Norm critical testing for sexually transmitted diseases
Diverse sex = need for diverse testing for sexually transmitted diseases
This article is written by Anne-Mette Glud Hjerrild /@femme_lioness who is a doctor, sex counsellor and queer activist - as well as co-founder of Normcritical Doctors.
Norm-critical testing is needed
As a queer person, it is unfortunately relatively common to encounter normative ideas and prejudices about how to have sex - and therefore how and where to be tested for sexually transmitted diseases - when encountering healthcare professionals.
Standard testing for sexually transmitted diseases at the doctor's office will often be a test for chlamydia and gonorrhoea in the form of a urine sample for those who have a penis, and an inoculation, for those who have a vagina. If you get a sore around the genitals you will often be tested for herpes and you may also be diagnosed with genital warts if these are seen clinically.
However, that is often where the testing stops. Therefore, it is important as a health professional, and unfortunately as a patient, to be aware that STDs are transmitted in other ways and to other sites than just the penis and vagina through vaginal penetrative sex. You may therefore need to ask for inoculation of other relevant sites - both as a queer person and as a cis/hetero person with sexual practices other than just vaginal penetrative sex.
Sexually transmitted infections can easily occur in ways other than penetrative sex. It can be contracted through various forms of secretions and through touching (e.g. touching another person and then oneself) or sharing sex toys.
At the AIDS Foundation's Checkpoint clinic, 33% of users test positive for chlamydia or gonorrhoea in the throat and/or rectum WITHOUT testing positive for the same sexually transmitted disease by urine testing or vaginal inoculation.
This only highlights the need to test from more sites than just the genitals.
Sites that may be relevant to test for sexually transmitted diseases:
- Urethra (both in persons with a penis and persons with a vagina)
Sexually transmitted diseases you can test for:
- Herpes Genitalis
- Lymphogranuloma Venereum
It will rarely be appropriate or needed to test for all of the above sexually transmitted diseases. Talk to the staff where you are being tested if you think it might be appropriate to be tested for something other than what they are offering. For an overview of where you can get tested and how to test for the different sexually transmitted diseases, read our guide here. Be aware that some tests will require a blood sample.
Remember that the only thing that protects against sexually transmitted diseases is barrier prevention - that is, condoms, dental dams and fingercoats. You can also read our full guide to contraception here.
Everyone has the right to proper treatment
Health professional, check yourself
Queer person, screen yourself
As a health professional, remember to be aware of your own normative ideas about sex and where any sexually transmitted infections can be transmitted to/from, as well as which sexually transmitted infections it may be appropriate to test for. In this way, you avoid offering your patients inadequate diagnosis and treatment.
Unfortunately, there are studies showing that queer people who have sex with other people with vaginas are at extra risk of being misguided both when it comes to testing for STDs and when it comes to screening for cervical cancer. It may well be appropriate to be tested for STDs if you are a person with a vagina who has sex exclusively with other people with vaginas. It is also very important to have a Pap smear/screening for cervical cancer if you have a cervix, regardless of your sexuality or gender identity.
You can also read other articles from Norm Critical Doctors: 'The myth of the virginity - from a medical perspective' or 'The myth of the virginity - from a queer perspective'.