Doctors Are Failing Single Women With STIs in This Country

“The nurses and attendants made jokes about the way my labia looked and the number of sexual partners I must have had.”

Amna remembers how her legs started trembling when her doctor asked her the question she had been dreading. “Are you sexually active?”

When she responded with a “yes,” she noticed a visible change in her gynecologist’s demeanor. A hardened, aloof stare appeared where moments before a cordial smile had been. Earlier, Amna had disclosed to her doctor that she was unmarried.

Amna had sought out treatment for a suspected case of gonorrhea. Fearing her family would find out, she had secretly traveled to a nearby government hospital in Pakistan’s Rawalpindi city. 

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The 22-year-old’s name, like those of other patients cited in this article, has been changed because they requested anonymity given the sensitivity of the matter. 

She is still traumatized by what happened next during that physical examination. “The nurses and attendants made jokes about the way my labia looked and the number of sexual partners I must have had,” Amna told VICE World News.

“I felt so guilty and ashamed for having to seek treatment in the first place. Because of this I believed that I had no right to say anything back to them,” said Amna. “The gynecologist didn’t stop or discourage them either. She seemed amused by what they said.” 

Amna isn’t alone. In Pakistan, unmarried women seeking screening and treatment for STIs routinely face discrimination, neglect and sexual shaming in medical settings. Experts say that conservative and moral judgements largely inform the attitudes, policies and nature of services provided by sexual and reproductive healthcare practitioners. This results in many unmarried women with STIs falling through the cracks of receiving essential healthcare. 

In Pakistan, premarital sex is a crime that can be punishable with five years in prison and a fine. This law is haphazardly enforced, disproportionately targeting women from low income backgrounds. In the past, it has even been used against rape survivors, who up until last year were subjected to two-finger virginity tests. In popular culture, myths surrounding female virginity are closely tied to notions of familial reputation and honor. Premarital sex is highly taboo in the country, and women who engage in it are labelled as immoral and promiscuous.

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In this environment, cultural stigmas inhibiting open dialogues about sex have led to an overwhelming vaccum of sexual and reproductive health education. 

“From my research I've seen that about 80 percent of young adults are not really aware of STIs. This is partly attributable to the lack of sexual and reproductive health programs in our country, but also because there’s so much stigma around sexual health and nobody really wants to talk about it,” biomedical researcher and population health expert Saher A. Khan told VICE World News. 

In a recent study, which assessed STI awareness among 150 women of reproductive age in Rawalpindi city, researchers found that 58 percent of women had insufficient knowledge about STIs. It also revealed that one-third of all respondents had an STI but only 19 women had knowledge about the disease they had. 

For unmarried women, the burden of silence can be particularly damaging. Lack of awareness around sex and STDs prevent many from seeking sexual and reproductive health services. This is compounded by costly testing, mobility restrictions, and fears of being outed to families and communities. If left untreated, women face an increased risk of worsening infections, fertility problems and cervical cancer.

Internalized shame also factors in as a major hindrance in unmarried women seeking treatment for STIs. “There’s this moral burden that you carry, that you are doing something wrong or that you are bringing shame to your entire family,” Aisha Ijaz, program director at sexual health and reproductive rights nonprofit Aahung, told VICE World News.

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For women in rural areas, anxieties surrounding doctor-patient confidentiality are an added stressor. “Everyone knows everyone in smaller communities, so there's a high likelihood that the healthcare provider knows which family she's from. That anonymity might not be there as much as we find it in a bigger city,” said Ijaz. 

Women protesting for their rights at the Aurat March in Karachi on March 8, 2022. Photo: Asif HASSAN / AFP

Those who ultimately do end up setting foot in clinics are often confronted with hostile judgements or outright neglect. In many healthcare settings, physical examinations of unmarried women are not conducted at all. 

“The underlying assumption is that if you’re unmarried then you are not engaging in any kind of sexual activity so you dont need these services,” said Ijaz.

“Or it is a very judgemental approach where they make the person feel shame or guilt about whatever services they are coming in for.”

As was the case for Anushay, 32, who was recently diagnosed and treated for chlamydia at a private facility in the city of Peshawar.

“The doctor kept making disgusted faces while examining me. When I would ask her questions regarding my illness she would not even look at me directly or answer my questions properly,” Anushey told VICE World News.

“When I was about to leave, the attendant whispered in my ear in what was supposed to be a ‘well-intentioned’ comment. She told me to ask God for forgiveness.”

In her work with unmarried female clients with comorbid diagnoses of HIV and STIs, sex therapist Tahira Rubab has heard regular reports of verbal abuse and refusals by doctors to treat patients. 

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“They say things like, ‘Look at you now spreading your legs in front of us. You smell down there. Didn't you feel shame doing this to yourself in the first place?’” Rubab told VICE World News. 

For other patients, brief consultation periods with doctors overburdened and pressed for time result in incomplete recordings of patient histories and inaccurate diagnoses.

It took Myrah, 28, two years, two gynecologists and three dermatologists to be provided with an accurate diagnosis of genital warts. The Islamabad resident suspects that the delays were largely in part to an initial diagnosis during a short and cursory consultation.

“With the first diagnosis, maybe the doctor thought that because I'm unmarried she didn't need to consider an STI as a possibility,” Myrah told VICE World News. The inaccurate diagnosis was readily accepted by doctors she met with afterwards due to persisting symptoms. Finally with a proper physical examination and in-depth recording of her clinical history, a dermatologist eventually diagnosed and provided her with the right treatment.

Ultimately, experts believe that the solution to flawed sexual and reproductive healthcare services for unmarried women lies in the introduction of comprehensive sex education. 

“We need more programs in schools. We need parents to understand why it's important for young people to have this information,” said Aahung’s program director Ijaz.

“At the same time, we need to continuously work with the healthcare system to really build the capacity of providers and really bring in the aspect of quality back into the services they are giving.”

Follow Rimal Farrukh on Twitter.

Tagged:

Sex, sti, Πακιστάν, women health, south asia, worldnews

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