First: how is the US lagging on this insanely cool nanotechnology? Consumers in the US only have access to urine-sample kits sent into a lab for processing. (I wrote about one such private service earlier this year.) The future of STI testing may be arriving soon, but not on this side of the pond.
Second: there is a big conceptual gap evidenced in these government agencies concerning STI testing.
Snip from the NYT Blog:
F.D.A. officials said they needed to first confirm the test was accurate.
There are “a lot of social implications if there is a false result, as you can imagine,’’ said Dr. Sally Hojvat, director of microbiology for the medical device division at the agency.
Another concern of the F.D.A. is whether people who test positive will have access to a doctor. Mr. Smith said Identigene has doctors on contract who will approve each test ordered and release the result. But he said the company could not ensure the doctors would talk to patients.
Snip from the Guardian:
Prof Noel Gill, head of HIV and STIs at the Health Protection Agency, the government agency that monitors infections and advises on containment strategies, said: “HPA surveillance has shown that the impact of STIs is greatest among young people and we hope that the application of new technology will help to reduce transmission of infection in this age group.
“This is an exciting research and development consortium which will develop new technologies that both improve and expand testing for STIs. As innovations become available, the HPA will co-ordinate large-scale evaluations within a network of collaborating STI clinics,” Gill added.
While there is no way to ensure with either technology that users will seek medical treatment, there is also no way to ensure a patient will take the antibiotics given to them. (Or follow any of a health professional’s advice. How many times has your dentist told you to floss?) The level of control exercised by the FDA on this matter seems mistrustful of consumers and favoring doctors. In contrast, the message from the UK agencies seem to simply be: “We’ll do whatever we can to get you tested.”
Personally, I don’t think the FDA should be restricting the public’s access to reliable STI tests. The most important thing is that the tests are accurate, accessible and results come with information on how to obtain treatment.
“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
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.
“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.
In everything-you-think-you-know-is-wrong news, Dr. Alfred Kinsey was not the pioneer of sex surveys. Before Kinsey moved from a taxonomy of gall wasps to a taxonomy of human sexual behaviors, Dr. Clelia Mosher (pictured above), Dr. Katharine Davis and Dr. Robert Lou Dickinson had already collected survey data on early 20th century sexual attitudes and behaviors.
Dr. Katharine Davis worked in New York as a corrections officer and social reformer during the early 1900s. Sexual studies were not the focus of her career but in 1929 she published the results of 2,200 questionnaires filled out by educated women. The most interesting finding (according to me)? 71.8% of women felt that an abortion “should ever be performed”. Compare this to a current poll finding “57 per cent of respondents think abortion should be legal in all or most cases”.
The numbers were roughly the same in both studies but though Davis had more total responses, all those responses were women. I wonder if the inclusion of male respondents tipped the data in the most recent study? In a CBS/NYT poll, more men supported abortion than women (by a small margin) so modern attitudes may have become more conservative or women’s attitudes may have been influenced by witnessing higher maternal and child morbidity rates. Abortion might not seem like such a big deal when babies or mothers giving birth died more frequently.
An East Coast gynecologist and researcher during the early 20th century, Dickinson pioneered the practice of large-scale sexual histories. He studied sexuality in marriage, personal sexual histories of his female patients, was one of the first doctors to use vibrators on female patients and used his impressive drawing skills to catalog diverse appearances in sexual physiology, namely genitals.
In his survey of one thousand married women he found that they most frequently complained about failure to reach orgasm and that obstacles to sexual pleasure were primarily inorganic, ie. not physiological in nature. Essentially, attitudes towards sex impacted the ability to enjoy sex, findings on female sexual response echoed in later research. He also had a kick-ass middle name.
In the category of kick-ass full names and all-around character is Clelia Duel Mosher. While Davis and Dickinson toiled on the East Coast, Dr. Mosher conducted possibly the first known female sexual attitudes survey in 1892 in the Midwest. Her study was meant to fill her own knowledge gaps for a married life presentation for the Mothers Club of the University of Wisconsin.
She continued conducting surveys into 1920 but only created 45 profiles that remained buried with other paperwork until Carl Degler discovered the work in 1973, decades after Mosher’s death. The papers became a sensational peek into Victorian female sexuality, affirming that the public record of values often disappears in private conduct. The majority of women in the 45 profiles reported enjoying sex and experiencing sexual desire, contrary to popular belief.
Mosher achieved recognition in her lifetime for menstruation studies. Common knowledge at the time assumed women to be naturally frail but Mosher’s work proved that binding corsets, bad diet and socially prescribed physical inertia contributed to women’s breathing issues and menstrual pain. She was far ahead of her time and recommended abdominal and breathing exercises (called Moshers!) in addition to being physically active during menstruation.
Dr. Clelia Duel Mosher is a fascinating figure, though ultimately lonely because she was so far ahead of her time. I strongly recommend reading the in-depth American Heritage article on her or the recent Stanford article on her life and work.
Thanks to my friend David for sending me the Stanford article on Dr. Clelia Mosher that reminded me about pioneering sex researchers!
I hate STI images in sexuality/health education textbooks. Every image you have ever seen of STI afflicted genitals are the worst cases encountered by doctors. Some argue that we need to show these images so that people understand the dangers associated with unprotected sex but I say cauliflower dick pics do more harm than good. Some very NSFW photos will illustrate my point nicely. (Do not click through if you are squeamish about STI photos.) Continue reading →
In the late 19th and early 20th century, many women were diagnosed with female hysteria, a generally vague affliction that could cause things like irritability and trouble making tendencies. (Male hysteria was also recognized but not as publicly and the treatment was usually just psychotherapy). Because the clitoris was not publicly recognized as a major point of sexual response, doctors would massage a lady’s happy button as treatment for hysteria. This was not considered a sexual act but probably a profitable one for the doctors as the massage was “treatment” and not a “cure” from some whack affliction
As this was pretty time consuming and could lead to some sore wrists and fingers, the vibrator was invented as a mechanical alternative. Once vibrators began appearing in “stag films” (porn!) and the sexual nature of the objects started to become publicly known, the treatment for hysteria was a little scandalized. Doctors definitely stopped giving clitjobs at that point but still kept selling vibrators. Did you know that you used to have a medical prescription to get one? I mean, in many parts of the country they’re still sold as marital aids.