Could I suggest that a patient rethink her relationship with a man?

At the April 14 to 17, 2010 Contraceptive Technology Update conference in Boston for 670 counselors, nurse practitioners and physicians, the following question came from an employee at the Yale University Health Service.  It could just as easily have come from a counselor or clinician at any college or high school in the country.  Here was the question:

 

“Is it professionally appropriate to advise a woman, from a purely medical point of view, to rethink a relationship with a man who will not use condoms at the tender age of 18-21?” 

A:        In answering this question one may assume that the phrase “the tender age of 18 to 21″ refers to both women and men, since this is a college health service. My opinion is and the consensus of others at the conference was that a clinician or counselor at this health service would definitely be wise to ask a woman to seriously rethink the wisdom of having sex with a guy who would not use a condom.  Definitely rethink having sex with that person!        

Many young men and women enter college having had intercourse with several people and unless there is good reason to believe that both the guy and the gal have never had sex with any other person, the risk of infection should be as important to both of them as the risk of pregnancy. Here are two good reasons why:

First, more than half of the following infections are spread from a person with no symptoms at all:

·     Chlamydia infections that can lead to infertility.

·     Human papilloma virus infections (HPV infections) that can cause cervical cancer.

·       Herpes infections that can be very painful and lead to recurrences that last for years and that may necessitate using medications that are very, very expensive.

·    Human immunodeficiency virus (HIV) infections that eventually lead to AIDS and death.

So a man or a woman with one of the above infections may have zero symptoms suggesting an infection on a given evening– no red flags are up saying “we had best use a condom tonight.” 

No, the red flag is always up at Yale, at the University of Georgia, at Rabun County High School in northeast Georgia, and at every other high school and college in the land.

Secondly, the risk for the woman, that both of her fallopian tubes will be completely occluded (blocked) goes up with each episode of pelvic infection (infection of the uterus or fallopian tubes). After one infection the risk is about 10%.  After two episodes, the risk is about 25%.  And after three episodes the risk that both tubes will be occluded is about 50%. Many women who are infertile today because of blocked fallopian tubes from infection never knew they had a pelvic infection and had never been treated for an episode of Chlamydia.  Chlamydia definitely can fly under the radar.  Chlamydia is likely to have almost no symptoms at all, but may be doing damage for years without detection.

Complete refusal to use a condom would be a strong indication for a young woman or man entering a dating relationship to end the relationship quickly.

If a high school or university counselor is not urging women whose boyfriends refuse to use condoms to rethink that relationship, an important opportunity is being lost.