Sex Gets Real 171: Queer and trans healthcare with Zena Sharman

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Zena Sharman, editor of “The Remedy: Queer and Trans Voices on Health and Health Care,” is here talking about queer and trans health issues, community-based care, and oppression within the medical community.

We geek out about trauma-informed care and talk about why cis straight men are really suffering inside these systems, too, based on the statistics.

What does it look like to have healthcare informed by community, disability justice, racial justice, fat justice, and trauma? Zena has some stories and amazing ideas to get the activist in all of us going.

How do we start asking, “Who are you and what’s important to you?” instead of assuming what kinds of care and cures someone might want? Change is on the horizon, but we need to start looking at different possibilities that include kinky folks and poly folks and people of color among so many other intersections of oppression.

When this happens, our sexual health and our mental health would improve drastically. Ready to dive in? Me too!

Follow Dawn on Instagram.

In this episode, Zena and I talk about:

• Why it was important to her to collect these rich stories about queer and trans experiences in health care. It’s raw, painful, moving, and deeply inspiring. Zena shares what brought her to this point of creating the book.
• How do we center the voices of queer, intersex, and trans folks, especially in areas where they’re usually overlooked, ignored, or misunderstood?
• Getting discriminated against as a bisexual person, fat person, poly person, a person of color, or someone at any other of the multiple intersections of oppression within the medical community. Doctors have the ability to cause deep harm and trauma – naming that is important.
• Communities creating spaces for healing outside of mainstream medicine.
• How the Black Panthers and the Young Lords created community healthcare as a way to bring together community in the face of racism and police violence in the 70’s.
• Community as caring. Creating systems that enable communities to care for one another outside of existing systems.
• Trauma-informed care and allowing people to choose what happens to their body within the medical framework. Imagine if doctors had to ask for permission and negotiate around the kinds of touch someone felt safe to receive.
• Changing the ways medical students are trained to include awareness of privilege, power, and oppression.
• Receiving help and what it looks like when you have community that’s able to show up for you when you’re sick, hurting, grieving, or struggling in other ways.
• Disability advocates who are creating their own care groups around getting their care needs met.
• The difference between interdependence and codependence – it all comes down to healthy boundaries. So, how do we cultivate interdependence and healthy boundaries in our lives?
• Trauma and how it causes us to endure a lot of things we don’t want to endure, especially in medical situations and with doctors. What’s the alternative?
• Trans buddy system. AMAZING. Trained advocates who go with trans folks to doctor’s appointments to help trans people feel respected and heard using a buddy system by disrupting the hierarchy. I want to create this for fat folks!
• Sex workers. Fat folks. Disabled folks. Kinky folks. Poly folks. Trans folks. Intersex folks. Queer folks. POC and indigenous folks. All people who experience stigma and end up suffering at the hands of oppressive medical practices. Let’s buddy up and support each other around our health.
• Cis straight men have terrible rates of suicide and health issues because of the incredibly restrictive norms around gender and sexuality. They are suffering, too.

Resources discussed in this episode

Eli Clare’s “Brilliant Imperfection: Grappling with Cure”

Zena’s blog post on Queer Interdependence

“Living in Liberation: Boundary Setting, Self Care, and Social Change” by Cristien Storm

Kelli Dunham’s zine, “You Don’t Have to Love Your Body to Take Care of It” and PLEASE send her a few bucks if you access this zine. Here’s her PayPal to do just that.

About Zena Sharman

Zena Sharman is a femme force of nature and a passionate advocate for queer and trans health. She has over a decade’s experience in health research, including seven years as the Assistant Director of Canada’s national gender and health research funding institute. Zena co-chairs the board of the Catherine White Holman Wellness Centre, a holistic health care centre for transgender and gender-diverse communities. She served on the board of the Canadian Professional Association for Transgender Health from 2013-2015.

Zena is the editor of the Lambda Literary award-winning anthology The Remedy: Queer and Trans Voices on Health and Health Care (Arsenal Pulp Press, 2016). The Remedy brings together her love of writing and stories with her commitment to making the world a healthier and more equitable place. Zena co-edited the Lambda Literary award-nominated anthology, Persistence: All Ways Butch and Femme (Arsenal Pulp Press, 2011), and she’s presented on gender, sexuality, and health to audiences across North America. Zena has a PhD in interdisciplinary studies from the University of British Columbia. Her resume also includes party thrower, cabaret host, go-go dancer for a queer punk band, campus radio DJ, and elementary school public speaking champion.

Zena is grateful to live and write on the lands of the Musqueam, Sḵwxwú7mesh, and Tsleil-Waututh peoples. As a small gesture of thanks for living on their unceded territories, she’ll donate half of her royalties from The Remedy to Indigenous-led organizations.

Follow Zena on Twitter @zenasharman

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Episode Transcript

Dawn Serra: You’re listening to (You’re listening) (You’re listening) You’re listening to Sex Gets Real (Sex Get Real) (Sex Gets Real) Sex Gets Real with Dawn Serra (with Dawn Serra). Thanks, bye!

Hey, you. Welcome to this week’s episode of Sex Gets Real. If you are listening to this on Sunday, July 23, then today is the next Sex is A Social Skill group call – every two weeks I’m doing live calls where we’re diving into all kinds of super rad stuff – practicing skills, creating community. This week’s call is all about respect. We’re going to unpack what it means to have self-respect, and also talk about what it looks like to have respect in relationships. So if you want to join in the call, head to sexgetsreal.com/ep171 or check out the show notes for this episode, because I’ve got a link so that you can get signed up. I would love to have you there. 

Dawn Serra: Of course people who support the show at the $20 per month level on Patreon get free access to those group calls. So even if you can’t join in the group calls, you want to throw $1 or three or a couple more my way to help with the show. You can do that at patreon.com/sgrpodcast. So let’s talk about this week and this very special episode. So you know that I just recently moved to Vancouver, Canada, and I am loving it here. The weather in the summer is a far cry from the Washington DC area, and it is an improvement in my eyes. But Zena Sharman, who is the editor of a new book called The Remedy: Queer and Trans Voices on Health and Healthcare. She is actually local, so we got together in person and recorded this chat. We were just sitting in a room geeking out. We had an amazing time. We talked for, god, I don’t know, 45 minutes before we even started recording the show. 

So this entire episode is all about health and health care, specifically accessing it when you are in some type of oppressed or marginalized identity or situation. So, Zena is an expert in queer and trans health and there are some amazing people out in the world, making healthcare and access to health a lot easier for people who are queer and trans. But we also talked about how it can be really hard to have good health care and positive experiences with doctors-if you’re kinky, or if you’re poly, certainly if you’re in a fat body, or if you’ve had trauma of any kind, if you’re a person of color or you’re indigenous. So it’s an amazing conversation where we talked about things like a trans buddy system. We talked about what it really looks like to have trauma-informed care and to have doctors who actually treat us as equal partners, who understand that we live in our bodies, and we are the experts in our bodies, and so actually respect that as a position of power. We break down all the different ways that marginalized communities, especially queer and trans communities, and trauma communities; are coming together and offering each other care from a place of interdependence, which flies in the face of our very capitalist, self-sufficient, “Pull yourself up by your bootstraps” kind of narrative that we have of like, “I’ll figure it out and do it on my own. I don’t need anybody.” And the power of receiving and giving care, which I think is something that’s so needed in kinky communities and swinger communities and poly communities. 

Dawn Serra: So I’m hoping that this conversation inspires lots of us to think about community and care and health in a really, really different radical way. Then another thing that’s super awesome about Zena is she’s so plugged in to so many different, really, really great communities and leaders. She has a whole bunch of great recommendations through our chat for other books. There’s a book she recommends that, specifically, I’m learning how to set better boundaries. So I already ordered the book, because I’m really excited. But I think you’re going to really enjoy this episode. It’s something that’s so important, especially when we talk about sexual health and STIs, and being able to have really radically open conversations with our healthcare providers if we do sex work, or if we’re poly, and we have multiple partners. So how do we get there? Zena has some ideas. 

So let me tell you a little bit about Zena and then we will jump in. Zena Sharman is a femme force of nature and a passionate advocate for queer and trans health. She has over a decade’s experience in health research, including seven years as the assistant director of Canada’s National Gender and Health Research Funding Institute. Zena co-chairs the board of the Catherine White Home and Wellness Center, a holistic health care center for transgender and gender diverse communities. She served on the board of the Canadian professional association for Transgender Health from 2013 to 2015. So you can already hear, Zena is super into trans and queer healthcare in a really amazing way. 

Dawn Serra: Zena is also the editor of the Lambda Literary Award winning anthology The Remedy – The Remedy brings together her love of writing and stories with her commitment to making the world a much healthier and more equitable place. She also co-edited the Lambda Literary Award nominated anthology Persistence: All Ways Butch and Femme, and she’s presented on gender, sexuality, and health to audiences all around North America. She has a PhD in interdisciplinary studies from the University of British Columbia. And her resume also includes party thrower, cabaret host, Go Go dancer for queer punk band, campus radio DJ, and elementary school public speaking champion. 

There’s a whole bunch of other rad information about Zena at sexgetsreal.com/ep171 for this episode, and I hope you enjoy our very vivacious and fun in person in Vancouver, Canada chat. So here we go. 

Dawn Serra: This is my first live interview since moving to Vancouver. So welcome to the show.

Zena Sharman: Thanks and welcome to Canada. 

Dawn Serra: Thank you. It feels so good. 

Zena Sharman: I feel like I should really play out my Canadian accent that I probably have for your American listeners. I’ll just say “about” a lot. I would also like your listeners to know that you’re wearing really nice glitter eyeshadow. 

Dawn Serra: Oh, thank you very much.

Zena Sharman: Your efforts do not go unrecognized.

Dawn Serra: Oh, I appreciate it.

Zena Sharman: Thanks for bringing your glittering self to our country.

Dawn Serra: You’re so welcome. Maybe we should end every sentence with, “Eh?”

Zena Sharman: It does happen sometimes.

Dawn Serra: Yes, it does. I encountered that in Toronto when I was there.

Zena Sharman: There was once, many years ago, I grew up in a border community. So my city was just across – very close to the Minnesota border. I remember driving across, hanging out and meeting somebody Americans and they said, “Oh, you’re from Canada. Do you know so and so?”

Dawn Serra: Of course.

Zena Sharman: And then I knew the person.

Dawn Serra: Oh no!

Zena Sharman: I was like, “Okay, you just need to know that this is a total coincidence, okay? I don’t know all of Canada. There’s tens and millions of us.”

Dawn Serra: So how I found you was your incredible book that just recently came out called The Remedy, which is all about Trans and Queer Health and Stories, which one included Sinclair Sexsmith we’ve had on the show, talking all about kink and submission and all that good stuff. But the book is absolutely beautiful. I felt so moved and I cried, and I felt angry. I think one of the things that struck me so much was this is one of the first times that I’ve had the opportunity to sit in these voices from people who have experienced these, often violent ,experiences within the medical community. So I’m wondering, for you, what was it like to decide you wanted to cultivate these stories and then to actually bring them together?

Zena Sharman: Well, thank you for your really amazing words about the book first. I really appreciate that, and especially hearing how you engage with the stories. It’s one of the things I love so much about anthology is that it’s a form that allows the reader to experience so many different voices and perspectives. There are pieces you read that resonate deeply with you, there are pieces that are surprising or enraging, there are those ones that move you to tears. So, with the project, I mean, really, the idea grew out of, I think, two strands. One was my love of anthologies, my love of writing, my passion for queer art and culture, and really seeing that as an important tool of social justice and also the power of representing our stories in books and other media. It also was born out of my background in health research and teaching. In this case, actually first year med students.

I was part of a group of folks guest lecturing in the very weirdly titled lecture called “Sexual Medicine Day”, which I’m saying in quotation marks, which somehow became the LGBTQ health lecture. 

Dawn Serra: Interesting. 

Zena Sharman: I know it’s weird. Yeah, I don’t know how that name evolved nor where the Sexual Medicine day came from, not to be confused, a sexual healing day, which is obviously different, brought to you by Marvin Gaye. Teaching in Sexual Medicine Day, teaching in LGBTQ Health and not only getting to lecture – it’s like hundreds of students, they’re really listening. They’ve got really good questions. But then afterwards, getting to sit down in a tutorial in a much smaller group and talk with a group of students in a more one on one way, where they were asking questions about who I was as a career person and really wanting, not only to get to know me; but really to understand how, as a future doctor, and they could do a really good job of taking care of me and people in my community. 

So those things really knitted together in the genesis of this project, and I realized that I wanted to do a book that put people’s stories and put people’s voices at the center of the conversation. Because so often, LGBT health, queer and trans health gets talked about or written about, again, in forms that are really useful, but maybe less accessible. Maybe it’s an academic journal article, maybe it’s a clinical practice guideline that tells doctors or nurses, or other health care providers how to care for people. But it’s not that gateway to empathy, understanding connection, and being able to viscerally feel the impact of your actions. Because the book is really – it’s both for the queer trans community and it’s also very much for healthcare providers, people training to be healthcare providers. Anybody else with a stake in queer trans health.

Dawn Serra: Yeah. I had the opportunity this year to be part of a six-month program with the American Medical School Association. I had a group of about five second and third year medical students. For six months, all we talked about was aspects of sexuality and sexual health. I think one of the things that struck me was, even though they were bringing their personal values to the table, there was definitely strong feelings about like, “Well, I never want my parents to be kinky. But if someone shows up in my office, who’s kinky, of course, I want them to feel safe and disclosed,” and finding them trying to grapple with that, “How can I be the best doctor possible?” And also like, “This feels really foreign to me.” They were so eager to ask questions and to understand, to go into these places that they had never even considered. And at the same time, having them come into our meetings and hear about the ways that the larger medical program they were in was already starting to beat out of them – that it’s okay to spend time with people. It’s okay to really ask personalized questions, it’s more about, “How can I be as efficient as possible to get to the answer?” 

So it was fascinating to see them starting to try and find ways to like, “How can I be super accepting and ask open ended questions without assuming anyone’s gender?” And still meet these industry new expectations around efficiency and insurance. It kind of made me hopeful that the medical students were so interested but it also made me feel sad that the larger institutions in place weren’t supporting the knowledge that they were getting. It’s like they’re going to have this knowledge and then not really have a lot of control over how to use it.

Zena Sharman: I think that’s such an important story because I think it really centers that notion of doctor or future doctor or a future healthcare provider of any kind as being embedded in systems and institutions. So just like systems and institutions have the potential to be anti-oppressive, we also know that they absolutely have the power to be oppressive, right? So that can happen at an individual level. Maybe it’s a doctor being transphobic or homophobic toward a patient or racist or otherwise discriminatory, but that also gets built into an institution as a whole.

Dawn Serra: Yeah, yeah. I think that’s one of the things that really stood out to me as I was reading these stories is, as someone who is 1.) a survivor, and 2.) has lived in a fat body my whole life, I’ve had really terrible and sometimes dismissive and borderline abusive experiences with doctors; and to then read these stories of people who were indigenous or First Nations or trans or intersex, and seeing a lot of those same stories being paralleled around institutions deciding that if you don’t fit into a very normative situation, then there’s something wrong with you. We pushed all the things that you might need, and I’m just going to apply the template that I use with everyone, and how that actually feels really harming for so many different people. 

I was thinking – I know so many kinky people who would never disclose to a doctor that they’re kinky, because then the conversations around, “Oh, well, that’s abuse,” might come up. Or folks who are poly and – I had a situation where some friends who are poly were really confronted with having multiple partners present in the hospital when they were ill, and how that presented a lot of issues. It’s like anyone who’s in a marginalized identity has the potential to bump up against so many of these oppressive frameworks that happen inside of medicine, and it’s hurting all of us. We don’t get to actually get the care that we need. And that came through so much and all these stories that you brought together of “Look at all the ways that we’re failing our community.”

Zena Sharman: I think it’s also an opportunity to think about where’s the potential for solidarity? Right? Because you are an evening of reality, which is these kinds of things – the kinds of discrimination maybe that a bisexual person might experience with a healthcare provider who is making assumptions about their identity, their desires, who they may or may not be partnering with, or what their risk factors may or may not be – that person may have a set of experiences that somehow connect up with, even if they look different from the experience of a fat person who’s getting discriminated against for their health care provider. Where is the potential for folks that experienced marginalization or oppression or discrimination in the health system to come together to say. “Hey, wait a minute. That’s not okay.” At the same time, I think it’s also such a huge call to action and an opportunity for healthcare providers. 

One of the things I’ve always said when I’ve done this kind of education for trainees and for med students, let’s say is to say, “Look, learning how to not make assumptions about the person in the room with you benefits all of your patients.” This isn’t just something that applies to the person who maybe is trans in front of you, or queer, or kinky or poly or whatever. It really is an invitation to a different kind of dialogue and exchange. And how do you actually get to learn about that person in the fullness of their life and their identity? Yeah. Because we’re not just these sacks of organs walking around, right? We’re human beings in relationship with ourselves, with each other, with the world, with our histories of trauma, however, we carry those in our bodies. I mean, especially in the context of, I think, even more and more literature talking about intergenerational trauma. What does it mean to be a queer person and a trans person? We do have this lineage of trauma that may come up and through our identities, as well as potentially through our own family histories as well. How do we navigate that in a healthcare encounter? And how can we build a health system that’s able to really meet and honor us where we’re at?

Dawn Serra: It’s really interesting because so much of what is in these stories from The Remedy is people and communities coming together outside of the medical establishment to care for each other, the community acupuncture that gets featured. That was actually, for me, one of the most healing stories that I read around, people coming together on the backs of the Black Panthers and the Young Lords who actually were creating community health care, because of police violence and institutional racism; and to have people who were like, “I’m going to learn how to do acupuncture, and I’m going to charge you as little as I possibly can so that we can all heal.” I can so see certain elements of that within all of the various communities that we have within fat communities trying to validate for each other like “You don’t have to change in order to actually be seen as a human being,” or kink communities helping give each other little tips around how to heal bruises or hide them. We all kind of have these little hacks.

I’m wondering for you, I know that there are people out there who are 3D printing speculum and trying to offer each other gynecological care outside the system, and we’ve got community acupuncture. What do you see as the role of community health care? Is there danger in it, potential in it? How can we support each other through these places, that the medical establishment is really failing right now?

Zena Sharman: I really appreciate that you highlighted the piece about community acupuncture because I think one of the real beauties of that piece, and it’s written by Lisa Barrett, and I was able to see her read it live at the launch of The Remedy in Toronto. It was so powerful to hear Lisa read that piece live, and I remember feeling and looking around the room, I was not the only one that was crying while she read that piece. And the feeling that I had was, she was giving us a possibility model. It was that feeling like another world is possible. We can create ways of caring for one another that really honor, trauma that honor. The fact in this case, Lisa talks about being a health care practitioner and also a queer person, and a survivor – what does it mean to bring the fullness of her identities and and really see those as gifts and also being held in the way that she’s able to practice in community acupuncture. So I really love the example of that piece as a way to imagine how do we extrapolate this?

When I think about one of the other pieces, you mentioned briefly, like Sinclair Sexsmith’s piece. One of the things Sinclair talks about is basically crowdsourcing so much health information because they were like, “Well, the medical system can’t give me the information that I need. So I’m going to take matters into my own hands.” As much as of course there’s complexity and maybe some kinds of risk – Yes, some kinds of risk in having to fill in the gaps in information that may be don’t exist in maybe more formal settings or in the knowledge base of healthcare providers. It’s also incredibly powerful and empowering to step back and say, “Okay, I’m the expert on my own body. I am part of and held by a community. And we’re going to figure this out together.” There’s another piece in the book, because I’ll just talk about all of them. So Kelly Dunham has a really fantastic piece, and it’s all about your caregiving. In this case, Kelly is talking about the experience of caring for a partner who’s dying with cancer.

Dawn Serra: Oh, god. That story, yes.

Zena Sharman: Right? I love how Kelly highlights the strengths of the queer community and basically is like, “Hey, everybody, everybody else, health system, you should really look at us and not trying to make this a model where only one person or two people are allowed to be with, in this case, the dying person.” How do we actually create a system that enables us to bring webs of people together to care for one another? So again, I feel like there’s an enormous amount of opportunity to look at the ways we, as queer people, have held and cared for each other and figured stuff out in the absence of information or systems that are not able to care for us.

Dawn Serra: Oh my god. Okay, so I have 70 things I want to talk about. So going back to the community acupuncture – Was it Lisa that wrote that? So one of the things that really struck me powerfully, is I talked constantly on the show about consent culture and rape culture, and the importance of just respecting the sovereignty and autonomy of another human being and letting them choose what happens to their body. And yet, we have no way have a consent culture within our medical institutions. I know there was a heartbreaking story where someone’s getting genital exams and no one’s telling them why or what’s happening to them. But in Lisa’s story she was talking about how, I’m assuming that Lisa uses female pronouns, but Lisa was talking about how at their center where they are doing community acupuncture, that people who came got to choose for themselves every single thing that happened to their body, how their body was positioned, where they sat – that they got to be fully in control of their experience. And, and that was 1.) it never even occurred to me that I could receive care in that way. Because I’ve never seen it done. I’ve never had someone ask me, where I would prefer to sit in the room, or when I’m ready to be touched. It’s just, “I’m going to do the things and you have to tolerate it,” which is the opposite of consent culture, so I thought that was really beautiful. 

It also felt really scary because, for me, sometimes my body is not a safe place for me to be. It can sometimes also be really foreign. So this thought of, “I get to be fully in control of my body and the experience.” My body has all of its wisdom. It also brings up this – “Sometimes my body is in a safe space. So then how do I navigate that?” It brought up these paradigm shifting questions and thought that it never even occurred to me, like, “What if every time we saw somebody who’s going to have anything to do with our body, they checked in with us and asked us, ‘May I touch you in this way? or what would make you more comfortable?’” That’s just so foreign to me.

Zena Sharman: What your listeners can’t see is me nodding emphatically at Dawn right now. Yes. It would be a radical culture shift. It would require massive changes to the way that we educate healthcare providers and structure the health system, which isn’t to say that those models don’t exist. I mean, for example, we see them in community acupuncture. I think, also, they’re more and more present in trauma-informed care. I think there are more and more healthcare providers that are really thinking about that, which is so important right now. How do we actually build content culture into the health system? How do we let someone know what’s happening and talk them through the process? And really, again, meet the patient as an engaged partner in the process and honor your bodily autonomy, your expertise. Because you’re the person that’s living in that body 24/7, right? But yes, it’s a humongous difference.

Dawn Serra: Yeah. I even think this community and this trauma-informed approach, I think, would leave so much more space to start deconstructing some of the ableism that’s inherent in the medical community of, “Of course, you want to be fixed or different. Of course, you want to be normal.” And forcing people into treatment regimens without really explaining to them what’s going to be happening or assuming that if you’re fat, of course, you want to lose weight. There’s all of these able estate deals baked into medicine, because medicine at this point in time, assumes that what’s best for the patient is conformity with what they think is the one way to be healthy. So I see so much more opportunity in these other approaches to wellness of like, “Maybe I don’t want to get better. Maybe I just want to live the best that I can with what I have now. Or maybe I’m super happy the way that I am even if that boggles your mind. So then how do we work with that?” I think that takes a lot more resilience and flexibility in care providers, which I think is also really scary to the medical establishment.

Zena Sharman: Absolutely. What would it mean to build Disability Justice into our health system? There’s a really amazing book. So shout out to so many other writers out there. Eli Claire has a new book called Brilliant Imperfection. I think the subtitle is Grappling with Cure (Brilliant Imperfection: Grappling with Cure). So Eli is a trans person, a disabled person, a survivor, and a really brilliant thinker and writer – someone who writes in this really powerful way that engages, I think, in a really accessible but complex way – theory and lived experience, and engagement with the natural world, and a deeply politicized approach to thinking about Disability Justice. So the reason that feels so relevant in this conversation is one of the strong themes in that book is really troubling the notion of cure. 

So that, for sure in some cases, and Eli gives the example of, maybe someone who’s living with really intense chronic pain, maybe for them, to be cured of that chronic pain would be a welcome life changing shift. Then for other folks, they’re so happy in their lived bodies, their existing bodies as a disabled person. So how do you, again, meet people where they’re at? I think, also, push away potentially from say, a focus on “cure” to how do we actually – not just at the individual level, but at the societal level? Create ways of inviting in full participation, autonomy, supporting people to live in the fullness of their lives, whatever that looks like for them. Again, I mean, I think this is one of the places where we start to touch into, where does the medical system or the healthcare system end and the entire everything else begin? 

Zena Sharman: On the way over here, ‘cause I’m super nerdy, I was reading a book about – an article, I should say, about teaching The Social Determinants of Health in Medical Education. It was really interesting, very activist-oriented, critical perspective on it coming from a group of folks within medical education. One of the things they were talking about is, how do we actually push away from a model that basically doesn’t give, in this case, medical students the opportunity to not just look at a list of things that might influence health? So maybe it’s your income, maybe it’s your age, maybe it’s your race or ethnicity, your gender, your sexual orientation. Yes, all of those things are real. But how do we actually have a model that positions those facets of identity in a power structure of intersecting oppressions and privileges? 

How do you enable healthcare providers to actually reflect on their own privileges and power, and how they might actually participate in oppression? How do you, and they talked about this idea of Doctor citizen, so how do you actually train healthcare providers to become these active citizens who want to participate in overturning disparities? Not just doing that at the level of, how do I help this individual patient? How do I create access to safe and affordable housing? How do I support food justice so people can have access to food that is healthy and nourishing to them and their communities? How do I create Disability Justice so that we have accessible communities where folks have all kinds of bodies can really thrive and participate? What would that mean to transform healthcare like that? I mean, that’s the world I want to work toward. I don’t expect that that’s going to happen in my lifetime. But the remedy is absolutely, a drop in that magical bucket of social change.

Dawn Serra: Yeah. It just makes me think, and this is one of the other things I really want to talk to you about, is this model of interdependence, which I think it’s really clear in so many of the stories and thinking about like community activism for so many different things. Not just health care, but even sexual health and sexual exchange. When we have a community where we’re actually accountable to each other, but also available to receive support, and actually not feel bad about receiving support, and give support – I think if we were actually involved in community in that way that would completely revolutionize the way that we offer care. So even if our profession is to be a medical provider, if we are deeply entrenched in our community, and we actually have an opportunity to have real conversations and see real impact, I think it changes the way we offer the care, ultimately. 

So you wrote this beautiful blog post on your blog, which I’ll link to in this episode called Queer Interdependence. It moved me so much but you were really touching on this. I’ve mentioned this on the show a couple of times, where we’re in a culture that highly prizes individualism to the extreme, where you pull yourself up by your bootstraps, and you make it work no matter what. It’s all about mindset. And if your mindsets not right, then everything else is your fault. To receive help or to ask for help, is really seen as weakness. Whereas within so many marginalized communities, interdependence and actually offering support and care is a big reason that these communities have even survived. So I’d love for you to talk about that a little bit more like your personal experience with it, and maybe how we can build stronger interdependence and all the ways we have community.

Zena Sharman: Well, thank you. Thank you for reading that blog post. The piece I wrote on Queer Interdependence was partly inspired by my own personal experience of a period in my life where basically, I would say it was like a forest fire. Everything that was foundational in my life changed radically in a pretty short period of time. So this was in 2014, my mom died in 2014. I’m an only child raised by a single mom, she was sick for six years – lots of layers of complexity there. So she died in March 2014. Then my partner at the time, we split up in October of that year, and I moved out of the home that we shared together. It was all the things that I thought, “Okay, these are these are the foundations.” It was just like [imitates fire sound]. Everything went up in flames and it was incredibly difficult. I mean, there is no doubt that it was – I mean, to this point, who knows what the future holds, but it was absolutely the hardest experience I’ve had in my adult life – bar none. 

Also it was profound, how held I was through that process by my community. I’m someone who, my own family history, it’s definitely one that’s really colored by really complicated experiences of abandonment and – I mean, I know you’re a sex and relationship coach, so I know you can get down with attachment theory. I love me some attachment theory, really. So how do I think about, in my own lived experience, what it means to have complicated feelings around trusting in the relationships that are core to my life? I bring that I bring that in. And that came with me through that whole process. Plus, of course, all of the complex capitalist narratives of self sufficiency and interdependence. So to be in a process where I was so decimated by the experience that I couldn’t not ask for, and receive help – and receive so much more help than I was even asking for. It was really profound. So that was my entry point into writing that piece, but also really wanting to think about that, again, in a larger way. Because I think there is an opportunity for us to really honor and lift up that interdependence much more than we’re able to, and I think much more than, for sure, as you already touched on those kinds of capitalist narratives of you must be self-sufficient, asking for help is a weakness.

Zena Sharman: I’m so glad that Brené Brown had that super popular talk on vulnerability. That was a game changer for me when I watched it years ago because I think it actually was, again, one of those entry points for me in actually being able to invite in more interdependence and welcome my own vulnerability, be able to ask for help, be able to say, “Hey, I can’t hold all of this. I’m not a superhero. Please, someone help me” So yeah, I think how do we invite in more vulnerability? How do we honor that? How do we hold out more interdependence? How do we actually put that into action, not just in terms of receiving care, but also giving care? 

There’s disabled folks I know and some of them are doing this really incredible work around forming care collectives, where they’re basically self-organizing their own care. Again, that to me is such a powerful model where there is a person at the center who is in-charge, In the sense of saying, “Look, I’m the person at the core of this, these are the needs I have. Community, I need you to step up for me and do this kind of care,” whether it’s coming in and doing meal preparation, bodily care, whether it’s going out and running errands, that kind of thing. Again, that, to me, is a very specific model. Again, I’ll give a shout out to the Disability Justice community because that’s where this work and wisdom comes from. But I feel like that’s such a powerful model for thinking about what interdependence could look like, and I feel like we can all invite more interdependence into our lives.

Dawn Serra: Yeah. It’s been a really interesting experience leaving DC, where in my years there, I had a really serious bout with depression for a number of years. Then I really came out of that, because I was so held and I had so many beautiful friends that were really able to allow me to be where I was, and that was super healing. At the time, I was also moving in witchy circles and doing a lot of healing spiritually. Now, in my experience of living every day with anxiety, I left the tribe behind of people who I felt comfortable asking for help. And that’s a really hard thing to do, I’ve noticed, especially depending on your identity and how you move through the world, and kind of how you grew up. But for me, asking for help is a really hard thing. It feels like a burden that I’m placing on someone else. So to have friends, where I could actually ask for that help and have it received, and trust that when I gave it to me it was because they really wanted to, but they could care themselves through yes and nos. Also being able to support them in that way and to move away from that. To feel what it’s like to not have that right now, and trusting that it will come again.

It’s a very interesting experience to know you have community and care and that, when you need to, you can ask for help. Then to actually see yourself removed from that, it’s a really interesting experience. It also makes me feel heartbroken for people who don’t have access to that kind of thing. I think oftentimes, folks who are heterosexual and cis, and following all over the social cues, I think often are super lonely. Because there isn’t that baked in community of, “We have to be together because the world’s not safe for us.” And encountering this loneliness for lots of different reasons, or even folks with disabilities who are in rural areas and don’t have access to friends and community – thinking through what does it mean to have interdependence and community, and what does it also mean when you don’t have that and you miss it or you need it? How do we care for ourselves through

Zena Sharman: Absolutely. I think to acknowledge as you went in the examples you’re giving, interdependence is a privilege or it can be a privilege, right? That kind of access to community is not something that everybody has, and it’s not something that everybody in the queer and trans community has, let alone society at large. Because I agree with you, I think, other more normative family structures can be really isolating, potentially, if you look at maybe a more “nuclear family model”; where it’s a husband and a wife raising kids together, and it’s the two of them and those kids. That would feel incredibly isolating. It’s hard to raise children without any people around you. I also, again, want to make that in the context of the queer and trans community – even in my own experience, and I appreciate receiving even some feedback on the piece that I wrote about this in a way that was gentle, but also a really important reminder for me, that I am a person that is privileged to be tapped into a lot of community. 

I’ve been where I am for 16 years now. I know a lot of people, and that has made a huge difference for me in terms of my access to support and also my need for access to support was within a relatively time-bound period. It was a year but it wasn’t, “Hey, I am interdependent and I will be this type of interdependent for the rest of my life.” Again, how do we think about that? How do we cultivate interdependence in our own lives, in ways that feel really healthy and nourishing for us?? I always say it’s like, “I don’t want co-dependence. I’ve done enough work to be less co-dependent. That’s real.” How do we have healthy boundaries? How do we also move away from this notion that it’s not okay to ask for help, and that it’s not okay to offer help. Again, that’s that dance of co-dependence and boundaries and interdependence. There’s lots wrapped up in there.

Dawn Serra: Yeah, because I think one of the things that just comes up over and over and over again, anytime I’m talking about sex, is I still get lots of pushback from people around the very basics of consent. That in itself can feel super threatening, especially to folks who have been assigned male at birth and socialized within a toxic masculinity model. But to even be able to have these conversations where we’re talking about it’s okay to ask for help. And beyond that, to know what it means to have healthy boundaries, requires some communication skills of, “I have to have resilience around receiving someone’s no, even if I really want their yes. And trust that they’re taking care of themselves.” I think for so many people who are listening, to have a tough conversation where someone might reject your question is catastrophic. Culturally, we don’t have the tools or the skills to be able to set even the most basic of boundaries and we certainly don’t trust people with their yeses or their nose. 

Culturally, we’re expected to pressure our friends into joining us into things, we can’t respect the no or to judge people for their yes. So we would have to, as a collective culture, find skills that allow us to have these conversations so that we can even trust people when they say, “I really want to care for you” or “I can’t offer that kind of care for you” and to know it’s not them saying, “Ew, no” to you, but this is me caring for myself, and I still love you that’s why I’m saying no. That’s next level relationship and communication skills. Sometimes I’m like, “We’ve got a ways to go because we’re still at the place where like pressuring people into sex is okay for a lot of people.”

Zena Sharman: There’s a really great book. Again, I will just keep talking about books. I’m always reading all the time. There’s a great book called Living and Liberation by Christien Storm. I think it’s the author’s name, and it’s all about boundaries.

Dawn Serra: Oh, okay. I want to read this

Zena Sharman: I feel like it might be your jam. So what I love about it is that, again, it’s a really thoughtful exploration of boundaries, definitely in a very social justice and forum kind of way. But one of the things I found that was a helpful takeaway for me after reading it was remembering that a boundary can be a no and a boundary can also be an enthusiastic invitation in. That, I think, is something that I think sometimes gets lost in the conversation around boundaries. So that is something that could be applied in a day to day in context around giving or receiving care. It absolutely could be applied in a sexual context. Tthat doesn’t mean that if you’re getting a no, to say, “Can we have sex?” If the answer is no, that doesn’t mean that you talk your way around until you get an enthusiastic yes.

Dawn Serra: Right.

Zena Sharman: You need to know when to respect a no. However, I think it is a really great way to step back and think about that, like, how can I change a medical encounter? We have a consent culture where you’re having a negotiation. Maybe you’re going in for a pelvic exam, and it’s like, “Okay, can I put the speculum in you?” “No.” “How would you feel about putting the speculum in yourself?” Okay, it might not be an enthusiastic invitation.

Dawn Serra: Right, but your like, “That is a little bit better.”

Zena Sharman: Right. So maybe there can be at least that kind of exchange. Maybe a speculum is a bad example. I don’t know. Some people love a speculum. That’s real.

Dawn Serra: Totes!

Zena Sharman: It’s a whole other conversation. However, I think, again, the place where there is the “Hard no.” The “Not right now.” The “Not with you.” But also the getting to a maybe, but maybe not today, or maybe not with you. Then moving into that territory of the enthusiastic yes. I think absolutely that can apply to experiences, but I think it also can apply to processes of giving and receiving help.

Dawn Serra: Yes. Yeah, I think that’s so important to think about of, there’s so many situations in our lives where I think until someone actually tells us “It’s okay to say the thing.” You don’t know you’re allowed to say that thing. I didn’t even know about the word consent until I was in my mid early 20s. I understood the no touching people and they don’t want to thing, but I didn’t have the language for that. There’s still so many people who don’t. But it never would have occurred to me, and I think even now, it’d be really hard for me to tell a doctor, “No.” Like, “Okay, we’re going to do this.” “Actually, I need a minute.” That would be so hard. I think a lot of people don’t even know that they have that option, because it feels like a powerless situation where things are just being done to you. 

I think often, people in various types of genders and bodies feel like sex and relationships kind of experienced the same way like, “These are things that are done to me, and as long as it’s not really painful or grossly abusive, then my job is to just take it or to tolerate it.” Or “It’s not so bad that I should leave. I can tolerate this kind of ‘Eh, I guess it’s okay,’” place. It’s so often because people haven’t been told, like, “Here’s all the ways that you can actually negotiate, advocate for yourself, say, ‘This doesn’t feel very good for me.’” But I’m not saying I don’t want it to happen. I’m saying maybe we need to change the circumstances. I mean, that’s a big huge permission slip that I think so many of us don’t have in the most basic places in our lives, and then to step into a place where a doctor in a hospital, where it feels like all of these people know so much more than you. It becomes infinitely harder, I think, to start advocating for yourself, especially when you’re talking about things like genitals, or sex or STIs. I mean, that ups the shame factor for so many of us. 

Zena Sharman: Absolutely. The phrase that came to mind when you were talking was trauma is an endurance sport. That’s real and complicated. When we’ve experienced trauma, whether it’s in the context of a medical encounter, whether it’s at various points in our lives. I mean, we are both enduring that trauma, but it is also as we move through life carrying that trauma with us in whatever way that we do, whatever our own journey of healing is. I think something, and I say this from my own experience of trauma, and especially in terms of some of the things about my upbringing, that that I think, really gave me a very strong capacity that I’m continuing to try to unlearn – to just endure through things. So that’s where I come back to that piece about how do I set boundaries? How do I feel empowered to be able to ask for help? How do I feel able to say, “Yes, I will offer this.” “No, I can’t offer that.”? 

I think in the context of the health system, that is often not only a site of trauma for so many people in general, and certainly for so many queer and trans people. It also is a site that triggers so many traumas for people. So there is no doubt to me that there are lots of people just dissociating their way through healthcare experiences or just white knuckling it through, even if it’s awful, they have made the Herculean effort to get into that clinic to do that thing or to go see that therapist or whatever it is. I think it can be just hard enough to get through the door sometimes, let alone as you pointed to challenge the medical hierarchy. I know that I have a big advantage in a lot of my medical encounters because I have a PhD, and I’ve worked in health research for many, many years. I am one of those patients and I have white privilege. I have gender privilege. I have thin privilege. There’s all these ways that a healthcare provider will look at me and say, “Okay, this is probably a patient who I will need to interact with differently than I might, for example, if I was dealing with somebody who was a patient who happened to be maybe a trans person, who was street involved, and also a person of color.” That person should not get different care than I do. And they do. My body is not a body that bears the brunt of the kind of discrimination and disparities that many queer and trans people face today. And I know that because it absolutely affects the texture of the kinds of encounters I have with my health care providers. 

Zena Sharman: I also know, because so many people in my community, so many people that I love, have painful and frustrating and invisibilizing, and absolutely, sometimes downright violent encounters. We absolutely need to change that. I think part of it is actually about shifting the hierarchy. I know one of the things we were talking about earlier, so tell me if I’m getting ahead of ourselves, there’s a really amazing program that’s profiled in The Remedy that’s called The Trans Body Program. 

Dawn Serra: Oh my god, I love that so much. 

Zena Sharman: It’s so brilliant. They did this in Nashville, and basically, they trained advocates to go, and of course, with the enthusiastic invitation of a trans patient, they could have a trained health advocate accompany them to an appointment. What a game changer. It can be triggering enough to just be in the room. Of course, if we’re feeling triggered, how the heck are we going to be able to take in and process information? Will we feel able to advocate for ourselves? Will we actually even be in our bodies? So if you could be in a situation where maybe you actually don’t feel like you can you can bring your whole self to bear in the same way that you might want to to be fully present in that encounter, because maybe actually dissociating is the way to get through your pelvic – maybe that’s your strategy. But if there could be someone in the room with you, who’s like, “I got you. I am the person who will advocate for you. I will make notes, I will ask questions. I will help to disrupt the hierarchy.” And also again, demand shifts in how health care providers are tracked as patients because that comes back to how we designed the system. There’s a lot more talk of patient and family-centered care. That’s a very big focus, even in the province that you and I are living in now. But it actually also demands a really big transformation of the health system.

Dawn Serra: Yeah. As soon as I read about the Trans Body Program, I was like, “Oh, my God, I need this.” Not only for folks who are in fat bodies, because I think that’s a really important place where so many people who are in fat bodies refuse to go to the doctor, because whenever they go, it’s all about “You have to lose weight.” I actually had a situation last Summer where I fell and actually injured my knee and the doctor just wanted to talk to me about, “Your knees hurt because you’re fat.” I actually acquired an injury but they weren’t interested whatsoever in that. So I actually took care of my own knee and was doing remedies at home to help myself care through that, because I was like, “I don’t need to deal with this crap.”

Also, for me, I tend to dissociate very much in doctors’ offices, unless I’ve established a very long relationship with a doctor over a long period of time, which I’ve been fortunate enough to do a few times. But as soon as I heard about that, I thought, 1.), I would love to be able to do that for others. I would love to be able to go into a room, as a sex educator, I would love to be able to go into a room with someone and say, “I will be there on your behalf to talk about your STI status, to ask questions about the types of sex that you want to have, if you can’t bring yourself to say the words “fisting” or whatever it is. Let me ask those questions for you and get that information. Then we can do this together.” or “Let me be there to hold the doctor accountable to not be focused on the size of your body and instead to be focused on your health.” I mean, I think there’s so many beautiful applications of holding medical professionals accountable for the kind of care they’re giving when you bring that third person into the room. That can really Be the voice and the eyes and the ears and say, “This is what we need to be doing and these are the questions that we have.” 

Dawn Serra: I mean, I love that that probe program exists. I wish it existed everywhere for so many different types of identities and experiences and bodies. I was like, “This is brilliant.” Until the medical industry and until these systemic oppressions start shifting to know someone can be there with me – it kind of comes back to the interdependence of, “I don’t have to go through this alone.” That, to me, is exciting. It would make me be like, “Oh, well, I should go get that checked out. I’ll just hook up with my community buddy,” or whatever. instead of six months later, “I should have gotten that looked at,” which I think a lot of people do. 

Zena Sharman: Absolutely. I think that there is so much avoidance of healthcare because of the kind of fatphobic discrimination you experienced, which is… Can I swear in your podcast? 

Dawn Serra: Oh, yeah!

Zena Sharman: Bullshit!

Dawn Serra: Bullshit!

Zena Sharman: Total bullshit. Seriously. Just checking. I realize it’s not entirely a family friendly podcast, but it’s good to know. I mean, again, like the fact of discrimination you experienced. I mean, there obviously is a huge amount of discrimination, especially trans and gender non-conforming people, bisexual people experienced a lot of health disparities – of course, people who are racialized people, who are indigenous people, who are living in poverty, sex workers. I mean, again, folks who experience stigma and discrimination as a result of their identities, which is about oppression. It’s not about who they are as individuals. It’s not that they are more risky somehow, it’s that they are living in structures that are creating more oppression and risk for them. 

Again, we absolutely should be able to have a system that meets them and honors them and that doesn’t discriminate and further against and further traumatize. So I would love to see a trained health advocate model that’s accessible to more people. And, as you know, that is hopefully the bridge to the future transformation. I would love for us to get to a place where you don’t actually need to have a trained advocate with you in the room. We know that that is not a short term – that’s not a short term strategy. I don’t know. I mean, maybe it’s an invitation to your listeners. Maybe there are people out there that are listening right now and thinking, “Wow, it is really hard for me to go to the doctor. What would it be like if I talked to that friend who I really trust? Maybe they couldn’t come with me.Maybe we could tag off and be each other’s buddy?”

Dawn Serra: Yeah, I was even thinking as we’re talking, it doesn’t even have to be like a formal program, right? I mean, even within a kinky community. Let’s say there’s a handful of you that all have been avoiding going to the doctor because you didn’t want questions about your bruises or whatever it is that you’ve got going on in your life, and to actually band together and say, “Let’s go with each other to each other’s appointments and just be there to help take up that space and ask those questions.” I mean, that could be a radical experience for people or to like – I mean, there’s so many people that avoid getting an STI testing because of the stigma associated with STIs. 

So to have a friend who’s not going to shame you, based on whatever your results are, actually be there with you and go through that. It doesn’t have to be these nonprofits that are huge and integrated with the medical system. I mean, that would be great. But I think you’re so right, even if we could just say, “Hey, trans buddy. Let the two of us go and call out this doctor and this nurse who constantly misgender you. I will be there for you to say, “Nope, wrong pronoun.” And you can do whatever you need to care for yourself through that. I mean, we can totally advocate for each other that way. It would be amazing.

Zena Sharman: There’s a great zine, so Kelly Dunham, who I talked about earlier who wrote that amazing piece in The Remedy about queer caregiving is also a nurse by training and does a lot of health advocacy. So Kelly Dunham has a zine that you can find online. It’s called You Don’t Have to Love Your Body to Take Care of It. 

Dawn Serra: Oh, yes. I love that. 

Zena Sharman: It’s basically Kelly’s and I think crowdsource really thoughtful, practical, funny, deeply trauma informed advice for queer and trans folks accessing healthcare. Also, I would say, so much of the advice is applicable to anybody that feels barriers to accessing healthcare. Part of it is definitely about – I mean, I’ll paraphrase, but it’s really about understanding what are the things you need to be able to get yourself through the appointment? For some folks that absolutely is to find a friend. So yes, if you can find that person, absolutely. Or, if you have a relationship with someone in your community who maybe you have more privilege than in some regards, and they enthusiastically consent, maybe there’s an opportunity for you to lend some of that privilege.

So let’s say, for example, it’s with a trans person that’s experiencing a lot of discrimination in the health systems, with their enthusiastic consent, of course, because I’m always mindful of these complex power differential and not trotting in as the “savior”. But if this trans friend is like, “Hey, cis person, amazing. I would love for you to come to this appointment with me. Great. You can drive me there. You can take notes, you can take me out for dinner afterwards because it really feels great for me to have a nourishing delicious meal after this stressful thing that I just did. Also, I would like you to give me a sticker as a reward.” That’s available to all of us. You don’t need to go through creating a nonprofit for example, although if somebody wants to I support that. If there’s a wealthy listener with a large endowment – a well endowed listener, shall we say, create that nonprofit. I’m excited about it. 

Dawn Serra: God that would be such a different way for so many different types of people to actually experience care. I mean, even thinking about sex workers. There’s a story in The Remedy by a sex worker around stigma within the medical community. And, I think one of the things that drives home over and over again, the importance for all of us to be having these conversations is when our STI status is stigmatized, or our history as a sex worker is so stigmatized or the fact that trans bodies are so stigmatized – We start hiding and lying the truth from others, and that can be harmful to others. It can be harmful to ourselves, certainly when we’re not telling our medical professionals, the full scope of what’s going on with ourselves because then we’re only getting bits and pieces of care when we need something much more holistic. 

I think that’s the thing that people forget is when we’re shaming people for what’s going on with their body, or with how they’re experiencing their lives; all we’re doing is making health and wellness and connection impossible. Because none of us actually get to say, “Here’s what’s going on for me.” Now all of us get to have these open conversations and make good decisions for ourselves from this place of information. It’s, “I’m giving you half truths to test if this is safe or not. And the second I feel like it’s not, I’m going to basically say what I need to to get through this interaction.” That doesn’t serve any of us in our personal relationships or in our relationships where we’re actually trying to take care of our bodies, and whatever that looks like. That was reinforced over and over and over again, for me in all of the stories that were in your book.

Zena Sharman: I mean, I think again, that holding back and the place where our own internalized shame and our own internalized stigma bumps up against the kind of very real shaming and stigma that we can encounter. I mean, certainly in the world in general, but absolutely, in healthcare encounters – that can create so many barriers, and as you say, that kind of selective sharing of information. I even think about recently, I went to the STI clinic to get routine STI testing, which is something I do because that’s a sexually healthy thing to do. I am this out queer person, queer and trans health advocate. I gave a talk at the Continuing Professional Development Conference for all the sexual health care providers earlier this year, in front of all these doctors and nurses, and talked about queer and trans health. So with all of that context, plus all the privilege that I acknowledged earlier, I happen to be in a situation where they were going to pair me up with a male clinician and I said, “ I don’t feel comfortable getting a pelvic with a male clinician. I prefer to see a woman.” That was an embodied consenting choice that I needed. They were definitely supportive of that. 

The thing that became so interesting to me in terms of noticing my own internalized stigma, is instead of sending me back to the waiting room, they had me waiting at this weird junction in the hallway. I happen to work in the health research field. And there are folks that I know absolutely that I’ve connected with when I’ve been up there on the podium as a proud queer and trans health advocate talking about health, but also saying, “I love for queer sex. Being queer is great!” And they’re also people that I know in my work life. Of course, I’m out as queer in my work life, but I’m not necessarily talking about all the sexy things at the boardroom table. So I was standing there in the hallway waiting for them to find me a clinician feeling increasingly weird and uncomfortable, and very aware that somebody I knew from my workplace might walk by because I knew one of them had an office down the hall. I was standing there thinking, “If I see this person, how am I going to explain my presence in the hallway?” And this is someone who is a sexual health clinician. This is someone who’s a leading researcher in the area. And I still felt fear despite all of my own woke politics to this kind of stuff. 

Zena Sharman: I still felt fear and internalized stigma around how I could possibly talk about why I happened to be at the STI clinic getting routine STI testing – Oh my god. And noticing that I’m even seeing routine STI testing, there’s that part of me that feels like I need to say, “Oh, and it’s just routine. Just regularly scheduled maintenance.” That’s my own internalized shame and stigma coming up. So just to name that and to say, “Look, this is a thing. We are all carrying in different ways.” And that we live in a culture that is deeply repressive of all kinds of stuff about our sexualities, our genders – nevermind everything. 

I spent many, many years working in a gender and health-focused research organization, and one of the areas that we funded and that I learned about some of the research articles around men’s health specifically. Again, I have so much empathy for cisgender straight men. I mean, Lord knows they piss me off sometime and I rant about the patriarchy and misogyny, that’s real. Also, I have real deep empathy for straight men because if you look at the statistics, in terms of their health issues, suicide rates – there are so many ways in which their bodies are also bearing the brunt of incredibly restrictive norms around gender and sexuality – so boxed in by this is the only way to be a man. Whether that’s this is the only way to express your gender as a man, this is the only way to express your sexuality as a man, boys don’t cry – whatever. Think of all the things that those folks need to unravel, to be able to slowly but surely, and hopefully with some luck along the way and meeting the right people – come into the fullness of their identities. That’s incredibly complicated. Just like I have my own complicated stuff around what it is to have been assigned female and identify as female and socialized as a girl and as a woman. That’s its own complicated kettle of fish, but at least with the norms of feminine gender socialization, we apparently go to the doctor more often and we also take care of our partners’ health.

Dawn Serra: Yes.

Zena Sharman: That’s a whole other conversation.

Dawn Serra: I think that’s interesting. It’s exactly what you said, I get so many questions from cisgendered men who are terrified of the way that their genitals are or are not performing or look – the things that doctors say to them about sexual health. This cultural soup that we’re swimming in, of course, carries over to people who are in the medical profession. It’s not like they’re completely isolated from all of the myths that exists around gender and bodies and norms; so of course doctors are constantly trying to push hard penises and intercourse is the only way that you’re experiencing sex. To have a doctor you feel like has all the answers about your body tell you, “Something is broken or not working,” or “You need a pill.” That’s incredibly harmful to the way that you experience yourself. 

So I think that’s another layer of it all around like, “Oh, you’ve got a vulva and you’re not getting wet “enough”,” and then treating you like there’s something wrong. And instead, what if we were actually talking about, how are you experiencing your body? What are all the different ways that you experience pleasure? I mean, pleasure is completely absent from any of the conversations that we’re having right now in medical communities for the most part – small community and activist-y clinics, I think, do that. But I think you’re so right. There is no type of identity that’s immune from the myths, the harms, the oppression that’s existing – all of us are suffering from it, even if we don’t think we are. 

Dawn Serra: I think that’s also one of the things that when you’re a little bit more normative, you don’t think that you’re suffering in a lot of the ways that, of course, queer and trans folks and intersex folks are having a very unique, violent experience within our oppressive systems. But all of us are being impacted by these very short sighted conversations that aren’t centering the wisdom of our lives and our experiences. And instead just trying to say like, “Here’s what’s ‘normal’.” And now I have to try and fit every person that comes into my practice into this. Everything I talked about on this show around love and sex is to try and undo that constantly, like “Let’s pull it back out of that box over and over and over again.” Because all it’s doing is making everyone feel broken and/or they can’t ask for help.

Zena Sharman: I’m not laughing at what you just said, I’m responding and emphasizing with the depth of the sigh that just came out after what you said. Yeah, wouldn’t it be incredible to be able to have a health system and a society that honored us in the fullness of our identities and met us where we were at? And that it wasn’t about, Here’s all the ways you’re weird.” “Here’s all the ways you’re broken.” “Here’s all the ways I don’t understand you.” That was really about, “Hey, I would love to know more about who you are and what matters to you.” Again, that isn’t to say that there aren’t incredible health care providers out there doing really amazing work, because I always really want to honor that. I know there’s also a lot of quuer and trans folks working in the health system, straddling both of those worlds and identities. I think, absolutely, things are getting better, things are changing. There has been and continues to be a lot of activism from within the health system, the medical system, nursing care. 

I read a great article yesterday about some really amazing work actually being driven by midwives here in Vancouver, that are really trying to have more trans competent midwifery care. So really thinking about, again, how do we provide pregnancy care for people who have bodies that can grow and bear babies and also that don’t happen to be bodies that are identified as female? Those are all really amazing shifts. So again, I think they start to create possibility models, just like when I look around my circles and think, “Okay, wow. My amazing queer femme friend just graduated from nursing school. I’m so excited that she’s out there as a registered nurse.” Another amazing friend of mine is training to be a doctor. I cannot wait until that person is out there as a physician. The change is happening, and of course, it’s never fast enough for my liking.

Dawn Serra: Right, exactly. I just want to stress to everyone who’s listening and feeling like, “This doesn’t really apply to me.” I think there’s this fear that if we become too inclusive, that we make things so difficult to move through, when in fact, it’s the opposite, right? If we were able to walk into a doctor’s office and have someone have open-ended questions on a forum, where we got to name all the things that were true about ourselves, that doesn’t slow us down. It doesn’t make it more difficult for people who do check all the normal boxes – “normal”, but it gives us an opportunity to actually use our own language about ourselves, even if our language is “I’m heterosexual and I was born a male, and identified as a man and my name is David.” There’s freedom and getting to actually use those words because maybe I like to say male and you like to say man. And now as a healthcare provider, I get to say man, because that’s what you like to do. 

I think it’s so important to stress – when we have trans-informed and queer-informed and trauma-informed healthcare happening, every single one of us gets seen. Whereas in the system that we’ve got now only certain of us get seen and the rest are just neglected or worse, right? Even though it can be hard to ask for the new questions, when we start arriving in that place, it actually becomes very easy to live in that space, because it’s like, “Tell me about yourself and let’s work from there.” I’m ready.

Zena Sharman: And what would it be like if the conversation started from a place of “Who are you and what matters the most to you?” So for example, what if it was going in and having a conversation about the possibility of getting a surgery or not? And it wasn’t just about, “Well, your knee looks like this, and therefore, your surgical options are A or B.” It’s really about saying, “Hey, what brings you joy? What kind of experience do you want to have? How could that inform our treatment? Is surgery going to be really painful and really disruptive in your life?” “Okay, maybe that’s actually not the best option for you right now. If you don’t want to do that, what are the possibilities that are in front of us?” So again, it becomes more of a dialogue. It’s much more consent-granted, in the sense that the patient is able to really participate actively in the conversation. I mean, that, as far as I’m concerned, would be revolutionary for all people. It’s like, are you listening to this podcast? Are you a human with a body? Great, if you’re another kind of being with a body, this is potentially relevant to you if you’re accessing healthcare.

Dawn Serra: Oh my god. I feel like I could just geek out with you forever. But we should probably wrap up because we are right at our hour. So I would love it if you could share with people how they can find the book and how they can stay in touch with you online and see all those super rad stuff that you share.

Zena Sharman: Sure. Well, if you want to check out the website for the book, writetheremedy.com. I’m on Twitter @zenasharman so people can find me on there. That’s definitely a place I use to share, especially a lot of articles that I find, things that are really interesting related to queer and trans healthcare. So it’s a really good resource spot. I will occasionally say interesting things, but definitely mostly use it to say, “This thing is awesome. Check it out.” Yeah, so those are the two best places to go.

Dawn Serra: Thank you so much for being here with me today. 

Zena Sharman: You’re so welcome and thanks for the invitation. And it’s exciting that it coincided with you moving to Canada. 

Dawn Serra: I know, right? It was amazing. 

Zena Sharman: I should have brought you some sort of Maple flavored candy or something. Next time.

Dawn Serra: Next time! To everybody who joined us, thank you so much for listening. I hope that this was fun and validating, and informative and makes lots of questions come into your head. Of course, I want to hear those questions. So if you go to sexgetsreal.com/ep171 for this episode, you can find all of Zena’s information, information and links to the book, The Remedy. And of course you can let me know what you thought about this and maybe your ideas for how you can advocate for yourself and your friends better when it comes to your medical care and your sexual health. I would love to hear all the creative thoughts that all of you are having about this. So thank you so much and I will talk to you next week. Bye.