Women’s health: a taboo topic

Streams of sunlight enter the room through the large window behind Dr. Kim Joo-young’s desk. She sits facing the door, answering the phone or reading the latest medical literature. In her ironed white coat, she cuts a cool, professional figure. Outside the brick building, the Ewha Womans University campus is bustling with smartly dressed young women.
Dr. Kim has worked as a general medical practitioner to the students here for 21 years. These college students are her passion. So when a student in the latest Ferragamo shoes and Olivier barrette walks in, Dr. Kim has a ready smile and nods her head in greeting. The student puts down her purse, crosses her legs, leans in and asks, “So, how do you get pregnant?”
It’s 2004, and the student who just asked that question scored at least 340 out of 400 on the College Scholastic Ability Test to get into this university, one of Korea’s most prestigious. Ewha has 15,000 undergraduate students and another 5,000 on the graduate level, and she is one of them.
At night, she takes study breaks to watch “Sex and the City” or the popular Korean drama “Stairway to Heaven.” She hangs out with a clique of fabulous girlfriends and has an even more fabulous boyfriend. She’s worked hard to get to where she is, and she has a bright future ahead of her. She is one of Korea’s elite ― and she knows next to nothing about her own sexual health. Pap smear? Never heard of it. Spend money on a gynecologist? She’d rather buy new shoes.
A number of factors help keep her in the dark: a stigma attached to gynecologist visits, the current medical insurance system and poor sex education, as well as a lack of concern from the government. Such ignorance, combined with changing attitudes toward sex, threatens the health of young women in Korea.

Sex is a subject that has long been neglected in this country. While the Health Service Center at Ewha was established in 1956, it was only in 1999 that sexual health counseling was officially allowed. Korea’s first association about sex, the Korean Association for Sexology, was created less than two months ago, in late November.
“There are so many ridiculous taboos and myths concerning sex that have warped our culture,” says Dr. Park Hyun-jun, a member of the Korean Association of Sexology.
Dr. Roh Sung-rae with the Riz Rejuvenation Center of Shinchon, a clinic for young women, says, “One societal prejudice is that an unmarried woman who visits a gynecologist is there for an abortion. So young, unmarried women don’t visit gynecologists.”
“People think unmarried women who go to the gynecologist are the ones who made a mistake,” Dr. Kim says. As a result, fewer than 5 percent of Dr. Kim’s walk-in clients report problems of a sexual nature. Lee Eun-kyung, a nurse at the health clinic of Sookmyung Women’s University, reports seeing at most four sex-health related patients a month.
The sexology association’s 50 founding members, who include gynecologists, psychologists and urologists, say that more young people are engaging in premarital sex, which has great implications as a public health issue. For example, the number of HIV cases has risen in Korea. In 2003, 398 cases were reported, an increase of 209% since 1998, according to the Korea UNAIDS Information Support Center.

In Korean tradition, the ideal young lady is chaste, but in today’s Korea, young women are adopting a more modern attitude. The sexology institute has no statistics on the number of the sexually active among Korea’s young adults, but doctors say that their young patients have become more frank and open about premarital sex and marriage.
In light of these developments, Dr. Roh says that every female should visit a gynecologist for a routine pelvic exam. From the start of menstruation, any number of problems that involve the reproductive organs can occur.
“The visit seems to cause anxiety, but it’s necessary to detect problems and treat them before they become worse. Something like cervical cancer can be nipped in the bud if it’s detected in the early stages with a simple test, the Pap smear,” Dr. Roh says. If detected early, cervical cancer has a 90 percent recovery rate. If discovered late, that number drops to 20 to 30 percent.
Some health care practitioners such as Dr. Kim and Ms. Lee of Sookmyung Women’s University say it isn’t necessary for women who abstain from sex to visit the gynecologist until their mid-20s. But because not all gynecological visits are related to sex, they would like to see an end to the shame attached to such visits. Most of the female patients Ms. Lee sees, for example, deal with irregular menstruation.
The stigma is so great that a young lady might upset her mother simply by standing near a gynecologist’s office.
“I walked inside a building once because I didn’t have an umbrella and it was raining,” says one college student, who asked that her name be withheld. A gynecological clinic was housed in that building, and her mother happened to pass by and see her daughter. When the daughter came home, her mother was livid. She told her, “I don’t care if it was raining, you don’t go near a gynecologist’s office. What will people say?”
The pressure to appear chaste is so great that even doctors will discourage certain tests. A blood checkup for one women in her late 20s showed that she might have cervical cancer. However, her doctor discouraged her from getting a Pap smear because he said it could damage her hymen. The woman was astounded that the doctor would rather risk her health than her apparent virginity.
An open conversation about sex between mother and daughter is rare. Of Dr. Kim’s patients who require care because of irregular menstrual cycles, only half say they feel comfortable talking to their mothers about it. The ones who don’t talk to their mothers still have to figure out a way to get a hold of their family’s medical insurance card to visit the clinic, which is another barrier to treatment.

In Korea, until a single man or woman becomes independent and starts working for a company that issues a separate insurance card, they are listed on the family card. Visits of any kind to medical clinics are stamped on the card for their parents to see. “Some students are afraid their parents will see the stamp on the card, flip out, and ask why they went,” Dr. Kim says.
Even if students are willing to pay out of pocket, most clinics require the insurance card as identification, Dr. Kim says.
The current system was created after a number of hospitals reported false earnings. Now, the holder of the insurance card has a record that, in theory, matches the hospital’s. “But it has a negative effect since it prevents unmarried women from visiting the gynecologist,” Dr. Roh says.
The government’s attitude toward this public health issue has been less than urgent. The Ministry of Education and Human Resources helped develop the existing sex education system in 1998. Prior to that, sex education was left up to individual schools.
One 24-year-old recalls her high school sex education as being “totally bad,” “boring” and “outdated.” Song Hee-jung says her teacher turned on an old videotape. “It was about giving birth, and it was very scary ― blood, water and all. They didn’t teach us how to avoid pregnancy.”
In the current sex education system, Chung Mi-sook of the Ministry of Education and Human Resources department says, “We strongly recommend that every school allocate at least 10 hours to sex education a year.” The individual schools can decide who will give the instruction, however. If the school has a health clinic, the main physician might teach a class. Or it may be a teacher of domestic affairs, or perhaps the biology teacher.
“From my personal view,” Mr. Chung says, “the Ministry of Gender Equality should engage in the promotion of women’s health.”
Such neglect of sex education means that “how do you get pregnant?” continues to be the question Dr. Kim fields most often.
Young women who need to go to a clinic may do so under a guise. One college senior says she found an office as far away from her home as possible. “I was afraid that someone who knows me would see me. You have to fill out some kind of form. I filled it out with false information.”

To change societal beliefs, Dr. Park says the sexology association is planning regular conferences and publishing periodicals. “This is just the beginning,” he says.
Dr. Kim has tried small group sessions with young women to encourage openness about sex and reproductive health, but says the results have not been fruitful.
“Students want to remain anonymous,” she says. “Women don’t like revealing their weight and lie about their height. How much more are they going to loathe revealing personal information like their sex lives?”
She plans on creating lectures, counseling students anonymously on the phone and individually in person. The going might be slow, but perhaps one day, young women will realize that taking care of their health is more important than buying shoes.

by Joe Yong-hee