Muslims: Sexual Health
Sex is a very private matter for Muslims and is generally regarded as something to be kept confidential between a man and wife. Talking about your sexual preferences and practices is not only frowned on by Muslim society, but is actually haram – banned in the Qur'an. This may make it difficult to take a clinical history that includes conditions relating to sexual activity, especially from an Islamic woman.
Islam is quite strict on the need for proper segregation of men and women to prevent any distractions from the importance of correct religious and social behaviour. Extra-marital or pre-marital sex is absolutely haram (forbidden). Even slight physical contact between the two genders is regarded as a dangerous temptation and to be avoided at all times – this includes shaking hands with a member of the opposite sex.
Because of this, great sensitivity needs to be shown by healthcare staff when dealing with issues of sexual health in the Muslim community.
When examining an individual for physical problems, it would be good practice for the examiner and the patient to be of the same gender. Muslim patients of both genders may be reluctant to expose their genitals, chest and legs even to staff of the same gender, and will usually permit only the area that is to be examined to be uncovered. Surrounding a patient with a group of students – especially a mixed-gender group – may frighten or offend your patient. Examinations must be a private and quiet affair, so it is better if only the patient and examiner are present.
A married woman may request that a female chaperone or her husband is present during a physical examination.
In vitro fertilisation is permissible if every other possibility for conception has been ruled out. However, the eggs and sperm used must belong to the couple concerned; donated eggs or sperm cannot be used without effectively making the child illegitimate and laying the parents open to charges of adultery. If a Muslim couple have approached you because of infertility, then discuss the need for them both to be tested to determine the cause of infertility; you will need to discuss this issue carefully to avoid offending them, as infertility is often considered to be due to the woman alone.
If treatment proceeds, there may be many more stumbling blocks along the way, from taking a semen sample from the husband, to the issue of what happens to unused fertilised eggs. It is suggested that you talk to an imam about the whole process so that you understand any fears your patients may have about infertility treatment.
Taking samples is a sensitive matter, as touching the genitals is considered to be sinful and harmful in Islam. If there is a medical necessity to take a sample to make a diagnosis, then this is reluctantly permitted; however, the need to take a semen sample for fertility testing, for example, is a grey area. Suggest that the sample is collected at home to remove fears about having to do this in hospital.
Surrogacy is absolutely forbidden under Muslim law for a number of reasons, including confusion in the child's heritage and legitimacy, and the possibility of being charged with violation of the marriage state. Muslims believe that a child has a right to have a clear lineage and full knowledge of their parentage, and surrogacy confuses both this and issues of inheritance.
Contraception may be used to prevent a woman becoming pregnant if pregnancy would harm either the woman or her unborn child. Permitted methods include the rhythm method and use of the Pill, although they must not be seen as a long-term solution. Discussions about contraception ought to include both husband and wife where possible. Any method of contraception that involves preventing the implantation of the fertilised egg (such as intrauterine devices or the 'morning after pill') is not allowed as it is considered to be a form of early infanticide.
Because a hysterectomy renders a woman unable to have children in the future, this procedure is permissible only as a last resort. For married women, discussion that includes the husband is good practice; if the woman is unmarried, it may be wise to include her parents or guardians.
termination of pregnancy
Muslims believe that when a foetus is four months old, angels come to breathe life into its flesh – this is when a foetus begins to 'quicken' in the womb. Termination after this point would be considered murder of the unborn but now living child. In extreme circumstances, such as where the life of the mother is in danger, termination is considered permissible. However, all efforts to save both lives must be exhausted first. The presentation of extreme danger to the life of the mother is the only condition under which termination is permitted in Islam.
miscarriage and stillbirth
If a baby is miscarried after four months of pregnancy or later, then it is considered to have had life and must be treated as any other deceased person. This includes ritual washing and burial, and a period of proper mourning. For this reason, it is important to remember to wear disposable gloves when touching the baby, and to wrap the baby in a clean white cloth. Do not offer to take a photograph of the baby as it is forbidden to take an image of a person in Islam. Hand the baby to the family for washing and burial. The placenta and other non-foetal tissues are still considered to be human flesh and therefore must not be incinerated if at all possible; it is more correct to bury them as though they were part of a person.
Anal sex of any kind – whether between man and wife or two men – is absolutely forbidden under Islamic law. For this reason, homosexuality is regarded as an aberration and sin
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