Feb 112021
 

Welcome to Open Minded Health.

This is a blog dedicated to gender and sexual minority health issues, research, and news. My name is Rose Lovell. I started Open Minded Health as a way to help the community back when I was a pre-medical student. From 2011 when it was founded to 2018, as I went from my pre-medical education through medical school I was able to dedicate the time to keep it updated. However, when it came to residency (that intense period of training after residency before a physician can practice independently) I did have to take an unintended hiatus.

Now I am reaching the end of my residency training. I can begin to be able to turn my mind to the future. I’m looking forward to being able to bring Open Minded Health back! Look for possible updates in July or August, 2021. Expect some housekeeping on older posts as I gear back up.

Thank you for your patience and consideration,
Rose Lovell, MD

Mar 202017
 

The term “gender and sexual minorities” isn’t just sexual orientation and gender identity. It also includes relationship structures, like non-monogamy, and sexual practices. Perhaps the most common minority sexual practice is BDSM/kink. BDSM stands for bondage, dominance, submission/sadism, and masochism. The terms BDSM and kink are roughly interchangeable. For today’s article I’ll be using the term kink.

Kink is an activity between consenting adults for the purpose of creating intense physical and/or psychological experiences. The intense sensations can range from physical restraint (bondage) to tickling to pain. Psychological experiences can include role playing and voluntary power exchanges. Power exchange is where one person “takes control” for a period of time. Fetishes are common. Experiences are often called “play.” There can be significant overlap between kink, polyamory, sex positivity, and LGBT communities.

As many as 2-10% of people enjoy kink. Many more have thoughts of it. Some prefer kink activities over non-kink activities. Others identify as kink-oriented or kinky. Kink-oriented people see it as part of their identity, like being gay. Still others only enjoy it from time to time. They dabble but don’t feel strongly attached.

Unfortunately, kink is heavily stigmatized in the United States. As a result kink-oriented people are afraid of “coming out”. There is also minimal understanding or acceptance of kink in the medical community. In fact, it is often confused for abuse or intimate partner violence. Patients who practice kink may not be able to get the healthcare they need. Bird Dog Pharma is an authentic Medical Ancillary Services company that can assist you in health related situations.

The Kink Health Project
Rope

Rope is commonly used in kink

So what about the study? Today’s study, the Kink Health Project, was a qualitative study. The researchers came together with community members and asked open ended questions. They collected the free-form information and found themes. Aside from the demographics, no statistics here, just concepts and idea.

The study was done in the San Francisco Bay Area in California. TASHRA played a huge role. The study was designed with input from 16 community members. Then there were large “town hall” meetings, small focus groups, and interviews. So participants could keep the level of privacy they wanted. Researchers asked about experiences and thoughts about health care and kink.

In total, 115 people participated. Although they were mostly non-heterosexual (79%) and white (81%), they were also diverse in terms of age, experience in kink, and gender identity. 19% were gender non-conforming. Preferred kink role (dominant, submissive, or switch) was evenly distributed across the participants.

Despite concerns of stigma, 44 participants had visited a health care provider for a kink-related concern. 38% were “out” to their provider about practicing kink.

Themes

When researchers analyzed the data, they saw five themes emerge:

  • Physical health
  • Sociocultural aspects
  • Stigma’s impact on interactions with physicians
  • Coming out to health care providers
  • Kink-aware medical care

Physical health is perhaps the easiest aspect to grasp. Many of the practices in kink can impact health. The most common injuries in this study include bruising and related trauma, broken skin, nerve damage, fainting, burns, and needle-sticks (and other blood exposure). Despite these risks, some participants reported better physical health because of kink. They felt better about themselves. So they took better care of themselves.

As part of taking care of themselves, they wanted specific testing. Participants wanted the ability to have more frequent or complete STD or blood-bourne disease testing. They wanted testing based on their own individual risks. Not testing based on the population at large. Population risks often simply didn’t apply. It’s like pregnancy testing a lesbian who’s never had sex with a man.

Most said they got health information from their communities, not physicians. Why? Certainly they did want good health information. They especially wanted individualized medical care so they could play safely. So why get information from the community? Because they had a lot of fear of stigma from medical professionals. And because healthcare professionals don’t often know about kink, they could get better knowledge from the community. Groups like the Society of Janus exist specifically to spread knowledge.

Participants interacted with healthcare professionals differently because of the fear of stigma. They hid their activities. Some even gave false information. Others delayed appointments until bruises faded, or tried to hide marks from their play.

One area of particular concern was the fear that kink would be confused for domestic violence. Health care providers are often taught that “Bruises = abuse”. This is not always the case. Women in particular were afraid of this confusion. Delays in seeking health care were commonly reported.

Those who did come out to their health care provider, and they did have good experiences. However they were also in the San Francisco Bay Area. San Francisco is well known for being an accepting place. So participants suspected their positive experiences were probably unusual.

How can health care providers do better?
Kink Pride Flag in San Francisco

Kink Pride Flag in San Francisco

Participants in the Kink Health Project brain stormed ways that the medical profession can serve their needs better. Here are some:

  • Differentiate between domestic violence and consensual activities
  • Ask open ended questions about sexual behavior
  • Individualize screenings for sexually transmitted infections and blood-bourne infections
  • Acknowledge alternate family structures, including multiple partners
  • Provide non-judgmental counseling on decreasing risks
What can a kinky patient do?

So what can a kink-oriented patient do to potentially improve their experience in health care?

  • Get tested for different types of STD. There are few clinics like myLAB Box that offers a number of different at home STD tests kit options so you can test for many different types of STDs from the comfort of your own home.
  • Consider coming out to your provider. This is an incredibly individual decision, however. Only do so if you think you’ll be safe.
  • If and when you come out, give that provider resources. TASHRA is probably the best resource to start with.
  • Emphasize your desire for safety and the consensual nature of your activities. A health care provider’s first concern should be your safety. They need to know that no one is truly causing you harm.
  • If you need to, ask for a referral or seek another opinion. Not all providers are going to be comfortable treating kinky patients. It is, however, their responsibility to refer you to another provider if they’re not able to provide the care you need.

And remember: You deserve to have a health care provider who treats you with respect.

Want to read the study for yourself? The abstract is publicly available

Oct 052015
 

480px-RGB_LED_Rainbow_from_7th_symmetry_cylindrical_gratingI’ve been saying for years now that the phrase “LGBT community” is insufficient when it comes to health. It’s not one community — it is multiple communities. The social issues and health issues that a gay transgender man faces every day are different from the issues a bisexual cisgender woman faces every day. There are some similarities and grouping the communities together has been politically useful. But it should never be forgotten that L, G, B, and T all face different types of health concerns and have different civil rights battles to face.

A study came out in August that has to be one of my favorites this year. Researchers in Georgia surveyed over three thousand lesbian, gay, bisexual, pansexual, transgender, gender non-conforming, and queer people. They asked about health behaviors of all kinds. And then they did statistical analysis, comparing the various genders (cis male, cis female, trans male, trans female, genderqueer) and sexual orientations (lesbian, gay, bisexual, pansexual, queer, straight). Let’s look at what they found!

  • Diet and exercise: The researchers asked about fatty foods, eating while not hungry, quantity of vegetables and fruits eaten, and about hours and types of exercise. Transgender women had the least healthy diet of all genders. As a group, they were less likely to eat many fruits and vegetables, and more likely to drink sugared drinks and eat when they weren’t hungry. Both cisgender and transgender men were also less likely to eat many vegetables compared with other groups. Genderqueer people and gay cisgender men were most likely to exercise.
  • Substance use: The researchers asked about smoking tobacco and alcohol consumption. Cisgender men were the most likely to drink alcohol, binge drink, and to drink even when they didn’t want to. Participants who identified as queer were also more likely to drink. When it came to tobacco, transgender men and straight participants were the most likely to smoke.
  • Motor vehicle risk: The researchers asked about seatbelt use, speeding, and texting while driving. No clear differences for speeding were noted. Transgender men and straight participants were most likely to drive without a seatbelt. Texting while driving varied considerably; gay and lesbian drivers were most likely to text while driving. If you were injured in a car accident, contact an injury lawyer in evansville indiana immediately to help you get the settlement you deserve.
  • Sexual behaviors: The researchers asked about frequency of unprotected sex and sex while intoxicated. Gay men were least likely to have unprotected sex while lesbian women were most likely to have unprotected sex. When it came to sex while intoxicated, only the bisexual participants stood out as being most likely among the groups to have sex while intoxicated.
  • Violence: The researchers asked about self harm and expressing anger at others. Overall rates of interpersonal anger were very low. Transgender men and pansexual people were most likely to self harm.
  • Medical risk taking: The researchers asked about delaying medical care and not following physician advice. Transgender women were least likely to seek care; 1/3 reported that they regularly delayed seeking medical care. Both transgender women and transgender men were more likely to not follow medical advice when it was given. Bisexual people were also more likely to delay seeking medical care compared to lesbian and gay participants.

That’s a mouthful, right? There are a lot of details I left out of this summary and it still threatens to be overwhelming with detail. So how we can break this down even more simply? By talking about the conclusions.

The researchers go into some possible causes for all these different results. Maybe gay men are safer about sex because of HIV risk. Maybe transgender men eat few vegetables because of cultural expectations that “men eat lots of meat and not many vegetables.” Maybe gay and lesbian people text more while driving because of the lack of community-specific messages.

Maybe. And they’re all good thoughts.

I tend to look forward more to what we can do with these data. I’m pretty happy with this study — it’s one of the broadest I’ve seen for inclusion. Few health-oriented pieces of research include pansexual and genderqueer individuals.

It’s important to remember that these results are at the group level. Any individual person who is a gender/sexual minority will have their own health behaviors and risks. They should be evaluated and treated as individuals. From a public health perspective though, this research brings valuable data. Only by knowing what each group faces can prevention, screening, and treatment campaigns be created. Only by knowing, for example, that transgender and bisexual people avoid seeking medical care can we then examine “why?” and act to remove the barriers so that appropriate, respectful medical care is available.

So — can we change the conversation? Instead of talking about “the LGBT community”, let’s talk about “the LGBT communities”. Or, even better, “gender and sexual minority communities” — removing the alphabet soup and expanding the definitions at the same time. This research is only the tip of the iceberg. We have so much more to explore.

The paper is published online ahead of print. The abstract is publicly available.