Review of Health Care Without Shame


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A BOOK WHOSE TIME HAS COME

A Review of Health Care Without Shame: A Handbook for the Sexually Diverse and Their Caregivers

by Charles Moser, Ph.D., M.D.

San Francisco: Greenery Press

Review Copyright © 1999 by William A. Henkin

 

 

A comedian I know read the title of this book over my shoulder and asked if it was a self-help book for people beyond help, but he was being humorous, and as Charles Moser says in the Introduction to Health Care Without Shame, the situation he's addressing is the antithesis of funny.

The sad truth is that many people with unusual sexual lifestyles and behaviors - including gays, lesbians, and bisexuals, folks who enjoy S/M, who have body modifications such as piercings or tattoos, who crossdress, who are sex workers, who have multiple partners, who are transgendered, who engage in fetish behaviors - are not getting the health care they need and deserve....

The present situation is unconscionable.

Moser has set out to remedy the situation, and he is remarkably the right person for the job. He received his Ph.D. from the Institute for Advanced Study of Human Sexuality 20 years ago, and has been on the faculty there more or less ever since. In the late 1980s, seeking to better serve the communities with which he had become acquainted, he went off to medical school and returned full-time to San Francisco in 1991 as a physician whose special focus is adult sexual medicine in general and "the medical problems of sexual minorities" in particular. He has since contributed mightily to the Society for the Scientific Study of Sexuality, including serving a term as President of the organization's Western Region, and he is on the board of San Francisco Medicine. In the course of publishing widely in professional journals about sexual minority practices, he has become something of a bridge and interpreter between the medical community and people whose sexual practices are less vanilla than the doctors themselves may have encountered in their lives or in their training. Finally, in some frustration with the failures of the medical community in providing responsible health care for people who practice alternative sexualities, or live alternative sexual lifestyles, he has founded a new professional group for physicians, the American College of Sexual Medicine and Health.

Moser subtitles his book A Handbook for the Sexually Diverse and Their Caregivers, which is wonderfully accurate. First, this is just what a handbook should be: a short book - little more than 100 pages - written in a clear, simple, direct style so that the information it contains will be as useful as possible to the greatest possible number of people. Second, if you are among the world's sexual minorities - if your sexuality steps beyond heterosexual genital intercourse - this book is written with you specifically in mind. It may also be written for you if heterosexual genital intercourse is the extent of your experience, fantasy, and interest, simply because you may still someday have sexual concerns you are reluctant to discuss with your health care provider.

Third, it is also written for that health care provider you may wish to consult, because given the lives that most people lead, and given the almost non-existent training about the real facts of human sexuality most medical schools provide - reproductive data apart - the doc is probably just as uncomfortable as you are discussing the fact that you have a vagina or a penis or an anus or breasts, let alone that you have, have had, or will have orgasms based on the use of those or other body parts. When the doc asks how often you have sex she almost certainly is asking how often your genitals rub on the inside of, or are rubbed on the inside by, another set of genitals. She is almost never asking how or how often you masturbate, how often your boyfriend of girlfriend fucks your ass, how frequently you whip or get whipped by someone, how many partners you like at once, whether your body's sex and your mind's gender are companionable, whether you use your lover's clothes for stimulation, whether sitting motionless with your eyes gazing into someone else's gets you off, or whether you have any other interpretation of what "having sex" might mean.

At least in the biological sense everyone is a sexual being, and our reproductive parts have ailments just like our other parts. Yet, while we'll rattle blithely on about our tennis elbows, carpal tunnel wrists, obscured and otherwise twisted vision, and even our broken hearts, almost no one among us is comfortable talking to her or his doctor about sex and sexuality; and, as Moser observes, almost no doctor is comfortable with the subject either. For these reasons, among others, Health Care Without Shame is useful not just for pierced, tattooed, bisexual transgendered polyamorous slaves and owners of human property, but for anyone who has to talk about sex, sexual matters, or sexual body parts to a health care provider, and for any health care provider whose patients who are sexual beings.

Why? Because it stands to reason that if both you and your health care provider have difficulty discussing your sexuality in any dimension, you're going to find it next to impossible to get adequate health care after you have a sexual disease or disorder, and even closer to impossible to get adequate preventative health care around sexual matters.

In its nine chapters Health Care Without Shame covers all the ground you need in order to become a competent user of health care - yes, even in this era of HMOs, PPOs, and other purveyors of Medicine as Business. And if you're a health care provider it provides a solid foundation on which to base your sexual work with your patients. For example, in the chapter called "A Practitioner's Guide to Sexual Minorities" Moser helps prepare health care providers to talk with their prospective sexual minority patients. He explains who they are, what they do, and how to proceed with the relationship, then offers "a brief glossary of sexual minority terminology" so that the provider can understand what the patient is talking about. You've noticed, I'm sure, how it is so very uncool to try to be seen as cool when it is obvious to all concerned that you are square as a brick? Well, if you're a doc it's also no way to win your patient's confidence. Therefore, along with the terminology, Moser includes the ideal warning for vanilla docs: "Do not use these terms yourself; it is very easy to make a faux pas. Many of these terms can have many different meanings and pejorative implications when used by someone outside the patient's sexual community; you will be misunderstood!"

Unlike the mode with most self-help books, the information Moser offers in his chapters is actually useful: it can really help you help yourself. For example, after introducing himself and his subject Moser provides a "Portrait of a Sex-Positive Health Care Practitioner." No, this is not the author's autobiography: it's a profile to help you identify the doc you are really looking for, as opposed to the one you've been having medical fantasies about. In "Doc, There's Something I want to Tell You..." Moser tells you how and when to talk to your health care provider, and, in general, what to say: what information he needs, what is superfluous, and what is problematic. He also provides models of successful and unsuccessful ways to communicate what you want to say.

As Moser tells it, "Being a Desirable Patient" may have nothing to do with your sexual minority status. It may, instead, have to do with how you make the best - or the worst - use of your physician, including the time you spend with him in office visits, on the phone, and by proxy with his assistants. In "How Can You Tell If It's Working?" Moser describes how you can do your part to maintain a good relationship between you and your provider, complete with a checklist you could even carry with you.

Nothing is perfect, so "When It Goes Wrong" - "it" being the relationship between patient and provider - it helps to know how to proceed. And "What If Your Practitioner Isn't Available"? Then it's important to know how to use - and not use - back-up docs.

"A Practitioner's Guide to Sexual Minorities" is a guide for docs to prospective sexual minority patients - who they are, what they do, and how to proceed with the relationship. This is the chapter that contains the "brief glossary of sexual minority terminology" and that wonderful warning I quoted above.

I particularly appreciated the section on "Working with Other Professionals," which is largely about working with psychotherapists. But in general, as Moser notes,

When dealing with other professionals, you will use most of the same skills and techniques we've already discussed in this book. Explain simply and straightforwardly what you do and what relevance in might have to the professional's work. If you feel like answering a few good-natured but personal questions, that's fine; if the questions seem too personal or intrusive, it's also fine to ask politely, "How does that relate to my concerns?" Do make sure that the question-and-answer period is "off the meter" - nobody should have to pay $200/hr. for the privilege of educating their attorney or accountant.

The book includes a Resource Guide I did not see in galleys, but I found the very short conclusion extremely germane.

Throughout this book, I have shared my concerns about the barriers sexual minorities encounter in seeking good health care.....

All these problems have essentially the same solution: information. Health care professionals cannot give top-notch care to someone whose lifestyle they don't understand or don't approve of. Sexual minorities cannot get the best that the health care system has to offer if they refuse to use that system, or if they withhold information out of fear or shame.

In the incredible sexual diversity that greets us at the dawn of a new millennium, there is no excuse for ignorance.....

So: Health Care Without Shame. Is this a book whose time has come? Honey, it's a book that humans have been waiting for forever.


William A. Henkin, the son of a radiologist, is co-author, with Sybil Holiday, of Consensual Sadomasochism: How to Talk About It and How to Do It Safely. He is a psychotherapist and sex therapist who conducts his private practice in San Francisco.


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