“To a large extent the health professions have avoided any involvement by the simple expedient of providing no sex education at the professional level in medical and nursing schools. Consequently, the physician and the nurse often lack essential knowledge and, naturally enough, prefer not to become involved in a branch of medicine in which they find themselves personally embarrassed and professionally incompetent.
Patients do not accept this attitude, however. More and more aware of the sexual nature of their problems, they turn with reason and confidence to their health practitioners, but often encounter a reluctance to tackle the problem or are given a superficial reply.” -The Teaching of Human Sexuality in Schools for Health Professionals, page 11
In 1974 the World Health organization issued The Teaching of Human Sexuality in Schools for Health Professionals, a 46 page document on training health professionals in sexuality wherein they stressed the importance of communication skills alongside sexual health knowledge. Three and a half decades later and the Association of American Medical Colleges still provides no guidelines for sexuality medical training. This means no medical school is required to teach their doctors anything about sexuality whatsoever.
As you can imagine, this leads to some misbehaving medical practitioners. Anyone I’ve ever spoken to about STI testing or sex questions to a general practitioner has had at least one awful, shaming experience. I elicited stories from readers, friends and colleagues and what I heard was par for the course, with some outstandingly bad interactions.
Despite the World Health Organization’s recommendations for practitioner objectivity and sensitivity, health professionals still abuse their position of power to force their own views on patients.
One woman told me about her difficult decision to terminate her pregnancy and the awful treatment she received:
“The nurse that administered the ultra sound described the wand as a huge dildo before she shoved it into me. I asked her to be very discreet during the ultra sound because this was hard for me and she proceeded to describe the fetus and then leave the photos sitting face up on the bench near my clothes.” [Later on after taking RU-486] “When I told the nurse I had been throwing up for 10 hours because of the pain she said that I must have contracted a stomach bug at the exact same time that I took the miscarry pills.”
Another woman told me about blatant sex-shaming:
“[A]fter some concern that I might have an STD, I made an appointment for a pelvic exam and screening. After discussing my concerns with the doctor, a middle-aged woman, she proceeded to very flatly tell me, “You know, you have sex with a lot of people, and this is what happens when you do that.”
Some practitioners brought shame upon their patients by simply avoiding the sex issue as much as possible:
“The doctor who performed an “STD Screening” on me by looking at then poking my penis and then telling me I was fine.”
On Scarleteen, a user posted a story about an outrageously insensitive doctor lecturing instead of listening to her patient with PTSD. My blood started to boil when I read this line:
“She asked if I could have someone take me home, and I said I didn’t have anyone that I would feel comfortable seeing me like that. Then she said that I’m alone because I don’t let people be close to me.”
Education Trumps Personal Experience
The most common theme in the stories I read and heard was doctors assuming their training and textbook knowledge was more important than listening to their patients.
“I had a male gynecologist at the time and he had no sympathy whatsoever. He used a cold speculum and then when doing the procedure, it hurt horrifically. I was screaming and crying and while the nurse was holding my hand he said “this doesn’t hurt, you can’t feel it”"
Try to imagine what that must feel like. A relative stranger in a position of power with their hands inside you, telling you the pain you’re obviously feeling is not real. This is a common story of women seeing male gynecologists but all genders perpetrate bad bedside manner.
An article on Scarleteen echoes the story above:
“One second in and I told her it hurt. Another few seconds and I told her to stop. This wasn’t right. Her technique was the dangerous nonsense medical schools seem to teach — plunge in, turn your head away from the patient, feel around hurriedly to get the information you need, pull out.
My voice got quieter and quieter. She ignored me and kept telling me to breathe. It hurt. I kept saying it hurt, but her response was to thrust around more quickly, keep her head 90 degrees away from me, and tell me to breathe. I didn’t know what to do. I don’t know if I said stop again. I started thinking it would be over soon and if she stopped now, I’d just have to let someone else put a speculum in later. When she was finished she said it probably hurt because she was applying pressure near the cyst: I had a cyst. She made no acknowledgment of what had actually just happened to me.”
Another friend told me about some rather rough treatment from a hospital doctor:
“When I went to the hospital while in labor with my son, the jackass who examined me when I got there at 6am jammed his fingers up so far and so hard and so quickly that he broke my goddamn water.”
These stories of unnecessary roughness are maddeningly common. What’s worse is that many women avoid getting pelvic exams because it’s often a traumatic experience. One woman wrote an article in the UK Guardian on why she would never again get another pap smear. A writer at Jezebel countered by saying women need to be more communicative with their providers, but many readers still disagreed.
For some the trauma can fade. For others, the consequences of bad medical practice can be lifelong:
“[A]t the age of 16 I was pretty much forced by the sexual health clinic to go on the Depo Provera injection. I researched it online at the time and went back with a bunch of questions about it being used to chastise sex offenders in prisons (low sex drive in women), weight gain and risk of osteoperosis [sic]. The sexual health clinic doctor pretty much lied and said all that stuff was made up and put out by people who want to bring the drug companies down.
Now it’s 10 years later (6 years after I came off the injection because they stopped prescribing it…where I was living at the time due to the health risks!!) and I’m STILL having side effects and it may have irreversibly affected my fertility.”
This is on top of heinous sex education in our country. One reader sent in a hilarious yet saddening sex ed story:
The scene: sixth grade “Family Life” sex ed class (circa 1993). The girls have been separated from the boys. On the overhead projector is a labeled diagram of a vulva, with a SQUARE OF PAPER over the clitoris so we can’t see it. No mention is made of it.
At the end of class every day we all have to write down an anonymous question about the day’s lesson and put it in a box for discussion the next day, the idea being that we would all have the opportunity to ask questions that we were too embarrassed to say out loud. Since I was already intimately familiar with my own clitoris and found the censorship on the diagram kind of weird (although I didn’t realize at the time just how outrageous and infuriating it was), I decided to press the issue and wrote down “Where is the clitoris located and what does it do?” The next day we were informed that it’s located above the vaginal opening and that it’s “a gland.” A gland! Because, you know, it would have been totally scandalous to say “The clitoris is a group of highly sensitive nerve endings that create pleasurable sensations when stimulated.” We couldn’t have all the sixth grade girls running home and experimenting with *that*.
What a crock of shit. Did they put a square of paper over the head of the penis in the boys’ class because that’s a sensitive area too? Somehow I doubt it.
Granted, this was in 1993, but I recently had a student ask me if two people having unprotected anal sex could create HIV. His health teacher at a previous high school told him this. Last year.
While there are more than enough doctors with poor training in sexuality, some medical schools are very progressive. I asked a friend in her first year of med school to ask other med students about their training.
A second year student perspective:
I think we’ve had pretty decent training on the issues of discussing sexuality with patients and STIs especially. Keeping in mind that course time is valuable and we don’t really [hear] on many issues more than once, to the best of my memory we’ve had full afternoon workshops on taking sexual histories, diversity in sexuality (LGBT and spectrum discussion, concerns, especially pertinent medical issues and interviewing skills), sexuality and aging, birth control and then lectures interspersed regarding STIs, sexual dysfunction in both sexes, gynecology and urology ad nauseum, etc. So, I think it’s something, at least at [our university] (home of the biopsychosocial model), that is addressed pretty well. We get to work with standardized patient actors in the first two years to develop interview skills (and physical exam skills such as digital rectal exams and pelvic exams) that are of this “sensitive” nature, which I feel like helps break the ice. Diversity is stressed and we are urged to stay open minded and ask questions in a non-judgmental, open-ended way and to address all concerns delicately but thoroughly. We have also had the opportunity second year to shadow OB-GYNs in their clinic which treats the full spectrum of gynecological concerns, from STI to birth control to sexual dysfunction.
A fourth year about to start his Ob/Gyn residency:
Our school specifically provides us with a couple lectures on sexuality and sexual orientation (full LGBT awareness and health issues relating to them) which covers normal patterns of sexual arousal with details on physiological and emotional responses, theories of arousal cycles, etc. We also receive training in communicating with patients in a neutral and non-judgmental manner when taking histories, such as referring to partner instead of spouse, asking about sex with men, women, or both, and exploring all aspects of a patient’s sexual health including frequency, number of partners, sexual activities performed, protection used, prior infections, all to asses the patient’s health and possible risk for current or future disease.
Hearing from those students and talking to other health care professionals gives me some hope. The biggest issue right now is that there is no standard requirement for medical schools. That is what I find to be absolutely insane. Despite the World Health Organization outlining training recommendations over thirty years ago, the AAMC has not created training guidelines. If we want these stories to decrease in frequency and provide excellent health treatment to patients, the medical community must adopt guidelines.
Are you listening AAMC? Sexuality needs to be a topic in the medical field.
A special Thank You to everyone that responded to my request. Even if I was unable to fit your words directly into this article your story helped immensely.