Women and sexuality
Dr. Sumithra Tissera M.B.B.S (Colombo), Dip. in Health Development (Colombo) Family Planning Association of Sri Lanka
Working as a Medical Officer at the Family Planning Association Sri Lanka (FPASL), for the last 5 years we have observed an increasing trend among the population as a whole regarding problems related to human sexuality.
The reasons for this have not been investigated, nor documented. Some contributory factors can be experimentation about sex at the adolescent age, stressful life styles and no proper communication among adult couples about their sexual needs, and even less knowledge on the reproductive system and sexuality.
These problems can be broadly categorised as physical, psychological and socio-cultural, and are prevalent among both the sexes.
My focus will be mainly on the females, who could be the adolescent, the young adult female and the middle age to the menopausal woman. The problems they face depend primarily on their age (but some can overlap).
The main problems that face females can be categorised as:
- Virginity issue and problems related to the hymen.
- Vaginismus / Dyspareunia
- Orgasmic problems.
- Pre-marital & casual sex and its implications.
Though concerned persons have often discussed this issue it still remains a problem in our society. A lot of young females have to go through this ordeal and trauma after marriage to prove their innocence. This is a very awkward situation for the girls, and sometimes even for their partner.
A Virgin is not someone who bleeds at the first time of sexual intercourse, but a female who has never had sexual intimacy with a male.
It should be said here, that it is very unfair for only the female to prove her innocence, when the males get away with having had sexual intercourse pre-maritally without any after effects, as there is no way to show their innocence. If this double standard does not exist I do not think that “proving of the females innocence” would be much of a problem.
Hymen is a thin tissue membrane that covers the opening of the vagina. The perforation allows the blood to pass out during and after puberty. It is not a functional organ. The hymen can vary in size, shape and thickness.
Usually doctors may not be able to decide if a female is a virgin by doing a pelvic examination alone. (but sometimes can tell if penetration happened recently by examining within 12-24 hours of the incident).
The hymen can be stretched or damaged by exercise, inserting fingers or objects. Also some females are born with a partial hymen or no hymen at all, and sometimes it may be that it has stretched without causing any bleeding. Therefore, the presence or the absence of a hymen is not a correct tool to assess their prior sexual behaviour.
A condition in which the pelvic musculature surrounding the vagina involuntarily spasms in response to any form of penetration, thus making it difficult or impossible to penetrate. This is mainly seen in females who are having sexual intercourse for the first time.
Primary : May be due to absent hymen, tight hymen. But almost always due to fears and anxiety on penetration.
Secondary: Due to painful vaginal lesions.
Is pain during sexual intercourse. This can happen at any stage of life. Can be due to several reasons such as emotional reasons, vaginal infections, Pelvic Inflammatory Disease, Endometriosis, Painful Vaginal lesions, Epsiotomy scar after child birth. This may also inhibit arousal.
When effective stimulation continues, a point may be reached where the body discharges its collected sexual tension in a peak of sexual arousal called “orgasm.” But about 10% of women never experience any form of such arousal in their life time. One third of the rest reach orgasm in most acts of sexual intercourse and most of the rest will respond to other forms of stimulation (clitoral or breast). Therefore, you should not think of this as an illness even if you have not experienced this in your life time. The most important part is to make the partner happy and build a strong marriage /relationship. But there are some instances which are purely psychological and they can be corrected if proper professional help is sought early.
Pre Marital Sex
Is experiencing sexual activity before marriage. This can end in sexual intercourse or other forms of stimulation. Though this may not have been observed in the past, it is now commonly seen among the young adults. This can be due to the change in the socio-cultural scene that has occurred during the past few years, mainly due to the popularity of the Western and Indian films and teledramas which promote these life styles as normal behaviour.
Having or not having pre marital sex would be the individual’s choice, but they should be educated in the implications of these alliances such as (a) sexually transmitted diseases (STD) (b) unwanted pregnancies ( c) psychological trauma following break-ups and (d) contraception use.
A very crucial factor in such behaviour would be the reliability of your partner, particularly the male. A lot of young females have got into trouble in not paying enough attention, or taking preventive measures in respect of these issues.
Therefore, the children should be educated by suitable persons about these issues, before they get into trouble.
Having sexual contact with a person whom you have met once or casually. The main problem with this is that after such behaviour they are worried about their STD/HIV status. This is mostly seen among males but is on the rise among females too. But one should always stick to one partner than having multiple partners, as this can also be a strong risk factor for cervical cancer.
At the FPASL, we counsel those persons who seek advice on their individual problems. This is done by doctors, both males and females, and later referred to trained counsellors (psychologists) at the Youth Counselling Centre, in the same venue.
The biggest problem we face is that many of these individuals have taken treatment, when most really have psychological problems. In Sri Lanka we lack qualified and trained sexual therapists or counsellors. As this problem is on the rise the government should look into this matter at a greater depth.