My professional life as an obstetrician and gynaecologist enables me to engage with the choices that women and men make in their sexual lives. These choices often become known to me in my professional interactions.
During what for many people is a joyous period, sometimes couples face dilemmas during the antenatal stage. The question of whether the foetus is male or female is often the first question that is asked by them. In countries where it is allowed by law to disclose the sex of the foetus, the answer can devastate or bring great joy to the couple. It is usually not consequential if this is the first pregnancy, but when the couple has had previous children of the same sex, the reaction can be quite different.
The female child still faces discrimination right from the beginning of life, and it is the duty of obstetricians to constantly educate their patients that every child is a precious child who can bring joy, fulfilment and love to the family unit. Obstetricians may face pressures about undertaking termination of pregnancy due to the sex of the foetus, but they must always act within the boundaries of the laws of the country and purely on medical grounds.
Recent advances in reproductive technology and genetic testing have brought the realms of designer babies and manipulation of the genetic code closer to reality. Doctors are now on a slippery slope with some of these questions of whether to use cutting edge technologies of genetic engineering and manipulation. Click To Tweet Ethical uprightness on the part of doctors is required so that they do not undertake such procedures other than with regulatory sanction and oversight as well as on medical grounds rather than because of choices like sex, colour of hair and eyes and other physical characteristics.
Why do we need to discuss these issues when we discuss sexuality? Only a female-bodied person can become pregnant and carry the pregnancy through to term before delivery. Choices have to be made even before conception. Sometimes complications occur and the pregnancy may be spontaneously aborted or delivered prematurely. Very importantly, the role of the male partner (or sperm donor) must not be forgotten in this process as without the male gamete that fertilises the female ovum, whether naturally or artificially through assisted conception, pregnancy cannot occur. Therefore, both women and men have responsibilities. Sex is more than a physical act of desire and brings added responsibilities and decisions when it results in pregnancy. Even the use of contraception to prevent undesired pregnancies must be a responsible decision taken by both partners.
While at a physiological level, sexual arousal is a response to internal and external stimuli and is mediated by both the central and peripheral nervous systems, factors like cultural influences, the status of women in society, religious edicts and personal choices all make sexuality a highly debated topic although it should be a purely personal choice. Factors of upbringing and parental guidance do play an important role in influencing sexuality.
Can one have no sexuality? Sexuality is an intrinsic part of all people, including people who may identify themselves as asexual. “Chastity – the most unnatural of all the sexual perversions” said Aldous Huxley in his novel Eyeless in Gaza. Even the shape and size of women’s bodies have become associated with sexuality. Naomi Wolf said “to ask women to become unnaturally thin is to ask them to relinquish their sexuality” in The Beauty Myth.
In a study on women undergoing abortions, it was noted that the majority of respondents had poor knowledge of sexual and reproductive health, inadequate contraceptive information and did not know about the complications of abortion.Lack of knowledge of sexuality issues is a recurring theme, and healthcare providers .are themselves not immune to it. Sexuality topics should not be whispered about, but need to be critically discussed with respect for individual choices uppermost in everyone’s minds.
It cannot be denied that laws and regulations are required in every country to create a sense of orderliness and conformance to the norms of behaviour and societal interaction. However, sexuality is a deeply personal choice. It should not be dictated to by the state.
“Woman’s degradation is in man’s idea of his sexual rights. Our religion, laws, customs are all founded on the belief that woman was made for man,” said Elizabeth Cady Stanton. I believe that is the root cause of many of the dilemmas around sexuality in the world. There has to be a realisation that both men and women are equal in every sense of the word, especially in sexual matters.
Human beings cannot run away with not having sexual thoughts. Choices in the sexual area should remain personal while maintaining the dignity and the rights of all people who must be able to make fully informed choices in this area. It is the duty of the state to provide the education and information to its people in this area but not intrude into their personal choices.
In summary, with regards to sexuality and choice, one should Avoid (A) shortcuts (be fully informed), Behave (B) with dignity, Communicate (C) well, Document (D) best practices and practice Equality (E). In my case, my choices were as simple as A to E!
Reproductive rights and choice: Insights from women on pregnancy termination. Wah-Yun Low, Yut-Lin Wong, Sim-Poey Choong, Ravindran Jegasothy, Wen-Ting Tong. In: Issues of Safe Abortions in Malaysia – Reproductive Rights and Choice. Wah Yun Low, Wen Ting Tong, Veenah Gunasegaran (eds) 2013: 97-187. Publishers: UNFPA, University of Malaya, World Health Organisation.
Study of medical doctors’ knowledge, attitude and willingness to provide abortion related services as a reproductive right of women. Mary Soo-Lee Huang, Ravindran Jegasothy, Shiang-Cheng Lim. In: Issues of Safe Abortions in Malaysia – Reproductive Rights and Choice. Wah Yun Low, Wen Ting Tong, Veenah Gunasegaran (eds) 2013: 59-94. Publishers: UNFPA, University of Malaya, World Health Organisation.