In the gynecology clinic, especially, every vaginal/speculum examination or order of collection for semen analysis requires a careful reconsideration.
During last year, I remember this conversation with my patient in fertility clinic.
Puan: Can give me Clomid?
Me: I will re-start you on Clomid induction next month, since you not having intercourse during this month. (Clomid induction is to induce ovulation by taking clomiphene citrate to increase fertility, and usually taken on Day 2 to D6 menses)
Dr. N: Not really lah. No intercourse during fasting hours only lah. (N is my colleague who overheard, or eavesdropping, i can’t really tell)
P: Ya, Dr. N is correct. But then again, after a day of fasting and my husband attending long prayers at night, usually he’s too tired at night and we rarely have intercourse during this month.
N: Now, that pretty true as well.
M: Err… Why don’t I prescribe you Clomid, and you discussed with your husband, whether to use it during this month or next month? Can?
During Ramadhan, there will be a handful of ladies, at certain times of the month, which will be hiding and eating during those supposedly fasting hours. Do not mistaken them as the deviant group of Muslims who break religious practice. They are probably having their menses and not allowed to fast.
I remembered going to the boutique with my dearest in Queensbay Mall few weeks back. I (and so does every customers at the shop) overheard a conversation between the Chinese lady boss and her Muslim sales attendant. The boss was being nice, but at the same time ignorant.
Boss: I beli makanan untuk you buka puasa, mahu tak?
Salesgirl: Terima kasih. Tak payah lar, hari ni tak puasa.
B: Kenapa tak puasa? Mana boleh tak puasa?
S: Tak boleh puasa. Tak boleh lah. (Look at her boss in one kind, hoping she understands)
B: Apa tak boleh. You tak sakit
S: Boss, tak boleh lah. Nanti I bagitahu you. (silent ‘Ishk’).
Some people can be pretty lost, at times.
Not that having menses is illegal or dirty or cheap, women just don’t want the whole wide world to know that they’re having menses. Similarly, for men, you don’t really want to let the whole universe to know you got body fluids (other than urine) coming out of your genitals, do you?
But then again, there was this fasting rule that I only knew this year.
I was seeing this auntie, new patient, who came to us with prolonged menses. Not heavy, just prolong. And at her age with 4 children, she had never been screened with Pap smear before. Her menses came since few days before Ramadhan and continueing everyday till now, a few days before Raya. By this time, frankly, I should really rule out those nasty gynae cancer, and ask her if I can proceed with perineal examination in view of the fact that she is not practicing puasa on that day.
“Saya puasa hari ni…”
”Mai kotor boleh puasa keh?”
“Jika lebih dari 15 hari, boleh puasa balik sampai Raya.”
“Oh...ok, lepas Raya, baru kita periksa balik”
Learn a new thing this Ramadhan. The great teacher is always the patient.
At times, it can be pretty enlightening.