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PSYCHOSEXUAL PROBLEMS IN THE CONTRACEPTIVE CONSULTATION – COVERT PRESENTATIONS (CASE)
Miss B. originally attended with her partner for a new patient interview. They were an incongruous pair: he was grubby with a marked local accent, wearing torn jeans and with his hair in a pony-tail, while she was a slim, neat girl with a well-educated voice. He did all the talking and was concerned because she was always feeling ill. Some tests were arranged and the doctor was relieved when she reattended by herself. Miss B. ignored the test results and reassurance offered. Her boyfriend had told her to get a coil fitted. She said that after the enquiries at the last consultation (when he had assured the doctor that contraception was not a problem), he had thought about it and decided that as he did not want any children about the place, she had better get fixed up. Suggestions that she might have some opinions or feelings about it were met with a look of incomprehension and after battling for a while – ‘I must have a coil today’, she kept saying – the doctor gave her some leaflets to read and arranged to see her with her period the following week. At that consultation, she arrived in complete distress, her boyfriend having been picked up in possession of drugs. Decisions were postponed. Next time she was more composed and ‘they’ had decided she would go back on the Pill, which she had taken ‘for several years’. Further enquiry revealed that her boyfriend was on remand and likely to be sent to prison. Naively the doctor enquired why contraception was necessary, only to discover that Miss B. lived in a multi-occupied house and without her boyfriend’s presence would be expected to be available to the other men living there. The doctor, sure by now that there were deep underlying problems, probed and listened and encouraged until the girl, relaxed and open, was able to reveal that she had been dominated totally by her authoritarian solicitor father and sexually abused by him until she was 20. She had then met her present boyfriend through her black sheep brother who had rebelled against her father and was into drugs and various criminal activities. She had been thrown out of her home only to join another abusive environment, and had no idea
of how to take control over her own life or sexuality. She saw herself as available to be used and only considered contraception as a necessary part of this.
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