The sexual health consultation as a moral occasion

Sexually transmitted infections (STIs) are socially constructed as more dirty' than other gynaecological conditions. This article analyses women's accounts of interactions with clinicians, subsequent to a diagnosis of genital herpes simplex virus or human papilloma virus. Women conceptualised consultations as a moral event,' different from other consultations. This moral component is highlighted drawing on Foucault's notion of the confessional.' Additionally, Douglas' anthropological construction of dirt' is used to consider why these consultations are confessional' experiences. Email interviews were conducted with 26 women diagnosed with a viral STI and 12 sexual health clinicians. Data were analysed thematically using a feminist, poststructuralist approach. Findings indicated that discourses of morality shape sexual health consultations. Five themes were identified in relation to the moral work' in clinical consultations about a viral STI diagnosis: the particular dirtiness' of viral STIs, clinicians as moral agents, the non-judgmental' clinician, women juggling truth-telling and risk and clinicians prescribing moral work. Clinicians support and educate women more effectively if they recognise subjective, moral aspects of sexual health consultations rather than assuming that effective clinical teaching is rational, scientific and non-judgmental.