Photo credit: The Gender Spectrum Collection
In a 2012 episode of House, titular protagonist Dr. Gregory House (Hugh Laurie) attempts to disprove a couple’s claim that they’re asexual. In House’s view, the only people who don’t “want” sex are “sick, dead, or lying.” The episode resolves with the doctor discovering that the husband has a pituitary tumor that affects his sex drive (note: sex drive ≠ asexuality), and that his wife was just lying to preserve her husband’s pride. In other words, House was right: Asexuality wasn’t real, and it’s often a symptom of a medical issue. Unfortunately, House’s mentality is all too common in the real world. “As discriminatory as this is in fiction, it’s really not too far from what I’ve actually experienced,” asexual (or ace) artist Courtney Lane says. “Not only does it lead to fear and mistrust, but it does real, tangible harm diagnostically and financially.”
Lane has a disability, the nature of which she didn’t disclose, that requires her to undergo an above-average number of X-rays in a given year. Before the X-rays are conducted, she has to take a mandatory pregnancy test, even though she’s repeatedly shared that she’s asexual. “I’ve quite literally been sitting in my doctor’s office having difficulty breathing and urgently needing a lung X-ray to check for pneumonia while waiting on a urinalysis to come back and tell my doctors the obvious,” she says. “It’s humiliating to not be believed by the people I’m supposed to trust to oversee my health, but it’s also tremendously expensive when all of these little costs throughout the year add up.” Because of doctors’ assumptions, Lane’s been forced to pay out of pocket for certain procedures, such as urine tests, and has endured unnecessary emotional stress. “My disability has riddled my medical history with question marks, and not all physicians are prepared to diagnose or treat something so rare and underresearched,” she says. “I’ve seen firsthand how harmful it can be when doctors try to pathologize your illness when they’ve run out of ideas. I don’t want doctors to pathologize my illness, and I don’t want doctors to medicalize my sexual orientation, but I find that the two often go hand in hand. It’s exhausting.”
The pathologizing of LGBTQ+ people isn’t new: Until 1973, the American Psychiatric Association equated queerness with being “crazy” in its Diagnostic and Statistical Manual (DSM). Though the DSM no longer lists “homosexuality” as a mental illness, the manual’s fifth edition relates asexuality to a condition called hypoactive sexual desire disorder, or HSDD, defined by “low sexual desire accompanied by marked distress or interpersonal difficulties.” Whether this distress is attributed to having “low sexual desire” or is associated with existing as asexual in an allonormative/aphobic society is the question. When people in the asexual community come out, they’re oftentimes met with incredulity and/or skepticism from family, friends, and even medical practitioners. Lane says they’ve “experienced burdensome biases from healthcare providers” throughout their life, which has contributed to a “culture of distrust in medicine when it comes to patients who are women and/or exist within the LGBTQ+ spectrum.”
According to the Asexual Visibility and Education Network, asexuality is defined as a “person who does not experience sexual attraction.” It isn’t equivalent to celibacy, and while some asexual people may not experience sexual attraction—demisexuals and graysexuals can be an exception—they can experience other types of attraction, including romantic, sensual, and aesthetic, as well as other types of human connection. Contrary to popular belief, asexuality isn’t the same as aromanticism, the orientation defined by a lack of romantic attraction, though there are aces who identify as both asexual and aromantic (otherwise known as aroaces). As one of the most underrepresented groups—often termed the “invisible orientation”—within the LGBTQ+ community, asexuals face a number of challenges, including being discriminated against by medical professionals. Because they may be pathologized, many asexuals fear going to the doctor’s office, particularly when they’re seeing a physician about their sexual or reproductive health.
In her 2020 book, Ace: What Asexuality Reveals About Desire, Society, and the Meaning of Sex, Angela Chen explains extensively the medical bias asexuals (both disabled and nondisabled) face. “Medical authority can be powerful even when it is imaginary,” she writes. “Doctors encourage aces to ask ourselves if we’re sick and doctors also diagnose and make declarations without caring what an ace person might think.” I experienced this firsthand a few years ago, when I visited an ob-gyn for a clinical breast exam and routine checkup and decided to share that I’m asexual. I couldn’t tell if I wanted to gauge my doctor’s reaction or if I just wanted to be fully honest with the medical practitioner tasked with helping me take the best care of my body. After I told her, she offhandedly mentioned the idea of prescribing me medication. A chill that had nothing to do with my exposed chest went through me. I was relieved when I learned I didn’t have to return to that same office for reproductive care. To this day, I can’t remember exactly what kind of medication my practitioner wanted to prescribe me, nor exactly what it was for. But I do remember her tone, the way she so easily suggested treatment as if there were something I needed to be cured of, as if my asexuality needed to be cured.
I’m not alone in this experience. “I’ve had to find a new primary care provider a few times…and every time I do, they ask a bunch of questions about my sexual history,” S., who didn’t disclose their last name, says. “I always flinch a little. It catches me off guard that I’m apprehensive about talking about my lack of sexual activity, even with my care provider, because of a few experiences with nonmedical folks that make me fear [my asexuality] will be ridiculed or believed.” Some asexuals I spoke with for this article said some doctors have expressed disbelief before offering hormonal therapy and other unwanted treatments that invalidated their identity and needs. Some were told their orientation stemmed from a psychological issue such as trauma, and/or referred to services equivalent to conversion therapy. Some doctors default to prescribing medication to their asexual patients, believing their asexuality may be a mask for other health issues. Others automatically assume a patient’s low sex drive is a symptom of hormonal imbalances or some other ailment, or a side effect of medication. (For the record, asexuality is defined by attraction rather than sex drive or libido, which asexuals may experience to varying degrees.)
Asexual people aren’t broken—and doctors shouldn’t treat us as if we are.
As such, when many asexuals disclose their identity, doctors attempt to “treat” their asexuality like it’s a medical issue instead of a legitimate identity of which they claim ownership. When a system is calibrated in favor of a supposed “majority,” the system then neglects and harms minority groups. Take, for example, healthcare’s noted racial biases, which create treatment disparities between white patients and patients of color or queerphobic biases that leave those who don’t have sex with cis men at a noted disadvantage. Trans people seeking trans-inclusive medical care often face obstacles, from legal targeting to a lack of respectful clinical training. The fear of being misgendered is enough to keep some trans people from going to the doctor, afraid of the dysphoria that will trigger more pain instead of decreasing it. “It’s hard to feel safe talking to a medical professional whose priorities may be so different from yours,” M. Rodriguez, an asexual woman and medical practitioner, explains. “For example, people have tried to deny me needed medications to save my nonexistent libido and sex life, attempted to refuse me treatment for fear of damaging an impossible pregnancy, and derailed entire appointments about other things to try to fix some aspect of my asexuality despite my protest. I have always been lucky enough to be able to advocate for and get the care I needed in the end. But it should have never been that difficult in the first place.”
I’ve had to learn about asexuality mostly on my own. There was no mention of it in my sex-education classes in high school or college, so I combed through various websites and books to find stories that matched my own and helped validate that I was not strange, weird, or “broken,” as so many people in my asexual community grow up believing about themselves. I’m now at a point where I’m in community with other asexuals and can even claim pride over this part of myself. But the idea that I might step into a doctor’s office and be told I need to be cured of something I’ve just learned to be proud of is heartbreaking and exhausting. Thanks in part to Yasmin Benoit, David Jay, and other activists, there’s a growing awareness about the needs of the asexual community. Asexual people are also becoming better advocates for themselves, but that burden shouldn’t be entirely on our shoulders. People like me shouldn’t have to be afraid of going to the doctor, of having unnecessary tests, procedures, or medications pushed on us because of assumptions made about our sexuality and/or lack of sexual activity.
By creating uncomfortable environments for their patients, doctors reinforce the idea that patients will not be able to trust their medical providers. And by not trusting your medical providers, ace and other queer-adjacent folk will be less inclined to go to them for assistance, which puts our lives at risk. Medical establishments treating both physical and mental health need to expand their education, constantly update their terminology, and work to provide inclusive care. When I revealed to my therapist that I was asexual, she was affirming and positive about my orientation. In turn, I felt safe in our sessions, which allowed me to open up more. While no one can expect their healthcare providers to be aware of every issue, doctors and other medical professionals should be open to learning—and to admitting they’re not the ultimate authority on their patients’ needs. It’s up to the medical establishment to become more inclusive and to learn about the sociopolitical issues that could be affecting their patients’ mental and/or physical health. Most importantly, the medical community must learn and constantly understand that asexuality is a real identity. Asexuality isn’t an internet sexuality or a medical dysfunction. Asexual people aren’t broken—and doctors shouldn’t treat us as if we are.
