The Asexual

Well the annual Pride Toronto Festival has come and gone again; we had one here in Vancouver as well, but this year’s Toronto iteration apparently broke all records for attendance, parade, and participation. I have to admit to my own feeling of pride that Society is making such progress in accepting –even welcoming- diversity. Especially, it would seem, in Canada.

The LGBTQ (have I got those initials in the right order?) community has done a wonderful job of publicizing and integrating their orientations in the public’s mind. Gay marriage –an unthinkable concept only a few years ago- is now accepted in most areas with barely a glance. That a loving couple should be able to legally dedicate their lives to each other with all the rights normally accorded to a marriage seems now so obvious and compelling that it is hard for many of us to countenance a time when it was restricted to heterosexuals.

But the orientation diversity has not run its course; there are other voices finally audible now that the din of battle has dimmed somewhat –voices that I, at least, had not heard before. Readers of this blog may recall my essay on Gender in January 2013, when I had to admit to an age-dependent naïveté concerning gendered public washrooms –you know, designating separate rooms for male and female toilets. I had always thought of the arrangement as being eminently sensible until disavowed of this by a patient, indignant that she had to accept the arbitrary (she felt) assignation of the female room by the accident of her (unchosen) chromosomal array. So I felt that I had witnessed the final frontier of the orientation choices: none. No-name toilets for the sexually unassigned.

I was wrong –again. My innocence was dragged to the surface once more when I heard a CBC radio interview with a woman who was feeling unaccepted even by the LGBTQ group because she identified herself as asexual –i.e. none of the above. Well, to consider oneself as a non-participant is fair enough I suppose, but the absence of something really doesn’t give one much to identify with I would have thought. How ignorant of me; how unsophisticated! I mean there was an unfilled niche there just begging for attention… And there is a growing community of asexuals, some of whom apparently marched in this year’s Toronto Pride Festival parade.

But I suppose I shouldn’t have been surprised. As with most issues, I am often exposed to them first in my office. And under those circumstances, they don’t seem odd or aberrant –just interesting.

Thinking about it now, I suppose I was first introduced to asexuality several years ago -during an investigation of infertility of all things.

There are many causes of infertility. Some are complicated and require referral to a specialized infertility clinic for more intensive investigation and treatment. Others are less onerous, less worrisome and after taking a thorough history and doing a detailed physical exam need only a few simple investigations followed by a large dollop of patience and reassurance. Needless to say, it is this latter group that I prefer, if only because I feel that dialogue is still useful; I get a chance to show that listening, interacting and empathizing is part of Medicine.

Of course, sometimes the reasons for infertility seem blindingly obvious -like the frequency of intercourse. Infrequency, I mean…

“Oh, we don’t have sex very often, doctor,” the sweat shirt and blue jean clad woman said almost proudly. And when one of my eyebrows crept up involuntarily –I try to stay neutral, but sometimes I am weak- she scowled and explained that she didn’t really like sex. “It’s not who I am,” she added, staring at me defiantly. “Once a month is plenty…”

I intended to follow up with a question about whether or not she found the act painful, or whether there might be some impediment to her enjoyment of sex but I felt the mood change in the room. Or at least the mood on her face changed.

I thought maybe I should play the ‘please clarify’ card rather than the ‘I don’t understand’ one which seems to annoy people nowadays. I pretended to read from the notes I had just written. “You say you are only sexually active once a month…?”

“Only when I’m ovulating.” She interrupted before I could finish the question. “That’s when the best chance to conceive exists,” she continued, as if perhaps this was a thought about fertility that hadn’t occurred to me.

I nodded in agreement, but my expression must have remained puzzled because she sighed and sat back in her seat as if exasperated. “Not everybody enjoys sex, you know. For some of us it is simply a means to an end: a baby.” She continued to stare at me –defying me to disagree. “I don’t enjoy washing dishes either, but if I want to have dinner…” she added somewhat cryptically.

I put my pen down on the chart and decided to sit back in my seat as well.  “Well, so far everything seems completely normal,” I said helpfully, hoping to diffuse the tension. I was trying to reassure her that she would likely be able to conceive –but with such infrequent exposure to sperm, might have to be patient or change her frequency. “You may just have to start washing more dishes,” I added carefully. I thought it was a humorous and inoffensive rejoinder to her example. I said it with a smile and with what I hoped was a twinkle in my eye. But to tell you the truth, I couldn’t resist. 

She shot forward in her seat, her eyes narrowed, and I could see her face hardening like concrete. “I had hoped you of all people would understand, doctor!” She said the ‘doctor’ word through clenched teeth.

“I’m sorry…” It slipped through my mouth involuntarily as it often does when I’ve inadvertently crossed some line or other. I actually meant it as a query –as in, ‘Pardon me?’- but when her face relaxed a little from my apparent capitulation I decided to lie fallow. I had no idea what had enraged her, however. Had I been Aspergerially inappropriate and insensitive? Or had she wanted some other more easily acceptable regimen?

She got up from her chair, picked up the little backpack she had worn on arrival and walked to the door. There she hesitated and I could see her tension dissolving. She turned to me and almost whispered, “I’m sorry, too, doctor. It’s just that I’m an Asexual.” She said it as if it were a noun rather than an adjective. And then she left –not angry, not frustrated… More sad that I hadn’t known.

I never saw her again, and I may never understand what she was going through, but I hope things have worked out. I hope she eventually had the child she so desperately wanted and that they went to this Toronto Pride Festival to watch the parade. And I hope that she has at last achieved the recognition and validation of her orientation that she obviously needed. The one that society evidently needs to offer.

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