Dear Jake,
I’m a bisexual man in my early 30’s and I enjoy an active sex life. Even though some of my friends like to jokingly slut shame me, I have made a real effort not to judge myself for hooking up a lot. Life is short, and sex is fun!
My therapist has helped me understand that as long as I’m taking care of myself, it might actually be healthy to acknowledge my bisexuality and give it an outlet, rather than feeling shame about it (especially since my youth was full of so much repression).
How about we take this to the next level?
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On that note, I recently went to a new doctor to see about going on DoxyPEP to protect myself from getting STIs. To my surprise, he laughed at me and suggested that I might consider “wearing more condoms” and even asked if I ever thought I might have a “sex addiction.” I left without a prescription and feeling uncomfortable and embarrassed.
I’m pretty sure this new doctor is straight, but is it really my job to teach him this stuff? How would you handle this situation?
Self-Care Slut
Dear Self-Care Slut,
What you experienced in the health system is unfortunately all too common. When you reach out for help, you deserve to know you’re in a safe, non-judgmental place, with an expert who’s willing to try and understand the various factors in your life so that they can create the best healthcare plan for you.
Sadly, many “professionals” out there are not LGBTQ+ affirming, with no understanding of the nuances of queer culture, nor the ways we protect ourselves.
Even if your doctor had not heard about DoxyPEP (which he should have!), the appropriate thing to do would have been to look into it for you, before simply dismissing it and labeling you as the problem or incorrectly diagnosing you as a “sex addict.” What a jerk!
Rather than trying to educate him–which, BTW, isn’t your job or burden–I recommend never going back to his clinic again and instead finding a different provider who is more open about and understanding of the needs of LGBTQ+ patients.
Things like PrEP, PEP, and DoxyPEP are incredibly useful tools for preventing HIV and STIs for those with active sex lives, while honoring the reality that a lot of people don’t always use condoms.
I’m truly sorry this new doctor of yours was so close-minded. Luckily, there are services are out there that can help you locate better, more LGBTQ+ affirming providers, such as EqualityMD, Folx, OutCare, and the LGBTQ Healthcare Directory.
You might also see if there are local LGBTQ+ clinics and centers that offer healthcare near you. Keep an eye out for LGBTQ+ messaging on provider websites. Referrals through word of mouth can also be super helpful.
If you’re living somewhere more rural, don’t fret! You can still access DoxyPEP (and PREP) through low-cost online services, such as Q Care Plus.
At the end of the day, you want to find care that understands and honors your individual needs as a queer person. No one deserves to be slut shamed, and your intention to enjoy sex in a safe and healthy way is smart and responsible.
Now, excuse me while I go Google “Is there a morning-after pill for incompetence?”
Ask Jake is our advice column by Queerty editor and Licensed Marriage & Family Therapist Jake Myers. If you have a question for Jake, email [email protected], or contact him through his LGBTQ therapy platform.
Raphael
Also, Jake “forgot” to mention, you can always report him.
rikard_pearson
i am resisting rounding this up to a hate crime. maybe as an older gay slut i am less sensitive. the dr joked and made dumb comments that i take as a way to ask for more information without a furrowed brow and solemn tones. because it should be mentioned the conventional medical opinion is to still use condoms and limit partners to trusted people for men who have sex with men, and get tested every three months even on prep. i’m in my 60’s and never had sex without condoms until this year. i talked to my doc for two years before deciding to take a daily med. i would expect my md to ask how often i have sex, how many different partners, the specific sex acts to asses my risk and this is the guy i’ve been seeing for 20 years. i have to get a new doc now and have an appointment next month, so i hope they are cool, but i found them with the LGBTQ+ tab on the hospital’s website. fingers crossed.
Man About Town
Raphael: my thoughts exactly. Report this nitwit to the AMA!
And per Jake’s suggestion, stay away from homophobic professionals.
inbama
The doc’s advice was correct – only c o n d o m s protect you from everything.
Use them out of respect for your unsuspecting partners.
gregg2010
Find a new doctor, one who is sex positive. Since I am a member of a semi national health cooperative, I would have immediately reported this doctor and filed a complaint. Luckily, the doctors I have encountered have been educated.
tjack47
Condoms don’t protect you from all STIs. Herpes, for example. The doctor was an unprofessional, immature jerk. I live in the Bible belt. I’ve encountered physicians or PAs who brought out the Bible or tried to shame me for being gay or an atheist. They don’t get away with it. I won’t be treated that way.
Kangol2
Report the doc.
He was out of line.
winemaker
Sadly there are many incompetent and downright lousy people who call themselves doctors. Being a doctor requires a committment, not only educational but having empathy and being open in dealing with peoples healthcare issues. it also takes a certain personality to become a good, competent doctor and either you’ve got it or you don’t. That said from my experience, avoid clinics, especially ones run by the city health departments. Why is this? Simple and to the point, many clinics are staffed by mediocre doctors that see a large number of patients and don’t have the time to give each patient their full attention as their day is often overbooked with appointments. Many clinic doctors are new doctors just recently out of medical school and just getting experience or they’re not ready to go into private practice or not good enough to go private. My late mother had some timeless advice and told me this when I was young: In life you’re going to need the services of at least 3 professionals: your doctor, your dentist and if you have a legal issue, a tough competent attorney. With your doctor you want the best you can find as they have your health in their hands. There are lots of mediocre and downright lousy doctors out there and you want to avoid these at all costs. You want to be able to discuss your issues with them, even the most embarrassing things without shame and if you get the feeling they’re not on the same page with you or dismissive, run, don’t walk and find another doctor, it’s not worth sticking around!. The same also applies with your dentist as they often will work in concert with your doctor and vice versa to keep you healthy. And last but not least, if you have a legal issue, find a competent, tough and well experienced attorney.
Eternal.Cowboy
Inbama is wrong again. Shocking, I know.
The current recommend standard of care is to prescribe prep or DoxyPEP as requested and to educate about why it is still important to use protection. Simply suggesting protection is not medically sound nor good advice.
henare
Yeah. I’d just get a different physician. Not your job to educate your medical health professionals.
MaritimeNerd
Actually the recent CDC DoxyPEP guidelines are specific to MSM/TGW that actually acquired a STI within the previous year. There is yet to be devised an official standard of care for the profile described in the original question, however real or merely illustrative to stimulate discussion, assuming an active sex life free of bacterial STI to date. Nevertheless, fully in agreement regarding critique of the physician’s manner; that is a no-brainer.
What accounts for non-USA jurisdictions’ reticence to emulate the current guidelines may be related to a different take on the efficacy evidence to date and to a different way of approaching the risk behaviours that generate STI incidence.
DoxyPEP efficacy against Gonorrhea is since revised downward when synthesizing the relevant data, and that update was available months before the final CDC summary. Moreover, along with low effectiveness is a high rate of Gonorrhea infection among study recipients of DoxyPEP that would be expected to occur among populations with the same risk as those study participants, that is, a previous STI infection diagnosed within 12 months previously essentially serving as a benchmark for sexual activity that supports statistical analysis comparing prophylaxis to placebo.
The guidelines gloss over the likelihood of breakthrough Gonorrhea infection in spite of attempted prophylaxis. Similarly, the growing rate of Gonorrhea antimicrobial resistance to conventional treatment (i.e., Ceftriaxone) is downplayed. The takeaway from the guidelines among some Infectious Diseases stakeholders is that prospective candidates for DoxyPEP are unfairly considered to be poorly equipped to process information related to differing efficacy data across the targeted infections and that it is futile to educate about problematic incidence rates because transmission will occur anyway. In fact, as seen with MPox for example, folks can and will adjust behaviour when given accurate information, while maintaining self-determination.
I would never say to somebody I cared about that DoxyPEP is a legitimate 3-for-1. Subtracting to 2-for-1 essentially calls for condom protection. Well, duh, that makes DoxyPEP obsolete. Sorry not sorry. I am going for reality over apologist stance. It’s not as simple as a 3-course meal with one element that failed to ‘wow’.