Review of Health Care without Shame

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review by Vamp

Health Care Without Shame
by Charles Moser, Ph.D., M.D.
Greenery Press, 1999

Ask anyone in the alternative sexuality communities questions about how to find an appropriate physician and how to deal with their health questions and you'll always get the same response: "Read Health Care Without Shame by Charles Moser."

You'll get some bad advice full of good intentions too, but if you read this book you will avoid following it.

The book is a fairly thin volume with separate sections dedicated to consumers and practitioners. It can easily be read in a day, and so it makes a great gift for a doctor that may not have a lot of time to research things but would like to be more aware and sensitive to his clients.

The first thing you should know about this book is that it is about procuring proper health care, and not about specific health questions. This isn't going to be the answer if you need to know what tests people should be running on you if you engage in rimming. It is the right book if you need to find out how to approach telling a physician that you have elements to your sexuality that may need to be brought to their attention if you are going to receive proper care.

Bearing that in mind, one of the points that is driven home again and again is that if you want good care you must find a competent physician. They may not be in any particular community or even like the idea that you do what you do, but ultimately that shouldn't matter. What should matter is that the physician is a professional, ethical, and competent provider. In return, patients have the responsibility to represent their choices in a sane, self-aware, and sensible manner that respects the professional atmosphere of the office.

Dr. Charles Moser gives plenty of suggestions within the book to do just that. He points out obvious things like never ever ever put your health care provider in a situation where they are being asked to participate in your sexuality rather than just take it into account when examining you. For example, he tells a story of a patient that kept calling him "Sir" and treating him as if she were his submissive. That is extremely impolite and puts the doctor in a bad spot. Similarly, he's had problems with patients disrespecting the professional atmosphere of his office space and coming in and waiting for an appointment wearing very provocative clothing. I don't think any doctor appreciates that, whether you are a sexual minority or not. Wearing something that is easy to take on and off and that is appropriate for the office is a LOT better than dressing as if you have a date with the doctor.

In essence, your doctor will most likely deal with you in a respectful and professional manner if you show them the same courtesy.

There are many things that he does suggest are quite relevant to the doctor/patient situation, and here are a few:

The most important thing to emphasize with your caregiver is that what you do is consensual and done for enjoyment. You should stress that you have educated yourself in these things and that you try to do them as safely as possible.

You don't have to answer for why you do anything or apologize for it, you merely need to state that you enjoy it and that it is consensual. If they ask for more than that, don't be afraid to ask them why they need to know.

I was curious to read about what things physicians are compelled to report. It appears that in general they have to report abuse of minors, abuse of dependant adults, and threats of harm to yourself or others (such as suicidal or homicidal statements). These are all things that you definitely WILL be reported for.

In some cases, health care providers also must report some infections and STD's to the Health Department.

The doctor claims that it is only in extremely rare cases that people have been committed for evaluation, and that he hasn't heard of someone turned into the officials by a doctor in the case of consensual (non dependant) adult sexuality. The worst case scenario he presents is that they may be uncomfortable treating you and ask you to see another health care provider unless you are willing to change your activities.

He says that physicians should be quite all right discussing what they are compelled to record or report and what will be kept completely off the record. You may want to ask them this before engaging in any discussion, especially if what you do for a living is illegal.

The maximum in precaution would be to see a physician under an assumed name and pay cash, but that will get very expensive and is probably not necessary at all.

He stresses that if you have a nontraditional family you really need to execute a power of attorney for health care and a living will. He also recommends a general durable power of attorney and a will. I know that sometimes the National Coalition for Sexual Freedom ( has legal clinics at some community functions in which you can get this done very cheaply.

He outlines how to deal with rare situations where your health care service is substandard and unethical also.

Some of the options he discusses:

You can find the information you need to complain to a state medical board at the Federation of State Medical Boards of the United States, INC's website. You can get similar information about psychology boards at the website Psychology Information Online. He warns that most of this process will NOT leave you feeling empowered, but it will help change things in the future.

Many people in the SM communities are haunted by the question of what to do if something goes very wrong and they have to go to the emergency room. This book addresses that, but also recommends that if you have addressed the fact that you engage in consensual intense sensation with a partner ahead of time it will seem less fishy to a physician if you show up in such a situation later.

Lying about your injuries will usually be detected rather quickly in the hospital, as it is hard to convince someone that your marks happened because you "fell down" or something. That just makes it look as if you are in a domestic violence situation and afraid (which emergency personnel get to see all to often unfortunately). Therefore, if you have marks you better just come clean about them. Emphasize that you were involved in consensual rough sex play that you have participated willingly in and never been harmed by before. The injury you incurred was an accident and that your physician is aware of the fact that you do so things (if they are).

While this may be very uncomfortable, it might save your life. It may be embarrassing to tell an emergency room doctor that you are not there for the bruises on your shoulders from the flogging you enjoyed, but are there for the dildo that is lodged in your intestine and causing you pain. If you don't do it though, you put your life in jeopardy. They may find it odd or embarrassing also, but they are health care professionals and they are there to heal. Give them the information they need to do that.

Luckily, through the hard work of people like Dr. Moser the future is much brighter for those of us that have some intricate issues surrounding our sexuality and gender. His book is a wonderful step in the right direction, since you can easily purchase a copy for your doctor and send it to the office! It is a very reasonable price and it MAY just help to make the office visit easier if s/he's read it. It is also a great thing to read, so that you can learn to be a better patient that will come across properly when broaching certain topics.

The next step is better education for doctors. They don't receive much in the way of education on sexuality, gender, and alternative communities. Dr. Moser is working on this at the moment by forming The American College of Sexual Medicine and Health. I'm so pleased to hear that he's doing this, and I think the next generation will have much to thank him for.

Some other online references that you might want to check up on are the Kink Aware Professionals and The Journal of Sex Research sites.

So who would I recommend this book to?

I think this book is a MUST for any sexual minority, and is quite a good guide to patient/doctor relations for anyone who has ever had a hard time figuring out how to bring up questions about sex to their doctor. I think even the sexually uptight will be just fine with this book.

Who would I tell to skip it?

If you need specific info about a particular activity and the medical ramifications of it, this isn't your book.

I can't say one bad thing about this book, but I can say that the message it sends is sometimes a bit depressing for those involved in incarceration situations or in the military. In those situations it might be that the best advice is to lie, and that really stinks. It is also rather startling to hear how little information most doctors have about sexuality.

That said, what a bright new future we are starting to see unfold.

Thanks Dr. Moser.

Vamp :)=

This review is Copyright © 2000 Vamp Ire.

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