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2.7.2019

Bedside With Dr. Candice Fraser: On Modern Sexual Wellness

Bedside is an interview series that examines the influence of sex and gender as it pertains to the work of affluent creators, entrepreneurs, and educators. By contributing to the shifting cultural dialogue, we aim to break down the many stigmas of sex and normalize its context in the everyday.

Doctor Candice Fraser is a New York City-based OBGYN and owner of Trinity gynecological practice. At age 13 Fraser decided she wanted to be a doctor, and by the time she entered medical school in the States, knew that gynecology was her route to impact the worlds of young women and teenagers; her true passion. We had the pleasure of sitting with Dr. Fraser to real-talk her experience growing up as a pastor’s kid, discuss what creating safe spaces really looks like, and unpack the many stigmas and fears behind “the gyno visit”.

What was growing up and coming-of-age like for you?

I come from a pretty small family in Trinidad; it’s me, my older sister, and my mom and dad. I grew up in church, my dad actually became a pastor and was also a teacher, while my mom was a banker. My parents are amazing, and were really open in terms of being a PK (pastor’s kid). PK’s can tend to have a bad rep, one where we evolve and feel really restricted, and then just go crazy off-kilter. But my parents were really value based always putting family first and making sure we felt supported. There were things we knew they expected, but we didn’t feel like it was anything we didn’t want for ourselves. My dad, being a pastor, was always open to talking about sex. He never shied away from the topic nor was it taboo. There was openness and we were a team.

What does your current day-to-day look like as an OBGYN?

A day in the office here is busy. I see patients, while at the same time I answer messages, phone calls, pay bills, fix copier machines, and manage staff. I run this whole practice, and I’m the only doctor, but the best part is seeing patients and talking to people. My clinical goals in terms of my patients is making my practice a comfortable space. A lot of women have a fear, and they may not identify it as a fear, but a lot avoid going to the OBGYN. I don’t ever pretend that it’s comfortable, I tell everyone yeah I know it’s not fun, but at least I can try and make it as pleasant as can be. My favorite part about any patient visit is at the end when people are like “oh that was it?”. That’s what I know I did my job well.

For those who don’t know, or have yet to go to their first gynecological appointment, tell me about the process of a standard checkup.

Sure! What I first do is have a conversation. As physicians we all have a framework about what we ask patients and need to know to get the full picture to make decisions. My first question is usually why are you here? From there I try to get as much information as possible. I cover things like menstrual history, period symptoms, past pregnancies, sexual activity, sexual preferences, birth control, STD prevention, and past medical history. People may not always think these things are relevant, but everything is relevant.

The exam for OBGYN specifically starts with a quick head to toe. I check thyroid, do a breast exam, abdominal exam, and then there’s the part everyone is afraid of, which is the pelvic exam and speculum exam. I examine of the exterior to see if there are any lumps, bumps, or abnormalities, and then use a speculum (often referred to as the clamp) that helps to look inside the vagina and look at the walls, the cervix, see if anything looks abnormal. Then if we need to, I do testing like a pap smear or swabs. A pelvic exam is a couple fingers in the vagina and feeling the abdomen to feel uterus and around the ovaries. That’s pretty much it! You may not need every single step of what I just explained when going to the gynecologist.

Is there a definitive age you should go to the OBGYN?

It’s recommended coming in for a first visit between age 12 and 16, just to talk about things, establish a relationship, and get started on HPV vaccinations (Human Papillomavirus). For a pap smear specifically, that starts at age 21. Previously it was also based on when you started having sex, but that doesn’t matter at all.

I remember the fear as a teenager was having private information exposed to a parent or guardian after going to the gynecologist. Can you speak to that?

Whatever is told to me in confidence as a doctor I cannot legally disclose. The only situation is if and when harmful information is disclosed to me. Every physician is a mandated reporter if you’re being abused, whether or not you realize it, or if it’s an illegal sexual relationship. I don’t ask questions to trap people, but if I have a 15 year old who’s pregnant and her partner is 30 I’m going to lose my job if I don’t say anything. In general, we do not disclose birth control prescriptions, and we aren’t sending notes to parents.

If someone has something tough to bring up how do they talk to their doctor?

I mean it depends, but hopefully you have a physician you trust. If it’s someone you’re meeting for the first time it’s best to just say it and get it addressed. From there you can determine if the response met your needs, and it’s always okay to take that information somewhere else. OBGYNs are not all one size fits all so it’s okay to move on if you don’t feel like it’s a fit.

I’m curious about your protocol when a patient comes to you with traumas like abuse or rape.

I ask every patient about sexual or domestic abuse. If it happened, I ask if it was someone the patient knew, and if they addressed the circumstances in counseling or therapy. I try as best I can to get as much relevant information. That way I can deliver the most comfortable experience to my patients. If they don’t want to talk about it I respect that, but if that’s their moment to discuss it I want to give them that moment. I am mindful with exams and always try to have someone else in the room with me, especially with patients who might have been victims of abuse. I want someone there to hold their hand and comfort them, and I don’t want this to come off wrong, but it’s also protection for myself. You know trauma is trauma. It’s deep. So I want my approach to have been witnessed. Even just from a feedback stance.

How do you define sex?

I think it depends on the person. I always ask people if they are sexually active and then I think it really comes down to my patients definition. There’s penetrative penile, oral, anal, any sort of fluid to fluid (sexual organ to sexual organ) contact in any way is sex. It’s not one way and about the standard penetrative sex.

How often do you recommend people to get tested for STDs and STIs?

It depends. Guidelines vary per person. I think it’s good to have some sort of testing annually, and I offer it to everyone during their visits. If people don’t want it that’s fine, but you never know. Under 25, the standard is to test for Gonorrhea and Chlamydia every well visit exam. If you have changed a partner, even if it’s another monogamous partner since your last testing, I definitely recommend it. Same goes for multiple partners and polyamorous relationships. In those scenarios I might suggest tests every few months.

Any tips for asking if a new partner has gotten tested?

I think you just ask them! It’s the most important thing to ask and tell. If you’re having sex with someone, asking to see results is okay. I believe it’s vital for partners to reassure themselves that having an STD is not a stain or a plague either. It’s just about knowing how to protect yourself.

How do you recommend teens take control of their sexual wellness.

It’s all about having open dialogue. I know this doesn’t apply to every household, but I think everyone just needs that older person who they can trust and have open dialog with. As older adults, I think it’s our responsibility to create the space for teenagers that we are a safe space for reliable information.

Tell me about your personal wellness routine.

For me when I started this practice I had this one goal: being a physician and an entrepreneur. I just worked and worked and worked after this space I wanted to create, and it was like nothing else existed. Realizing self care in the context of my life and my own belief system is what I’m tapping into these days. Bringing all that I identify with back to me and asking myself where I want to be is so important. In my personal life, and my faith, I’ve chosen to be celibate. I’m open to dating and finding time to just let go. My word for the year is “chill”. Last year my word was “purpose”, but by the end of the year I was like I’m burning out. The way I’m choosing to stay well is to just chill and let life happen.

Can you talk a bit more about your choice to be celibate?

Growing up and being in a Christian home, that was always part of my values. I always wanted for myself to have a relationship with someone outside of sex before marriage, which hasn’t been always easy. Now I’m older, I’m wiser, and I know that you experience things. What made me choose celibacy as I got older was intentional. I’ve realized that while sex is great and while sex is wonderful it’s not everything. I have patients who are celibate not because of religion, and they are in their 20’s, and that’s just what they’ve chosen. Whatever is important to you, stick to that and stand up for that, and make sure if it changes that it’s on your terms.

Thank you for saying that! There’s so much permission behind that. I think people get lost in what they should be doing.

Just because you’re not having sex does not mean you’re not a sexual being. Just because you are or aren’t doing something currently doesn’t define you, things aren’t always so black and white. You’re still you. Just like I mentioned with my parents, even though they had expectations for us didn’t mean we wouldn’t talk about sex. I always remember this story my sister tells about my dad. She was around 16 or 17 at the time, and he said to her, “you know if you were to get pregnant right now, it’s okay. Come home.” We lived in a society and a small island where the kids would get notoriously kicked out or run away if things were to happen, and my sister tells me this story and what a powerful moment that was for her. It goes back to dialog, and just realizing that life happens, things happen. Knowing that as much as my dad didn’t want his 16 year old daughter to be having sex, that if she did have sex, life keeps moving. Having someone say that is important. It gives teenagers freedom and security.

What’s one thing you want women to keep in mind when taking care of their sexual wellbeing?

Get to know yourself and be true to yourself.

Stay tuned to Milk for more from the bedside of our favorite fam members.

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