I attended an interesting talk today at the CRT at 20 conference on the topic of medical education and cultural competency, focusing especially on women of color’s experiences with gynecology. I started thinking about a tangential topic that I think is sometimes overlooked in LGBT studies: lesbians’ experience with sexual and reproductive health care services.
Later I will probably post some comments on how lesbians experience sexual and reproductive health care generally and differently from heterosexual women. Just now, though, I had a thought about the construction of the female body and how badly this jives with feminism and with lesbianism.
There has been a lot of talk among feminists about how the female sexual organs are reduced to their reproductive function, and how women’s sexual pleasure can be effectively erased from a discussion about women’s anatomy. My thought is that the woman’s body is sexualized, but it is sexualized only with reference to the man/the male body.
When you think about this part of the body, it’s likely that one of your first thoughts concerns the vagina. My guess is that gynecologists and other health care professionals see the vagina in two ways: as a receptacle for the penis (focusing on sexual health, contraception, disease, etc.) or as a passageway for a child (focusing on pregnancy, fertility, etc.) I think this is also true of the culture in general.
One problem is that the vagina is, for many women, not the site of sexual pleasure (or not the sole site), and so there is a separation between health and pleasure. I would posit that it is difficult to celebrate and enjoy the experience of health and health care when it is separated in this way from sexual pleasure. I think most of us experience our body in vastly different ways in the bedroom and in the doctor’s office. Another problem is that it makes the healthcare experience irrelevant for lesbian women, especially lesbian women not interested in giving birth. Our concerns may be difficult to express because society and our health care experiences have not given us a language to express them. I know that I find the gynecologist fairly irrelevant to me – I get an annual pap smear and I get birth control for migraines, but that’s it. My doctor is not necessarily someone I trust, nor do I associate him with my overall health.
I think that this disconnect may also have something to do with why lesbian women often do not go in for services such as pap smears, mammograms, and STI tests. STIs are often conceived of as a penis-in-vagina consequence. Even if we know that STIs can be transferred through any fluid contact, the lesbian community tends to see barrier methods as weird. If not weird, they’re just a pain. I’d guess that many of us haven’t asked our health care provider for advice concerning sexual health. I’ve had experiences with a female gynecologist who told me I only needed pap smears if I were having sex with a man, and a female resident whom I asked about sexual health and she said she didn’t know anything about STI risks. I’ve also had a lot of frustrating experiences when I’m talking with a health care professional about PCOS and he or she tells me repeatedly about my fertility options and forces literature on me, even though I say that I am not interested in having children, ever. I was even once told “oh, you’ll change your mind.” I find this condescending, and the lack of agency makes me fearful of healthcare.
I’m not sure exactly how this could be fixed, but I do think that in anatomy courses and wherever else medical students learn about the female body, the woman should be construed as a whole person, and her experiences of her body considered fully. I want health care professionals to think of women’s sexuality in terms of her own body, and all of it – not in terms of a penis and a vagina, plus possible “alternatives.” I also think that healthcare professionals need to learn how to have effective dialogues that do not make assumptions about sexual practices or reproductive choices. I don’t know how we get there, but I hope it’s where we’re going.