How Asexual People Can Come To Doctors

In Season 8, Episode 9 ("Better Half") of the medical drama series "House," after lead character Dr. Gregory House (Hugh Laurie) encounters a couple who express they're asexual, the entire basis of the plot revolved around disproving them.

In House's view, the only people who would identify as asexual or people who don't "want" sex are either "sick, dead or lying." Eventually, the titular character discovered the male partner had a pituitary tumor, which affected his sex drive, and that his wife was simply lying. Tada, the show solved the mystery. Except it didn't.

While many people know that a lack of sex drive is not the same as asexuality and that it represents a legit orientation—and that much of this show is entirely fiction—attitudes like House's are directly pulled from real-world stigma.

For many, going to the doctor's office for sexual health concerns comes with an avalanche of stress. Coming out to your doctor isn't easy. And when it comes to this particular community, there are a few particular added stressors, including the strong chance that the person assigned to their care will pathologize their sexual orientation.

As an asexual person, I've had to deal with this fear in social settings. I've had to consider if it would be safe to disclose my asexuality or whether I would risk humiliation and disrespect by doing so. Too often, there's a large group of people who assume those who identify as such are automatically "broken"— that something must be medically wrong with our bodies. Unfortunately, that group can and does include doctors.

What is asexuality?

According to the Asexual Visibility and Education Network (AVEN), an asexual person experiences little to no sexual attraction. Unlike celibacy, which is the act of actively obtaining from sexual relations, asexuality is an orientation, like heterosexuality or bisexuality.

And while many people conflate asexuality with aromanticism (i.e., experiencing little to no romantic attraction), many people who identify in this way can and do experience romantic attraction, identifying as heteroromantic, biromantic, etc., although aromantic asexuals do exist, and are completely valid.

It is estimated that at least 1 percent of the human population identifies as asexual, which is currently about 78 million people of the total global population of 7.8 billion. Some scholars, such as those from the UCLA Williams Institute, theorize that as awareness of the orientation becomes more mainstream, "the prevalence and understanding of asexuality will grow as more youth reach adolescence and become familiar with the identity," which means we'll see more patients with a need for proper medical care.

The medical stigma

In her 2020 book, "Ace: What Asexuality Reveals About Desire, Society, and the Meaning of Sex," author and science journalist Angela Chen writes that "medical authority can be powerful even when it is imaginary….Doctors encourage aces to ask ourselves if we're sick and doctors also diagnose and make declarations without caring what an ace person might think."

Rather than treating this as a legitimate orientation, many medical professors have treated asexuality as a pathology. Coming out as asexual to your doctor can chalk up asexuality to certain "issues," like the case in "House": blaming asexuality on something like irregular hormones, sexual dysfunctions, etc.

Within the latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, there is a condition labeled as "Hypoactive Sexual Desire Disorder," or HSDD, defined as "low sexual desire accompanied by marked distress or interpersonal difficulties." Upon seeing the description, the asexual community noted how the wording of this criteria might lead psychiatrists to impose inaccurate diagnoses on patients looking for mental health care.

Madison Huffman, 26, even experienced asexual pathologization after going to a new doctor for a broken foot.

The doctor, following protocol, asked Huffman if she was sexually active or not. "Her whole demeanor shifted when I said 'no' and she focused entirely on that and kept asking me why I wasn't sexually active," explained Huffman. "She wouldn't take anything I said for an answer." Huffman herself had to redirect the doctor's attention to her broken foot, the real reason she came to the doctor's office in the first place.

I've had to consider if it would be safe to disclose my orientation or whether I would risk humiliation and disrespect by doing so.

As a result of the stereotypes and assumptions, many asexuals are terrified of disclosing this part of their identity to their doctors. For this community, one that has constantly been erased, misrepresented and maligned in mainstream media, the idea of facing more acephobia, or discrimination is exhausting and frustrating.

With there already being large gaps in queer-conscious medical care, the lack of awareness for asexuality and associated biases signals harm and distress that asexual patients need to be warned of and medical professionals need to take care not to perpetuate.

Luckily, there are increasing resources, including queer-friendly medical care, for those who wish to become better allies to their asexual patient, as well as a number of organizations that both aces and non-aces can go to for information. Among the most important pieces of advice that any professional (whether within a medical office or school setting) can take to become more inclusive: Learn "about the asexual identity spectrum," approach "asexuality with an open mind," and, most importantly, listen to their patient. M. Rodriguez, a registered nurse and asexual woman, said that doctors should "ask questions and not assume things."

Patients are the foremost experts of their own bodies, so when an asexual patient comes to you with an issue, try not to automatically pin that issue on their orientation, and instead be open to what they actually have to say. Coming out to your doctor as asexual shouldn't be shrouded in fear or misunderstanding.