STERILIZATION: SENSIBLE CHOICE OR SERIOUS TROUBLE? – FLIGHT INTO CONTROL (COUNSELLING)
A couple came to a counselling clinic with a short note of introduction. The man was in his 30s, intelligent, sensitive and outgoing, and the woman was tiny, fair and very shy. They were accompanied by four children between 6 and 12 years. The woman gave her age as 28 but the most striking thing about her was her appearance of extreme youth. She hardly looked older than early adolescence, and confided that she was wearing a dress given to her own daughter by a charity. As she was encouraged to talk, it became clear she had a very low opinion of herself and did not feel herself worthy of any consideration. She said she could not respond sexually to her partner, and then she told the doctor she had been very promiscuous in her early 20s.
She was invited to expand on the bare details she had offered, and during several appointments the woman described a brutal history of sexual abuse starting at home at the age of 13 and continuing after an early marriage at 16. She felt her doll-like appearance must have invited the treatment she had received, and she realized that she had accepted a passive role where she made no decisions. She was widowed early by an accident, and left with a family to support. Perhaps one can understand how a sterilization operation had been offered to her at the age of 22 as she seemed unable to use contraception. She had come for help now because she had met a man who cared for her and wanted to share her life rather than abuse her. During the time she attended the clinic she responded sexually for the first time in her life and her appearance became more adult. She wanted another child and bitterly regretted her operation for sterilization.
It was clear that this patient had never been able to discuss the terror of her past abuse on any previous occasion. She had accepted her operation as she had accepted all the treatment meted out to her as an abused child. Perhaps it would be worth offering counselling of some depth in instances where the patient is unusually young and unsupported, and has a chaotic lifestyle.
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