Polyamory Weekly

As a health care practitioner, how do you identify polyamorous and kinky clients?

This week, I had the pleasure of participating in an event at the Bastyr Center for Natural Health. (Thanks to Allena Gabosch for recommending me for the event when she was booked!) The event was called the “human library,” and about a dozen of us activists acted as “books” to the participants, who were all in the program. Since health care professional deal with people of all orientations, genders and abilities, we were there to act as open books into our respective communities and to lend advice to future naturopathic practitioners.

I wasn’t sure what to expect going in, and I had no idea of the questions I might be asked. Most of the students I met with were unsure what to ask and wanted a basic primer on polyamory and kink. “What do I need to know about polyamory/kink?” was the most common question. For this, I recommended two books, a paper and a local resource:

•  Opening Up by Tristan Taormino for an overview of non-monogamy relationship structures
• The Ultimate Guide to Kink, also by Taormino, for a beginner’s guide of the why and how-to of BDSM
• What Psychology Professionals Should Know About Polyamory, a paper published by the Chicago School
• The Center for Sex-Positive Culture, a local community center hosting events for the GLBT community, the poly community and the BDSM community

However, some did have specific concerns, including:

• When I take a history, what would I ask to discover if a person is polyamorous?
• When I take a history, what would I ask to discover if a person is kinky?
• What does “polyamorous” actually mean, and what do I need to know about these people?

Creating a safe space

The first question was fairly easy to answer. Just as we poly folks create a safe space for emotional and relationship discussions, health care practitioners should do everything possible to set their patients at ease. The best way to do this is not to make assumptions: don’t assume the person is straight, of one particular gender, monogamous or vanilla. Even if it’s too personal to ask, it’s best not to be heteronormative. Or relationship-normative.

Also, do your best to create a safe, judgment-free zone to encourage your patients to be comfortable enough to reveal their orientations. My favorite personal experience with this was a fantastic gynecologist who, when I was in the stirrups, asked, “Do you sleep with men, women, or both?” I’d never heard “or both” before, and I was delighted she’d asked! I answered, “both,” to which she replied with a cheery, “Good for you!” And just like that, she established trust. I knew I could tell her about my partners, probably even my kinky proclivities, and she wouldn’t flinch, blink or judge.

Compare this to my previous gynecologist, who, when I told her I was now in a polyamorous relationship, left an awkward pause, sat back with considerable discomfort and mumbled, “it’s best if you try to limit the number of partners.” Ugh! At the time, I had TWO long-term, committed partners. She just assumed that “polyamorous” meant I’d installed a revolving door to my bedroom. I knew I couldn’t trust her to be considerate and informed, so I switched to someone I could.

So how does a practitioner establish a safe space to discuss orientations and lifestyles? “Male, female or both?” is a good start. A good follow-up question is, “What is your relationship structure?” Monogamous folks will probably reply “single,” “married” or the like, but this question opens up the opportunity for non-monogamous folks to share both their orientation and partner information if they are comfortable doing so.

What about kink?

Asking about BDSM proclivities and activities is far, far more difficult, and I’ve personally never found a good, non-offensive lead-in to asking if someone is kinky unless he or she had already dropped a significant hint. Most kinksters I know frankly will not share this information with a health care practitioner because they believe it to be private and irrelevant. One could argue against the “irrelevant” factor, depending upon the type of visit and health care practitioner, but it is definitely private and personal information. There is no good way to broach this topic in a casual way. The best you can do is to create a safe space in which your patient will be willing to share relevant details with you and ask you health-related questions as needed.

How do we tell the difference between kink and abuse?

There is of course a big difference between kink and abuse: consent. And health care practitioners are mandatory reporters, so they must by law report abuse. This is why many kinksters don’t come out to their doctors: they could mistakenly be reported as abuse victims and inadvertently make their partner suspect of being an abuser. Health care practitioners are trained to question bruises with a conversational, “Hey, how did that come about?” or “Wow, big bruise. What happened there?”

Here, I’ll give a little advice to the kinksters: be honest. When you try to hide the information, it only makes you look more like an abuse victim! A few suggestions:

• [big smile] Oh, that? That was FUN!
• [big smile + eyebrow raise] Do you really want to know?
• [big smile + happy sigh] That was the cause of my last orgasm.
• Or, if you must lie: [big smile] Carpet burn.

For the practitioners, do you notice the common theme? While most of the time kinksters will simply lie to avoid sharing private details, you can often discern them from abuse victims by a sincere but fleeting smile when you ask about bruises or marks. It’s similar to the reaction when you ask someone about a hickey: it’s not a litmus test by any means, but it might give a clue that the situation was consensual.

Back to safe

After all that, the creation of a safe space is really what’s most important for health care practitioners if they really want all the information. Doctors know that patients lie all the time: about whether they took their medication or not, about how many drinks they have, about how often they exercise. The best health care folks can do is to let their patients know that they won’t be judged and that the conversation will be easy to have. And the best the patients can do is to be honest about their lifestyle choices and be informed enough to ask your doctor or therapist all your questions, even if some of them are a little embarrassing.