Unsalved MysteriesThe Case of the Heternormative Healthcare

Photo credit: Ashley Armitage/Refinery29 for Getty Images

This article was published in Sick Issue #86 | Spring 2020

In 2015, I started routinely going to the gynecologist because my vulva was constantly itching. It was the first time I’d ever been at odds with my body, and in particular my vagina, so I bought all kinds of products—yeast-infection creams, cranberry pills, garlic—that I shoved into my vagina, along with all-natural, all-organic, cure-all cranberry juice from a “health” store. Nothing worked. And then the infections suddenly stopped. Months later, a gynecologist at my college clinic diagnosed me with chronic yeast infections and prescribed probiotics to balance out “good” bacteria, as well as more yeast-infection medication. This wasn’t the first time I’d experienced an inexplicable vaginal problem: After having sex with another cisgender woman for the first time, I suddenly developed stomach pains. I initially thought I had a urinary tract infection, but UTIs don’t cause that kind or level of pain.

Another gynecologist prescribed yeast-infection medication, though the pain felt different from the aches associated with yeast infections. And then the pain suddenly stopped. Did the medication ease the pain? Or did the pain end because this woman and I stopped having sex? These questions have gone unanswered, though the pain returned after I had sex with a different partner. Whenever I experience this pain or another vaginal issue after sex, I wonder if my body chemistry doesn’t mesh with my new partner’s body chemistry, but what does that even mean? There’s a lack of medical language around such experiences and a dearth of experts who focus on queer women’s reproductive health—and who might be able to explain why having sex with a new partner may cause difficult-to-diagnose medical issues.

Most gynecologists I’ve seen don’t ask me about my sexuality. I am open about my queerness though, so I reveal it when I feel safe with a new provider. But even after they’ve added notes about queerness to my chart, they don’t ask questions: No one asks if I use protection or mentions gloves or dental dams or asks if I engage primarily in oral, finger-fucking, strap-ons, or other sex toys. There’s a legitimate feeling that the gynecologists I’ve encountered—who I am trusting with my health—are not interested in understanding the needs of women who have sex with women (WSW). Though it’s unlikely that any of these doctors have a standard definition of lesbian sex, they don’t inquire about my sexual habits, and they end up with minimal context as to what could be causing these infections. At one appointment, the doctor asked, “Could you have STDs?” I replied, “I have no idea?” And without asking another question, my doctor sent me off with UTI medicine.

Vaginal healthcare for WSW seems nonexistent. While WSW are often advised on how to tell our doctors we have sex with other women, we could use more guidance on how these conversations might offer more solutions. How is a doctor going to help me with my reproductive health if they don’t even know how I do or don’t have sex or what is or isn’t going in, or around, my vagina? “In 2016, I had a case of oral thrush that caused painful swallowing,” Elena, 27, a bisexual writer from Washington, D.C., tells Bitch. “My doctor diagnosed it pretty quickly, so that was fine [but while] doing more research on my own, I realized it was probably caused by having oral sex with a woman with a yeast infection. My doctor’s lack of familiarity with queer women caused me to receive less competent care.” When I need help understanding my body, I turn to the internet—just like many other queer people.

In an August 2019 article for Shape, Gabrielle Kassel writes that STIs shouldn’t be the beginning and end of the conversation about queer women’s sexual health: “If you and your partner have gotten tested and everything looks clear, know that STIs aren’t the only concern; women who sleep with other women are still at risk for other not-so-fun things like sex injuries, microtears, bacterial vaginosis, and UTIs.” I also keep coming across the idea that queer women are more likely to pass a variety of infections back and forth rather than exchange “real” STIs (especially given that most STIs are defined through a lens that views penis-vagina sex as “real sex”). A 2004 study from the Department of General Practice and Primary Care at King’s College found that it’s common for WSW to transmit bacterial vaginosis (BV) to one another. “The increasing odds of BV with larger numbers of female sexual partners suggest that BV may be sexually transmitted between women,” the report stated.

And yet, queer women are still not being centered in the ways that we need, according to sex educator and writer Cameron Glover. “Medical professionals receive a low number of hours specifically on sex education while obtaining their medical degrees, and that lack of education [and unchecked bias] contributes to queer women being ignored at the expense of their health.” I’ve never had a doctor, educator, or medical professional advise me to make sure my hands are clean before sex or explain how to wash my sex toys. This lack of understanding and expertise just accentuates the lack of time, respect, and adequate care given to queer women. In some ways, this is unsurprising; the medical establishment has yet to invest in women’s healthcare in general, so it’s not surprising that homophobia overlaps with sexism (and likely classism, considering that coupled WSW tend to be low income), which pushes us to the margins of healthcare.

Though some love to joke that vaginas are a mystery, they aren’t; they’re just body parts, and we deserve to have doctors who understand our bodies rather than shove them under the broad umbrella of “mysterious.”

Trans women face even more erasure when it comes to healthcare: The National Transgender Discrimination Survey, created by the National LGBTQ Task Force and the National Center for Transgender Equality, found that 50 percent of those surveyed reported having to teach their medical providers about transgender care, and nearly one in five (19 percent) reported being refused care outright because they were transgender or gender nonconforming. These days, books and digital communities are beginning to fill the gaps. Books like Fucking Trans Women (2013) by Mira Bellwether, Girl Sex 101 (2015) by Allison Moon, and Queer Sex (2018) by Juno Roche; and media outlets like Autostraddle (where I am a writer); and lesbian YouTubers like Stevie Boebi are helping to provide more comprehensive sex education, even if they can’t actually provide prescriptions or provide diagnoses.

“If you’re living near a metropolitan area, searching for a queer-informed gynecologist or medical professional is a privilege that is available,” Glover says. “However, if this isn’t doable for you, understand that you are your best advocate. Do your own research [from credible sources] before your appointment, be specific and direct about what your questions and needs are, and understand that you know yourself and your health better than anyone else. If you’re getting pushback from a medical professional who doesn’t want to perform a service that you need or want done, you can also request that their denial of service be recorded on your official chart.” My vaginal healthcare mysteries have been—and may continue to be—demoralizing and frustrating, but I’m also fortunate to have adequate healthcare. Many queer women, however, are forced to navigate a queerphobic and nonaffirming healthcare system without any support. Though some love to joke that vaginas are a mystery, they aren’t; they’re just body parts, and we deserve to have doctors who understand our bodies rather than shove them under the broad umbrella of “mysterious.”

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by Rachel Charlene Lewis
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Rachel Charlene Lewis is the Senior Editor at Bitch. She has written about culture, identity, and the internet for publications including i-D, Teen Vogue, Refinery29, Greatist, Glamour, Autostraddle, Ravishly, SELF, StyleCaster, The Frisky (RIP), The Mary Sue, and elsewhere. Her literary work, reviews, and interviews have been published in Catapult, The Los Angeles Review of Books, The Normal School, Publisher’s Weekly, The Offing, and in several other magazines. She is on Twitter and Instagram, always.