PSYCHOSEXUAL PROBLEMS IN THE CONTRACEPTIVE CONSULTATION – BEGINNING SEXUAL ACTIVITY (CONTRACEPTIVE CONSULTATIONS – CASE)
Miss K. was a lovely girl who looked like a model, tastefully made up, a little too thin, but beautifully and elegantly dressed. The doctor felt old, untidy and frumpy. The list of contraceptive consultations was quite long, as she had started and stopped the Pill several times. At the last attendance three months previously she had given a history of being on her period and wishing to restart the Pill as she had a new relationship. A previous doctor had written rather peevishly that she refused to consider using condoms (and underlined ‘fifth partner in six years’. She had been asked to return for a cervical smear as she had not yet had one. The doctor noticed that there was no cervical smear form in the notes and started to look for one to fill in. Miss K. tipped back her head moving her long hair back slightly from covering part of her face and said, ‘Oh, didn’t you see what nurse has written? I’m on my period this week.’ The doctor looked at the record and felt quite unreasonably cross: ‘You knew that you were due for a smear; why didn’t you come two weeks ago when your appointment . . .’ and just caught herself before the accusation was completed. More gently she changed tack. ‘I notice that you’ve been coming to this clinic for six years and have managed to avoid having a smear all that time. That takes some doing!’ The girl shrugged her shoulders and did not look at the doctor, who felt another surge of annoyance. What was going on? The doctor tried again. ‘It seems to me that you might find the thought of having a smear rather frightening?’ No response except a twitch of the shoulders, turning away and excluding the doctor. She tried again. ‘Why do you think you don’t want to have a smear?’ Miss K. muttered something into her hair. The doctor had to ask her to repeat it. ‘I just don’t want it done.’ The doctor waited but nothing was forthcoming, and she pressed again, feeling frustrated, ‘I feel very shut out from what you must be feeling.’
*308/197/1*
