Going to the doctor for sexual health matters

Getting the best care

Strong, trusting relationships between patients and health care providers foster better health outcomes and improve access to services.

Many things can either make it easier or more difficult to access health care or affect the quality of care we get. While a good health care experience can look differently depending on what we need, our preferences, and who/what is available and because not everyone wants the same thing, has access to the same resources, or faces the same circumstances, there are factors that are essential to a positive experience:

• Feeling respected
• Feeling connected to your health care provider/team (for instance, a family doctor who remembers the details of your last visit or the team taking care of you during a birth)
• Feeling like you are safe
• Feeling like you have a say in important decisions related to your body and your health
• Having the information you need to make important health care decisions for yourself

Talking about sexual health with your health care provider

Not all health care providers have received specific training to be able to comfortably talk about sexual and reproductive health. The most important thing is to find a health care provider who listens to you and makes you a partner in your own care because sexual health is an essential part of our overall health.

How can I tell if my provider is sex positive?

Sex positivity means taking a neutral stance around sex and sexuality and placing no moral value or judgement on different sexuality or sex acts. It must be reflected in the kind of care we get and how informed and capable health care providers have a duty to be regardless of the gender and/or sexuality of their patients.

Some ways to assess whether your health care provider is sex positive are:

• Comfort level: How does your health care provider handle your questions about sexual or reproductive health. Do they respond with comfort, or do you feel discomfort or sense judgement or defensiveness?
• Not making assumptions: Is your health care provider listening to you to create a complete picture of what you may need or why are you are seeking care? Do they ask you open ended questions or make assumptions about what you need, or assumptions based on information you are providing? (For example, your doctor not assuming that you are in a heterosexual and/or monogamous relationships)
• Using the right terminology: Does your health care provider follow your lead in terms of your pronouns, how you call your loved ones or your body? (For example, do they use the right pronouns and name if you have shared that information with them? Or you have a specific way to speak about your genitals because of gender dysphoria, are they using the right words?)
• Acknowledging the limitations of knowledge: Health care providers don’t know everything – much of their job involves researching topics and coming back with more information. Is your health care provider up front when they don’t know an answer? Are they willing to explore the topic or research options with you? (For example, if they have never supported someone through transition or through navigating sex with an HIV+ partner, are they upfront about their need to get informed?)
• Making the referrals you need: If your health care provider can’t provide you with the services you are looking for, are they providing an effective and timely referral to someone who can? (For example, if you need an abortion and your health care provider can’t provide it themselves, are they making sure you are connected to the right service providers?)
• Lack of pressure or coercion: Do you feel like you are given information to explore what is best for you, when it comes to a specific treatment or course of action? Are you being provided with a range of unbiased sexual and reproductive health options so you can make a decision that’s best for you? (For example, are you given the full range of contraceptive options available to you?)
• Feeling of agency: Does your health care provider ensure that you are feeling like you have a say and included in your care and treatment choices?
• Safety to disclose: You don’t have to disclose anything you aren’t comfortable with, but do you feel like you can safely disclose important information about yourself and your sexual health?
• Respect for your whole self: Do you feel like your health care provider seeks to understand you and provide you with a sense of cultural safety? Cultural safety means action that demonstrate respect and nurture your unique cultural identity as you define it. Culture includes, but is not restricted to, age or generation, gender, sexual orientation, occupation and socioeconomic status, ethnic origin or migrant experience, religious or spiritual beliefs, and/or ability. Unsafe cultural practice comprises any action which diminishes, demeans, or dis-empowers the cultural identity and wellbeing of a person.
• Age inclusiveness: Is your health care provider knowledgeable about the issues that are impacting your age group, and is their information up to date?
• Confidentiality: Does your health care provider respect your confidentiality? Can they clearly answer questions about any limitations to this confidentiality that might exist?

Beyond doing this type of assessment, asking your health care provider specific questions can be a great way to determine whether they are the right fit for you when it comes to your sexual and reproductive health care.

My doctor said no?! (or What is conscientious objection?)

In the context of health care, conscientious objection is when a health care provider refuses to perform particular services because of their personal moral or religious beliefs. The specific sexual and reproductive health services that are most often refused on the basis of conscientious objection are abortion, contraception, and assisted reproduction.

If you find yourself in your health care provider’s office and they are either outright refusing to provide a service, refusing to refer you elsewhere to access it, creating barriers for you to access them (for example, delaying appointments, imposing time to “think it through” etc.), or shaming you for wanting to access them in the first place (which can include assuming the choice you’ll make and/or belittling you for asking questions about options), it might be that you are experiencing conscientious objection. While doctors may have a right to refuse to provide a service on moral or religious grounds (it looks different depending on province), they should be providing you with a timely referral to someone who can provide you that service. Unfortunately, this is not strictly mandated or monitored anywhere in Canada despite the harm it causes. Read this to get more information on the different positions of professional colleges across Canada and what rules their members have to follow.

Sometimes, an entire hospital or health care institution will claim that they will not provide certain services (contraception, abortion, or medical assistance in dying) because of conscientious objection. Institutions don’t have a conscience like humans do, so this amounts to a violation of patient rights and medical ethics. Unfortunately, there is little to no monitoring or enforcement of rules to ensure people get the health care they have a right to.

Conscientious objection is a serious problem as it gets in the way of people’s ability to make choices and take charge of their own health, wellbeing, and life in ways that work best for them. Some provinces have started to work on policies to define the responsibilities of doctors and health care providers who refuse to provide services.

If you think someone might be denying your services on these grounds, you can call our Access Line to get support in finding a sexual health clinic or other relevant services in your area.

Making the most of your appointment

Going to the doctor isn’t always going to be fun or enjoyable but you should feel safe, accepted, and heard. Generally speaking, our relationships with our health care providers should be interactive, meaning both you (the patient) and your doctor should be engaged in the conversation about your health, in answering questions and assessing possible options you may face.

Talking points to foster good partnerships

Sometimes, it can be a waiting game to see who is going to bring up a particular topic first during a doctor’s appointment, especially if it is about gender or sexuality. In general, it is important to know that you always have the right to stop what is happening, if you are uncomfortable, ask questions before, during or after, and also to ask for clarification if something a health care provider is saying doesn’t make sense.

Privacy and confidentiality

That type of trust can be built over time with a health care provider that you see regularly, but it might be a bit harder to trust a specialist that you might only see once or twice.

However, whether or not you have a long-term relationship with the health care provider you are currently seeing, confidentiality and privacy applies. It can be helpful to know the difference between privacy and confidentiality, as well as where any limitations to that exist.

If you have concerns around confidentiality and privacy, you might ask, “Is this conversation completely confidential? What are the limitations to that confidentiality?” or “What happens to the information that you note in my file, and who is it shared with and under what circumstances?”

What can you do when your health care provider doesn’t believe you?

It might happen that you feel there is a disconnect between the concerns you are bringing to your health care provider and how you are being treated. This is a real thing that happens to some of us and so, it is important to feel informed and prepared about the possibility of it happening. Gender stereotypes (for example, “women are melodramatic, exaggerate, seek attention, etc.”) often result in women and feminine presenting people experiencing some disbelief when they access health care. In the study The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain, the author identifies ways gender bias tends to play out in clinical pain management. According to this study, women are “more likely to be treated less aggressively in their initial encounters with the health care system until they ‘prove that they are as sick as male patients,’”—a phenomenon referred to in the medical community as the “Yentl Syndrome.”

This also means that diagnoses that impact women (and people who were assigned female at birth/have a uterus) are sometimes less researched, or taken less seriously, than diagnoses that disproportionately impact men, such as with things like endometriosis or chronic pelvic pain. It can also mean that that symptoms experienced by men for a particular health issue are understood as universal (for instance, the symptoms of a heart attack can manifest differently depending on sex, but often the symptoms that impact men are the most talked about and recognized). In short, sexism runs deep in our society and this permeates the health care sector, too.

In a nutshell, pain or discomfort experienced by people other than white men might be perceived as constructed or exaggerated (as surprising as this may sound to many, this is something that studies confirm). While most people may physically recover from times when they are dismissed or brushed off, it can delay care and it can impact diagnoses, treatment plans. It also fuels mistrust and, for many, it might mean dealing with the trauma of “not being seen and believed.” This can make someone less likely to seek out medical care in the future when they need it.

This vulnerability can be compounded by a person’s race, disability, class, drug use, etc. When we talk of racial disparities in health, one important factor is the racial empathy gap. A recent study shows that people, including medical personnel, assume Black people feel less pain than white people. In addition, medical education often does not teach health care providers to recognize how symptoms manifest on different skin tones – for example, burns or different skin conditions, meaning that white skin is taken as the default. This has real impacts on the quality of treatment received.

For people who use drugs, who use opioids for chronic pain and/or “look the part” of what a drug user could look like, this can mean being labeled a “drug seeker” and not being believed and/or treated for pain.

In the cases of Indigenous people, a study by Dr. Janet Smylie of the Centre for Research on Inner City Health at St. Michael’s Hospital shows the impact of differential decision-making and how it comes from what she calls ‘unintentional racism’ by well-meaning care practitioners.

In short, assumptions, stereotypes and biases all impact the experiences we have when we access health care. Things like racism, classism, homophobia, and cissexism permeate society, and this means they also permeate the health care system. While it’s not up to you to educate your health care provider, nor is it your fault if your health care provider doesn’t believe you, the following sections outlines some tips that can help you advocate for yourself within a health care context and feel fully heard when you speak with a health care provider.

Tips to get your doctor to listen to you

We deserve to have positive and affirming health care experiences where we feel heard and respected. While your treatment shouldn’t depend on your ability to advocate for yourself, sometimes this can make a big difference. Here are some things that can help when advocating for yourself:

• If it feels appropriate, it can be helpful to bring someone with you who can witness the interaction and, if needed, advocate on your behalf and/or help you question or name some assumptions that you feel may be guiding the care you are receiving. It can also help when it comes to retaining information, or remembering to ask important questions, since sometimes we can feel flustered or overwhelmed by information in the moment.
• Prepare a list of your symptoms, the questions you want to ask, or topics you’d like to discuss during your appointment. Then, try and answer the doctor’s pressing questions first. Many health care providers rely on check lists and may want to get through some standard questions first before they veer off script. When that has been done, mention that you have a list of topics that you’d like to check in about.
• If your health care provider only asks close ended question and is not giving you much space to give context, add more information about your personal experience or situation at the end of the yes/no answers.
• Interrupt when interrupted. If your doctor cuts you off when you try to give them a full answer, feel free to interrupt them to finish your thought. This may help make sure that answers can’t be taken out of context and that your entire answer is heard.
• Focus on your concerns. If you get the sense that they are being brushed off, speak up, saying something like “excuse me, I have tried to answer all your questions, but I am still not sure my concerns have been addressed. Can you please help me understand why it is that I have been feeling (this and that symptom)?”
• Ask for explanations about decisions being made so you can understand why the doctor is recommending a certain course of action. Having a clear understanding can make us more likely to stick to a particular treatment or course of action when we understand the why!
• If you are requesting a test or specific form of health care and your health care provider says no, ask them to note it in your file that they have refused this particular form of care. This will often make health care providers think twice about refusing you care or will prompt them to share more information about why they have made that decision.

If you try these tactics and still find you are not feeling heard, some hospitals, clinics, and health care centres have patient advocates or patient ombudsman if you are interested in making a complaint. Ask the receptionist, hospital administration, or health care provider themselves what the process is for making a complaint.

On a larger scale, since provinces and territories are responsible for the administration and delivery of health care services throughout the province, if you have a negative experience accessing health care, you can contact your local provincial/territorial Ministry of Health through their provincial Ombudsman. The provincial office of the ombudsman helps with complaints or investigating systemic issues happening in health care settings. You can also contact your province or territory’s College of Physicians and Surgeons, if you had a negative experience with a physician. Links to each provincial and territorial medical regulatory authority can be found on the College of Physicians and Surgeons of Canada website.

Facing discrimination in the health care system: taking care of yourself

If or when we face discrimination or stigma while accessing health care, it takes a toll on us and it might make it more difficult to engage in relationships with health care providers in the future. It can also jeopardize our ability to follow-up on treatment or care. Sometimes we may need to go back to this same health care provider, which can make things even more difficult.

Here are some things we can do to take care of ourselves when that happens:

• Pay attention to your body: One basic way that can help our ability to cope with tough situations is to pay attention to our surroundings, using grounding exercises, noting how much sleep we are getting and ensuring we are eating regularly. We may not always have control over our housing, our food and our sleep, but when we can take care of our body in the ways that are available to us, we may be able to feel a greater sense of control, as well as security and calm, which may help us deal with challenges.
• Share your stories: Breaking the silence is a great way to process difficult emotions when experiencing stigma and discrimination. Turn to friends or family, someone you can trust, who will support you and validate your feelings and experiences. Look online for stories from people who have experienced similar situations, to help you understand that you’re not alone, and learn about strategies that other people have taken to cope.
• Find your community: A feeling of belonging is an important part of coping with difficult experiences. This is especially important after having been mistreated. Look for supports in your community, through community groups, online networks, drop-ins, etc. Connect with likeminded individuals who may share similar experiences, who can offer guidance, resources and support when you are facing a difficult situation. Connecting with others who are dealing with the same issue is a powerful tool for building strength and finding solidarity.
• Keep relationships going: Maintaining good and healthy relationships (from intimate relationships to friendships to the important connections we have in our communities and at services we access) can help with a sense of stability and constancy in our lives. This sense of stability and support can help us navigate difficult times.
• Educate and connect: Learning about yourself and the communities you are a part of may help make sense of an incident, for example, if you were mistreated because of your HIV status, your trans experience, the colour of your skin, or the religious symbols you wear. Connecting with others in your community can help normalize and validate impressions you may have (“did this really happen?!” “Am I right to feel angry about this?” “Did I read the situation right?!”), which can provide an antidote to feeling like you are over-reacting or like everything is in your head. The internet and/or local social networks can be good starting points for information and for connection. Learning can help us recognize biases as well as support the building of a positive identity to fight against discrimination or prejudice.
• Find some good comebacks: Brainstorm in advance some ways of addressing difficult situations and advocating for yourself when it feels possible/safe. We can learn to identify our own stress levels, locate that stress in the body, communicate our feelings and find ways to face tense situations more calmly when we want to make our views known.
• Be brave but also learn how to lean on others: Being brave means facing uncomfortable feelings (like speaking up in a doctor’s office) and figuring out how to actively work with them (like feeling motivated to file a complaint). Explore what being brave means to you and experiment with things that help you feel brave, confident, and in control. This may mean being able to point bad behaviour out, fill out a complaint form, talk about how we have been mistreated, talk it through with health care providers who may or may not be aware of how they come across, or educate people around you. Being brave also means being able to make yourself vulnerable and seek the support we all need. It can also mean choosing not to engage when we know that it is in our best interest to take a step back and focus on ourselves first. Asking for help is also an important part of the picture. This might look like having someone you trust follow-up with a health care provider when you have been mistreated, or help you find resources like support groups, complaint forms, etc.
• Seek professional support: In some instances, trained counsellors can provide you with needed support and help you develop ways to cope and thrive, particularly after experiencing trauma. If you have access to them, trained professionals can help you identify how you have been affected, and help you stop blaming yourself for what you have experienced, which is a common response to experiencing mistreatment.