Diversity in sexual health: problems and dilemmas
J. Rademakers (1), I. Mouthaan (2), M. de Neef (2)
School of Medical Sciences, University Medical Center Utrecht, The
Netherlands (1); Rutgers Nisso Group, Utrecht; Mouthaan & de Neef,
Breda/Amsterdam, The Netherlands (2)
The increase of migrant populations within western European societies leads
to specific problems and dilemmas in the area of sexual and reproductive health
and service provision. Specific groups differ with respect to their cultural
background, religion, migration history and present living conditions, which in
its turn impacts their sexual and reproductive status. In general, the problems
and dilemmas around sexual and reproductive health can be divided into four
categories: (1) epidemiology of diseases and risk factors in specific
populations; (2) psychosocial and cultural aspects; (3) communication; and (4)
moral and ethical dilemma’s.
Regarding epidemiology there is an increased prevalence in migrant groups of
unwanted pregnancy and abortion, HIV/STD’s, and sexual violence. Effective
contraceptive use is hampered by knowledge deficits, uncertain living conditions,
ambivalence regarding the use of contraceptives and problems accessing (information
Psychosocial and cultural aspects relate to the norms and attitudes
individuals and groups have regarding the family, social relationships,
sexuality and gender. These norms and attitudes have an impact on the sexual and
reproductive choices people make and the possibilities and restrictions they
feel in this respect. For example: virginity at marriage is crucial for Islamic
girls, but growing up in a western, sexual liberal culture makes it more
difficult to comply with this norm. This dilemma may eventually result in
requests for hymen reconstruction or ‘virginity certificates’. Another
example: both the taboo on homosexuality and gender-inequality in heterosexual
relationships may lead to more difficulty in negotiating safe sex practices.
This results in higher HIV/STD rates.
Problems in communication do not only concern language, but also
communication styles, the way patients present their problems and the
expectations they have from the service provider. Communication problems
inevitably lead to a lesser quality of care.
Moral and ethical dilemmas arise where cultures collide. Sex education in
primary and secondary education runs counter to the wishes and believes of many
Islamic parents. Can they exclude their children from it, should the boys and
the girls be divided, or should school sex education be abandoned at all?
Virginity problems are another topic where an individual gynecologist or a
department should make the ethical decision: will we perform hymen
reconstructions, thus contributing to deception and the myth of bleeding at