“Do you have sex with men, women, or both?” the provider looks at me kindly and expectantly.
As a trans man, I always stumble when I answer this.
I know what they’re really asking. They want to know about my risk of sexually-transmitted infections, and whether, as a trans man with a uterus, I’m having the kind of sex that could get me pregnant. Basically, they want to know whether I’m having sex involving a penis.
So when they ask the question like this, it makes me feel like they don’t understand trans bodies.
“Men,” I once said to a provider, who then instantly wanted to talk about birth control, leaving me scrambling to clarify that my only current partner was another trans man.
I’d thought the provider was trans competent. I’d thought she understood that men don’t always have penises. Her question felt like a betrayal. It suggested that the gender identity of my partners has something to do with our anatomy or our sex acts. And it erased non-binary people completely.
The conventional, risk-based framework for sexual history intake has too often shamed LGBTQIA+ people for having sexual lives outside of heterosexual, monogamous relationships. In fact, 15% of LGBTQIA+ folks reported not seeking medical care due to discrimination.
The GOALS framework for sexual history-taking, developed by Sarit A. Golub, PhD, MPH, and the New York City Department of Health and Mental Hygiene provides a flexible framework to encourage more open and affirming conversations about sexual health.
When I think back to my past experiences, I’m reminded that there are so many stories just like mine that could have been prevented by a solution like the GOALS framework.
The framework encourages providers to ease into the conversation. Instead of rattling off the typical battery of questions, the framework offers physicians a more mindful approach:
It’s time to have conversations about sexual health that center pleasure and autonomy, rather than risk, and these conversations need to start from a different place. A conventional, risk-based framework for sexual history-taking has too often been used to shame LGBTQIA+ people for having sexual lives outside of a heterosexual monogamous relationship—the GOALS framework helps us move toward conversations about sexual health that center pleasure and autonomy for all genders and sexualities.