Sex: What you don’t know can hurt you

A lack of open dialogue about sexuality has kept many Lebanese in the dark about sex and their sexual health. Lebanese sexologists and NGOs are seeking to shed light on the subject and offer judgment-free environments for information and clinical services. “Unfortunately sex is a taboo. In Lebanon and in all other countries, talking about sexuality is not easy,” says Dr. Sandrine Atallah a clinical sexologist and former host of LBC’s Lezim Taaref (“You need to know”) – a show about health and sex. As a clinical sexologist, Atallah encounters male and female individuals, as well as couples suffering from a variety of sexual dysfunctions. While many of her patients seek help for physical and psychological ailments affecting their ability to have a fulfilling sex life, she has observed a general lack of knowledge about sexuality that can lead to more than just trouble with consummating marriage, negatively affect a person’s health. “Even before talking about sexual needs, we need to consider sexual health – their reproductive health, gynecological health. Women’s health is affected because they do not see a gynecologist if they are not married or if they are not pregnant,” Atallah explains. Insistence on virginity and judgmental attitudes mean that many people avoid seeking the examinations they need, Atallah explains. “Virginity is a big issue in Lebanon with a lot of misconceptions and unfortunately resulting in a lack of freedom for women to take care of their own bodies and be responsible for their own sexuality,” she says, describing the scrutiny an unmarried woman can face simply going to see a gynecologist. “[In the waiting room] when she is addressed, they will call her “madame,” not even taking into consideration that she could be a non-married person. They ask how many children she has, ask about her husband and all of this can be very embarrassing, even though you can go to a gynecologist for lots of problems that are not linked to sexuality. People are not aware of this.” The Marsa Sexual Health Center officially opened in 2011 to address the type of situation Attallah describes, becoming the first nondiscriminatory, anonymous and confidential comprehensive sexual health center in the MENA region. “The main purpose of the center is to provide all the services related to sexual health, sexuality and gender, whether psychological, social or medical,” says Johnny Tohme, who works as the psycho-sexual coordinator at the center. One of the most important aspects of Marsa, Tohme continues, is that the center guarantees total confidentiality and anonymity. “We don’t take any names or any personal information from our clients. Everything they need, it happens here in the center and they don’t need to go elsewhere. Even if they need lab tests, we send the samples and we get the results back – [patients] only deal with us. We’re trying to provide everything a person might need in one center.” The center originated as the health unit of Helem, the Lebanese advocacy group for the social and legal rights of LGBT people, after a studied published in 2010 and conducted in partnership with AUB Professor and clinical gynecologist Dr. Faysal El-Kak revealed common discriminatory practices and homophobia in Lebanon’s clinical services. While the study examined discrimination toward LGBT patients specifically, it also revealed that only 50 percent of physicians surveyed even initiated a discussion on safe sex practices, sexual health and took a sexual history of their patients. Only a third asked about their client’s sexual orientation and less than 13 percent of physicians viewed homosexuality as an “acceptable behavior.” “We have a general problem in Lebanon when it comes to privacy in the medical health care system – it’s not particularly private and people are suffering from treatment by health care providers,” claims Diana Abou Abbas, Marsa’s management coordinator. Marsa’s one-stop-shop sexual health services include free Voluntary Counseling and Testing (VCT) for HIV, free testing for Hepatitis B and Hepatitis C, medical consultations for STIs at a cost of LL10,000, psychological and social counseling for LL10,000 per session, pap smears to screen for HPV, a general panel for medical lab testing for $160 (a service that can cost up to $400) and a referral system to trusted doctors in different practices from gynecology and urology to dermatology and infectious diseases. Other NGOS – such as the Lebanese Family Planning Association and Soins Infirmiers et Developpement Communautaire – provide free, confidential VCT services paid for by the Lebanese government’s National Aids Program, extensive counseling for people living with HIV and other reproductive health services. Yet, for people seeking STI lab testing and consultations, aside from the Marsa center, there is no other option than to see a doctor in a private health clinic which generally is more expensive and doesn’t offer anonymity. “Everyone can benefit from our services despite their sexual orientation, gender identity or religion but the two populations that benefit most are LGBT and single, young women because they are populations that suffer the most from discrimination when they go to certain doctors or centers,” says Tohme. Tohme adds that the people that come to Marsa are generally under-educated about sexual health, but the situation is improving. “In terms of HIV, people have some general idea. When it comes to STIs, very few individuals really know the importance of being tested or how it might make them more vulnerable to HIV if they are infected,” says Tohme, adding that through the educational work at Marsa, they are beginning to see some changes. “We have a lot of clients that each time they come they bring a friend. It means they are discussing sex. And also the general atmosphere in Beirut is changing. It’s much easier to discuss sexual health among intimate groups, couples. It’s getting much better.” Atallah agrees, describing the state of sexual awareness in Lebanon as “evolving and not as desperate as people think,” based on growing media coverage and a recent trend for people to see sexologists. The route forward lies in schools. “We are trying to talk about [sex] and it brings more awareness but does not equal sex education, we cannot fool ourselves. Sex education should start in schools and at home, not on TV,” she says.