The pedagogy of the clinic: health professionals and women with viral sexually transmitted infections

Abstract

This study investigates sexual health teaching and its effects. The focus is on how the health clinic works as a pedagogical environment where lessons are offered by clinicians to women patients (often unwittingly) about morality, femininity and the body. Of central concern is the question of how health professionals might contribute to women's quality of life after a viral STI diagnosis. I use examples of the reported engagement between clinicians, women and the two most common viral STIs, the human papilloma virus (HPV) and the herpes simplex virus (HSV). To consider the effects of the myriad beliefs that inform clinical teaching I draw from poststructuralist feminist discourse theory. For data collection I used in-depth email interviews, a research method that allowed participants with viral STIs to 'speak' more freely than might be possible in face-to-face interviews. The method also readily enabled me to interview sexual health clinicians and other women within a wide geographical area, in New Zealand, Australia, North America and England. My research findings include the insights that: by the time women seek out medical care for a viral STI they have received considerable social 'education' that STIs are categorically different from other conditions; although clinicians emphasise the normalcy of viral STIs they tend to have limited knowledge of the difficulties women face in disruptions to sexuality after a diagnosis. Liberal views about sex do not necessarily make the negotiation of safer heterosexual sex and prevention of STI transmission easier for women. Women found it helpful when clinicians addressed both the medical 'normalcy' of viral STIs and their potential to disrupt women's sense of self, sexual and social relationships. In public health education, gynaecological examinations are presented as a routine and essential practice, yet my study found that such examinations are often difficult for women. Research addressing women's reasons for non-compliance with screening emphasises 'underlying' psychological categories of 'anxiety' and 'poor coping'. Minimal attention is paid to the effects of clinicians' interventions upon women's decision-making. My findings indicate that women's screening compliance is influenced by clinicians' gender, (in) attention to power relations, rapport-building, attentiveness to bodily (dis)comfort, and technical skill. In striving for non-judgmental, scientific teaching, clinicians were often unaware that their talk inevitably constituted viral STIs as 'moral' infections. Clinicians may best contribute to women's lives by acknowledging that medical discourse is only one part of the fragmentary and contradictory education women receive about bodies and selves.