A sharing by Angela Tan Qiuli
We learn to take sexual history at the time we learn to take the history of presenting complaint, past medical and surgical history, social history, travel history, etc. Yet over time, when life and busyness get in the way, we tend to drop exploring whatever is not on the surface, and sometimes sexual history is the first to be dropped.
The Morning After
M was twenty-six. She had registered her marriage six months ago to K, and they had set up home in their apartment. However, they had not gone through the traditional wedding rites, and their tea ceremony was not due for another six months.
M attended because the condom had torn the night before. The last thing she and K wanted was the thought of a pregnancy before the tea ceremony. Because of this she had spent an agitated, sleepless night.
She had regular cycles and her next period was due in a week. Despite understanding that her chance of conceiving was low, it was difficult for M to stop worrying, and she wanted the morning after pill as insurance.
Commentary
Sex matters are a topic for whispering about rather than for open discussion.
With sexually transmitted diseases, an understandable stigma contributes to a taboo situation, where concerns about discovery are compounded by guilt and other anxieties.
Apart from the fear of catching infections, pre-marital and extra-marital sex may also carry its own other burden. The drawing depicts a couple who enjoyed themselves the previous night but are now on tenterhooks about a potential unintended pregnancy.
Even within the boundaries of traditional, sanctioned relationships, there may be social expectations and norms that affect how people feel. In the accompanying vignette, the couple is married in the eyes of the law but do not feel married in the eyes of their ancestors yet.
A side consequence of these apparently illicit activities is that the family doctor is asked for the remediation to their indiscretions. In some cases, these requests are made “by the way”, wrapped up in some other more respectable reason for encounter.
——- Dr Angela Tan Qiuli
Dr Angela Tan Qiuli works with geriatric and palliative patients in the community. She is certified in sexual medicine and is also an intimacy coach in private practice. She teaches medical students and has a special interest in human dynamics.
The commentary and vignette were reproduced with permission from the book “Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore. Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.
