As more people embrace their inner kinkster, doctors need to know the details to provide quality health care. This… can be complicated.
Daily Beast
by
Recently, Claire Conrad, 36, found herself trussed up in stirrups—and not in a fun way. Conrad was at the ob-gyn to check to see if, as the Maryland resident likes to put it, “My cervix is trying to kill me.”
She’d had an abnormal pap smear, and was getting a colposcopy to make sure it wasn’t cancer. In the process, Conrad, who asked that her real name not be used, was coming out to her ob-gyn as kinky. It was plain as the purple and black caning marks on her legs.
Conrad, you see, is in an open marriage and enjoys a little submission and a little pain with her sex.
When her doctor blurted out, “Oh! You are bruised,” Conrad figured it could have been worse. Still, she left the appointment with the clear sense that the staff would be gossiping about her after she’d gone. If she ever had a caning session that broke the skin and became infected, she said she’d think twice about going back to her doctor.
“That’s a tough one,” she said. “If I had been injured, I don’t think I would be comfortable with talking to my doctor about it. Even if I did, I don’t know if I would be honest about what happened.”
Conrad’s not alone. Preliminary research finds that fewer than half of all kinksters are out to their healthcare providers about their kinks—and that’s in the San Francisco Bay Area, a notoriously kink-friendly place. Among those that are out, almost everyone anticipated being stigmatized, prompting them to hide aspects of their behavior that could impact their health. And while the medical field has gotten better about understanding sexual minorities, there’s still a distance to go before kinksters like Conrad feel comfortable in medical offices around the country.
“Up until now, it’s been a don’t-ask-don’t-tell kind of situation,” said Dr. Jess Waldura, lead investigator of The Alternative Sexualities Health Research Alliance (TASHRA), which plans to conduct a nationwide survey in 2015. “We need to destigmatize kink so providers can think straight when we’re confronted by it.”
The New Don’t-Ask-Don’t Tell
In the past year, Dr. Mike Lesniak has noticed a trend: His urgent care clinic in rural Pennsylvania was the go-to place for kinksters to get their wounds treated. He figured that was because the clinic wasn’t set up to document injuries in a way that would be admissible in court. And because he wasn’t their primary care doctor, they wouldn’t have to worry about looking him in the eye next time they needed to have a sinus infection checked out.
The experience left Lesniak in a quandary. He wanted to make sure the wounds were consensual. And he’d want to make sure that, if they were, they were being made safely.
“Sometimes, they’d say, ‘Everything’s OK,’ and you could tell it was. Other times, the response would be, ‘Everything’s OK,’ but you would get the vibe that there’s no way that everything is OK,” he said. “I try to delve into what they are doing so that I can assure myself that they are acting safely. And if not, then I can help them adjust some things to be safer.”
Kinksters’ reticence makes sense. Before 2013, people interested in bondage and discipline or sado-masochism (BDSM)—that is, getting an erotic thrill from being tied up or tying someone else up, or hurting someone or being hurt by someone—were treated in the Diagnostic and Statistical Manual (DSM), the bible of psychiatric care, as a mental disorder that could then be used in court to remove children from kinkster parents, among other things. Today, the DSM defines BDSM as a kink that only becomes a disorder if it’s causing distress or dysfunction.
The problem, said Dr. Charles Moser, a San Francisco-based internal medicine physician and perhaps the leading researcher on kink in healthcare, is that it’s up to a doctor to determine if a kink is causing distress. If the doctor is biased, he may still classify it as a disorder that can lead to legal repercussions.
Shame-Free Care
It’s a shame because, though because the majority of the 120 self-identified Bay Area kinksters Waldura recruited for the initial study said it’s important to be open with one’s providers about one’s kink, fewer than half actually were. And many said they had physical and mental health needs associated with their kinks.
Those needs varied depending on where respondents were in the kink universe. You’d expect submissives and masochists to sustain more injuries than dominants and sadists—but neither tend to bring their concerns to physicians, said Moser.
Moser had made a practice of treating the kinky. Sometimes this means talking about hepatitis A and B vaccines and risk for hepatitis C infection with someone participating in blood play, or talking about how to reduce risk of infection if someone is playing with needles. More often, thought, it’s high blood pressure, diabetes and other typical health needs that go unaddressed when kinksters delay care to avoid provider bias.
“I always say that people have more accidents on the way to and from the play party than at the party,” said Moser, author of Healthcare Without Shame.
Avoiding care can lead to the same kind of health disparities experienced by anyone who delays care: unchecked diabetes, for instance, or undiagnosed high blood pressure, which put people at higher risk for major health problems like kidney failure or heart attack.
And while other research indicates that kinksters may be more mentally healthy than their vanilla counterparts, the TASHRA participants said they experienced fears around talking to therapists about their kinks. …