Dermatology and veneralogy specialist Dr. Elham Mutahar:Youth must be educated about sexually transmitted infections [Archives:2006/968/Health]

Interviewed by: Amel Al-Ariqi
The World Health Organization (WHO) estimates that more than one million new cases of sexually transmitted bacterial infections (STI), such as chlamydia and gonorrhea, occur worldwide every day in those aged 15-49. It's estimated that 80-90 percent of this global STI burden occurs in poor and marginalized populations in the developing world where there is poor or no access to diagnostics.

On the other hand, many specialists refer to the link between STIs and skin diseases, as some venereal diseases can only be diagnosed in patients with altered skin. Such diseases were included in the dermatology field from the very beginning.

Yemen lacks studies and statistics measuring and estimating the medical conditions of those suffering dermatological and venereal diseases. Most studies conducted have been based on the personal efforts of some dermatology and veneralogy doctors. Additionally, citizens are embarrassed to talk about the subject; therefore, they rarely seek treatment.

In the following interview, dermatology and veneralogy specialist Dr. Elham Abdulghani Mutahar highlights skin and venereal diseases affecting Yemenis, as well as public awareness in this regard and other issues.

Why did you choose this field and how do find it?

This field is very interesting, I chose this specialty because most dermatological and venereal diseases involve infected individuals living in low economic and poor hygienic situations, so it's very satisfying when I diagnose and treat such patients.

Why is this field so rare in Yemen?

It's not really that rare, as quite a few doctors already specialize in dermatology. However, I want to point out that in the United States and Europe, veneralogy and dermatology are separate fields; that is, each field has its own specialists, whereas in Yemen, dermatology and veneralogy are merged. Of course, it would be better if there were more specialists in each field, as specialty is very important because it's more diagnostic for certain diseases.

Are there any studies dealing with dermatological and venereal diseases in Yemen?

Some surveys have been done in Yemen regarding sexually transmitted diseases (STDs). For example, according to the Dec. 2004 Yemeni Health & Medical Research Journal No. 4, such a survey was conducted in 2003 at Al-Thawra Hospital in Sana'a. The survey exposed that approximately 200 women visiting the hospital at that time were suffering STDs.

What's the relationship between dermatological and venereal diseases and what are the differences between them?

Most signs and symptoms of dermatological disease appear on the skin, whereas sexual diseases, formally known as venereal diseases, are transmitted by sexual contact.

What are the most common dermatological and venereal diseases your center treats?

The most common diseases I diagnose at my center are allergies, infectious diseases, acne, leprosy, melasma, vitiligo, psoriasis, bacterial vaginosis and chlamydia.

Why are such diseases so common?

Well, environmental and occupational effects, as well as poor hygienic behavior, contribute to raising infection rates. For example, Sana'a weather, which is characterized by dryness, causes dry skin, hair loss, etc.; whereas in humidity, citizens may complain of other skin diseases, such as different types of fungal infections. Those living in poor hygienic situations may be affected by certain diseases like bacterial infections and some types of allergies.

How do you rate psychological effects upon skin diseases?

They have a direct effect. For example, those subjected to constant stress are most affected by skin infections like acne.

How do you describe public awareness regarding venereal and skin diseases?

Unfortunately, most of the public has no awareness about these issues. For example, women experiencing any type of genital inflammation go to gynecologists or sometimes diagnosticians, who in turn, do not transfer such cases to specialists (veneralogists). This happens when patients have no knowledge of venereal diseases, so they have no idea where they must go to receive treatment for such diseases.

Regarding protection from these diseases, most people have no idea. Some knowledge on this point is derived from religious concepts, for example, which prevent and forbid sexual contact outside of marriage; however, these individuals have no idea about STIs or venereal diseases.

Regarding awareness, what does Yemen need and are you for or against teaching sexual education in schools?

We need to educate the public to be aware of these problems and how to prevent them from occurring. Mass media must participate in this regard because they have a large and direct impact upon the public. Youth also must be educated about STIs, especially HIV and AIDS, by presenting lectures in schools and at certain centers. I don't call for open sexual education, as in the West, but rather for educating Yemenis about how such diseases occur and are transmitted and how to avoid them.

What are the diseases that may cause sterility in Yemeni women?

Well, fertility is very high in Yemen, but some venereal diseases may cause sterility. However, what's more dangerous is the fact that some venereal diseases, such as AIDS or syphilis, may be transmitted from mother to fetus. Other venereal diseases, if left untreated, may cause debilitating pain during labor.

Many women prefer asking their friends or older women instead of asking a doctor. What's your comment on this subject?

Unfortunately, this happens a lot. Numerous times, patients have come to me requesting medicine for problems occurring in their friends, giving the excuse that their friends are too far away or too busy to come in.

I also want to point to another problem, which is that some also may be embarrassed or unable to seek treatment for STIs. This means that not only are they more likely to pass the disease to others, they also have a greater risk of suffering the long-term consequences of untreated STIs.

How do you deal with patients coming to your center seeking treatment but also feeling shy to explain their cases?

It's really difficult to explain some medical problems to patients; however, it's my duty and my job to draw the patient's attention to the nature of his or her illness. In the beginning, I try to converse generally with the patient to ease his or her embarrassment, as well as learn more about his or her medical background. Gradually, I try to gain the patient's confidence to encourage him or her to speak.

Major Yemeni cities recently witnessed the wide spread of beauty centers claiming to provide customers with treatment for some skin diseases and now some centers are using lasers to treat skin. What is your opinion?

Most skin problems require a dermatologist or dermatology consultant to cure them and beauty centers don't regularly employ these types of specialists because it's expensive. As for laser treatment, this is a very specialized field and one very easily can damage the customer's skin (as well as his or her own eyes) if not properly trained in handling lasers.

Additionally, due to the absence of a monitoring authority, many of these centers are selling bad quality creams that affect the skin. So, I advise women not to take the risk and apply any cosmetic product to their skin. They should buy well-known brands of creams, such as Chanel, Dior, etc.

Does Yemen need cosmetic surgery?

We really need specialists in this field, which still is considered a new field in Yemen. Dermatology is a significant and important part of cosmetic surgery. Dermatologists are needed in many cosmetic plastic surgery operations, such as removing excess skin and fatty tissue from eyelids and the eye area and facelifts to remove the signs of aging. Another cosmetic technique is removing conspicuous scars by cutting out scar tissue and adjusting wound edges, etc.

Many Yemenis prefer turning to folk medicine or herbal dealers when seeking skin treatment, believing that nature won't affect them. Do you agree?

This isn't correct. Natural products also can affect the skin negatively. For example, honey, which mostly is prescribed in many cases, is considered a natural skin cleanser, but it may cause allergies in some skin. Therefore, a dermatologist is the only one able to determine the skin problem and prescribe proper treatment.

Dr. Elham Abdulghani Mutahar is a General Practitioner and Dermatologist at Al-Thawra General Hospital, Sana'a, Yemen.
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