The year was 1983 and I had come out as a lesbian in the past year. I was a doctoral student at the University of Iowa and got my healthcare at the Student Health Clinic. On this particular day, I was on the table with my legs spread open, feet in the stirrups as the physician sitting between my legs was about to begin my annual pap test. The paper gown crinkled and tickled my legs when she pushed it down out of her way so she could see my face.

“Are you sexually active?” she asked and then she lifted the large metal instrument from the basin of warm water on the metal stand next to her and squirted lubricant on it. I had a fleeting thought as I saw the wicked looking speculum—why couldn’t they make something a little smaller and less torture chamber-like? Really, no woman would have created such a monstrosity. This had to be a man-made device.

“Not with men,” I replied. “I’m gay.”

I heard a horrible clattering noise as the wheeled stool she sat on flew six feet away from the exam table and thumped against the wall. She must have involuntarily pushed off with her legs. Then she jumped up and bolted out of the room without a word. I was stunned, feeling exposed physically and mentally. What should I do? I was frozen for the moment in shock as I contemplated whether to extricate my legs from the stirrups and flee, or wait. There must be a reasonable explanation. I tried to talk myself into some excuse for her behavior that wasn’t related to my coming out to her.

Before I made up my mind, she returned to the room with a grim looking nurse in tow, pulled the stool back to the exam table, and finished the exam in a painful silence. The nurse hovered near the door. Was she there as a witness? Did the doctor think I would hit on her in the middle of a pap test? They rushed out the room, and this time I knew to dress and get the hell out of there.

I had been mostly lucky in my coming out disclosures and had rarely experienced negative reactions, but this one stayed with me for years. I had worked as a nurse in health care settings for ten years by this time and was appalled by the unprofessional behavior of this ob/gyn doctor. When I became a faculty member four years later in the College of Nursing, I was determined to teach students about LGBT issues. I came out in every class, taught students about LGBTQ healthcare issues, and proposed that they ask more open questions, such as “Are you sexually active with men, women, both, or neither?” and “What does being sexually active mean to you?”

I moved to San Francisco in 2005. The Gay Mecca, some called it, but I discovered that I had a more cohesive and larger lesbian community in Iowa City. Around 2010, I switched my healthcare plan and was meeting a new primary care doctor for the first time. She was asking the question in preparation for a pap test. “Are you sexually active?” she asked.

“I’m a lesbian,” I announced. I was about to add that I wasn’t currently in a relationship or dating, but she interjected in a matter-of-fact, no-big-deal tone of voice, “Well, make sure you thoroughly wash your sex toys between uses.” She proceeded with the pap test and I left thinking that as far as health care visits go, this one was fine.

But I pondered this exchange for days. Of course, it was better than my experience in the 1980s. My new doctor had seemed a little bit awkward, but not horribly uncomfortable like the one in 1983 had been. But she had made a big assumption about my sexual behaviors and that felt just weird. By this time, it was common knowledge that some lesbians had sex with men and some engaged in behaviors that carried risk for sexually transmitted infections. She didn’t ask those questions. Instead, she made an assumption.

Asking the simple “Are you sexually active,” is still a challenge for many lesbians I know. If you just say “yes,” you generally get the birth control lecture, at least if you are still young enough to be fertile. Heterosexuality is assumed. If you didn’t want that talk, you had to come out and say something like, “Yes I’m sexually active, but only with women” or some such response. One is forced into disclosure in a way that can feel awkward and forced.

My new doctor hadn’t asked any question that would be relevant to my sexual health. She didn’t ask if I actually used sex toys. She didn’t ask anything except the “sexually active” question. It seemed that we hadn’t really improved in terms of sexual history talk in all these years, at least in mainstream health clinics.

So yes, things were better in 2010, but they were still weird and awkward and incomplete. It’s still anxiety-provoking to come out in a health care setting, especially with your legs splayed open in stirrups awaiting penetration by a cold metal object. Come on, we can do better.

Mickey Eliason is a retired university professor and former teacher of sexuality studies and LGBTQ studies, first at the University of Iowa (1987-2004), then San Francisco State University (2005-2022). She has published several academic books and articles on LGBTQ issues, and now writes mostly creative nonfiction, memoir, and essays. Her favorite project was a book about the unique qualities of lesbian communities in her coming out era (the 1980s Iowa City lesbian feminist community), a humor book called The Dyke Dykinostic Manual (available on Amazon). She also dabbles in lesbian romance.