Asexuality and the Health Professional
Those who treat asexual clients must acknowledge this invisible orientation
Posted January 5, 2015
"I'm going to be honest. I think . . . you have a disorder. Are you sure you don't need professional help?"
This, along with some similar statements, represents a pretty common reaction from the average person when I disclose my sexual orientation. I, along with approximately one percent of my fellow citizens of the world, am asexual, meaning I am not sexually attracted to anyone.
Asexuality isn't incredibly unusual, though most of us who identify somewhere on the asexual spectrum find very few like ourselves in our social groups unless we deliberately seek them out. But what's notable about some of the reactions coming from the other ninety-nine percent is how intense and severe they can be; we come out to our friends and family and their first response is panic or concern. They're sure it means something is wrong with us. And they want to be sure we go right to the experts to get ourselves sorted out--presumably to rid us of what they perceive to be a sickness or complex. When and if we do disclose our orientation to professionals, their handling of the situation can be of incredible importance to our safety and well-being.
Strong negative reactions, especially from people close to us or professionals we trust, can be alarming and sometimes scarring, particularly if we experience these reactions multiple times while living in isolation from others like ourselves. Asexual discovery dialogues are full of people finding the asexual community and uttering phrases like "I thought I was broken" or "I was terrified I would never be able to be happy"--and these fears did not develop spontaneously, nor do they reflect inherent recognitions of something missing. These fears were instilled by people who believe asexuality is unacceptable, and like it or not, it often falls upon the experts to whom we are referred to evaluate us, reassure us, and give us guidance. They cannot do so responsibly if they know little to nothing about this nuanced and diverse orientation.
Over the course of more than two decades identifying as asexual and interacting with hundreds of other asexual individuals, I have heard an incredible number of horror stories from people led astray by the professionals they trusted.
I spoke with a young woman who was prescribed testosterone to boost her "sex drive" when she didn't have words for why she didn't want her boyfriend the way he expected. The professional treated her for low libido, without truly hearing what she was saying about not finding anyone attractive and not intrinsically enjoying sex. She said the treatment had effects on her voice that she regretted, and did nothing to improve her life.
I know another woman who thought desiring sex was a necessary facet of keeping a husband. She was treated by at least three medical and psychological professionals--none of whom suggested that lack of sexual attraction to others was one manifestation of normal. All assumed desiring sex was categorically better than not doing so, and no one asked her why she wanted to pursue this. It was simply taken for granted by everyone involved that she could not access fulfillment by staying the way she was.
I spoke with a young man who did not desire his fiancée the way she wanted him to, and during pre-marriage counseling, the therapist encouraged his wife-to-be to harass and pressure him for sex despite his discomfort because he just needed to "get over the block" through aggressive confrontation. His distress was considered unimportant, and his partner was not asked to question any beliefs she had about compromise and alternate routes to intimacy.
I've heard multiple tales of asexual people whose mental health practitioners treated their orientation as a symptom of a disorder or as a disorder in and of itself, and refused to see it as anything other than pathological.
In all of these cases, the professional irresponsibly assumed that experiencing sexual attraction and sexual desire is always the ideal to which their patient should conform, and they were willing to recommend rather drastic medical, social, and psychological interferences without examining whether achieving (or tolerating) the supposed norm would result in a happier life for the seeker.
The general population looks to its "experts" to help them define what is worth worrying about, and in this way, psychologists, psychiatrists, medical professionals, sex educators, sexuality professionals, therapists, counselors, researchers, and other authorities are saddled--for better or for worse--with drastically affecting the reality of those who access their services. It's unfortunate, then, that some of these folks remain out of touch with the reality of their patients and clients. Homosexuality wasn't removed as a disorder from the Diagnostic and Statistical Manual of Mental Disorders until the 1980s, but even now there are professionals who treat some or all types of queer orientations as aberrant. Asexuality was never explicitly listed as a disorder in the DSM, but Hypoactive Sexual Desire Disorder and some other sexuality variations were often attached to mental health patients who presented with a persistent lack of sexual interest in or attraction to others, and only in the most recent edition of the manual is asexuality even mentioned to exist.
Some researchers, psychologists, and other professionals have taken their cue from the multitudes describing their asexual experience and have asked the responsible, difficult questions about sexual diversity as it encompasses the asexual spectrum, but others have chosen to repeat entrenched assumptions that perpetuate an oppressive culture of compulsory sexuality, and anyone who trusts these irresponsible practitioners risks their mental and physical health.
It is vital that any professional involved in discussing and examining sexuality understand the true diversity of its spectrum, and they must acknowledge that asexuality is part of it. Leaders in medical and psychological fields must develop the ability to challenge their own personal convictions about sexuality's relationship with intimacy and fulfillment. Too often, the people in whose hands we place our personal care betray that trust by reacting like the average layperson: "Oh yes, that's a problem. Let's fix it." It's doubly important to recognize that some people with mental and physical illnesses or abusive pasts are also asexual, and that the intersection of complex elements of identity do not invalidate asexuality (in general or in each particular case). In other words, mentally ill and physically ill asexual people do exist, and their asexual identity, while sometimes completely irrelevant to other conditions and situations, is not always completely separable from their complicating factors--which does NOT make it less legitimate. Asexuality isn't a diagnosis, and it isn't something that can only exist if nothing else explains or intersects with a person's asexual experience.
Professionals who engage with clients, patients, or customers on sexuality subjects can become more informed about asexuality by keeping up with existing research, reviewing the asexuality-related caveats in the DSM-5, and reading some recommended textbooks. However, like any profession with a human element, it is just as important for these professionals to engage authentically with those who seek their services and listen to their experiences. Cooperative, consensual care should always be the goal; adversarial perspectives featuring hardline "normality" standards only compound problems instead of solving them.