PSYCHOSEXUAL PROBLEMS IN THE CONTRACEPTIVE CONSULTATION – OVERT SEXUAL COMPLAINTS (INSTANCE)
Sometimes patients can make what seems to be an overt complaint but need assistance in order to make the problem clear, not only to the doctor, but also to themselves.
Despite her 20 years, Miss A. looked like a schoolgirl with her white ankle socks and Alice-banded hair. She sat nervously on the edge of her chair, her big eyes gazing trustingly at the doctor. She had just seen the nurse, who had put her through to see the doctor again because she had a problem. ‘The nurse said you could sort out this problem I’ve got,’ she confided. The doctor felt wary. What was this problem that had to be handed over to the doctor to be sorted out? ‘Tell me about it,’ she responded. Miss A. said that she never enjoyed intercourse and her boyfriend was complaining. She stopped. The doctor went, ‘Urn,’ and nodded. ‘That’s it really.’ Miss A. sat back in her chair, problem handed over, ready for instruction. For an instant the doctor was tempted to launch into a lecture or question and answer session on ‘How to enjoy intercourse’ but recognized the teacher/pupil relationship and restrained herself. ‘Tell me a bit more about you and your boyfriend,’ she said. ‘What do you want to know?’ Miss A. countered. The doctor suppressed her irritation, recognizing the ‘adolescent child’ defiance. She tried to defuse the defence with a smile and said gently, ‘It is difficult to know where to begin, isn’t it?’ and waited. After a moment of bewilderment Miss A. began again. As she progressed through her account she constantly looked for approval that what she was saying was what the doctor wanted. ‘Do you want to hear about that?’ and ‘Perhaps this doesn’t matter’. As she told the story it emerged that she lived at home and they had intercourse only occasionally in either her or his parents’ house. She was able to discover how nervous she felt about either set of parents knowing what they were doing. She felt like a child in both environments and too young to be sexually active. She felt they should just be cuddling not going ‘all the way’. There was a short silence at the end of her account. Then she said, almost as if the doctor was not in the room, ‘We’re going away on holiday together next month; I think I’ll see what it’s like then. It might be better away from home.’ She came back to the present and said, ‘Well, I’d better have some more Pills hadn’t I?’ excluding the doctor from the previous problems and taking back into privacy her doubts about her sexuality.
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