Friday, November 28, 2008


All Supreme Court decisions aside I am loathed to use the above word. I hate it. I think it is vulgar and repulsive. Yet recently I find it popping into my mind with uncomfortable frequency. When does this happen? Let me give you an example.

Mikaela, the barely twenty year old mother whose baby I delivered in her final year of high school was in my office recently. Her live in boyfriend of the past two months came with her to the appointment. I am always a bit curious when a sexual partner comes with the patient to a gynecologic visit but over the years I have become increasingly comfortable talking with couples regardless of race, gender or their choice of sexual practices

Today the subject is a vaginal discharge. This particular patient has had a positive cervical culture for chlamydia twice since she has been under my care. The first time was at her initial prenatal exam in her pregnancy. She was then eighteen and she came to that visit alone. I asked her to bring her boyfriend with her to the next visit. Just as I had explained to Mikaela, I told that boyfriend chlamydia was a sexually transmitted disease. That it could cause a serious pelvic infection in her and blind their baby. It could even cause an infection in his reproductive system that could result in a great deal of pain and render him sterile. I instructed the two of them, just as I had instructed her when she was alone, that they were not to have sex again until they were sure that he too was free of this disease and that it was always best for him to use a condom to prevent the trasmission of this and other sexually transmitted diseases.

At this point the boyfriend seemed repentant, admitting that he had sexual relations with someone else and that he almost never used condoms. They were expensive. I gave him a hand full from a box that I keep in my samples closet. He also promised to go straight to the health department for treatment and screening for other sexually transmitted diseases, just as Mikaela had done in my office.

That was the first scenario with Mikaela. It was repeated six months after her baby was born when she had moved back home with her mother, who was now caring for the baby so she could work and go to school part-time. She and one of her college classmates began dating and she again contracted chlamydia. During her pregnancy and following it, I had several documented discussions with Mikaela about both contraception and prevention of sexually transmitted diseases.

As, I said, those occasions were two sexual partners ago and I recognized this man as someone new and I had introduced myself as I came into the room. Following the exam and genital cultures for bacteria, I again began to write out a prescription for the appropriate antibiotics, asking this new man if he was having any symptoms. When he answered, very politely I might add, "No ma'am!" I again explained the need for protection from sexually transmitted diseases as well as pregnancy.

Mikaela got an inquisitive look on her face as she said, "Now what did you say caused problem again?" Only the extreme patience I have developed over many years of practicing medicine and parenting kept me from replying, "F**king!"
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