Monogamy and Health Care

I have a really, really weird sexual background.

Oh no wait, that is not what I mean.

I was raised in a context where many people did not ever have sex outside of marriage, and went through life married to one person who also never had sex outside of marriage.

And this sort of sexual deviance (from the apparent norm in the United States) continues even today!

But for those raised in contexts where they saw their parents have multiple sexual partners and their health classes teach that it is only a matter of time before everyone catches some sort of STI (so you need to be really, really careful kids!) it can be unthinkable to consider the health care situation of the sexually monogamous.

SIDE NOTE: this is the point where I offend 90% of my readers by explaining that for this post, “monogamous” means only having one sexual partner over the course of one’s life. We will also assume that that sexual partner is also monogamous, and then offend all of the good upstanding Christians by excluding them from consideration by labeling them as “serial monogamists” or “converts to monogamy” or something else equally offensive which brings back nightmarish memories of the 2008 Republican Presidential primary when people wept tears of outrage over the realization that–Lord Have MERCY–the MORMON was the only truly monogamous one! And now that you understand how the term “monogamous” is being used for this post, let’s return to being deadly serious. Because, issues of health care are ultimately deadly.

This post, my (former) friends, is to educate you on (a few of) the realities of health care for the monogamous. I may not agree with the decisions in all of the cases described below, but they are all at least reasonable decisions given the circumstances.

So now, a peek into the bedrooms doctor’s offices of the monogamous.

Vaccines against STIs (such as Gardasil and Cervarix and any others that may come along eventually) are stupid. Of course they may or may not be good for “other people” but it makes no sense to subject a now-abstinent future-monogamous young person to them. After all, they will not ever be exposed to these STIs, and in the case that they should choose to marry someone who is, er, reformed, then they will have their engagement to get all of the vaccines.

There are fewer possible causes to consider when dealing with fertility issues. While just about no one actually thinks that their sexual history could possibly impact their fertility (after all, we all only slept with 2.2 people who looked very hygienic and always relied on synthetic materials which are 80% effective at preventing the transfer of STIs!) a doctor is more likely to be convinced that that is actually true if one has been monogamous.

When it comes to actually having babies, various tests and treatments for both mother and baby (all with their own minor risks) can be declined. Again, it is a completely different situation for a woman and her partner who are actually monogamous, compared with those of us who just feel good about our sexual history and know that we couldn’t possibly have anything like that to risk transmitting to our perfect little babies!

Speaking of babies, you can safely have more babies without stressing as much about your cervical health. Giving birth to three or more children increases your risk of cervical cancer. But you can give birth 20 times and cervical cancer will probably be no where near on your doctor’s list of worries if you are monogamous. That is not to say they won’t have lots of other worries about you, but that is beside the point.

And best of all, fewer Pap tests! Most women should have Pap tests every two years, but health care providers should be fine with few to none for women who really have virtually no risk whatsoever for cervical diseases.

There are, of course, many more differences, but I am a 25-year-old with no medical training, and who really needs to know more anyway?

The point is simply that you should know that health care is rightly different for couples who are sexually monogamous. Women in particular need to know their partner’s sexual history and whether they have been exposed to STIs despite only ever engaging in sexual activity with one man.

And while I am on the topic, let’s not pretend that exposure to STIs is a one-time-and-it-is-settled-forever thing. Previous stupid actions in which you risked exposure do not guarantee disease transmission. You (or your innocent, unknowing spouse) may have gotten lucky in a way which actually counts. So please don’t act as if there is no point in seeking testing and treatment and being smarter in the future. There is a point: your actions now matter for your health, regardless of what you have or have not done in the past.

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20 thoughts on “Monogamy and Health Care

  1. Young Mom

    “a doctor is more likely to be convinced that that is actually true if one has been monogamous.”

    Actually, I have yet to find a Dr who actually believes me when I tell them that I’ve only ever been with my husband and he has only ever been with me. I still get the same pressure to get tested for HIV, Gonorrea and Syphyllis every single pregnancy. When I tell them I am positive that I don’t have them, they just shake their heads in pity and chalk it up to ignorance.

    1. Megan

      I agree that while healthcare should be different, it often is not… nurses insisting that a never sexually active woman engaged to a never sexually active man, MUST get the HPV vaccine because it will be free of cost until her next birthday. Female (LDS) women preparing for missions must go through a physical, including a pap smear, where more often than the not, the pill is pushed. These and many other similar situations happen with seemingly no recognition of the fact that some people may actually not be sexually active now, or will ever only have a single sexual partner. It seems to be perceived as an impossibility!

      There is so much truth to your post. Huge benefits from abstinence and monogamy extend to everyone, regardless of their religious or moral positions, and I think that this point should be emphasized much more than it is, or has been. It is unfortunate though, that within the medical community, as a whole, it is very rare that a medical professional will acknowledge the facts you have set forth. I have never heard once of a woman being asked about her sexual history before a doctor gives a (unrequested) referral for a pap smear. The message is that the procedures are the same for everyone.

      1. Rae Post author

        I think that the general message has to be the same, because most people do need the tests etc. And I recognize that there is a lot of pressure for women to lie and minimize their sexual activity, so I think that it is reasonable for doctors to default to assuming the worst from a health persecutive until they are told otherwise. The problem is when they *are* told otherwise and prefer to be condescending!

        Thankfully I have found health care professionals to generally be very good about modifying their recommendations when I tell them my situation. I only learned about not needing Pap tests at my first visit to a gynecologist when she said that there was no need for me to have one since it would almost certainly be negative since “it isn’t like you catch these things though the air.”

        I know that it can be very hit-or-miss with attitudes in the medical field, but perhaps I somehow manage to come across as sexually conservative in some way because I have been able to find doctors and nurses who took me seriously in this area. In fact, when recommending artificial hormones for endometriosis, one gynecologist did not include the ring in the list of options because she simply considered it out of the question for her patients who weren’t sexually active.

        I really wonder why on earth LDS women preparing for missions have to have Pap tests though, unless they think that the women may be lying? Because I would hope their church would assume sexual abstinence!

    2. Rae Post author

      It is amazing how condescending some doctors can be! I think it is part of the whole paternalistic style of medicine that sees women as something less than responsible for their bodies. I hope that you’ll be able to find better doctors.

      1. Young Mom

        Yeah, so far they act as though I am being super irresponsible for trusting that my husband is being faithful, and of course that it is better to be safe than sorry.

  2. Michelle

    Indeed….yes to all of this. As my daughters get older, I keep trying to figure out when I will start taking them to my NFP only/pro-life doctor so I don’t have to worry about assumptions made about them by the current doctor we use. (I’d take them to my doctor now except for the drive…it’s a bit of a hike)

  3. Jackie

    I am all for everyone getting the Gardasil vaccine, regardless of beliefs about sexual behavior. Simply because rape is always a a possibility for anyone, and if HPV is something so easy to prevent, and with such significant consequences, it seems like there is no need to add cancer to the list of negative consequences of rape.

  4. NomadLibrarian

    I, like Young Mom, have not had a doctor who believes that E and I have only been with each other. In fact, the first doctor I had after we were married, after I had refused to be vaccinated with Guardasil for the second time, told me that I was a “naive idiot” who only had a few years to “protect myself” and that I would be kicking myself five years down the road when my husband had cheated on me while deployed or on temporary duty. “They all do eventually, and by the time you’ll find out about it, it will be too late. Go upstairs and get the vaccine today.”

    I just looked at her. She harrumphed at me and then left. I refused to see her again; thankfully we moved shortly after.

  5. Jenna

    Loved this post! (As I think you knew I would!) Also taught me several things. I’m apparently ignorant about pap smears because I’ve suffered through a few now (only like two, but still) and I assumed it was something I had to do after I became sexually active because… well I don’t really know why! And I am officially never having one again. Awesomesauce.

    Also, apparently the name for STD changed to STI? When did that happen?

    A lot of people dislike my stance on the STI vaccines, but I think we can sit down and have a rational discussion that your chances of rape increase based on your lifestyle choices/circumstances. Yes, we see lots of girls on TV shows grabbed out of the park on their run, but truthfully those occurences are very, very rare. Choosing not to consume alcohol (and thus no lowered inhibitions) greatly decreases your chance of being put in a compromising sexual situation. The college you choose to attend. The neighborhoods you live in. These things make a difference, and it’s why we won’t automatically give those vaccines to any daughters we might have.

    I most definitely declined the HIV test, and it’s pretty shocking to me the number of Mormon women around me who never think to question the eye goo administered at birth (then again, I find it shocking that they don’t question a lot of things).

    Also, if I had written this post people would be tearing me apart. You have nice readers! (I certainly do as well, for the most part, I just have a few not-as-nice ones to boot).

    And in reference to the missionary pap smears thing, I’m guessing it’s just part of a standard physical that women have to do, not necessarily something that the church leaders mandate. As in, the list doesn’t say “Buy long skirts and ugly shoes and get a pap smear” more like “Buy the clothes and then get a full physical including these vaccines and other things if you are going to country X”

    1. Rae Post author

      Thanks! I’m not sure about the STD vs. STI thing. All I know was that in college they explained something or other about STI being a broader term… maybe all diseases are infections, but not all infections are diseases? I don’t actually remember.

      I think that the community aspect of LDS culture is so different from standard American culture that it is silly to expect LDS girls to have the same health care (and thus vaccination) needs as the rest of the population. So your stance on vaccines for any future daughters makes perfect sense to me.

      And thanks for explaining the missionary thing. I hadn’t thought about missionaries going to different countries with different requirements for physicals.

  6. Fran Rossi Szpylczyn

    While I have not commented in a long time (we have had quite a time in our family, but that is another story and for the moment all is well, thanks be to God), I keep up in the reader the best I can. I read this yesterday and began to comment, but stopped, but I came back today.

    I come at this in different ways… As a woman who is 53 and was sexually abused from infancy to two weeks shy of my 13th birthday, when my abuser died. I come at this as someone who turned 13 in 1970, so do the math about what era I grew up in and add in my background. I was very sexually active due to my pain, my confusion and the time I came of age. For many years, far too many, I offered no apology for this. At this time however, I have confessed and have received my forgiveness; most of the time I accept it.

    Additionally, I am diagnosed with HPV and have had multiple cervical cancer scares as a result. Did I get it in childhood or teenage or early adult years? I have no idea but I have it and I have to be really careful and that is that.

    I also come at this with the POV of a step-mother of a 14 year old and am painfully aware of the expectations of a culture and society that proffer the “when” not even considering the “if” of teenage sexual behavior. It is very hard for me to take and I worry, as a step-parent, I have less of a say. I pray a lot.

    In any event, I also read through this and I am confused. That is one reason I hesitated to comment yesterday, perhaps I am misunderstanding. Part of me reads this and sees, God forgive me, hubris. Now please allow me to add that may be my own misunderstanding.

    If there is one thing that I do object to, misunderstanding or not, it is the use of the word stupid. I guess I don’t expect this from you, that is part of it. Is Guardasil stupid? I mean – I completely dislike the way it is pushed and I do mean completely. That said, I am not sure that I would use the word stupid and I am not sure that sexual behavior can be predicted. This is by no means a way of saying that women should get it, but I am not sure that it is “stupid.”

    Also, past “stupid” actions… Well, while I did many regrettable things, I am not sure I would call them stupid. It is such a negative and pointless, shaming way of looking at it. Again, I say that as someone who has had to navigate the complex pathways of healing – physically, emotionally, spiritually.

    I so appreciate that I think you are trying to say that minding one’s health is essential, but it feels shrouded in something that leaves me a bit uncomfortable. And as uncomfortable as I am about saying so in the comments, I am saying so in a spirit of inquiry and charity. I hope that you will be able to give me some clarity and if I offend you or others with this, I beg forgiveness from all.

    In the end it is a real challenge as expectations about behavior and even mockery about choices of living in a more chaste way elicit shock and disbelief. However, wisdom must also be present and a reminder that we are all capable of all sorts of things, even if we think that we are not.

    1. Rae Post author

      Just to reiterate publicly, I did not wish to in any way imply that I think that your actions (or anyone else’s) were stupid.

      Hopefully my follow up post will clarify more. And thank you for your comment and balanced perspective.

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  8. carrien_laughs

    This post made me laugh out loud.

    I see a midwife, who knows my situation, and never ever suggests I get a pap smear. I’ve had other encounters with a speculum, hymenotomy, post miscarriage exam, but never for a pap smear. I say no, they raise their eyebrows, I shrug and explain and they read me the list of why I ought to listen to them. That happens almost every pregnancy too, the ob visits, my midwife is lovely but I go to the OB for Rogham because then insurance covers it.

    Given the dire side effects of the HPV vaccine, one girl died, I consider that a greater risk than rape for my daughters.

  9. Katherine

    Another bonus: when you have babies, you can confidently decline the eye ointment meant to protect your baby from gonorrhea and chlamydia. When I had my first baby the nurse looked at me like I was an idiot and said, “You’re baby could go blind.” I looked at her and said, “Sure, if I had an STD, which I can say with absolute certainty that I don’t.”

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