'Not the time': How crises affect women's sexual health

  This report comes as part of the "Not on the Margins" project, which sheds light on freedoms, and sexual and reproductive health and rights in Lebanon

Now marks the first time that Maram, 31, experiences a break in her menstrual cycle. She got her period twice in one month, in addition to new, unusual pains and what seems like heavy menstrual bleeding.

"The death of marital life"

Maram, a resident of southern Lebanon, believes the tensions at the Lebanese-Israeli border are to blame, having affected her mental state. Israeli shelling at the border forced her to leave her hometown of Habbariyeh, and she tells Raseef22, “Under these conditions, life becomes meaningless, and everything in life, including marital life, dies, and everything a person loves becomes trivial.”

Maram believes that fear and terror in times of crises control a person more than their desires. She tells us of a decline in her sex drive since bombing began, and labels the circumstances an obstacle to achieving intimacy with her husband, “I try to control it, but I don't always succeed.”

"In these conditions, life becomes meaningless, everything in life, including marital life, dies, and everything a person loves becomes trivial."

She adds, “It's true that it does not go on for too long, but during, I feel like I'm making some sort of mistake, as if I'm betraying some unknown thing,” noting that nothing occupies her thoughts as much as her desire to return home safely, with her family.

While Maram's experience may seem individual, it is shared with many other Lebanese women who are living in a state of fear and psychological pressure, especially those from villages and towns near the country’s southern border, where they have witnessed traumatic scenes of bombing and clashes.

Rise in demand for sexual health examinations

Omgyno, an organization that provides free sexual and reproductive health consultations and examinations, reported a significant increase in questions it has received through social media and email. They also reported an increase in requests for home examinations since the start of the clashes in the South.

“The number of women who recognize that the cause of their problems may be related to anxiety is very low. Some try to deny their reality, and refuse to acknowledge the psychological stress they are exposed to. Women who have deduced that their recent issues are related to fear and anxiety are neglecting themselves, under the belief that the symptoms will disappear as soon as the psychological tensions subside,” according to Doreen Toutikian, founder and executive director of the organization.

According to her, the most requested type of examination recently has been a vaginal swab test, “Most of the women who contact us express a newly felt discomfort in the vagina, such as infections, severe itching, or irritation, and it is striking that the majority of questions are mixed with some kind of fear and tension.”

Effects of crises on women's sexual health

Toutikian stresses that women’s sexual health cannot be considered a secondary issue during times of crises, and awareness plays a crucial role in this context, “Many women neglect themselves in crises, believing that 'now is not the time', prioritizing family, children, parents and work over their health. Therefore, women should be encouraged to undergo examinations when needed.”

She adds, “Women's sexual health is important in all circumstances, and feeling guilt about caring for it is unacceptable. Issues or relapses that occur in a woman's body can worsen, and some problems can turn into cancerous diseases such as cervical cancer, leaving women with no choice but a hysterectomy in some seriouses cases.”

"Many women neglect themselves in crises, based on the principle of 'now is not the time', prioritizing their family, children, parents and work over their health. Therefore, women should be encouraged to undergo the necessary examinations”

Toutikian concludes her conversation with us by emphasizing that “prevention is better than a cure,” and that remaining diligent to sexual health can help spare women difficult and painful experiences in the future.

Menstrual disorders are one of many ways crises and psychological stress manifest in women’s sexual health. One study revealed that the risk of such disorders is heightened for women living in areas exposed to bombing.

Dr. Gael Abou Ghannam, a specialist in gynecology, explains that menstrual disorders are the most common problem among women facing psychological stress during times of war, crises, deaths, shock and severe anxiety. This is due to the impact on cortisol hormone levels, which, when elevated, affect reproductive hormones and can lead to menstrual problems such as delayed or advanced menstruation, excessive bleeding, or a lack of bleeding, along with increased pain and cramps.

Dr. Abou Ghannam points out that irregularities or an imbalance in the menstrual cycle can, in turn, affect fertility, “The woman's body will not be ready for the possibility of pregnancy if she wants it.”

She further notes that displaced women become more vulnerable to menstrual disorders, “Lack of sufficient sleep due to their circumstances may prevent cortisol levels from decreasing, consequently leading to problems with reproductive hormones.”

Dr. Abou Ghannam also reveals other problems women may experience during crises, such as involuntary vaginal spasms. Stress and tension can increase spasms, leading to an inability to relax and focus on the present moment, as well as cause pain during sexual intercourse, vaginal dryness, discomfort, and decreased sexual desire.

The specialist explains that "the cause of vaginal infections may be related to a disturbance in the levels of natural bacteria present in the vagina due to changes in hormone levels resulting from stress and psychological pressure. Displaced women living in difficult conditions may resort to using wet wipes due to water shortages, making them more prone to vaginal infections.”

“Women's sexual health is important in all circumstances, and feeling guilty about prioritizing it is unacceptable. Issues that occur in a woman's body could worsen, or turn into cancerous diseases, and in some cases, require a hysterectomy"

When do symptoms become concerning?

Ghadeer (pseudonym) has been experiencing vaginal spasms and cramps since the shelling in southern Lebanon began. The problem persisted for several days before she decided to leave her home in the South and seek refuge in a rented house in the southern suburbs of Beirut with her husband.

Speaking to Raseef22, she reveals the extreme fear she felt upon hearing the loud sounds of bombing on the first night when she went to sleep. Paralyzed by fear, she stopped eating and drinking. She believes that the experience of that first night of war was enough to result in significant changes to her body, “In addition to vaginal spasms that prevented me from being intimate with my husband for several days, my menstrual period was ten days late. My mother advised me to leave my residence in Kfarkela so that my womb would not be affected, and my ability to conceive would not be impacted, since I want to have children.”

As for Suha (pseudonym) who has not left her southern town, she tells Raseef22, “On the first day of the shelling, which coincided with the 30th day after the birth of my child, I experienced excessive bleeding that lasted for ten days before I contacted my doctor and received the appropriate treatment.”

“The number of women who recognize that their problems may be related to anxiety is very low, while women who have deduced that it's related to mental health are neglecting themselves, believing that the symptoms will disappear as soon as the stress subsides”

According to her doctor, her bleeding was caused by the intense fear she felt, which also led to other problems later on, such as an increase in vaginal infections. Despite her stress and anxiety about the events and their consequences, she and her family found no other option but to remain in their home.

Dr. Abou Ghannam advises women to visit a specialist if symptoms persist for more than two weeks, especially in cases of inflammation, pain, irritation, infections, or continuous menstrual irregularities. She insists, “It is necessary to identify the main cause of these problems.”

She concludes by saying, “Women should consume a diverse diet, drink sufficient amounts of water, and shower daily. Additionally, mental health should be at the top of the list of priorities because it is the main cause of many issues and difficulties."