THE OLDER ‘YOUNG’ PATIENT – SLOW DEVELOPERS
Older women who choose to come to a young person’s clinic can be viewed as slow developers who are completing the tasks of adolescence late. Often they are only now developing a mature sexual identity, and may be on the brink of making what they hope will be a satisfying heterosexual relationship. They present a different challenge to the doctor. Though adult attitudes prevail during the consultation and history-taking, a larger proportion will conceal psychosexual problems, which may come to light at the genital examination.
Miss C, a 30-year-old patient who was on the Pill, attended the clinic for routine repeat of supplies. She was an attractive woman of eastern origin, who was due for a repeat smear. When the speculum touched the introitus the woman’s legs clamped together and her hand came down to push the speculum away. ‘I can’t,’ she said. ‘It hurts too much.’ The doctor wondered how the previous smear had been managed. ‘Oh, I just screwed myself up and let the doctor get on with it, but it was awful and I’ve put off having another one.’ Patient and doctor decided to postpone the smear and talk about the pain. Miss C. seemed happy to stay on the couch and told about her decision not to have sex when her friends first took the plunge. She chose to wait for a special man. When she finally lost her virginity (her words) she was 26 and her first sexual encounter was ‘very funny’.
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