By Dr. Rashmira Balasuriya
Sexual and reproductive health (SHRH) issues used to be spoken about in hushed tones, given the cultural stigma and taboo associated with the topic in Sri Lanka. Due to the fear of judgement and shame, many still largely overlook their sexual health and do not pay enough attention to symptoms/signs of their reproductive health, regardless of how easily it can be managed, or how life-saving early intervention could be.
Despite the initiation of numerous SHRH conversations over social media platforms, how many persons have actually received contraceptive counselling before commencing on a contraceptive method? How many sexually active women over the age of 25 years have undergone a pap smear even once in their lives? How many sexually active youth persons have received sexually transmitted infection screening?
When should you see a doctor?
It is important that if you are sexually active, you should consider making regular visits to a medical practitioner. Some instances when you may consider visiting a doctor include:
- Contraception counselling
If you are sexually active and do not want to get pregnant, it is essential to use a modern form of family-planning, which will significantly reduce the risk of unintended pregnancies.
Prior to embarking on a method, it is important that the user is screened for potential underlying medical issues that may be affected by contraceptives. For example, prior to starting the hormonal oral contraceptive pill, it is important that the user is assessed for medical conditions such as migraines with auras and for the risk of blood clots. Users should also be counselled on the possible hormonal effects of taking the oral contraceptive pill so that they know what to expect, thereby reducing the rate of discontinuation.
- Sexually transmitted infections
What most do not realise is that many sexually transmitted infections (STIs) are asymptomatic (do not show any symptoms) – so if you have had unprotected sex (without the use of a condom) or have had other forms of sex (including oral sex) with non-regular partners, you maybe harbouring an infection and may accidentally pass it on.
Most STIs can be easily managed if early intervention occurs, it is therefore important to routinely get screened and tested for these infections.
According to the National STD/AIDs Control Programme (NSACP), new Human Immunodeficiency Virus (HIV) diagnoses among the youth (15–24 age group) were one of the highest with 54 positive diagnoses reported in 2019. With early treatment, the viral load of HIV can be effectively reduced to an undetectable level – all the more reason to get tested!
- Cervical cancer and Human Papilloma Virus (HPV)
The incidence of cervical cancer in Sri Lanka is increasing – initially more common in older women, but now the age of detection in the younger population is increasing as the age of first sexual activity continues to decrease. Cervical cancer is almost always caused by HPV, a viral infection that can also result in the development of warts, but is primarily asymptomatic. This infection can clear on its own, but sometimes can cause changes in the cells of the cervix, which overtime can develop into cancerous cells.
It is therefore important to get vaccinated against HPV if within the correct age category, and also undergo routine pap smears, which will detect changes early before they progress into cancer, thereby saving lives.
Real experiences
Mrs. G was nervous and filled with questions on contraception as a newly-married young woman. She wanted to delay having a child and did not want to make a medical decision without consulting a healthcare professional and understanding all the options available to her.
Hence, she decided to sort contraceptive counselling from a consultant gynaecologist. After the consultation, she felt her anxiety and stress ease as her doctor took time to answer all her questions, and also used diagrams to simply explain medical information.
She elaborated the importance of seeking advice from the correct source: “I am someone who religiously believes in healthcare. Google is not always the best place to find solutions, especially when it comes to your health. I would also advise anyone to try out a few doctors to find out who they feel most comfortable with.”
Ms. F had an extremely itchy rash in her genital region and was embarrassed to seek a medical opinion due to fear of judgement from the doctor. She finally plucked up the courage to consult a doctor once her symptoms became very severe.
Her doctor was not only empathetic and kind, but treated the condition and proactively offered her a pap smear. She felt relieved after the consultation, and further elaborated: “Doctors are there to give us advice! Don’t be shy. However much you google and try to self-treat, you need medical advice!”
Taking the first step
Whilst seeking help on sexual health matters, and openly expressing yourself to a medical doctor may seem like a daunting task, there are many ways to make the first move.
- At the Arka Initiative, a grassroot organisation tackling SHRH issues amongst Sri Lankans, queries on SHRH issues are always welcome. Questions can be sent via the Arka social media platforms on Instagram and Facebook, and a medical doctor from the Arka team will revert. If you need to find a consultant gynaecologist, the Arka Initiative also has a compilation of crowdsourced consultant obstetrician/gynaecologist recommendations
- The Family Planning Association of Sri Lanka (FPA) clinic is also a great place for sexual health consultations at a subsidised/free rate – from contraception to sexually transmitted diseases to counselling, the FPA offers non-judgemental and non-discriminatory services. Walk-ins are welcome, but it is recommended to make an appointment by calling the clinic
- The NSACP offers free non-judgemental sexual health services and have a phone application (know4sure.lk) where you can assess your HIV risk and even book an appointment for testing.
So, make a move and make your health a priority!
(The writer has a BSc [Hons], MBBS, PGCert [MedEd], DFM, and is also Head of Mentors at The Arka Initiative)
