Diversity in sexual health: problems and dilemmas

Diversity in sexual health: problems and dilemmas

J. Rademakers (1), I. Mouthaan (2), M. de Neef (2)

School of Medical Sciences, University Medical Center Utrecht, The

Netherlands (1); Rutgers Nisso Group, Utrecht; Mouthaan & de Neef,

Breda/Amsterdam, The Netherlands (2)

The increase of migrant populations within western European societies leads

to specific problems and dilemmas in the area of sexual and reproductive health

and service provision. Specific groups differ with respect to their cultural

background, religion, migration history and present living conditions, which in

its turn impacts their sexual and reproductive status. In general, the problems

and dilemmas around sexual and reproductive health can be divided into four

categories: (1) epidemiology of diseases and risk factors in specific

populations; (2) psychosocial and cultural aspects; (3) communication; and (4)

moral and ethical dilemma’s.

Regarding epidemiology there is an increased prevalence in migrant groups of

unwanted pregnancy and abortion, HIV/STD’s, and sexual violence. Effective

contraceptive use is hampered by knowledge deficits, uncertain living conditions,

ambivalence regarding the use of contraceptives and problems accessing (information

on) contraception.

Psychosocial and cultural aspects relate to the norms and attitudes

individuals and groups have regarding the family, social relationships,

sexuality and gender. These norms and attitudes have an impact on the sexual and

reproductive choices people make and the possibilities and restrictions they

feel in this respect. For example: virginity at marriage is crucial for Islamic

girls, but growing up in a western, sexual liberal culture makes it more

difficult to comply with this norm. This dilemma may eventually result in

requests for hymen reconstruction or ‘virginity certificates’. Another

example: both the taboo on homosexuality and gender-inequality in heterosexual

relationships may lead to more difficulty in negotiating safe sex practices.

This results in higher HIV/STD rates.

Problems in communication do not only concern language, but also

communication styles, the way patients present their problems and the

expectations they have from the service provider. Communication problems

inevitably lead to a lesser quality of care.

Moral and ethical dilemmas arise where cultures collide. Sex education in

primary and secondary education runs counter to the wishes and believes of many

Islamic parents. Can they exclude their children from it, should the boys and

the girls be divided, or should school sex education be abandoned at all?

Virginity problems are another topic where an individual gynecologist or a

department should make the ethical decision: will we perform hymen

reconstructions, thus contributing to deception and the myth of bleeding at

first intercourse?

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