Introduction
This is a case study of pre-sexual encounter counseling. The patient is 14 years old female who presented to the clinic for pre-sexual encounter counseling. From information obtained from the patient, it is will be the first encounter. The patient is not very active in extra-curricular activities and she does not believe to have broken her hymen in any manner possible. The patient is well conversant with her monthly periods and can point out the safe days confidently. She is curious and would have to try out the sex. She does not think of risks in having sex with her boyfriend. They have not gone for any test together and she is not sure of the HIV status of the boyfriend.
The counseling
Being the very first time that the female will engage in sex, she was advised to be aware that the first-time experience is likely to be a bit challenging. The main challenge pointed out was the breaking of the hymen. She was made aware that when the hymen breaks she will experience some sharp pain and there was going to be some slight bleeding. It was made clear to her that the first encounter may be painful and probably irritating to the vaginal walls depending on how her body may respond to the whole experience.
She was made aware that a female body when aroused in preparation for sex mucus is secreted into the vaginal walls to minimize friction upon penetration. Concerning that, she was advised to talk with her partner over the issue of ensuring that she is properly aroused to minimize instances of painful penetration. Upon being properly aroused she could feel the mucus secretion to her vagina.
Extra care was taken to advise her on what to do in case her body organ could not secret mucus. She was advised to use artificial lubricants which are water-based as opposed to oil-based ones. Care was taken to explain to her the risks of using other substances, which were likely to be available readily, such as yogurt, soaps, or hand lotions as these are likely to have some bad effects on her. Shading light on this issue Komisaruk (2009) et al, argued that “the vagina may become irritant by application of vinegar, yogurt, hand lotions, soaps, and bubble baths and by other douches” (p. 89).
However, care was taken to reassure her that chances of not secreting mucus were very minimal as this was a common experience with old women. She was advised that being the encounter it was good if she could not overdo the whole exercise as it would likely cause her some pain afterward in private parts and probably some slight difficulties in walking (Komisaruk, 2009).
After creating a picture of the whole experience attention was turned to some other equally significant issues. She was made aware of the risks likely which come with having sex and in her case the risks she was going to face for the first time. She was made aware of the common sexually transmitted disease such as HIV Aids, syphilis, gonorrhea among others. She was advised to advise her partner to use a condom to avoid transmission of the disease. She was however advised to take her partner for a medical check-up before they could engage in sex. She was informed that it is not guaranteed that condoms can completely prevent transmission of the STDs.
If she was not sure of her partner in terms of his health then she was advised to keep off oral sex. It was made clear to her that STDs could be transmitted through oral sex and not necessarily only through the traditional (penis-vagina) sex. Norman (2010) and Chen (2010) have shown that oral sex is as risky as traditional sex (Norman, 2010; Chen, 2010). As Norman (2010) has argued, she was advised of the risk of contracting skins disease from her partner if he was infected with a skin disease. She was advised to strongly consider a medical check-up with her partner to clear out these issues.
Although she had hinted that she was aware of her safe days it was nevertheless made clear to her that she could use contraceptives to avoid getting pregnant as one incident of sex encounter could make her pregnant. She was taken the advantage of using contraceptives and pills. She was advised to advise her partner to use the male condom to minimize the chances of her getting pregnant. She was advised to ensure that condoms to be used were of standard quality by obtaining them from authorized outlets such as health centers. As Akunjee, Jalali, and Siddiqui (2008) have argued, oil-based lubricants should not be used as they are to “weaken the condom and predispose it tears” (p. 86).
She was also informed of the use of pills as a way of preventing her from getting pregnant. It was made clear to her that pills only prevent one from getting pregnant but do not minimize in any way the chances of one getting pregnant. Some of the side effects of using pills as discussed by Akunjee, Jalali, and Siddiqui () were made clear to her:
Cholestatic jaundice, Oedema (corneal), Nasal congestion, Nasal congestion, Thromboembolism (DVT, PE), Raised BP, Acne, Alopecia, Anaemia, Elevated blood sugar, porphyria, pigmentation, pancreatitis, thyroid dysfunction, intracranial hypertension, vomiting (progesterone one), erythema nodosum, extrapyramidal effects and sensitivity to light. (Akunjee, Jalali and Siddiqui, 2008, p. 95)
In case she opted for the use of pills she was advised of the common drugs that could interfere with the effective working of the pills. These drugs include “antibiotics, anti TB drugs, antiepileptic medication” (Akunjee, Jalali and Siddiqui, 2008, p. 95).
It was also assumed useful to warn her against the use of any drugs which she may have thought would make the experience great. Warning her against the use of drugs was considered appropriate as it was a possibility taking into consideration that teenagers are very curious and are likely to try out everything. She was advised to stick to one partner as this would reduce the chances of her being infected with STDs.
The client is also made aware of the emergence pill which is to be used in case it happens that unsafe sex is carried out. The pill can be used if the condom being used during the sex exercise tears and if she is not on any pills implying that she is exposed to being pregnant. It is made clear to the client that these pills are only for the case of unsafe sex and when she is not on any pills. The pills work within 72 hours after the unprotected sex encounter (Bennett and Pope, 2009; May 2010).
It was pointed out to the girl that she was still young and there was no problem with her waiting for the correct timing when she could be above 18 years. She was also warned against having sex with older people though this did not mean that it was right to have sex with young men. The client was informed of the significance of abstaining. Abstaining was the best way to ensure that she could not contact STDs or get pregnant. Being a minor she was informed that some services could not easily be accessed for instance some birth control injections and probably some pills (Melnick, 2011).
Conclusion
The client was dully advised. It was observed that she was a minor and thus the need to cover the topic of sex encounter comprehensively to give at least a clear picture of what she was getting herself into. She was made aware of the challenges she was likely to face being the first time she would engage in sex. She was advised on the kind of lubricants to use in case the need arose which was not likely to be the case.
She was informed of the importance of good arousal to help in secretion to minimize unnecessary friction during the penetration. She was also advised on the risks of contracting STDs and appropriately informed on what she could do to reduce the chances of contracting the diseases. She was also advised on how she could reduce the chances of getting pregnant. Lastly, she was informed of the option of abstaining from sex completely as this was the best to help keep off all the risks she was running because she was a minor.
References
Akunjee, M., Jalali., S and Siddiqui, S. (2008). The Easy Guide to OSCEs for Specialties: A Step-by-step Guide to OSCE Success. New York, NY: Radcliffe.
Bennett, J and Pope, A. (2009). The Pill: Are You Sure It’s for You? New York, NY: Allen & Unwin.
Chen, W. (2010). Encyclopaedia of Asian American Issues Today. New York, NY: ABC-CLIO.
Komisaruk, et al. (2009). The Orgasm Answer Guide. New York, NY: Cengage.
May, E. (2010). America and the pill: a history of promise, peril, and liberation. New York, NY: Basic Books.
Melnick, M. (2011). Study: Teen Girls More Likely to Have Risky Sex than Teen Boys. Time Healthland. Web.
Norman, R. (2010). Preventive Dermatology. New York, NY: Springer.