Initially, when I was asked to write something about queer sexual health, I assumed it would be fairly simple. I identify as queer, I’ve used queer theory in my research, I work with sexual health, and I boldly tell people that I am especially interested in queer sexual health. Yet, weeks after the request I found myself at my desk staring at an empty word document, trying to wrestle a pen away from one of my cats. I felt at that point, despite the lack of opposable thumbs, they would be better placed to write this than me.

The main reason for this drawn-out process actually has something to do with one of things I love most about queerness – its resistance to definition. The word ‘queer’ is often used in numerous ways, with the meaning changing from context to context. Something that is both rich with possibility and potential but can also feel somewhat out of reach.

Consequently, in the spirit of queerness itself, I propose instead to engage in a reflective imagining about what queering sexual health does. As Julie Tilsen (2021, p.6) notes, using ‘queer’ as a verb is its “queerest elaboration”, and, let’s be honest, we all know that queers love to queer things. I would not be remotely surprised if we started seeing research queering toilet paper, isolation, and lockdown. That is, if they don’t already exist.

Exploring what work the word ‘queer’ is doing in sexual health

My central imagining is about exploring what the work the word ‘queer’ is doing in queer sexual health. What does queer mean is this context? And most importantly, what does it do? A simplistic way of understanding the role of the word queer could be to say that queer sexual health is about sexual health for queer people. And while that is certainly an admirable and useful goal, my feeling is that queer sexual health is less about sexual health for particular kinds of people, and more about a queer approach to sexual health.

In this sense, queering sexual health is more about what possibilities become available to you as a healthcare professional when you start to queer your understanding and practice of sexual health. As Tilsen (2021, p.6) argues, “when we queer something, we question and disrupt taken-for-granted practices and we can imagine new possibilities”.

In a sexual health context, this could mean many things, and the remainder of this post will be about articulating some of these possibilities. For instance, this could mean an insistence on the importance of pleasure. Making our work about facilitating pleasure and wellbeing. This is as opposed to a focus on dysfunction, damage or disease. In centering pleasure and wellbeing, we can begin to see sexual health framed as erotic possibility, cultivating shared kindness, openness and curiosity in ourselves and our clients.

Challenging preconceived rules and ideas

A queering is almost always about challenging preconceived rules and ideas. In sexual health, this may mean challenging our own and our clients’ assumptions about gender, sexuality, anatomy, identity, relationships, and the relationships between these. This means tossing out the rulebook that suggests particular kinds of sexual play have anything significant to say about your identities. Or that particular body parts mean anything about your gender identity.

Queering sexual health is a rejection of binaries. It’s about a resistance to simplified labels, and instead embracing the beautiful messy complex reality of people’s experiences. What is allowed to emerge in sexual health practice when we take seriously that experiences cannot be reduced to boxes? And when we give our clients permission to exist and explore outside of them?

This therefore means embracing uncertainty and exploration. It’s a rejection of the idea that the simplest answer is often the right one, or the idea that there is a right answer in the first place. In much the same way as pleasurable sex embraces the journey and the process rather than a particular outcome; queer sexual health is about fluidity and a commitment to remaining open to new possibilities and realities.

As Tilsen (2021, p.6) argues “Queering is an ever-emergent process of becoming, one that is flexible and fluid in response to context, and in resistance to norms.” What happens when we center becoming instead of being, what do we remain open to and curious about in our own and clients’ lives?

Prioritising the client’s knowledge and experiences

Queering sexual health is also about starting from where your client is at and prioritising their knowledge and experiences. From this viewpoint, consultations can be viewed as the meeting of two (or more) minds. Each mind with their own perspectives and expertise.

Consequently, we can resist conventional notions of medicalised professionalism by being able to identify and disrupt the power dynamics which are so present in healthcare settings today. This is about rethinking informed consent as an ongoing process, always giving your clients all the of the options available and letting them make the decisions that are best for them, perhaps guided by, but not determined by our own ideas and beliefs.

In order to facilitate this kind of reflective process, healthcare workers need to be mindful of our own beliefs, values and assumptions, and the ways in which these may create blind spots and/or undermine our clients’ agency. Being aware of the complexity of our clients’ identities and experiences is also about a commitment to intersectional practice.

Intersectionality and diversity

Intersectionality has recently become something of a buzzword which treats inclusivity and diversity as little more than a box-ticking exercise. Queering sexual health is about remaining aware of all our own intersecting identities, experiences and social realities, and the recognition that each client comes with their own. Some of these identities and experiences are less visible than others. We need to ensure we are able to listen out for these as and when they are articulated (or not), and the ways in which they may enter the consultation room and our lives. This requires an ongoing commitment to authenticity which can hopefully facilitate the same for our clients.

Tilsen (2021, p.6) says that a queering is about breaking rules “in order to liberate people who have been held hostage by what the rules require or prevent”. Sexual health tends to operate from the viewpoint of cisgender, heterosexual, vanilla, monogamous, able-bodied white humans, and their relationships. Rules about what kinds of sex and relationships are legitimate and normative are widespread, whether they are explicitly stated or not. As a result, breaking the rules is about identifying and labelling the discrimination and marginalisation experienced by those outside of Rubin’s (2011) Charmed Circle, and instead turning the circle inside out.

In healthcare settings like South Africa where white, middle class, able-bodied, cisgender men continue to be a large focus of research and intervention, we can queer our sexual health practice by centering the experiences of those who are currently on the margins.

What does sexual health look like when we start with the experiences of sex workers? Ace, intersex, trans and gender fluid humans? Non-monogamies and kinksters? What erotic possibilities are opened up by moving away from heteronormativity and monogamism?

Expanding our toolbox

Queering sexual health is about recognising that the toolbox we’ve been given is limited, comes with sets of rules and expectations and frames client experiences in ways that can have negative consequences for their emotional and sexual wellbeing. For instance, defining sex as a penetrative act that involves only a penis and a vagina has consequences for the ways in which we are able to engage with clients around their sexuality. It creates a hierarchy around what kinds of sexual practices are considered legitimate and normalised, makes assumptions about body parts and pleasure, and limits the ways in which we can talk about consent, play and safety.

A queering of sexual health is about offering new and alternative frameworks that challenge essentialism, reject binaries and facilitate fluidity. Let’s begin from the perspective of those on the margins, make a commitment to inclusivity and authenticity and dismantle power dynamics. Let’s center pleasure and wellbeing and suspend our assumptions and judgements long enough to work collaboratively towards facilitating sexual health, whatever that looks like from person to person.

In line with my feeling about the importance of locating yourself socially and being authentic, it would be remiss of me not to own that this is a vision of what queering sexual health could/does look like from my perspective: a queer, white, middle class, mental health professional in South Africa. I can also acknowledge from personal experience that it may feel anxiety-provoking and difficult to toss the rulebook out the window (although not your ethics please). It can leave you feeling stuck or wondering “Well, where do we go from here?” While that uncertainty isn’t always easy, it is also rife with potential.

Where do we go from here? Where can we go now that we could not previously? I invite you to dive headfirst into this beautiful complexity with your clients – who knows where the adventure will take you.

References:

• Rubin, G. S. (2011). Deviations: A Gayle Rubin Reader. Duke University Press: Durham & London.
• Tilsen, J. (2021). Queering Your Therapy Practice: Queer Theory, Narrative Therapy, and Imagining New Identities. Routledge: London & New York.

Author 

Chant Malan
Counselling Psychologist
SASHA Executive Committee & Media Committee
Email: malan.chantelle@gmail.com