Discussing sex—here referring to educating individuals about the information they need to be healthy and productive members of society—remains limited and approached with embarrassment. Education is generally confined to basic physiological information about the body and reproductive systems, which is introduced in school curricula at a later stage. Ideally, education about one’s body and how to care for it should begin at the age of five. However, other aspects of sexual education, particularly those relating to congenital or acquired conditions of the reproductive system and sexually transmitted diseases (STDs), are taboo and surrounded by many questions. This applies to public discussions, media coverage, and school curricula. As a result, individuals grow up ignorant of their bodies, unable to distinguish between natural developmental changes at various life stages and the early signs of treatable sexual diseases, some of which can be fully cured if addressed early.
In general, physical illness can affect sexual life and even marriage, even if the illness is not sexual in nature or does not directly affect an individual’s sexual ability. For instance, chronic illnesses like kidney failure, skin diseases, and respiratory conditions can all impact sexual life. The issue becomes more complicated when the illness is related to the reproductive system or is sexually transmitted. Men and women alike often neglect these illnesses and refrain from seeking treatment due to fear of societal stigma, shame, and being ostracized or labeled.
As a doctor, I observe that girls and women neglect issues related to menstrual cycles, reproductive system infections, excessive sweating, and even vaginal bleeding. Many girls delay seeking treatment until after marriage for various reasons. Chief among them is the belief that such problems could affect their prospects for marriage and childbearing. Moreover, there is significant fear surrounding treatments for reproductive health, particularly surgical interventions. I recall a 14-year-old girl who came to the hospital with her mother due to severe obesity that began at puberty. Ultrasound imaging revealed a congenital condition preventing her from shedding menstrual blood monthly, leading to its accumulation in the uterus. When I informed the mother of the need for a surgical incision in the hymen, she refused treatment and hurriedly left the hospital, abandoning her daughter to an uncertain fate.
Similarly, both men and women fear their partner’s reaction upon revealing they have a sexually transmitted disease, which may lead to divorce, separation, or even public shaming. STDs often require treatment for both the infected and uninfected partners, with some diseases requiring long-term treatment. This applies even to simple and curable infections, such as fungal infections, provided both parties adhere to treatment. However, ignorance and societal stigma may cause the uninfected partner to refuse treatment due to fears of societal judgment or unnecessary medical intervention. Consequently, silence widens the circle of infection and may contribute to increasing divorce rates.
The silence surrounding sexually transmitted infections (STIs) also endangers family members. STIs are not solely transmitted through sexual contact but can also spread through bodily fluids and secretions. The healthcare sector has documented cases where infections were transmitted to healthcare workers because patients concealed their illness. Additionally, ignorance and limited sexual education increase the vulnerability of healthy individuals, both married and unmarried, to risks such as teenage pregnancies outside of marriage. In such cases, young girls may resort to unsafe abortions, exposing themselves to bleeding and physical harm. Women also face injuries, such as tissue tears, during marriage consummation (“the wedding night”), and such cases regularly reach hospitals. I recall treating a patient who suffered severe bleeding and tissue damage on her wedding night, requiring several days of hospital care to recover.
Furthermore, limited healthcare services and the lack of awareness among medical staff regarding sexual illnesses pose significant barriers to spreading awareness and receiving treatment. In each governorate, treatment for many sexual diseases is available in only one center, forcing residents from rural areas to travel to cities, which increases treatment costs and reduces privacy, especially for girls who may need family justification or accompaniment to visit the city. Treatment for certain serious conditions, such as HIV/AIDS, is available only in Ramallah. This makes treatment costly, time-consuming, and inaccessible due to long distances and security conditions in the West Bank.
Bureaucratic protocols at sexual health centers also limit patients’ ability to access treatment. For example, these centers may refuse direct walk-ins and require patients to obtain a referral from a hospital doctor. Sometimes, doctors who refer patients to sexual health centers face questioning about the necessity of the referral. Such complexities often stem from societal sensitivity, as doctors risk harm from patients or their families if they mistakenly refer a healthy individual to a sexual health center.
Addressing these challenges requires improving the healthcare system and fostering societal awareness. Achieving this demands a comprehensive, long-term effort to change cultural attitudes and safeguard public health.