Do unmarried women in India feel judged and ashamed when visiting gynaecologists?

"I have had a 24-year-old patient who was judged by her previous gynaecologist for having premarital sex and was asked to call her mother into the room and describe her concerns. This patient was also refused contraceptives as she was told it was unnecessary before marriage. Incidents like these only make me realise how being judgmental comes so easily to even experts in our society," reveals Dr Divya Vora, obstetrician and gynaecologist.

Similarly, when asked if he too has come across a patient who was judged by a gynaecologist for being sexually active, Dr Rohan Palshetkar, head of unit Bloom IVF, professor at Dept of OBGY, D.Y. Patil School of Medicine says, "Unfortunately I have." The doctor chose not to share any more details for privacy reasons.

This is not to say that all the gynaecologists in the country have an orthodox mindset. To dive deep into this subject, Mid-day Online conversed with Vora and Palshetkar who shared relevant details and provided solutions to unmarried women for proper guidance and treatment.

Do unmarried women, especially those sexually active, fear visiting gynaecologists?

Vora: Absolutely. Our society is still very unaccepting of women being sexually active before marriage. Unfortunately, a lot of gynaecologists tend to have that mindset too. It is something that needs to be part of our medical curriculum - to be non-judgmental and be able to have open, progressive, and appropriate conversations about sex.

Palshetkar: To be honest it varies from area to area. When we are looking at the metro cities, it isn't a major issue. The majority of women residing in metro cities won't be concerned about their sexual status. Few might get worried and may even withhold the information if they are going to their gynaecologist for a regular check-up. However, if you do have any problems, it is important to be clear. We are there to help you and there will not be a judgement from our end. Sexual health and reproductive rights should be upheld and treated without judgement.

Does being judged negatively impact patients' overall well-being?

Vora: One bad experience with a gynaecologist can lead to fear in the patient to visit any gynaecologist even in the future. It can make them feel like all doctors are judgmental and insensitive. The experience can also make them feel like they did something morally incorrect. This not only leads to their inability to trust their doctor but also prevents them from seeking timely medical care when needed.

Palshetkar: Firstly, coming across a gynaecologist who is judgmental regarding the sexual health of an individual is rare. However, for those who do experience this, it can lead to breaking the trust of the patient towards the doctor. Such a patient won't divulge all the information leading to improper treatment due to lack of information.

Is there a viable solution?

Vora: Unfortunately, not even 1 per cent of our society can be called progressive considering the density of our population, especially rural. Having said that, there is a drastic improvement in this generation of doctors in terms of being able to have open, judgement-free conversations and the future looks better.

For women looking for a gynaecologist, do not go ahead with a doctor who asks your parent to be in the room, judges/scowls at you for being sexually active, makes you feel uncomfortable with their statements/expressions, denies treatment based on their cultural beliefs, and makes you feel guilty/impure. Don't go to your mother's/aunt's gynaecologist if it makes you uncomfortable. Ask around, do your research, and then pick a gynaecologist you can trust and be open with.

For me, the question I directly ask is ‘Are you sexually active?' When the marital status is not addressed, it makes my patient believe that it does not matter, and very honestly, it does not. It's very important to make the patient feel like they can share anything and everything with you without having to lie/hesitate. We need to understand that we deal with the most intimate concerns, and the only way to approach them is by being understanding, judgment-free, empathetic, and most importantly, confidential.

Palshetkar: I think times are changing where we can even talk about sex before marriage. I think the time will come when there probably won't be any judgement. We must accept everyone's individual decisions even if they don't match our line of thinking. Whether patients come for a regular check-up or they seek an abortion, it isn't our place to judge their actions. It is important to be objective and ensure they get the best line of treatment. We can advise them of options but not enforce them.

In my opinion, there isn't a right or wrong way to pick the doctor. Maybe you can consider going to their Google page or website, understand their speciality and then figure it out. Sometimes even after doing that you may meet doctors who may not suit your needs but they will refer you to someone who will help treat your conditions.

What societal changes are necessary to ensure women have easy access to sexual health-related medical assistance?

Vora: It's simple. By not talking about marriage at all! Why should someone's sexual activity be associated with being married? By implementing comprehensive sex education in the curriculum, having safe spaces for people to be able to talk about their bodies and concerns openly, having public awareness campaigns, providing healthcare workers training regarding these matters, conducting community workshops, and providing legal protections that ensure privacy and confidentiality for anyone seeking reproductive health advice can go a long way in bringing about a positive change.

Palshetkar: I think it's important to bring about awareness about sexually transmitted infections, the right to abortions, and sexual and reproductive health rights so that society is sensitised to all situations. This will help women approach gynaecologists to get their treatment in time and ensure that they do not have any long-term effects of their ailments.

Are there any benefits of being sexually active before marriage?

Vora: Engaging in consensual sexual activity before marriage can have potential benefits. Some of them include:

Emotional connect: Sexual intimacy can deepen bonds and foster better communication between partners.

Compatibility: Exploring sexual compatibility before marriage allows couples to understand each other's needs, preferences, and desires.

Reduced anxiety: Addressing sexual concerns before marriage can alleviate anxiety and promote a healthier relationship.

Understanding one's own body: Learning about one's own and each other's bodies and sexual needs can be empowering and contribute to overall well-being.

Open communication, mutual consent, and respect are extremely important for a positive and healthy sexual relationship, regardless of marital status.

Palshetkar: There are no benefits to being sexually active before marriage, however, it isn't a liability either if you are careful about your reproductive and sexual health.

How can women advocate for themselves?

Vora: It is always best to tell a gynaecologist who becomes your moral police about how uncomfortable they made you feel. It is also completely okay to change your doctor multiple times if need be. I don't believe in public humiliation, there are more positive ways of handling a situation.

Palshetkar: I think you should not get affected and consider changing your gynaecologist to ensure you get the right treatment without any judgement.