Image courtesy Women’s Views on News

The lady in front of me in the queue put a packet of condoms on the counter and we both could see the cashier’s eyes flicker over her left hand, obviously checking if she was married. Not seeing one, he looked at her and smirked. I watched her look at him straight in the eye and I’m sure we both almost wished he would say something. I know I wanted to give his judgmental mind a lecture he would never forget.

Watching this reminded me of a story I had been told a few years ago by a friend who was intent on spreading the word about a gynaecologist in Colombo who had put a colleague of hers through an extremely humiliating experience.

Let’s call her M. So M had gone to see this gynaecologist regarding an issue she was having and during the routine questioning at the beginning she had given her basic details – age, relationship status etc. When the time came for her to be examined he had looked at her vaginal area, after not more than 5 seconds spread her legs a little more and asked her “I thought you said you are not married?” She had been mildly puzzled and responded that she was indeed unmarried. The doctor had roughly pushed her thighs aside a little more, called the nurse (an elderly matronly individual) over to him and said “Bandala naa lu, eth ara balanna, hyman ekak naa” (She says she is unmarried, but look, no hymen).

M had said that she had felt so judged, so violated – to an extent that she had actually said being raped would have been a walk in the park compared to this mental and physical anguish. She had remained on the bed while he continued checking her issue, and said later that she wished had gathered the strength to tell him off and stop the examining then and there. He had lectured her while writing her prescription and had told her that she would find it very difficult to find a husband as she did not have a hymen. She had told him that if it meant not being married to the likes of him she would find herself extremely fortunate and walked off.

Her humiliation did not end there unfortunately – at the pharmacy while she was waiting for her medicine she had been hassled by the pharmacist (a woman) who refused to give one particular pill after she checked on M’s marital status. It was only after M had firmly said that she is well aware that the pill was not meant to be taken orally, that while she was not married she did not have a hymen and if the pharmacist had such a problem with giving this pill she would take her business elsewhere. She had subsequently been given the medicine while other people at the pharmacy had heard every word of this exchange and she left the building with several judgemental eyes on her.

Every time I remember this story I feel humiliated imagining the experience of M. I cannot imagine what she and countless others have gone through (and continue to go through) in the hands of these archaic doctors and nurses still unfortunately serving in our healthcare system.

It was appalling that the doctor never considered that she could have been married before (divorcees, widows – I wonder if he had heard of those terms?), whether she had been raped or molested, whether she had been active in sports and the possibilities can go on. But no, he functioned on two possibilities – 1) Married, no hymen. 2) Unmarried, hymen intact. He had not even bothered to check and treated his patient very badly.

What is dangerous about such conservative people working in our healthcare system (and this also includes people working in pharmacies who are as important as a doctor given the level and frequency of interaction) is that they are also unwilling to accept the changes in culture and lifestyle in Sri Lankan society – such as pre marital sex which has over the years become more and more accepted and part of the lifestyle of Sri Lankans, specifically among the young generation. One can take whatever stand they like on the issue but it needs to be recognised that Sri Lankans ARE indeed having sex and sometimes they are having sex with people who they are not married to. So behaving like a condom is a prize exclusively for married folk contributes to several issues – unwanted pregnancies, abortions, HIV/AIDS, STIs etc.

The value placed on a woman’s virginity, the growing acceptance of pre marital sex are discussions that have been taking place for years and not one I intend to get into by writing this piece. The intention of this piece is however, to speak out to the women who have had the humiliating experience at the hands of a pharmacist or a doctor – who were judged because they did not have a ring around a finger to justify the choices they wish to make with their own bodies , to those who do have a ring around their finger but still have to endure the glances of people when buying a condom or a morning after pill and also to those who have not had the misfortune of such experiences but should know that it can happen to them.

Speak up. If you have had a bad experience at the doctors – tell other women about it, tell other doctors about it, write to the management of the hospital.  If you encounter a judgemental cashier or pharmacist – don’t be ashamed. Look at them directly in the eye and challenge them. If you see another girl or woman experiencing this – show your support, speak up on behalf of them. Just as they are entitled to their opinions, you are entitled to yours. If they choose to make theirs known to you, even by smirking at you – make sure you make your opinion known to them, but never explain yourself and give reasons.

Talk about it. Why these things still happen is because any topic related to sex, reproductive organs, and contraception is treated as taboo. By talking about any incident you hear you might even enlighten some people that a hymen can be damaged in many ways. By talking about it you can prevent someone from going to dreadful doctors and instead seek out the many wonderful open minded doctors who do exist in Sri Lanka.

We cannot change the old fashioned views of people nor can we make them accept the changes in our society. Individuals speaking up will not bring about a revolutionary change among the conservative doctors, nurses, pharmacists and cashiers in Sri Lanka. However, it will in some way ensure that even one woman out there will never experience the violation M did. That even one woman out there is having safe sex because she was able to buy a condom because the cashier’s attitude did not make her leave the store without buying one. That even one woman feels like she can go to a doctor without feeling nervous and not contemplate for days about whether she will be judged.

  • DD

    I once went to this large pharmacy In Moratuwa manned largely by women to buy condoms. They just refused to understand me until they could find a male shop assistant. Then he proceeded to give me the evil eye and took me to the condoms section with disdain.
    I am in my forties and married. I wonder how a teenager would have been treated…

  • niranjan

    “archaic doctors and nurses”- Even some of the younger generation of doctors and nurses have the same opinions and attitudes as do the older generation. It has flowed down from the older generation to the younger.
    Being judgmental is a cultural problem and is not that easy to overcome in a conservative society.

  • pp

    Very timely article.

    This might be also interesting reading.

    It has an interesting premise. What if women, married or otherwise, just like having sex? Same thing can be asked of the doctors here (and maybe even this article?)

    “It was appalling that the doctor never considered that she could have been married before (divorcees, widows – I wonder if he had heard of those terms?), whether she had been raped or molested, whether she had been active in sports and the possibilities can go on.”

  • Gerard

    Well written article! I remember taking my mother to Navaloka hospital for a different kind of treatment and the way the doctor acted,was as if he was doing a “free service”. This is pathetic and everyone should stand up against such behavior, just like I told the doctor off! Totally unacceptable in medial practice!

  • Dr.Athgune

    Dear Iromi,

    I do not beleive this story. This could have happened in 60s. Not today. Most unbleivable part of this story is that the doctor called the sister to show the vagina of the patient and commented on the abscence of hymen. You should also understand that the doctors working in the private sector do not have time to engage in these kinds of pseudo-moral conversations with patients.

    As person involved with teaching medical students and being a doctors myself I do not think a doctor, especially a trained gynecologist would be worried with the absence of hymen in a unmarried woman.

    I do not say that our doctors are perfect. There are many area where doctors need to reform themselves to suit the 21st century needs of the patients. However, I do not think that our doctors, especially a trained specialst gynecologist are so out of touch with the current discourse of patients’ rights.

    Please do not write articles based on these kinds of anecdoteds to discuss important ethical and moral issues.

    • Iromi

      Dear Dr Athgune,

      “However, I do not think that our doctors, especially a trained specialst gynecologist are so out of touch with the current discourse of patients’ rights.”

      As much as I would like to believe this was true – going by the the emails I have received since this article went up online & the numerous anecdotes I have heard just in last few years – it unfortunately seems there are some trained specialist gynecologists who make the visit to the hospital a living hell for some women.

    • Rana

      Dr. Athgune,
      You are nothing but a person living in denial (just like those who deny GoSL and SL Army ever carried out war crimes ) despite a mountain of evidence to the contrary.
      Good luck. Enjoy life in your little cocoon and keep hiding your head in the sand.

      • DrAthgune

        Dear Iromi and Rana,

        Do not mix up the issues. This is nothing to do with alleged ‘war crime’.

        What I am saying is that even if this was a real incidentt it should have been an act of an eccentric gynaecologist.

        There are much more pressing issue with our medical community than this.

        I will tell you one single issue, which needs to be addressed by the medical communtiy it self, government and others, who are interested in health of our people as an urgent matter.

        The issue is the ‘private practice’. As soon as a doctor gets their SLMC registration their primary objective is to start a private practice. Is there mechanism to monitor these practices? Who knows what kind of medicine they prescribe for patients? Take for example the prescription of antibiotics. If you go to one of these doctors with one day fever (99% these fevers are of viral origin) most of them would invariably start antibiotics without any rationale.

        In UK GP practice is totally different from ours. Therefore, it can not be compared. However, the GPs are very reluctant to prescribe antibiotics. If they are indicated they would start with the simplest like Amoxicillin. This is becasue their practices are monitored by others. They can not do as they please.

        I do not understand why nobody is concerned with this issue. SLMC, GMOA, patient rights group etc are silent about it. It is one of the most fundamental of patients’ rights to receive a rational treatment. Unnecessary use of antibiotics makes them ineffective in the long run. Therefore, it would have a bad effect on the society in general as well.

        This is only one. These are the real issues, which should be dicussed.

  • Katmai

    In a modern, civilized society, yes this type of issue would be of significance and society would be looking for ways to educate the narrow minded people. (see “Birth Rape” discussions going on in other parts of the world)

    But in Sri Lanka, where the citizenry is oblivious to people being caught like dogs into white vans and being killed, where does this issue rest in the scheme of things?

    When ministers have ready made answers to why human bodies without heads attached are being found around the country, do you really think they would not have good excuses for why women are being treated this way at their medical establishments?

    It is the citizens that must become aware of what is going on but with an English article on the Internet is not going to reach that many.

  • justitia

    So called “virginity” of a bride was ‘confirmed’ in the sixties,especially in the ‘kandyan’ areas by the mother in law inspecting the bedsheet, after the honeymoon.
    A bride to be was very concerned and consulted a doctor privately who advised her to prick a finger with a safety pin and allow a small smear of blood on the bedsheet.
    The girl reported to him later that the mother in law was delighted.

    But, I doubt the above account.
    Gynaecologists are not bothered about looking for a hymen during a vaginal/internal examination, as the hymen is absent/not intact, in a good percentage of women,married or unmarried,and they know it.

  • Dr. Athgune

    Dear Justitia,

    There is no medical evidence to suggest that hymen can be congenitally absent in women.

    • justitia

      Multiparous women have bare remnants of it,or none at all.That is what I meant.

  • SR

    A much needed article about the stark reality of our health system. In 2009, i had to undergo a full medical examination and went to a leading surgical hospital in Narahenpita. The lady at the counter gave me a shy school girl grin and said “since you are not married we cannot do the pap smear test’

    I was appalled. Back in 1996 while at University overseas, all students were asked to get a annual screening which included the pap smear if they were sexually active.

    That was 16 years ago. Sri Lanka really needs to move on. Thank you for shining a light on these issues, especially at a time when we are trying to ensure Sri Lanka’s low HIV prevalence rate of 0.1% is maintained mainly through safe and responsible sex. No adult should be shy to buy, sell and use a condom.

    • justitia

      Last year it was reported that a Vice Chancellor had forcibly sent female undergradustes to hospital for a “virginity test”. The doctors had sent them back saying that there is no such test.
      This appears to be the level of knowledge about matters regarding sex & sexuality among educated elite.

  • Jo

    Dr Athgune is right that this has nothing to do with the war so please can we leave the two topics separate?

    However, the fact that Dr Athgune takes an absolute stand is the best example of why this is an issue people should talk about.

    In his world, this NEVER HAPPENS. Zero % probability of this happening.

    Medical attitudes need to change in Sri Lanka and Doctors need to start listening to patients. If there is a complaint, the answer is not denial.