Asexuality and Health Care Experiences
Ace Week (formerly, Asexual Awareness Week), takes place in the last full week of October. It is a campaign designed to increase awareness and education surrounding asexuality and asexual issues. Asexuality is a sexual orientation characterized by experiencing little to no sexual attraction to any gender. It may also be used as an umbrella term to encompass other related sexualities (eg, demisexuality, which is characterized by a person experiencing little to no sexual attraction to anyone until they develop a close personal bond with them). Often, asexuality is referred to as “the invisible orientation”, as it is often overlooked in discussions of sexual orientations and queer identities. This contributes to some of the issues that organizations and campaigns like Ace Week seek to address. This includes but is not limited to public awareness of asexuality, recognition of asexuality as part of the LGBTQIA+ community, media representation, and health care disparities.
Recognition (and Lack Thereof) in the Health Care Field
When considering the depathologization of sexual orientations, most people think of the removal of homosexuality from the Diagnostics and Statistical Manual of Mental Disorders (DSM) in 1973. After that point, mental health and medical practitioners were no longer advised to treat same-sex attraction as a mental disorder. However, experiencing reduced/no sexual attraction remained classified as either Female Sexual Interest/Arousal Disorder (FSIAD) or Male Hypoactive Sexual Desire Disorder (HSDD). It wasn’t until 2013 and the publishing of the DSM 5 that asexuality was officially recognized by the American Psychological Association (APA) as a sexual orientation instead of a sickness. The DSM 5 includes an exclusionary clause to note that, if a patient explains their lack of sexual attraction or desire as asexuality, they should not be diagnosed as having a disorder.
The explicit recognition of asexuality by the APA is a step toward better health care experiences for members of the asexual community. It has led to increased quality of care in many cases. However, the clinical differentiation between asexuality and FSIAD/HSDD relies on the patient having heard of asexuality and being able to communicate their identity to their practitioner. Additionally, this caveat is only included in the full DSM, and not the shortened desk manual. Health care professionals may be more likely to have the desk manual on hand. These holes in the acknowledgement of asexuality in the health care field can lead to negative health experiences and outcomes for members of the asexual community.
Current Health Care Experiences
As acceptance of the diversity of sexual and gender identities has become more common in various public and health spheres, health care providers have become more likely to either be familiar with asexuality or to express acceptance and support of it when a patient describes their identity and experience to them. This has led to asexuals having increased positive health outcomes as well as increased levels of trust in medical practitioners. It is worth noting that increased levels are not the same as high levels. Many asexual individuals still have or fear experiences that negatively affect their health outcomes and may deter them from seeking out care in the future. These experiences may include:
Practitioners refusing to treat them:
In certain medical settings, practitioners may refuse to treat or perform examinations on patients if they disclose that they have not had sex (something common, but not ubiquitous, for asexual individuals). This is most common when dealing with reproductive care. Specifically, individuals with female reproductive anatomy may be denied hormonal birth control (which is often used for managing menstruation-related conditions, endometriosis, migraines, and PCOS). They may also be denied routine Pap smears, which can prevent early detection of cervical cancer.
Practitioners not believing them when they disclose their identity or identity-related behaviors:
Routine screening questions in many health care settings include questions regarding the possibility of pregnancy or a patient’s sexual activity. If an adult patient denies being sexually active or having a history of sexual activity, practitioners may be quick to assume a patient is lying. They may assume this is either because they are embarrassed about their sexual history or because they are avoiding the disclosure that they have been having sex with same-sex partners.
Aside from believing they are being lied to, a practitioner might think that a patient’s experiences are not due to their sexual orientation. If a patient describes themselves as asexual, or explains that they do not feel sexual attraction or a desire to have sex, a provider may attribute the lack of attraction or desire to a condition the patient may have or to a past trauma. This may lead to a practitioner pressing patients for details on potential past abuse or sexual trauma. In addition, it may divert the focus of the visit to something that the patient did not go to the provider to have addressed (eg, the patient may be at therapy to discuss their relationships with their family, but the conversation turns to potential side effects/effectiveness of their depression medication).
Conversion therapy/treatment designed to “fix” their lack of sexual interest:
This is something that is most often experienced by individuals who are not firm in their asexual identity. This may be because they have never heard of asexuality, or because they are still questioning their identity and are able to be talked into complying with treatment. If a patient discloses that they have limited/no sexual attraction or desire, it may be construed as a hormonal imbalance, a side effect of a medication, a lingering effect of trauma, or a symptom of another condition that the patient has already been diagnosed with. This is especially the case with people who are both asexual and have a disability.
These assumptions may lead a practitioner to prescribe treatments to “fix” a patient’s lack of attraction or desire. Prescribed treatments may include talk therapies, other forms of counseling, hormonal medications, or other medications that the practitioner believes will “cure” the patient. Especially in the case of hormonal medications, patients can have long-term, deleterious side effects from these treatments.
Experiencing ridicule or judgment for their identity or identity-related behaviors:
If an individual decides to disclose their asexual identity or behaviors related to that identity (eg, not having sex, being single consistently or for long periods of time), they may be subject to the disdain of their health care providers. This can occur even if those providers do not refuse care or force treatment onto them. General judgment (eg, commenting that someone is a bad or even abusive partner if they withhold sex from their significant other) can negatively impact a patient’s view of themselves or make them feel uncomfortable or unsafe with their current care provider.
Having sex “prescribed” to them to fix unrelated problems:
Especially in reproductive health settings, or if an individual has a chronic condition, practitioners might pressure individuals that have disclosed being asexual or not having a sexual history to have sex. This may be the prescribed solution to sudden genital pain, to pain during examinations at OB/GYN clinics, or other conditions. This pressure from a health care professional can, in itself, be a traumatic experience. However, in addition, if an asexual person forces themself to have sex against their own desire because of these recommendations, this can lead to sexual trauma and other long-term mental and physical health consequences.
Steps Forward
People of all genders and sexualities deserve to both be and feel respected and safe in health care environments. Some of the ways that practitioners can ensure that they are providing the best possible care for those that fall under the umbrella of asexuality include:
- Seeking out information. Any health care providers, but especially those that label themselves as being LGBTQIA+ friendly, should make themselves familiar with what asexuality is and isn’t, as well as what impact that identity may have on a patient and their experiences.
- Listening to patients. Ultimately, a person is the expert in their own experiences. If they say that they do not experience sexual attraction, that their previously-disclosed lack of attraction is not a concern for them, or that it is unrelated to their current health concerns or goals, then it is a provider’s job to believe them, and act accordingly.
- Training in culturally competent care. Understanding the basics of culturally competent care can help practitioners when interacting with not only members of the asexual community, but any other minority population. Enacting culturally competent practices in care settings can help inspire confidence in providers. It can also make patients feel more safe and comfortable while they are in those spaces.
Additional Resources
Get involved with or learn more about Ace Week: https://aceweek.org/
A collection of articles about the basics of asexuality that may be useful to those questioning their identities, those who want to have a better understanding of asexual individuals in their lives, or those who simply want to learn more: https://www.asexualityarchive.com/category/asexuality-101/
This blog was written by STM Learning’s editorial staff for educational purposes only. It is not intended to give specific medical or legal advice. For expert information on the discussed subjects, please refer to STM Learning’s publications.
