CarnalNation

Well, let's start out by saying that one of us wrote a whole book about this (Health Care Without Shame: A Handbook for the Sexually Diverse and Their Caregivers), and that if you're gay, lesbian, bi, kinky, polyamorous, a swinger, a sex worker, transgendered, or anybody whose sexuality makes youfeel embarrassed to talk to straight doctors, we think you should read it.

But meanwhile, you don't have that book; you are reading this column. So let's at least get you started with a few hints.

Come out to your doctor before you think you need to. The time to tell your doctor that you enjoy being sodomized with large objects is not after the two-liter Coke bottle has gone missing. Give your doctor a chance to learn more about whatever it is you like to do and to voice objections, if any, before something goes wrong. This is only fair, and it's also a way to help ensure that you get informed and non-freaked-out medical care.

Use the least loaded terms you can come up with. It takes a pretty open-minded doctor not to flinch at terms like "cock and ball torture"—try "intense genital stimulation" instead. You might want to think about you want to tell your doctor, perhaps even making notes to yourself, before you go in for your appointment. Be sensitive to your doctor's reactions and body language as you share this information, and try not to overwhelm him or her with too much information all at once.

Some of the things you might want to discuss:

• Who you have sex with
• What kinds of sex you have with him, her, or them
• Your safer-sex precautions and techniques
• Your birth control methods, if any
• Any kinks, fetishes, or unusual preferences that could have an effect on your health
• Your drug or alcohol use patterns
• Any unusual family structures or relationships (polyamorous, owner/slave, etc.) which should be taken into account for hospital visitation, decision-making, and so on.
• Anyone in your family structure who doesn't know about these activities and should be shielded from this information... and anyone not in your legal family who should get the whole story

If any of the information you need to share with your doctor has to do with illegal activities, such as recreational drug use or sex work, check with your doctor first to find out what his or her policies are regarding record-keeping on such matters, and then make an informed decision about how you want to handle this communication. We're pretty sure you don't want your preferred brand of rolling papers noted in your chart.

You and your doctor should decide together how often you should be tested for STDs—if you're sexually active, once a year is the minimum. While you're at it, make sure your doc starts you on your course of hepatitis vaccines, OK?

And inevitably, you will find yourself a nice primary care physician who knows all about your weird perverted habits and takes good care of you anyway, then you'll have an emergency, or need to be referred to a specialist, and you'll be back on teh exam table looking up at someone who doesn't know anything about your sex life and doesn't want to know. This is where the doc you came out to can help you out—by interfacing with the new person for you, to make s/he has all the information s/he needs to give you good and understanding care.