Physician assistant Kristen Struzzieri said consent is always part of her safe-sex talk with patients, especially with first-timers and younger women. To her, affirmative consent — the concept of "yes means yes" — is an essential prerequisite to intimacy, and most of the women she sees at a New York City clinic agree.

But just last month, she was prepping a 22-year-old woman at an OBGYN office in Queens, New York, when the patient confided in her: The man she had been seeing for two months wanted to get her pregnant and she didn’t know how to prepare for a child. Struzzieri asked her if she wanted to be pregnant. The patient, taken aback, said no.

"She didn’t even realize she had that option,” Struzzieri, 23, said. “We wound up putting her on birth control that day.”

Struzzieri’s willingness to discuss the subject goes beyond the confines of the doctor’s office — she openly talks about consent with men she dates and her friends.

Kristen Struzzieri attends the Women's March in Pittsburgh in January 2018. Courtesy Kristen Struzzieri

"I have no qualms about bringing it up. I don’t feel uncomfortable," she said. "I don’t care if I make other people feel uncomfortable."

That patient reminded Struzzieri that conversations about consent and feminism can’t be taken for granted, even in the era of #MeToo and Time’s Up.

Struzzieri, who graduated from Duquesne University's five-year physician’s assistant program in August 2018, said she wasn't always so outspoken about affirmative consent, which California defined in 2014 legislation as a “conscious, and voluntary agreement to engage in sexual activity.” The state uses it as a standard to measure sexual assault on college campuses.

Struzzieri credits her coursework, the election of President Donald Trump and the rise of #MeToo for her motivation to raise her voice on women's issues — and to do so in everyday life.

She is far from alone. Young women like Struzzieri, emboldened by cultural shifts and affirmative consent laws, say they're more open to talking about issues surrounding consent, in sexual and everyday situations.

Performance-fueled club House of Yes in New York City has an extremely strict affirmative consent policy for its attendees. Courtesy of House of Yes

That attitude has carried over to venues such as yoga studios and dance clubs, where people often come in close contact with each other.

The increasing use of yoga tiles, from Amsterdam to North Carolina, are part of this trend. Two years ago, yoga instructor Laura Terry came across consent tiles and started using them in her class at the Carrboro Yoga Company, in Carrboro, North Carolina. The tiles have two different sides that indicate whether or not yoga students are OK with hands-on adjustments.

Before tiles, some instructors used items like poker chips or gestures in asking practitioners for their preferences. Most of Terry’s students opt for the assistance, but one or two people per class will opt out.

Consent tiles used in Laura Terry's yoga class in Carborro, North Carolina. Mark Terry

Terry, who has been teaching yoga for eight years, said the importance of consent tiles came to light during the confirmation hearing for Supreme Court Justice Brett Kavanaugh. A student approached her to express how much yoga helped her that day because the student had been molested as a child and the hearings brought back a lot of trauma.

"You can't tell if you put your hands on someone — and either they’re not expecting it or have a very strong, startled [reaction] — whether that’s just their nervous system or it’s attached trauma," she said. Terry said that when this happened in her class, she could see the tension build in her students, but they often wouldn’t say anything.

Clubs and bars, where low lighting, alcohol and cramped spaces contribute to the possibility of unwanted contact, have also become spaces where affirmative consent is coming into play.

One performance-fueled club in Brooklyn, New York, is taking steps to normalize affirmative consent.

House of Yes mandates that every attendee agree to the club’s consent policy before purchasing tickets. Jacqui Rabkin, House of Yes' marketing director, said the venue, which was founded by two women 10 years ago, is extremely focused on keeping all of its participants safe and goes great lengths to encourage people to report incidents of misconduct.

House of Yes in Brooklyn, New York. Kenny Rodriguez

Most bars and clubs will de-escalate conflict by separating people involved and warn them of ejection, Rabkin said. But at House of Yes, the security team is trained to always believe the victims who file complaints and eject anyone accused of improper behavior.

"There is no such thing as a safe space. There are safer spaces, but there’s no such thing as a safe space," she said.

Rabkin said that while there are efforts to address sexual assault in public and shared spaces, it’s important to have realistic goals about what can be achieved knowing that “there’s always going to be bad actors.” She said House of Yes hopes that by trusting patrons regarding assault complaints, people are emboldened to come forward when “nuanced behavior” is unreadable.

“I need to make you feel safe that you can report it to me and I’ll believe you,” Rabkin said. “Or that you can tell us about it and we can try to help you do something about it.”