Ashamed of my sexual past

All Woman

Dear Dr Mitchell,
I am somewhat embarrassed about the number of partners I have had, and I've never been honest about it when asked by medical practitioners. I have been safe for the most part, but I started having sex very early and now that I'm in my 40s the number just seems high. I'm also ashamed to say that I've had an abortion. Why would a doctor need to know all this anyway? How does knowledge about my past help a doctor? I've safely had four children and have never had any health problems.

The number of sexual partners that you have been with in your lifetime is important information that is usually obtained by your gynaecologist. Women who have had several sexual partners are at an increased risk for cervical cancer, pelvic inflammatory disease, infertility secondary to damaged and inflamed Fallopian tubes, chronic pelvic pain secondary to sexually transmitted infections, and cancer of the anus and throat.

Cervical cancer is caused by the human papilloma virus (HPV) and this is sexually transmitted. The earlier the age of sexual activity, coupled with several sexual contacts, the more significantly your risk increases for cervical, throat and anal cancer which are caused by HPV. Having children early in life, especially in the teenage years, also increases your risk for cervical cancer — and this is especially so if you have the pregnancies for several different partners.

Multiple sexual partners also increase your risk of contracting gonorrhoea and chlamydia, which cause inflammation of the uterus, cervix and Fallopian tubes. This results in damage to the Fallopian tubes if it is detected late or if it is incompletely treated. This can then result in an inability to become pregnant.

It is important to use condoms, both female and male, to reduce the risk of sexually transmitted diseases. Condom usage does not completely prevent the risk of transmission of the human papilloma virus, since the virus can be present in areas of the genital tract where condoms do not cover. Prevention of HPV infection by vaccination with either Cervarix or Gardasil will reduce your risk of cervical, anal and throat cancers.

The information about the number of pregnancies, including spontaneous losses and induced abortion, is important. This is even more important in a woman who is planning to become pregnant. If you have had several abortions this can damage your cervix, rendering the muscles weak and resulting in cervical incompetence. This can then result in the loss of your pregnancy after 14 weeks. Cervical incompetence can be confirmed on ultrasound and a stitch can be placed at 13-14 weeks with a good outcome

Some women who have had abortions can also have complications such as perforation of the uterus. This can result in a rupture of the uterus with a subsequent pregnancy so the doctor needs to have the complete history.

If your doctor knows that you have had several sexual partners, he will advise you to be vigilant with your Pap smears and encourage you to get vaccinated to prevent cervical, throat and anal cancer. You might be in a stable union now, but the exposure to the HPV infection could have been several years before.

As you get older, with a declining immune system, your risk for cancers caused by the human papilloma virus increases. Information obtained by your doctor is confidential and is vital so that you can be appropriately investigated and managed. This is sensitive information but is extremely important for your complete management.

Best regards.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.

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