What do you consider private and what do you consider secret?
After there has been a relationship betrayal of some kind (for example an extramarital affair, or sexual behavior not shared with the partner, or pornography viewing done in the absence of a partner), this question inevitably comes up. It's one of the most important questions we talk about in my office and yet one of the most scary for couples. Why? Because initially after the discovery of the betrayal, one or both partners want complete transparency: unlimited access to the cell phone, passwords to email and other online accounts, and heck, even ankle monitors! This is a direct result of the trauma felt by the betrayed partner and observed by the betraying partner (not to mention the guilt the betraying partner now feels): something was happening to/in their relationship without their knowledge or consent and now their world has turned upside down. What they thought was clear is now murky. Scary indeed -- to both partners. But complete transparency is impossible (believe me, I've seen and heard many clever strategies by the betraying partner to avoid so-called "complete transparency") and the betrayed partner usually end up saying something like "I don't want to be in the role of the cop", meaning they don't want to monitor their partner's activities 24-7. As their couples and sex therapist, I don't want this either. This can have profound implications down the road and it's my job to think about these things. The betrayed partner wants to trust. And if the betrayer is really committed to the relationship (and not doing the betrayal as a way out the door), they generally want to be trusted again too.
So eventually we circle around to this question -- defining what each partner thinks is private vs. secret. It can be a tough conversation because each partner is asserting themselves and there probably isn't going to be 100% agreement on everything. Nor should the partners expect there to be and they need the inner resources to handle that. More importantly, this question and conversation acknowledges that there are some things you just won't know about your partner. It's a necessary conversation. And having it helps each partner grow more into themselves and their relationship.
This is from a Q&A pamphlet from a gynecologist’s office about what a patient can expect during a pap smear. Oy, it makes my skin crawl. Here’s why:
While I understand every ethical doctors’ motives are to help their patients and this pamphlet has been created to do just that, this is horribly offensive to someone who is sex-positive. I don't doubt that some women do feel uncomfortable during this procedure and doctors try to ease their discomfort. Yet this paragraph demonstrates that doctors are expecting their patients to be embarrassed and uncomfortable during the exam and test. That's a dynamic the doctors are setting up even before the patient walks into the exam room -- and it tells me they've been trained to respond to it. But I ask: what is there to be embarrassed about? By getting a pap smear test, a woman (or a trans man) is doing something powerful: they are taking control of their health and getting tested for a potentially life-threatening disease (cervical cancer if you didn’t know). This is something to be proud of! It is empowerment and agency at its best. Doctors help us take better care of ourselves. Where’s the pamphlet from them that celebrates this notable act of courage?
And the part about what the patient can do to make it more pleasant is insulting and bordering on abusive ("distract yourself/don't be in your body and we'll finish soon"), not to mention patriarchal. The real question to ask is: what can providers do to make it more pleasant for the patient? They have the power and expertise in the doctor-patient relationship and the onus falls on them to ensure that the patient’s experience be a good one to the best of their ability. They can start by not indirectly shaming women and trans men for simply having certain body parts.
This pamphlet represents institutionalized shaming on a much deeper level. And as a mental health professional, here’s what I know about shame: it keeps us small and compliant. Is that what doctors, and the medical field for that matter, want in their patients? Eeek, I sure hope not. I challenge every medical professional who is reading this to look more critically at their office’s written materials and see what can be
made more sex-positive, respectful, and sensitive of the patient's experience. And I hope everyone who is due for their pap soon to go in asking their providers to support them in their bravery.
I am a licensed Marriage and Family Therapist and AASECT Certified Sex Therapist located in Sonoma county, California.