Love and Sex Prescription

By Rashmee Shah and Shweta Govindarajan

QUESTION

I've heard from my friends that girls are supposed to start going to the gynecologist as soon as they turn 18 or become sexually active. I'm 21 and have never been, but when I ask my mom to take me she says I don't need to go until I'm married! I've also started having sex with my boyfriend and I would like to get on the pill. I feel like I should have a check-up but I don't know how to get her to change her attitude. I would like her to take me but she's so old-fashioned. Help!

ANSWER

The choice to become sexually active is not only one of emotion, but one of responsibility, as well. Most people know about the risks of contracting HIV or getting pregnant, but many women may not realize the risks that exist for other, more subtle, sexually transmitted infections. In addition, as we get older the risk of cervical cancer increases. In 2002, 13,000 new cases of cervical cancer were diagnosed; in the same year, there 4,100 cervical cancer related deaths. If the cancer is caught in an early stage, survival rates improve considerably. Gynecologic exams provide an in office method to look for infections and screen for cervical cancer. The exam (a Papanicoulau smear, pap smear for short), involves examining the walls of the vagina and cervix and taking a small tissue sample with a swab. The procedure is painless and the sample is sent off to a lab to screen for abnormal cells. During the same exam, the doctor can take a sample to look for infections, as well.

Current guidelines from the United States Preventive Services Task Force (USPSTF) strongly recommend routine pap smears for women who have been sexually active for three years or are 21 years old, whichever comes first. It sounds as though you fit in the second category, so you need to consider beginning routine care. If it is not possible for you to see a gynecologist due to your mother’s apprehension, you still have options. First, a family practice or general medicine doctor is also qualified to do the exam. They are obligated by law to keep your medical care confidential from other people, including your mother. You may also consider going to your college’s health care center, if you are a student; they should have a gynecologist on staff. Finally, you could also show the guidelines to your mother. If you point out that any 21 year old women should have routine pap smears, you would not have to disclose your sexual activity.

Pregnancy is also a very important consideration for a sexually active woman. Your primary care physician, or whoever performs you gynecologic exams, can help you decide what form of birth control to use. The pill is most commonly used, and prevents ovulation and therefore, pregnancy. In the first year of use, about 5% of women will get pregnant; this number decreases after the first year. If you follow the instructions carefully, however, the failure rate can be as low as 0.1%. Most women are pleased with the benefits of the pill, including predictable cycles, less cramping, and shorter, lighter periods. The patch, when used properly, has similar results. Some couples choose condoms as their only form of birth control. Since most people do not diligently use the condom every time, the typical failure rate is about 14%. Other options include cervical caps, diaphragms, and withdrawal; all are less effective than the pill.

Finally, don’t forget about your partner as you begin your medical care. The screening and birth control is not only for your benefit, but for his as well.

QUESTION

I have recently announced to my parents my plans for engagement in a year to an American man. He was born and raised in America just like me, but his family is from South America. South American culture mirrors many of the same morals (family importance, having parents from a poorer country come to America to increase opportunities for children, etc.) as Indian culture, so we share the same value system. As far as our children, they will be raised mostly with Hinduism (as I am more religious then he is), but we will also teach them the beliefs of Catholicism. We want to emphasize the point that the basic beliefs for all religions are essentially the same. My parents are having a lot of difficulty accepting this decision. Even though I am giving them ample time to adjust, I can still sense their disappointment in me. How can I deal with my parents and the emotions I feel about their disappointment when I know I am making the right choice?

ANSWER

The first thing to realize is that your parents' reaction is largely emotional, meaning that a rational, well thought out argument on your end may not help them to understand your decision. Even though South Asian parents have been here for decades, anxiety about assimilation still exists, and is intensified by situations like yours. It's possible that your decision to marry someone outside of your heritage is seen by your parents as a kind of abandoning of your culture, or even your homeland. Realizing all of this can help you, and your fiancé, communicate with your parents on a level both of you understand.

It's great that both of you have already formed a game plan for how to raise your children - it's never too early to start. Children that have dual identities can be both enriched and confused by their cultures. Having concrete examples of your child-rearing plan to offer to your parents may help them to visualize the reality of the situation. When you sit down with your parents, try explaining your approach and make sure to mention specifics.

Think about certain Hindu or Catholic rites you plan on doing that might interfere with your desired religious upbringing for your children. For instance, baptizing your child means that you are dedicating them to the Catholic faith. But will your fiancé’s family be satisfied with only Hindu birth rites? What about food - are you vegetarian, and would you like your children to be? Will you celebrate Christmas as well as Diwali? It sounds silly, but having an idea of how to shape your life will help in the long run.

In addition, it also would be a good idea to establish the role of the children's grandparents in your lives. It sounds like you and fiancé have envisioned a certain lifestyle for your family; will your parents, and his parents, support the way you decide to raise your children or will they present contrary views that could make your job more difficult? For cultures that are extremely family-oriented, it's hard to separate immediate family from all of your relations, but at the end of the day, you both have to decide what is best for your chosen lifestyle.

Lastly, you must realize that your parents may never agree with your choice to marry outside your culture. If this happens, it's more important than ever that you and your husband stand firm in your belief that you are doing the right thing and seek guidance from each other. It also might be helpful to get involved in an online or weekly support group that can provide an outside shoulder to lean on. Check out your local paper to see what's offered in your community. And bone-up -- there are a number of books and articles on interfaith marriage that could be a useful resource. Beliefnet.com, which covers a broad religious landscape, has wonderful articles on bicultural marriage that can help you get started. Good luck!

ABCDlady does not provide medical advice, diagnosis or treatment. See additional information.

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