Scarleteen

Hey Scarleteam,

I want to preface my post with saying that I am super grateful for the important work you are all doing! What I'm about to discuss is meant as feedback, not senseless criticism.

Having read around this site a lot over the course of 3 years, I've noticed something about the way medical visits are treated. It all seems, for lack of a better term, very culturally US-centric.

What I mean by that is that there is a lot of focus on preventative screenings/checkups. I don't know how wide-spread this attitude is in other cultures, but I do know this is a common stance in the US and not, for example, where I'm from. Here, you only go to a doctor when you have reason to assume something is wrong or you have questions. Screening when healthy is actively discouraged by official health organisations, whether that concerns STIs or other areas of health.* The only exceptions are the government-organized (optional) screenings for some common cancers, for which you will get invites once you are in an at-risk age group. It's similar to how vaccination programs work, if I had to draw a comparison. When it comes to cervical cancer screening (so pap smear), those screenings start at 30 and are also way less frequent than the advice I see on here.

Interestingly, after a lot of digging I also found this article: https://www.scarleteen.com/read/sexual- ... -maybe-not
The information presented there is way more like the sexual health advice of my country, and rather different from the common attitude on the boards and in other articles.

Anxiety about medical visits and/or not having easy access to them are common themes I've seen in users' posts. Combine that with the fact some countries do not subscribe to this idea (and I see no reason to assume Western European health advice is any less science-backed than US American), and I can't help but wonder if this "frequent screening is essential for your health" stance is maybe putting unnecessary pressure on people.

So I guess my question is: what's up with that? Is it simply because a lot of advice here is based on US healthcare (I more often than not see US organizations listed as sources) and so this cultural norm has become dominant? Or is there more to it, like deliberate disagreement with the concept of only seeking out healthcare when at risk/symptomatic/seeking answers? I guess I just wonder if this is something on you folks' radar, and if not, I wanted to bring attention to it.

Let me know if I should clarify something or if I'm suffering from a glaring bias I cannot see myself.

*just to be really clear once again: this advice doesn't mean "only test if you have symptoms". More "only test if you have symptoms, were at risk or are about to pose a risk to others, are worried or otherwise have concerns" aka have a reason to get tested outside of the last time being a year ago

Hey there, Jess. Thanks for the gratitude!

The health advice we give here is and has always been primarily about best practices, and then secondarily about access. The things we suggest preventative or any other kind of healthcare for are things where what we are suggesting is, to the best of our knowledge at any given time (as health information changes with great frequency), best practice in healthcare from a universal perspective, such as what the WHO suggests. By all means, since we are a team of people with different levels of experience and different arenas of knowledge, you may find that sometimes someone does suggest something that isn't best current practice -- for sure, if you or anyone else ever catches something like that that I don't in my reviews, I always appreciate a note about it so we can make a correction.

I'm not sure which screenings you are asking about specifically -- you bring up our information on pap smears, so I'm not sure if that's all you're asking about -- as the best practices for a screening for any particular thing or group of things varies. But our advice on the boards is always bespoke, meant expressly for a given user in everything we know about their current situation, including their location (which is one big reason we ask for locations). But if you're asking about sexual health screenings on the whole, again, we use current best practices and a user's unique situation to advise what we do.

A lack of enough preventative care and STI screenings, in particular, are unfortunately something that has long been a near-universal problem -- and one recognized as such -- that has resulted in, for instance, people becoming much sicker than they should from what would otherwise be quickly treatable infections. For instance, with enough early screenings, almost no one would get pelvic inflammatory disease because that usually results from untreated Chlamydia or Gonorrhea. Most STIs are asymptomatic, for example, and will never show symptoms until the infection has gotten severe: waiting until there are symptoms to get tested has never been good health advice, in any part of the world. It's something infectious disease and sexual and health activists have been pushing back extra hard against since -- as you can imagine -- the AIDS crisis began in the early 80s both in the United States and in Africa.

People being afraid of healthcare also isn't a sound reason not to suggest people engage in best practices. But we are an d have always been here to talk with anyone who needs or wants care and feels anxious or scared to help them with strategies for managing those feelings and help working through them. If we didn't think the healthcare we suggest people get was essential, we wouldn't suggest it. We're not here to torture people, quite the opposite. <3

Our advice here keeps things like all that in mind, as do world health organizations like the WHO or UNICEF, and we keep current with recommendations from organizations like that (though you won't always see those changes reflected on the boards, since we don't go back to edit board responses like we update our static content).

Our approaches here aren't at odds with most approaches to sexual health in most countries from *their* health organizations, even if, as is so often the case in so many places, the US included, how healthcare is provided to the citizens of any given place doesn't match those best practices.

Unfortunately, there are very few places -- and the US is certainly not one of them -- where access to any kind of healthcare, including preventative care, is easy or within reach for everyone. I'm from here, for example, and the bulk of my healthcare over my lifetime, very much including my sexual healthcare, has come from places like public healthcare systems, not private practices. The way you are describing the way things are where you are also sounds like how preventative healthcare is still most often treated and legislated here, which is a big part of why there is a such a political focus on trying to get us national healthcare here.

Hope that cleared that up for you!