Journal Club: Asexuality and healthcare practitioners

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This month, the ace journal club discussed

“Asexual-Identified Adults: Interactions with Health-Care Practitioners” by Shelby K Flanagan & Heather J Peters. (2020) https://pubmed.ncbi.nlm.nih.gov/32222850/ (requires journal access)

The journal club meets once a month on Discord, using text or voice as club members prefer. We discuss a variety of academic works in ace studies, ranging from gender studies to psychology. Don’t worry about journal access, we can provide access. If you’re interested, please e-mail me at asexualagenda@gmail.com for an invite.

Our discussion notes are below the fold.

Summary
This study surveyed 136 participants about their interactions with mental and medical health practitioners. The majority did not disclose their identity to health practitioners, and there was a mix of positive and negative experiences explored in the paper.

Main takeaways
– Only 57% of people who disclosed their identity to mental health practitioners reported only positive experiences; for medical practitioners it was 52%.
– Some participants said it was a positive experience as long as the practitioners weren’t actively judgmental or stigmatizing.
– Sometimes practitioners feel they sufficiently understand LGBT communities, but lack understanding of asexuality. In one example, this seemed to make the practitioner more rigid in their beliefs about aces.
– A number of quotes indicated that people disclosed their identity because their doctor didn’t believe that they weren’t sexually active. The paper argues that it’s dangerous to assume that all non-asexual adults should want to have sex.

Educating health practitioners
– Anecdotally, while education on LGBTQ+ issues has improved over time, asexuality and aromanticism are usually still barely mentioned or not at all.
– While the DSM mentions asexuality in the long description of the HSDD diagnosis, it’s not in the diagnostic criteria, and practitioners might miss it.
– We mentioned a few resources on this topic, including Gupta’s 2017 recommendations for health professionals, RFAS’s resources for health professionals, and this 2017 review by Jones, Hayter, & Jomeen.
– There are also procedural improvements that could be made. One participant wished that they would put it in their charts so they didn’t have to explain it to every single nurse that they saw.

Implications for activism
– The study suggests that the problem isn’t necessarily a lack of awareness among health practitioners, but rather lack of curiosity, and acceptance. This points to a problem with the education paradigm of ace activism, which supposes that the main problem is simply a lack of information, rather than a problem of values.
– That said, educating health practitioners is still valuable.
– We discussed AVEN’s education paradigm, and observed that we weren’t aware of any recent attempts by them to target health practitioners.

Methodology
– This study had a fairly small sample, making it difficult to get statistically significant results. At one point the paper said “can be said to have approached significance”, which is just an improper way of saying “not statistically significant”.
– The study recruited from AVEN as well as from university LGBT resources. We don’t know the proportions of each, but it’s good to see them going outside of AVEN.
– The study didn’t collect demographic information, to make the survey feel more private. The authors recognized that this was unnecessary and a mistake.
– This study might be compared to the Ace Community Survey, which in 2015 asked about people’s experiences with mental health professionals. See page 49 of this report. Notably, disclosure rates were lower in the Ace Community Survey (24% vs 55%), which could come from differences in questions, or perhaps people with more interactions were more likely to respond to this study.
– The study didn’t ask about neutral experiences, which could bias results if participants were forced to classify neutral experiences as positive ones. However, we do believe the results are correct.

Definitions
– The definition of gray asexuality was much better than what we usually see in scholarly articles: “identifying along a spectrum between completely asexual and completely sexual”.
– They used “asexual” to refer to the entire asexual spectrum. We do that too sometimes, but felt a formal publication should be more precise for clarity.

Future topics and other connections
– The paper remarked on the similarities between their results and the experiences of lesbians, as reviewed in St. Pierre 2012.
– Multiple quotes are about participants trying to decline procedures such as pap smears, HPV vaccines, STD tests, or pelvic exams, which might not be necessary for people who aren’t sexually active. This deserves some deeper discussion.
– The paper mentioned that some participants received diagnoses related to their lack of sexual activity, and that some participants disagreed with those diagnoses. It would be interesting to learn what those diagnoses were, and go deeper on this subject.
– There was a good quote about trauma, and how it didn’t matter whether asexuality was “natural” or caused by trauma.
– The discussion raised aromanticism and participation in romantic relationships as a potential future topic of study. This is important, but researchers should take care to understand that romantic orientation and interest in romantic relationships don’t have a one-to-one correspondence, and some people may not classify themselves in terms of romantic orientation.

About Siggy

Siggy is an ace activist based in the U.S. He is gay gray-A, and has a Ph.D. in physics. He has another blog where he also talks about math, philosophy, godlessness, and social criticism. His other hobbies include board games and origami.
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1 Response to Journal Club: Asexuality and healthcare practitioners

  1. Shelby Flanagan says:

    Thanks so much for discussing our article! It was interesting to read your discussion, and I appreciate the feedback. I worked on this study when I was in undergrad, and I’m working on my PhD now, so hearing your thoughts is really helpful!

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