Diversity in sexual health: Problems and dilemmas

Abstract

A B S T R A C TThe increase in migrant populations in western Europe has led to specific problems and dilemmas in the area of sexual and reproductive health and service provision. In general, these problems and dilemmas can be divided into four categories: (1) epidemiology of diseases and risk factors; (2) psychosocial and cultural aspects; (3) communication; and (4) moral and ethical dilemmas.Regarding epidemiology, there is an increased prevalence in migrant groups of unwanted pregnancy and abortion, HIV/STDs, and sexual violence. Effective contraceptive use is hampered by knowledge deficits, uncertain living conditions, ambivalence regarding the use of contraceptives, and problems accessing (information on) contraception. 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. Problems in communication concern not only 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 lower quality of care. Moral and ethical dilemmas arise where cultures collide, for example regarding sexuality education and virginity problems. Two examples of practical situations in which migrant patients ask for help with sexual or reproductive health problems will be described.

Knowledge and Practices About Sexual and Reproductive Health in University Students

“…Tangmunkongvorakul et al [2] found similar results. Rademakers et al [23] stated that intercourse among Muslim young people were not appreciated before marriage, but men were tolerated more than girls. In a study about health staff's views related to adolescences' sexuality and abortion by Klingberg-Allvin et al [24], it was found out that midwives suggested that sexuality before marriage should be forbidden, however; doctors said that sexuality was a part of normal development, but it should still be delayed.…”

The Determination of Health School Students' Knowledge, Attitudes and Behaviors on the Matter of Sexual Health in Eastern Turkey

“…In Turkey friends and written and visual materials are more common among the sources of information of university students on the matter of sexuality (2)(3)(4)(5)(6)(7)(8). Studies show that as socio-economic level increases, the preferred sources of information change and written and visual materials (newspaper, magazines, and internet) is used more (17).…”

“…According to Çok et al (6) in general, premarital sexual intercourse for men is tolerated in Turkey, whereas women are expected to have no sexual experience before marriage. Rademakers et al (7) stated that this dilemma about virginity caused young Muslim girls to have virginity certificates or even hymen reconstruction. Sexuality is still seen as a taboo in Turkey and that is why sexual education, services and research are limited.…”

Reduction of Health-Related Risks Among Female Commercial Sex Workers: Learning From Their Life and Working Experiences

“…However, there were geographical differences in the behavioural changes, with the northern part of the country showing a smaller degree of change than other regions (Agha et al, 2001). Among migrants with different cultural backgrounds, not only language but also communication styles represent barriers to the negotiation of safer sex practices (Rademakers et al, 2005). The value of understanding local context and considering geographical differences was suggested in the management of programmes for commercial sex workers (Tuan et al, 2007).…”