sex toys. Some of these sexual practices have low risk, some have higher risk, but again, medical providers need to ask the right questions in order to counsel each patient on their individual risk factors.
When a safe and respectful environment is created in a medical clinic for the patient to be honest with their provider about their possible risk factors for HIV transmission, then real conversations can happen about PrEP.
PrEP is not just for cis gay men. This is a myth that was perpetuated by public health advertising in the past, but there is an active attempt to recreate the narrative of risk for the public so that uptake in PrEP happens among people who need it, including queer cis women. Ask your provider about PrEP. If they don’t prescribe it, ask why.
PEP is for anyone who feels like they have had possible exposure to HIV within the past 72 hours. You can call the NYC PEP Hotline at (844) 3-PEPNYC (844-373-7692) to find out where you can access PEP as quickly as possible depending on your location. Most clinics that provide PEP can help uninsured patients access the medication. PPNYC offers PrEP and PEP at all five of its clinics.
GO: Does PP offer free dental dams or finger cots for safer sex barriers?
KS: PPNYC offers free dental dams to patients, as well as external and internal condoms.