The voices of clinicians that provide reproductive and sexual health care are often muted by the raging political debate and moralistic anti-abortion tirades that are front and center on the national agenda.
Undeniably, providing abortion services is part of what I do. However, the majority of my work day is spent helping patients prevent pregnancy and screening for or treating sexually transmitted infections while also providing sexuality counseling.
A world where sexual mores are changing rapidly, hook-up apps like Grindr are popular, the opioid epidemic is out of control, and new HIV and syphilis infections are on the rise means my work has become very complex.
Nothing short of deft management of people’s physical and emotional health will work every time I walk into an exam room to take a sexual history and determine my plan of care. No one ever talks or writes about this in the media.
Now at 60, with 35 years of practice experience under my belt, I have come to believe that the body has a mind of its own that will take the psyche into all sorts of places, regardless of the warning signs and hazard lights that are visible ahead of time.
Just about all my patients — college professors, teens, physicians, bank tellers — have one thing in common: low sexual literacy and limited sexual self-advocacy skills. This reflects the microeffects of a macro social problem: we don’t really teach people anything about sex because we don’t really talk about sex.
When I walk into an exam room, my patients seem to recognize they are now in a sex-talk confessional with a sympathetic and wise senior stateswoman. I figuratively carry a sign that says: I will grant absolution for all things — and do my best to take care of you.
I am happy to report this is working nicely. I have many patients who request appointments with me personally and have developed a reputation for being both kind and competent. What more can a clinician ask for?
My perspective on care has raised more than one eyebrow among my colleagues and friends. When they hear me discussing the current syphilis outbreak, the hazards of casual sex with Grindr hook-ups, or my apparent tolerance of all kinds of sexual lifestyles, they can’t imagine how I avoid proselytizing about the virtues of more temperate behavior.
My answer? Doing so is not compassionate, effective, or comprehensive. My patients need to be honest with me in order for me to give them the best care. Talking about temperance will yield only fragments of the information I need to make the best clinical decisions I can on their behalf.
I hate to think about the many patients I may have offended in my younger days or those that my colleagues in medicine continue to offend when they launch into lectures about how sex should or shouldn’t be experienced. Such an approach is neither safe, effective, or frankly, honest.
The fact is, all of us are fallen angels when it comes to sex. Very likely, every one of us has done something we would rather not review, disclose, or discuss and may still be doing so while facing very high risks that we don’t know exist or chose to ignore.
Folks often ask me what my plans are for retirement. My answer? When I start seeing billboards and bumper stickers that say: Talk about sex often and openly, it’s safest that way! Then I’ll know it’s time to stop working.
Evelyn Resh is a clinician in practice in western Massachusetts. She also is a writer on topics related to health. She can be reached through her website: evelynresh.com