Women’s Sexual Lives Should Be Safe and Healthy
“Contraception and family planning remain highly relevant issues. This topic and the discussions surrounding it still leave considerable room for improvement. These matters should be discussed not only by obstetrician-gynecologists—the part of the medical community most interested in and knowledgeable about these issues—but also by general practitioners, with broader society becoming involved as well,” says Prof. Dr. Rūta Jolanta Nadišauskienė, Head of the Department of Obstetrics and Gynecology at the Lithuanian University of Health Sciences (LSMU) Medical Academy. We spoke with the professor in greater detail about contraception—an important topic that still receives insufficient attention today.
What Do You See as the Most Important Current Problem in the Use of Contraception?
It is still believed that gynecologists alone should be responsible for preventing the consequences that contraception can help avoid. In fact, even the Millennium Development Goals program, which concludes in 2015, included a goal of making family planning discussions one of the responsibilities of primary healthcare professionals.
I believe that several problems intersect in pursuing this goal. Perhaps we, as educators, do not provide students with knowledge effectively enough for them to acquire a more purposeful and thorough understanding of contraception. On the other hand, physicians themselves also lack this knowledge, because their attitudes are still strongly influenced by various myths and warnings surrounding contraceptive use, including unfounded claims that contraception is harmful and damages health.
Is This Why You Try to Emphasize That Every Statement Must Have a Scientific Basis?
I always emphasize that all our statements must be based on scientific knowledge—not on our emotions, attitudes, or beliefs. Both physicians and anyone else making a decision should use the knowledge they have acquired. Nowadays, it is unacceptable to claim that contraception is harmful simply because someone has said so.
In medicine, every statement must be supported by scientific evidence—perhaps the evidence is weak, in which case this should be stated, or perhaps it is very strong. Contraception and family planning are, and continue to be, highly relevant and important issues worldwide. A great deal of research is being conducted on the selection, use, effects, and consequences of contraceptive methods.
Hormonal contraception is still regarded as a frightening “bogeyman” in our country, even though it is one of the most extensively studied forms of contraception and is very safe, high-quality, reliable, and effective. Therefore, I believe that the role of general practitioners in informing patients about and offering contraceptive methods should be considerably greater.
Do Physicians Have Enough Information on This Subject?
To assist physicians, we translated and published a book on contraceptive eligibility in Lithuanian, as well as a methodological tool known as the Contraceptive Eligibility Wheel—something that only a few European countries have done. This methodological material is very practical and useful for physicians in their everyday work.
I therefore believe that the tools are available; we simply need to start using them. Even with limited time, a family physician can successfully use the methodological support we have developed, the essence of which is to provide very simple principles for counseling.
I believe that not only family physicians but also midwives, whom we successfully train at LSMU, should confidently become involved in this work. For example, in Sweden and other Scandinavian countries, midwives specialize and work in youth centers, where together with volunteers they help people who lack knowledge about contraception address these issues.
At the same time, it is always important to remember that our responsibility as specialists is to provide information about the contraceptive methods best suited to a particular stage of life, a specific situation, and an individual’s health status. These methods are not necessarily intended for lifelong use. Contraception should be of interest not only to women but also to men, and people should feel free to ask questions whenever they arise.
As physicians, we cannot simply tell someone which method to use. The advantages and disadvantages of each method must be explained in detail, while the woman or both partners should decide for themselves what suits them best at a particular stage of life. Families should take greater interest in these issues and strive to live safely and healthily. This is a very important area of life and should not be ignored.
What Are the Most Important Principles of Contraceptive Use at Different Stages of Life?
Contraceptive needs change throughout life. One type of contraception may be appropriate in early youth, after sexual activity begins, when sexual relationships may not yet be regular and may sometimes be unplanned or influenced by emotional experiences or other circumstances. At this stage, it is particularly important to know how to protect yourself and the person close to you.
When partners change more frequently, certain methods of protection may be more appropriate, whereas when sexual partners become stable, other contraceptive methods may be preferable. It is always important to understand the basic principles: one type of contraception may protect against unintended pregnancy but does not prevent sexually transmitted infections and diseases, which can seriously affect health and may cause infertility.
People need accurate information. Unfortunately, even physicians do not always tell the truth and sometimes seem to impose their own views. Today, however, information is widely accessible, and people—particularly young people—are educated, curious, and able to find additional information themselves.
It must also be acknowledged that Lithuania is a complete outsider among European countries across all these parameters—in terms of knowledge about contraception, the selection of contraceptive methods, and even their accessibility. And everything begins with education.
Interview by R. Pečeliūnienė
“Lietuvos gydytojo žurnalas”
