I was sitting on the edge of the doctor’s table, wearing my socks but otherwise naked from the waist down. 

My midwife, sitting on a stool nearby, was talking me through the testing I would be getting that day. I was at the end of my first trimester, one of the only “pants off” appointments during prenatal care. 

My midwife explained that she would be doing an exam and a vaginal swab. All pregnant women are tested for syphilis and chlamydia, in accordance with guidelines from the American College of Obstetricians and Gynecologists. A full panel for sexually transmitted infections was optional, she said, adding, “But you don’t need that.”

It’s impossible to know exactly what someone else is thinking, but I assume that my midwife considered me low-risk for STIs. She knew that I was married and that this was a planned pregnancy. From those two pieces of information, she was making assumptions about my monogamy status and my sexual habits. I presented as a well-educated, middle-class, white woman, and the privilege that comes with that contributed to my doctor assuming I didn’t have any STIs. 

I paused, but not too long since I had vowed to speak up if it came to this. 

What my midwife didn’t know was that I had, in agreement with my partner, sex outside my marriage. I felt like I had made safe decisions, but there had also been oral sex without barriers, which is a risk factor for STIs. I felt strongly that I should have the whole screen. Mostly it was a “better safe than sorry” approach, especially since STIs can affect the health of the fetus if they are undiagnosed or untreated. I knew my risk of having an STI was low, but it wasn’t negligible, and it had been on my mind.

I took a deep breath. 

“Actually, I would like the whole panel,” I explained to the midwife. She looked up, confused. I explained that my partner and I had been with a third person recently and that I hadn’t been tested since. 

She was entirely professional and didn’t give any reaction. That set me at ease and reminded me that I was doing the right thing in having this conversation. However, the disclosure prompted her to ask other questions that were pertinent to my health: was I having sex with men or women? Was my partner also having sex with other people?

Making assumptions about who needs STI screenings is problematic, especially if it is done using stereotypes. Just because someone is married doesn’t mean they’re sexually exclusive with one partner. It seems to me that the midwife should have asked about my sexual habits, not just my relationship status, before assuming I did or didn’t need a full STI screen.

Putting myself out there was a little awkward. I had never talked to a doctor so frankly about my sex life. Really, I had never done anything that a doctor would consider outside the “normal” bounds of a cisgender heterosexual marriage. 

Still, getting the STI screen felt like something I needed to do to advocate for myself. If I was mature enough to have extramarital sex, I should be mature enough to discuss that risk factor with my doctor, I reasoned. I’m sure I could have just demanded the panel without going into detail, but it felt important to be open with my provider, who I trusted deeply so that she had a full understanding of me as a patient. 

My screening came back negative for all STIs. That’s what I figured would happen, but it still offered me peace of mind. I no longer had to worry about my STI risk, no matter how small it was. Plus, I was very proud of myself for speaking up, advocating for my own health and challenging my midwife to expand her horizons about who needs STI screening.