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"I'm Kinky and I Know It. And as my Doctor, You Should Too." - kink culture and sex positivity

Updated: May 23

“What about fisting, watersports (sexual urine play), and like, scat (sexual fecal matter play)?” I inquired brazenly.

“Why don’t we proactively elicit these things, which could have tremendous clinical implications for patients in terms of managing their health?” I continued asking the guest lecturer in front of my entire class of first-year medical students during a doctoring session on how to take a sexual history.

To my consternation, the responses from the faculty who chimed in left much to be desired, and nauseatingly so. Essentially, the answers could be completely distilled into, “We would only ask these things on an ad hoc basis. And even then, we do not ask about specific kinks or fetishes, unless the information is explicitly volunteered by the patient.”

My stomach turned.

As the guest lecturer continued to elucidate what seemed to be an utterly myopic, antiquated, and even deleterious framework with which the current medical community seemingly deploys to understand a patient’s sexual health, I tried to maintain a sense of “professional” composure on the outside.

Inside, I was cringing.

Suddenly, like Carrie Bradshaw from Sex and the City, I couldn’t help but wonder, “Why is it that our engagement with patients’ sexual history in medical settings seemingly comes to a grinding halt once oral, vaginal, and maybe anal sex have been discussed, and some advice about STI prevention and contraception disseminated?”

You may have to use your imagination a bit for this part but, what about all the other things done outside of this non-exhaustive list that could more relevantly and critically impact one’s health like anilingus (a.k.a. “rimming”), BDSM, ABDL (Adult-Baby, Diaper-Lover), trampling, urethral sounding, and more? And why have we not revised this purportedly accepted model for sexual comprehension in order to be less stigmatizing/discriminatory, more normalizing, and possibly even more germane to the patient’s life upon eliciting an initial sexual history?

If the answer is in part related to “not enough people do these things” or “it’s not significant enough to impact care,” exactly how many people and how much (and what kind of) impact must there be for change to occur? And in that very instant, a conflagration of unrestrained impulse came over me to overhaul our present educational establishment and occupational paradigm, and replace them with something more inclusive and less sexually draconian.

You may be inclined to ask, “Why does the current medical scaffold we use to build understanding around our patient’s sexual health need to change?”

Allow me to answer that question with a question (or two). “How much does relevance matter to you when you consider a patient’s sexual health? And in what ways and to what extent do you believe that the current iteration of sexual history elicitation is not ideal or even injurious to optimal provision of patient care?”

Let’s probe into the first concept of relevancy. If your patient comparatively engages much less in what I call the “sexual trifecta” (i.e. oral, vaginal, and anal sex), and instead engages mostly or entirely in other sexual activities such as those mentioned thus far like fisting, rimming or scat, BDSM, and urethral sounding, how much less relevant would venereal diseases and contraception be in comparison to anal fissures, giardia and C. diff, skin contusions and abrasions, and UTIs, respectively?

Next, let’s briefly explore the second concept of idealness and injuriousness. Instead of inciting a potentially polemical debate over semantics, denotations, and quantitative operationalization of these words, we can start by considering the ways in which our current apparatus for sexual health in medicine is patently harmful.

In synthesizing the experiences of friends in the kink and fetish communities as well as those of classmates at medical school who have shared their deeply internalized agita towards the way in which medical settings that are supposedly meant to serve as lodestars and health havens for open dialogue, honesty, and transparency have become putrefying cesspools for (perhaps unintended) sexual stigma and kink/fetish stigma that may easily lead a patient to feel compelled to either dissemble information or flat-out lie in order to not feel judged, uncomfortable, awkward, or even discriminated against.

In order to properly care for patients, we have to understand them—their whole selves. Analogously, in order to understand their sexual health, we must understand their whole sexual health. Furthermore, for many of us, the kinky, fetish interests and activities we engage in behind closed doors occupy a considerable chunk of not only our sexual identities, but our human identities. How can we expect to build a 100% fiduciary relationship with our patients amidst a historically and culturally orthodox profession when we do not create a maximally conducive and safe space to share these unbelievably intimate details of our lives?

And thus, in order to earnestly reify our commitments to the tenets of medical care (e.g. patient’s best interest, beneficence, non-maleficence, etc.), it is incumbent upon the professional and academic medical community to also walk the walk by making into social imperatives the eradication of a pervasive culture of kink-shaming, the intercalation of novel sex-positive advocacy methods (e.g. formally teaching kink/fetish-related concepts/terms, safe practices, injuries, acquired illnesses, and treatments in the medical school curriculum for early exposure and insulation from what I call “kink shock”), and the reconceptualization and expansion of our putative understanding of what constitutes the essential elements of “sexual health” in medical education, medical training, and professional practice.

Lastly, in terms of solutions and approaches towards the amelioration of the sex-negative attitude of toxicity permeating the ether of clinical spaces and physician-patient dynamics, perhaps those who agree can engage in what I call “solidarity signaling” and show that you are “in-community” with the frequently disenfranchised and voiceless kink/fetish patient populations by appending a checkbox sheet at the end of an initial intake form enumerating a gamut of sexual paraphilias/kinks/fetishes that exist out there with an added “other” section where patients can opt-in to share this information with their provider prior to even seeing them. Imagine the colossal disarming, reassuring, and welcoming impact the presence of that sheet alone would have on patients and our culture of medicine? Imagine all the ways in which a patient would then be more apt to feel less bashful and be more honest, both of which affect the dispensation of optimal patient care.

Perhaps one day, LMFAO will make a new hit song: “I’m Kinky and YOU Know It”


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