Asexual-Identified Adults: Interactions with Health-Care Practitioners

Abstract

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.

This is a preview of subscription content, log in to check access.

References

  1. 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.

    Article  Google Scholar 

  2. Bogaert, A. F. (2006). Toward a conceptual understanding of asexuality. Review of General Psychology,10(3), 241–250. https://doi.org/10.1037/1089-2680.10.3.241.

    Article  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. Decker, J. S. (2014). The invisible orientation: An introduction to asexuality. New York: Skyhorse Publishing.

    Google Scholar 

  7. Decker, J. S. (2015). Asexuality and the health professional. Psychology Today. Retrieved October 18, 2017, from https://www.psychologytoday.com/us/.

  8. 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.

    Article  Google Scholar 

  9. Eckhert, E. (2016). A case for the demedicalization of queer bodies. Yale Journal of Biology and Medicine,89, 239–246.

    PubMed  Google Scholar 

  10. 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.

    Article  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. 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.

    Article  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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.

    Article  Google Scholar 

  20. 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.

    Article  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. Mathew, R. J., & Weinman, M. L. (1982). Sexual dysfunctions in depression. Archives of Sexual Behavior,11(4), 323–328.

    Article  Google Scholar 

  25. 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.

    Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. Phillips, R. L., & Slaughter, J. R. (2000). Depression and sexual desire. American Family Physician,62(4), 782–786.

    PubMed  Google Scholar 

  28. 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.

    Article  Google Scholar 

  29. Sokal, R. R., & Rohlf, F. J. (1981). Biometry, the principles and practice of statistics in biological research. New York: W. H. Freeman & Company.

    Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. 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.

    Article  Google Scholar 

  33. 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.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Heather J. Peters.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

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

Informed consent was obtained from all individual participants in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

  • Asexuality
  • Health care
  • Sexual identity
  • Pathologization
  • Sexual orientation
  • Sex education