Historically, people with minority sexual and gender identities (e.g., gay, lesbian, bisexual, transgender) have been pathologized by mental and medical health practitioners. The potential for pathologization of asexuality is particularly salient considering a lack of sexual desire or interest has been studied in relationship to depression, antidepressant medication, and hypothyroidism. To explore this potential pathologization, asexual individuals were asked about their interactions with mental health and medical practitioners. The study included 136 adult participants, primarily from the U.S., who self-identified as asexual. Participants completed an online survey which contained questions about their experiences with mental health and medical practitioners. Results indicated that the majority of participants did not disclose their identity and felt uncomfortable discussing issues related to sexuality with their providers. Participants were more likely to disclose their asexual identity to mental health providers, as compared to medical providers. Participants who had positive experiences were more likely than those who had negative experiences to indicate that their practitioners were familiar with asexuality, accepted the participant’s identity completely, and reacted to the disclosure in a positive and affirming manner. Positive experiences included practitioners educating themselves about asexuality, while negative experiences included practitioners disbelieving the existence of asexuality, and between one quarter and one half of participants reported that practitioners attributed their asexuality to a health condition. The findings from this study demonstrate the importance of including information about asexual identities in health education and ongoing diversity training in order to increase the cultural sensitivity of health practitioners.
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Bishop, G. F. (1987). Experiments with the middle response alternative in survey questions. Public Opinion Quarterly,51(2), 220–232. https://doi.org/10.1086/269030.
Bogaert, A. F. (2006). Toward a conceptual understanding of asexuality. Review of General Psychology,10(3), 241–250. https://doi.org/10.1037/1089-2618.104.22.168.
Brotto, L. A., & Yule, M. (2017). Asexuality: Sexual orientation, paraphilia, sexual dysfunction, or none of the above? Archives of Sexual Behavior,46(3), 619–627. https://doi.org/10.1007/s10508-016-0802-7.
Cook, S. C., Gunter, K. E., & Lopez, F. Y. (2017). Establishing effective health care partnerships with sexual and gender minority patients: Recommendations for obstetrician gynecologists. Seminars in Reproductive Medicine,35(5), 397–407. https://doi.org/10.1055/s-0037-1604464.
Dean, M. A., Victor, E., & Guidry-Grimes, L. (2016). Inhospitable healthcare spaces: Why diversity training on LGBTQIA issues is not enough. Journal of Bioethical Inquiry,13(4), 557–570. https://doi.org/10.1007/s11673-016-9738-9.
Decker, J. S. (2014). The invisible orientation: An introduction to asexuality. New York: Skyhorse Publishing.
Decker, J. S. (2015). Asexuality and the health professional. Psychology Today. Retrieved October 18, 2017, from https://www.psychologytoday.com/us/.
Drescher, J., Schwartz, A., Casoy, F., McIntosh, C. A., Hurley, B., Ashley, K., … Tompkins, D. A. (2016). The growing regulation of conversion therapy. Journal of Medical Regulation,102(2), 7–12.
Eckhert, E. (2016). A case for the demedicalization of queer bodies. Yale Journal of Biology and Medicine,89, 239–246.
Foster, A. B., & Scherrer, K. S. (2014). Asexual-identified clients in clinical settings: Implications for culturally competent practice. Psychology of Sexual Orientation and Gender Diversity,1(4), 422–430. https://doi.org/10.1037/sgd0000058.
Fuzzell, L., Fedesco, H. N., Alexander, S. C., Fortenberry, J. D., & Shields, C. G. (2016). “I just think that doctors need to ask more questions”: Sexual minority and majority adolescents’ experiences talking about sexuality with healthcare providers. Patient Education and Counseling,99(9), 1467–1472. https://doi.org/10.1016/j.pec.2016.06.004.
Gunnarsson, T., Sjoberg, S., Eriksson, M., & Nordin, C. (2001). Depressive symptoms in hypothyroid disorder with some observations on biochemical correlates. Neuropsychobiology,43(2), 70–74. https://doi.org/10.1159/000054869.
Gupta, K. (2017). “And now I’m just different, but there’s nothing actually wrong with me”: Asexual marginalization and resistance. Journal of Homosexuality,64(8), 991–1013. https://doi.org/10.1080/00918369.2016.1236590.
Hardacker, C. T., Rubinstein, B., Hotton, A., & Houlberg, M. (2013). Adding silver to the rainbow: The development of the nurses’ health education about LGBT elders (HEALE) cultural competency curriculum. Journal of Nursing Management,22(2), 257–266.
Hoffarth, M. R., Drolet, C. E., Hodson, G., & Hafer, C. L. (2015). Development and validation of the Attitudes Towards Asexuals (ATA) scale. Psychology & Sexuality,7(2), 88–100. https://doi.org/10.1080/19419899.2015.1050446.
Jones, C., Hayter, M., & Jomeen, J. (2017). Understanding asexual identity as a means to facilitate culturally competent care: A systematic literature review. Journal of Clinical Nursing,26(23–24), 3811–3831. https://doi.org/10.1111/jonm.12125.
Kano, M., Silva-Banuelos, A. R., Sturm, R., & Willging, C. E. (2015). Stakeholders’ recommendations to improve patient-centered “LGBTQ” primary care in rural and multicultural practices. Journal of the American Board of Family Medicine,29(1), 156–160. https://doi.org/10.3122/jabfm.2016.01.150205.
Kelleher, C. (2009). Minority stress and health: Implications for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) young people. Counselling Psychology Quarterly,22(4), 373–379. https://doi.org/10.1080/09515070903334995.
Kennedy, S. H., Dickens, S. E., Eisfeld, B. S., & Bagby, R. M. (1999). Sexual dysfunction before antidepressant therapy in major depression. Journal of Affective Disorders,56(2–3), 201–208.
Lev, A. I. (2013). Gender dysphoria: Two steps forward, one step back. Clinical Social Work Journal,41, 288–296. https://doi.org/10.1007/s10615-013-0447-0.
Lick, D. J., Durso, L. E., & Johnson, K. L. (2013). Minority stress and physical health among sexual minorities. Perspectives on Psychological Science,8(5), 521–548. https://doi.org/10.1177/1745691613497965.
MacInnis, C. C., & Hodson, G. (2012). Intergroup bias toward “Group X”: Evidence of prejudice, dehumanization, avoidance, and discrimination against asexuals. Group Processes & Intergroup Relations,15(6), 725–743. https://doi.org/10.1177/1368430212442419.
MacNeela, P., & Murphy, A. (2014). Freedom, invisibility, and community: A qualitative study of self-identification with asexuality. Archives of Sexual Behavior,44(3), 799–812. https://doi.org/10.1007/s10508-014-0458-0.
Mathew, R. J., & Weinman, M. L. (1982). Sexual dysfunctions in depression. Archives of Sexual Behavior,11(4), 323–328.
Miller, S. J. (2016). Glossary of terms: Defining a common queer language. In S. J. Miller (Ed.), Teaching, affirming, and recognizing trans and gender creative youth: A queer literacy framework (pp. 299–309). Boulder, CO: Palgrave Macmillan.
Moll, J., Krieger, P., Moreno-Walton, L., Lee, B., Slaven, E., James, T., … Heron, S. L. (2014). The prevalence of lesbian, gay, bisexual, and transgender health education and training in emergency medicine residency programs: What do we know? Academic Emergency Medicine, 21(5), 608–611. https://doi.org/10.1111/acem.12368.
Phillips, R. L., & Slaughter, J. R. (2000). Depression and sexual desire. American Family Physician,62(4), 782–786.
Snowdon, S. (2010). The medical school curriculum and LGBT health concerns. AMA Journal of Ethics,12(8), 638–643. https://doi.org/10.1001/virtualmentor.2010.12.8.medu1-1008.
Sokal, R. R., & Rohlf, F. J. (1981). Biometry, the principles and practice of statistics in biological research. New York: W. H. Freeman & Company.
St. Pierre, M. (2012). Under what conditions do lesbians disclose their sexual orientation to primary healthcare providers? A review of the literature. Journal of Lesbian Studies,16(2), 199–219. https://doi.org/10.1080/10894160.2011.604837.
Van Houdenhove, E., Gijs, L., T’Sjoen, G., & Enzlin, P. (2014). Asexuality: A multidimensional approach. Journal of Sex Research,52(6), 669–678. https://doi.org/10.1080/00224499.2014.898015.
Yingling, C. T., Cotler, K., & Hughes, T. L. (2016). Building nurses’ capacity to address health inequities: Incorporating lesbian, gay, bisexual and transgender health content in a family nurse practitioner programme. Journal of Clinical Nursing,26(17–18), 2807–2817. https://doi.org/10.1111/jocn.13707.
Yule, M., Brotto, L., & Gorzalka, B. (2015). A validated measure of no sexual attraction: The Asexuality Identification Scale. Psychological Assessment,27(1), 148–160. https://doi.org/10.1037/a0038196.
The authors Shelby K. Flanagan and Heather J. Peters have contributed equally to this work. This research was supported by the Psychology Endowment Fund at the University of Minnesota, Morris.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants in the study.
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Flanagan, S.K., Peters, H.J. Asexual-Identified Adults: Interactions with Health-Care Practitioners. Arch Sex Behav 49, 1631–1643 (2020). https://doi.org/10.1007/s10508-020-01670-6
- Health care
- Sexual identity
- Sexual orientation
- Sex education