Sasha: Questioning sexual orientation and getting an IUD

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Dear Sasha,

I'm a 30 year-old man and I've had a bit of a recurring problem that I first became aware of back in high school. The girl I was in love with at the time asked if I might find men attractive. I think my answer was along the lines of "Well, I could point out which I think are better looking than others, but that doesn't mean I want to make out with him or fuck him".

Since then, I've had several people either deride me for 'being' gay or allude to the idea in various ways. Throughout my twenties, I often wrestled with the question, losing sleep and generally feeling depressed for months on end whenever I was reminded of the notion that I was in denial and everybody knew something I didn't want to admit. (FYI, I'm not homophobic. I've had gay friends in the past that even hit on me, but I politely turned them down).

I've only ever slept with women (couple dozen), however I'll be forthcoming and say I have lost my erection with a few of those partners. I use porn (almost daily), but naked women in strip clubs have never made me hard. I often gladly admire the myriad beautiful women in the world but I wouldn't consider myself sexually aggressive or competitive. I'm not very good at approaching women confidently-which I think contributes to people's false beliefs. I thought I'd reached a point in my life where I was secure with my heterosexuality but apparently I was wrong. Yet I refuse to accept that I might be gay or even bi since I am not turned on by men. So why am I still susceptible to people's judgments?


Hmm...I've been poring over the official guidelines for what constitutes non-homophobic behaviour and I can't find "politely turning down same sex advances in the past" anywhere. Does anyone have a more updated version they can send me that might contain this passage? I've also had a good look at my copy of Signs That You Are Straight (with particular attention to the chapter Hard and Fast Rules) and I can't find anything specific to genital response in strip clubs and the ability to maintain an erection during every single heterosexual encounter. Clearly what this situation requires is a good phrenologist-unfortunately experts in this field stopped practicing in the late 1800s. I guess it's up to me and me alone to unravel this zany mess.

When a suggestion vexes or depresses you, some people might say it's because you have a phobia of this suggestion. Now, I'm sure your friends and colleagues making this suggestion are nice people so I hope you don't mind me telling them to fuck off. Here's why:

Making arch proclamations about someone's perceived orientation is in fact, bullying. AND WE ALL KNOW WHERE THAT LEADS. Speculating about someone's sexuality, to their face or otherwise, also implies that there is detrimental behaviour afoot. Even if this were the case, when an intervention is staged in response to self-abuse, it is not done in a way that is designed to engender fear or humiliation or service peoples' heedless desire to gossip and create drama.

If you are in fact queer, people needling you that you're "in denial" clearly isn't helping. It only creates a situation where you are reluctant to share or explore for fear of justifying peoples' self-serving remarks. You are in no way beholden to anyone to provide evidence that you are not gay. Who you fuck and why is your fucking business. (But thank you so much for contributing to my income by turning the issue over to me.) And since you did...

Why are you susceptible to -- and by that you mean insulted by -- peoples' judgments? Because you are homophobic. That you have been rendered depressed and sleepless by the implication are obvious signs of this. That you equate sexually aggressive and competitive behaviour with heterosexuality is another, more subtle one.

Under the Cervix

Dear Sasha,

I've been planning on getting my tubes tied -- I've never wanted kids, and I'm almost 40 now and I'd really like to go off the pill and stop worrying about pregnancy for good.

I did a bunch of research and discovered that it can be done transcervically -- they go through your vagina and cervix instead of operating and going through your abdomen but when I finally got an appointment with a specialist here in Toronto, I was told that they don't do it anywhere, though they used to.

The specialist said it's all about money -- not that the transcervical one is more expensive, (O.R. time and anesthesia ain't cheap) but because while the province will pay for that, the equipment for the transcervical methods comes out of the hospital's budget. It's done in some hospitals in other provinces -- do you think I could somehow make OHIP cover a procedure out of province?This seems ridiculous to me. A safer, easier procedure is out there and I can't get it.

The specialist suggested I get an IUD but the idea gives me the heebie-jeebies still. And there's a STRING. And it could get dislodged (or...lodged in my cervix. AUGH!) And it's not permanent. Do you know anything about newer IUDs or people who've had them and are happy with 'em?

I U Don't

Thank Goddess my ovaries shrivelled up before I really had to make the decision because I, too, shudder at the thought of having an IUD inserted. It's like going on a disastrous fishing trip and to the gynecologist's all rolled into one.

From Lyba Spring at TPH: "There are two types of long-term contraception that are placed in the uterus: the copper covered IUD and Mirena, an intrauterine system that releases a progestin.

The research on IUDs that claimed they caused pelvic inflammatory disease and sterility is long out of date. The IUD is safe (98%) and effective. A woman is a good candidate if she has normal menstrual bleeding, normal cramps and is not at risk for STIs. It is cheap and for a woman in her late 30s, can be used for up to five years. You check for the string once a month to see that the device is in place. There are a few risks, but that is true of most methods. Mirena is covered by Ontario Drug Benefit because it is considered to be a drug. Otherwise, it is quite expensive, but over the five years is quite cost effective."

This from a friend who has a Mirena IUD: I can't speak highly enough about my Mirena -- it's actually even more effective that getting your tubes tied. Yeah, if you think about it enough, it's weird (but, fuck, so is everything, right?). Plus I haven't had a period in five years! Also, I spoke to a doc recently who says that women can be on the pill until menopause -- there's really no reason to go off it if it's working for you, plus it can help with some perimenopausal symptoms too."

As for transcervival ligation, Rob Grady from Essure says this, "You can pay for the device and ask OHIP to reimburse you as there are not any programs in Ontario. Every other province has Essure programs; there are now about 40 programs in Canada. Essure will eventually be standard care everywhere because it is now proven to be safer, more effective and less costly.

The list of doctors trained in Ontario is small and not the issue. The issue in Canada is funding. Most gynecologists have the basic skill sets to easily do the Essure procedure, what they lack is the financial support of the hospitals, which must pay for the device and provide the logistic support. Doctors in Canada do not do procedures in their offices which are covered by our health system because they cannot be reimbursed for their expenses."

So, your options: either pay for the Essure device and ask OHIP to reimburse you, or get an IUD and wait for Essure to become more widely available in Ontario.

This column was originally published in NOW Magazine. Ask Sasha:

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