SPEZIELLE GRUPPE

“Our sexuality affects everything we do, and everything affects our sexuality. The same is true of our spirituality -that which is most deeply meaningful to us. We can deny both. But denying them does not mean they are not both alive in every breath and heartbeat of life.”

Tina Schermer Sellers, Sex, God, and the Conservative Church: Erasing Shame from Sexual Intimacy 

A couple of years ago while on a nightshift a middle-aged woman dashed through the ER door screaming that her daughter had been raped. My colleague and I quickly rushed to the vehicle on the driveway and tried to assist the daughter out of the vehicle. We managed to do so and got her to the examination couch. I was so confused about it all. It was still very unclear on exactly what I should do but my colleague had more experience in handling such delicate cases and guided me through it. We tried to make her as comfortable as possible but upon examination, things suddenly were not adding up. Something was just off. The more we conducted our assessment the more my intuition kept telling me that something was amiss. To keep both parties calm I said nothing and when all samples were collected the treatment process was initiated. A few days later when the police got actively involved new information was disclosed. There was no rape ordeal that had happened but rather she had learned she was pregnant a few weeks prior and had informed her boyfriend who denied impregnating her. Without having appropriate information she had assumed that if she reported being raped. The emergency treatment would terminate her pregnancy without her parents' knowledge. She didn't have full knowledge of what really goes on. At the time she was only 18 years old and had just started campus.

One Saturday while in triage there developed sudden flooding of a foul smell. As I tried to identify the source a young lady walked in. She appeared to be in significant pain but she didn't wish to fully divulge information yet. On enquiring further about her last menstrual cycle she dismissed it as they tend to be irregular and had no recollection of the date. Her presenting complaints were diarrhea and mild abdominal pain. On physical examination she was pyrexic at 38.50Cand tachycardic at 122beats per minute her skin appeared flushed. While in the doctors' room further examination revealed she had had a septic abortion which had resulted in retained products of conception and the infection was so bad that it had created a vesicovaginal fistula hence the foul smell, her cervix was injured and the infection had infiltrated and obstructed her fallopian tubes. The attending gynecologist informed her that future conception was not fully guaranteed if she did not get properly treated. She had no insurance and she wasn't ready for full disclosure to her family. She denied ever being pregnant to her father who had come to check up on her when she informed him she is in hospital. He paid only for what was done in the ER and requested a transfer to a different facility. She was only twenty years old.

These two examples are our sisters, daughters, friends, and grandchildren so if we say sexuality doesn't affect us we kid ourselves. It can be as simple as our reproductive health affecting our generalized physical health. For instance, if a young man develops an STI which is untreated and developed late-stage symptoms of syphilis later on in life. He will be quickly diagnosed as psychotic without it being quickly linked to the late-stage presentation of syphilis.  The reason it can be untreated for so long is because whenever he experiences symptoms he cannot phantom visiting a health facility to be mocked by the attending caregiver. Adolescents and young adults are a sensitive age group.

Did you know that in 2017 the MOHkenya had obtained data that showed that "one in five girls began having children by the age of 19 years and only about 2% of teenage mothers finally go back to school?" You can view it here, Kenya demographics and health survey It actually gets worse when the current ongoing pandemic started most health facilities shut down elective services and this then meant most ladies in the reproductive age group couldn't access these essential health services. For facilities that offered them, it was proving to be a costly affair as most people had lost their source of income. The ramification of this has started to be seen. It is projected that "in low and middle-income countries(LMICs) due to reduced access there will result in an additional 49 million women with an unmet need for modern contraceptives and an additional 15 million unintended pregnancies over a year."For a greater understanding view this Estimates of the potential impacts. These numbers are further expedited by transactional sex and lack of family support to fully comprehend what this is view this article here transactional sex among university students.

Examination of different studies show that huge figures later translate to 

• The continuation of the poverty cycle.
• Increased maternal deaths especially among teenage mothers whom physiologically are predisposed to more birth-related complications.
• Increased cases of gender-based violence as women are forced to stay in forced marriages.
• Increased malnutrition rates among the children.

 To try to mitigate this we should participate in it. How?

1. Make discussions on sexual matters a norm. For example, nurses can consider other models to conduct health assessment for example the use of Gordon's functional health patterns while assessing patients. This offers a concise assessment of your patient. Here is a very summarised version of this Gordon FHP summary.

2. As a health care provider, it is key to be self-aware. This will help you identify personal biases based on what you believe. This is key in avoiding the projection of personal feelings and perceptions to the patient. Our role is to guide toward the promotion of health not to coerce. Please review my previous blogpost on cultural competence.

3. Pay more attention to disease prevention and health promotion. We should take all lessons learned from this current pandemic and incorporate them in all avenues.

4. Actively work towards the provision of adolescent and youth-friendly services. How conducive is your health facility/institution to an 18year old student who is seeking treatment for an STI? View this video to see what such services mean and incorporate understanding youth-friendly services.

As we continue promoting healths lets not act as if sexual health is a very separate entity. When one digs dipper one realizes just how big a role it plays in all aspects of our lives. In our daily interaction with our patients' let us keep in mind that, "Sexual health is more than freedom from sexual disease or disorders. Sexual health is non-exploitive and respectful of self and others. Sexual health is dependent upon an individual's well-being and sense of self-esteem. Sexual health requires trust, honesty, and communication."

Eli Coleman, Ph.D., Director, Program in Human Sexuality,

University of Minnesota Medical School