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Excerpts from Sacrificing Our Selves for Love

Chapter 10: The Costs of Physical Love

Continued

CAN WE RELY ON OUR DOCTORS?

Medical practitioners are no less vulnerable than the rest of society to erroneous beliefs and prejudices. Yet many of us rely on our medical practitioners to recognize and treat our various symptoms in an honest and nonjudgmental way. Unfortunately, medical practitioners often display prejudices about women that undermine our diagnosis and treatment. For example, a double standard of sexuality persists: our need for physical love is often frowned upon while a man's need is not; and some sexually transmitted diseases are considered a "just punishment" for women but merely a regrettable, but understandable, inconvenience for men. Such a double standard impedes the free and respectful exchange of useful information we so urgently need.

For years after the link between intercourse and cervical cancer became known, researchers and physicians assumed that a woman's own sexual habits were all that counted. Women who had cervical dysplasia or cervical cancer were sometimes told by their gynecologists that they should not have had sex with so many men. Such remarks were part of the overall label "promiscuous" attached to an already frightened woman seeking help. The double-standard assumption of promiscuity and blame is even more a part of the medical approach to PID and HIV disease.

My [lesbian] lover and I wanted to have a baby and one of my longtime, close male friends agreed to donate the sperm The doctor who was helping me insisted that my friend be tested. I thought it was ridiculous. He didn't think he could be infected He was healthy He had no reason to lie to me. But the doctor was adamant. Both my friend and I were in a state of shock when the test results came back He was positive Then he remembered that one of his lovers from five or six years ago died later of AIDS. He just denied to himself all those years that he could have been infected

There is something about the care of women's sexual systems that includes blaming women and giving men a lot of freedom to act out. And I think we need to see that. Because I feel that part of the medical community's reluctance to bring our mate partners in is giving license to the mate to have sexual relationships with lots of people and not be fully responsible for the outcome. And part of treating a woman with PID like she's a weak person for having this problem "down there" is blaming her And that's where society is still at with men and women. And for women to get out of that, we need enough self-esteem to say: "This doesn't happen out Of the blue. There's a reason for this. " And for us to get our health back, is to understand how terrible this inequality is in our health care.

Physicians still tend to ignore or minimize men's roles in women's diseases. Many physicians do not mention the prominence of a sexually transmissible virus in cervical dysplasia and cervical cancer. Some physicians do not routinely call in the partners of women who have PID for diagnosis and treatments.89 Often men who have a sexually transmissible disease but have no symptoms are treated only if the disease could have serious consequences for them, not in order to prevent women from being infected. Do not consider yourself adequately treated for PID unless your partner(s) have been similarly treated.

Medical schools in the United States have been slow to provide adequate training. A 1985 survey showed that only one in five U.S. medical schools provided even half of its students with training in the prevention, detection, and treatment of sexually transmitted diseases.90 This means that many physicians still lack the knowledge and skill to counsel and treat us, leading directly to inadequate care. For example, because many doctors failed to recognize early signs of AIDS in women, many women received inadequate treatment. Probably because of late diagnosis, women have in the past survived, on average, much shorter times than men after being diagnosed with AIDS -- 13.4 months to men's 17 months. Someday fewer women who have PID will suffer irreversible damage if and when researchers focus more attention on PID's early stages, such as cervical infection, and symptoms other than pain. A trend in this direction is emerging, with physicians acknowledging that PID can quietly smolder throughout our reproductive organs, damaging us unnoticed. Currently, however, our symptoms may not be taken seriously until the disease becomes debilitating or life-threatening. Also, many physicians in private practice prescribe inappropriate antibiotics to treat PID.91

Some medical personnel still have prejudices and irrational fears about HIV infection. They may isolate women and heavily drape themselves, and some women have found that medical practitioners refused to treat them out of fear of contracting the disease. In reality, any precautions that are necessary for HIV should also be taken to prevent the spread of many other diseases. Inadequate infection-control precautions against HIV indicate overall inadequate procedures for cleanliness and sterility.

Moreover, medical professionals need training in how to ask about a person's sexual life. Fewer than one in ten physicians in the United States take an adequate sexual history of their patients.92 Thus, they often miss important clues for diagnosing sexually transmitted diseases.

Overall, we cannot count on medical practitioners to always diagnose or treat us correctly or to educate us about disease prevention. These are further reasons for learning on our own the self-esteem and skills necessary for preventing sexually transmissible diseases. We also need to consider how we can work together toward social change so that methods of prevention and bias-free treatment become available to all women.

The doctor never explained to me the connection between PID and sexually transmitted diseases. After my first hospitalization I went out and started doing some research on my own. I went to the library and looked at all the medical books that had to do with women's anatomy and women's health. And I found that the literature says that most cases of PID are caused by sexually transmitted diseases. Then, during my second time in the hospital my doctor was sitting in my room, and my husband and 9-year-old son were sitting with me And I happened to ask. "I understand that PID is caused by sexually transmitted diseases. Why wasn't I told about this?" And my doctor said. "No, that's not true." That's all he would say. Later on when my husband and son left, I asked him again. I said. "Look, this is what I found in the book Why can't you guys be upfront with me? " He said. "Well, I didn't want to say anything because your husband and son were there. "

I started saying that I wanted my husband tested. I would say: "If you can't find anything in me maybe you can find it in him. " But no one would test him. We had to go to New York to find a doctor who would test men. He worked in a fertility clinic, and he was the first one -- out of thirty doctors -- who told us that this was because of sexually transmitted diseases that we both had.

THE NEED FOR SOCIAL CHANGE

Ideally, social institutions would encourage and facilitate our efforts toward assertiveness and empowerment. We should expect social policies to remove social, legal, or religious barriers to our attempts to prevent sexually transmissible diseases. Unfortunately, some current social policies can obstruct disease prevention. For example, obscenity laws and postal regulations can limit our access to explicit HIV-prevention materials; regulations on male or female condoms can increase their cost or make them unavailable to us; failure to halt unemployment and discrimination in housing can render testing and counseling programs ineffective because people are too occupied with daily concerns to think about health care; and laws prohibiting possession of needles and syringes or limiting their distribution can actually increase needle sharing. In addition, girls and women are sometimes partly or entirely left out of education programs and research on prevention methods and treatment of sexually transmissible diseases. This neglect encourages us to compromise our health in love relationships.

Where Education Fails

Most of us have never had basic sex education that includes explicit information about how sexually transmissible organisms live and spread and what specific actions women can take to prevent their transmission. Left on our own, many of us underestimate the risks of unprotected sex, are unskilled in using barrier methods, and are shy about insisting that a partner use condoms. We need information and encouragement in order to help ourselves and educate our children. Yet only 15 percent of all school districts in the United States offer comprehensive health education programs, with even fewer providing education on HIV disease.93 For teens, this lack of information through schools is particularly deplorable since they are highly vulnerable to infection and seem most open to learning about safer sex.

An accurate description of how sexually transmissible diseases spread and how to prevent them requires very explicit talk about sex and drugs. To avoid controversy, much instruction on sex-related disease prevention is so vague or mechanical that it is not helpful. For instance, for many years educational material taught that people should avoid their partners' "body fluids" to prevent the spread of HIV. As a result, many people became afraid of touching others since it was not clear from the term "body fluids" that sweat, tears, and saliva are harmless.

Curricula designed to teach about sexually transmissible diseases reveal ambivalence about explicit discussions of sex. Some schools still teach their students that abstinence until marriage is the only way to avoid pregnancy and disease. Some school systems do offer explicit material such as how to use a condom properly and how to clean needles, but not necessarily at ages early enough to prevent disease. New York City, for example, was forced by some parents to avoid these topics until seventh grade. This does nothing to help those fifth and sixth grade girls who become pregnant or infected. New Haven, Connecticut, was the first school system to make condoms available to children as early as the fifth grade. The school board acted after a survey found that almost 30 percent of sixth graders and half of eighth graders claimed to be sexually active.94

At times, the federal government has colluded with those who wish to keep us ignorant about how to prevent the spread of HIV. In contrast, since 1986, Switzerland has conducted a public education campaign aimed at men. Over a three-year period, condom use among a representative sample increased from 8 to 48 percent in the 27 to 30 age group. In older men, condom use stayed about the same.95 Finland mails every 16-year-old a latex condom and a glossy graphic brochure on how to have safer sex.96

Much existing educational material in the United States is useless. It relays a simple "use a condom" message, without any alternatives, ignoring the possibility that a woman may not have any choice about whether her partner uses a condom or not. Some educational material ignores social contexts, even though white women in their late teens at an elite college have different concerns from those of inner-city Hispanic women of the same age group. Neither group is likely to be able to take effective action if its concerns are not addressed.

Researchers generally regard drug users, teenagers, and sex workers as unable to carry out instructions for their medical care. With the right approach, however, community outreach can be effective. In Colorado Springs, a program to dispense safer sex information and condoms, along with screening and counseling for sex workers and their clients, reduced gonorrhea 16 percent over three years.97 After educational efforts in Rhode Island, researchers found that women drug users were more likely to request HIV antibody testing even if they had no symptoms of HIV infection, thus showing that they were willing and able to take action on behalf of their health. In one urban high school, after two years of safer sex education and condom availability, condom use increased 43 percent among sexually active students. And about half of the students were sexually active, both before and after the study.98

Television and radio are today's most powerful messengers, especially for teenagers, who spend an average of 23 hours each week watching television or listening to the radio.100 Yet most sexually explicit television and radio stories do not mention birth control or sex-related disease prevention. But these media do have the potential to change attitudes about healthful behavior. For example, through public service announcements and popular TV situation comedies, the Harvard Alcohol Project promotes the concept of a designated driver. The same could be done for sexually transmissible disease prevention.

For a couple of years I had a lot of pain, and a lot of fevers, but I was dragging myself around because no one could find anything. My husband and I had been to marital counseling because I had painful intercourse. What was wrong with me? Then I went to a doctor in Boston who did a test that showed that I had a bacterial infection. And he said. "Both you and your husband have to be treated because these bacteria can get into a man's prostate and infect him later." And I said, "Wait a minute! You're treating me and my husband -- what is this?" Suddenly I had a different handle on what was happening to me: that I had something we both needed to be treated for.

My first sign of PID was itching and a urinary tract infection. I was a college student at the time, and someone there told me that I had a sexually transmitted infection. I went to the college health service. They did not give me a pelvic exam; they did not give me antibiotics. I was given some kind of powder that I was supposed to insert into my vagina, and I was put in the infirmary with ice bags between my legs. It sounds like the dark ages! I finally went to a doctor outside of college, who said. "You are sick'" and gave me antibiotics. I think I probably had gonorrhea. I had pelvic pain and fever, chills, fever chills -- it was a pretty classic case of PID, but I didn't know this until seven years later.

A lot of kids who come [to the high school teen health center] are incredibly embarrassed to even ask for condoms... I wish it would be easier for them. They have fears even to admit to themselves that they are sexually active, so to admit it to an adult ... I'm scared they are not safe because of that fear.99

Bias in Prevention Research

Over the years, very few organizations have voiced serious concerns about preventing the spread of sexually transmissible diseases. When they do, their efforts often focus on protecting men from infection; women are left without crucial techniques to make prevention easier. The lack of interest in developing prevention methods for women to use seems to imply that sex-related diseases in women are not as important as they are in men.

For example, prevention techniques have focused primarily on the only method under men's control: the male condom. Though a male condom theoretically offers the best protection, woman-controlled methods are likely to be more effective in actual use because women can be sure they are used each time. For example, one study showed that women who used either the diaphragm or the contraceptive sponge were less likely to contract gonorrhea, chlamydia, and trichomoniasis than those who used male condoms.101

Another serious problem is bias on contraceptive labeling. The Food and Drug Administration allows condom packages to state that the product is useful in preventing the spread of sexually transmitted diseases, even though testing outside of laboratories is limited. Research has also indicated that spermicides can be useful in pre- venting the spread of disease, yet spermicide labels cannot include any claims about preventing sexually transmissible diseases. Such information could be lifesaving.

Institutions that promote birth control are usually separate from those promoting prevention of sexually transmissible diseases. These institutions have often worked without much interaction, developing separate rather than overlapping goals, and ultimately retarding disease prevention. For years, research has focused on birth control methods that do not protect against diseases. That is, since the 1950s, contraceptive researchers have focused on hormonal methods and IUDs for women instead of developing and improving physical and chemical barrier methods. At times, this neglect has had a class, racial, or ethnic bias: Some of those who control money for research, education, and distribution of methods are more concerned about achieving demographic goals than about women's health.102

Another consequence of neglecting barrier methods is that only the reproductive aspects of sex (penile-vaginal intercourse) are emphasized. As a result, heterosexual couples whose sexual practices include anal or oral sex often do not realize that these activities can also spread disease. In addition, when we use high-technology contraceptive methods such as implants and injections, we do not learn about our sexual and reproductive organs, as we tend to when using barrier methods.

There is a desperate need for more and improved barrier methods since the few methods now available are not satisfactory for all. The Contraceptive Research and Development Project has begun investigating the acceptability of the female condom; studying a variety of spermicidal compounds that might also kill HIV; investigating the effects of the birth control pill on HIV transmission; and studying the negative effects on the immune system of the contraceptive vaccines under development -- all socially responsible projects.

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