Doing what you are, and being what you do? Sex and the Medical Ga(y)ze

‘Are you just having heterosexual sex?’

‘I…uh…’

‘Because if you are just having heterosexual sex you only need to pee into the cup. If you’re gay – gay men – or bisexual or one of you is an IV drug user, well then we’ll have to take bloods as well.’

I have been rushed into a small office by a harried doctor who now looks at me imploringly. I doubt that she is curious about my answer so much as she hopes that I will give it soon, that she can send me away and see to the next poor soul stuck in waiting room purgatory. I’m here for an STI check and the thing is, I actually don’t know how to answer her.

For some years now, I have understood and presented myself as queer. For me, that means that I am outside of whatever is considered “normal” in terms of gender and sexuality. I am unconcerned with my sexual and/or romantic partners’ pronouns and plumbing, I am polyamorous, shave my head to a number three and wear almost exclusively floral dresses. Existing in this way in this world means that I often need to do a lot of explaining. Explaining my haircut to hairdressers (yes, I’m sure I want it that short), explaining one of my partners’ non-binary pronouns to my family, explaining to colleagues why my ex was a boy and my newest partner is a girl… and, so it would seem, explaining my sex life to medical professionals.

This doctor was not the first health practitioner with whom I’ve had to talk through my sexuality in the past few months. Late last year I was filling out a form before my monthly plasma donation. The Red Cross Blood Service asks donors: ‘Within the last 12 months have you: Had sex (with or without a condom) with a male who you think may have had oral or anal sex (with or without a condom) with another man?’. Usually I fly through this page of the questionnaire ticking no, no, no, no, no. However, I came to this question and had to pause.

We know that social mores around sex are useful ways of controlling people who are not cis, straight, white men.

I am definitely not having any sort of sex with anyone who is a man, nor was I at the time. But I had a hunch that the Red Cross didn’t mean ‘man’ as in someone’s self-identified gender. I think that what they meant, was ‘have you had penetrative sex with someone who was born with a penis, who you think may have had penetrative sex with someone who was also born with a penis.’  To that question, my answer was yes. One of my partners is a woman who was assigned male at birth, who I trust enough not to subject to an intense quiz about her sexual history and who therefore could have had partners with all sorts of genitals.

After telling the nurse who interviewed me this, he proceeded to misgender my partner and ask if she was a sex worker, “promiscuous” or “untrustworthy”. The nurse proceeded to tell me that I was unable to donate for twelve months based on ‘bisexual contact’, as a HIV risk.

Which brings me back to the doctor’s office. I never for a moment believed that I might have an STI – as I understand it, the science behind rejecting my plasma as a HIV risk is tenuous at best – but I was due for a check-up, what with having a new sexual partner and all. I explained to the doctor that while I most certainly was not having ‘heterosexual sex’ – even when I am fucking a man I do it as a queer woman – I am a person with a vagina having sex with a person who has a penis. When I told her that my sexual partner is a trans woman (for want of a better way of communicating it), the doctor immediately decided that I would need bloods taken too.

It is almost certain that there was an element of trans* discrimination behind my rejection from the blood bank and the doctor’s decision to test me for all  STIs. I think that there are underlying assumptions about the type of people trans* people, and trans women particularly, are – and that these assumptions are based on old fashioned ‘science’ that locates any disagreement with one’s gender as assigned at birth with a mental illness. Transphobia in the medical profession continues to be well written about by trans writers who are both more experienced and articulate than I (here and here are some good starting points).

However there was something else that troubled me about these adventures as a queer woman in the medical gaze. What underscored the Red Cross’s rejection on the basis of ‘bisexual contact’ and the doctor’s use of the term ‘heterosexual sex’ was that both parties were talking about sexual acts, with the language of sexual identities. I identify as neither heterosexual, nor as bisexual – although Julia Serano makes some good points as to why I maybe should – yet my sexual acts involve my vagina, other people’s penises and their vaginas (not to mention teeth, fingers, eyes, nipples, arms, legs, tongues…). However, there is a difference between sexual acts and sexual identities, just as there is a difference between genitals and genders.

We are not what we do. In any other area of life, this is pretty easily accepted. People who stargaze are not automatically classified as astronomers, weekend gardeners are not classified as botanists and if I ride a bike it is something that I have done, being a cyclist is not who I am.

Why is it any different when it comes to sex?

What is it about sex, sexual acts and sexual identities that render them outside of the ordinary? What is so special about sex?

These are important questions to pose and ponder, even if we already know the answers. And we do. Know the answers, that is. We know that sex sells, that sex is the most private and the most public part of our lives. We know that social mores around sex are useful ways of controlling people who are not cis, straight, white men. We know this because we live it everyday. Everyday we are queer in a world that finds it easier to conflate acts and identities than to think critically about what ‘good’, ‘normal’, ‘natural’ sex and sexuality actually means and how it came to be like this. 

After all, how hard is it for medical practitioners to say what they mean? And why don’t they?

Ease, tradition, colloquialism, these are not good enough answers. When health professionals, or anyone really, continues to use language that conflates sexual acts and sexual identities or perpetuates old fashioned ideas about genital/gender correlation, they condone, indeed they perpetuate, the erasure of queer folk within both the medical practice and broader society. And when we are invisible, so too are our rights, our needs, our desires and our stories.

Which is why I have told this story. It is neither a new nor a unique one, but I tell it as a refusal to be erased, to defy my invisibility as a queer woman in the medical gaze.

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