Moving to a new country often involves fleeting romances and serious long-term relationships. Whether these relationships last or not, it's crucial for expats to safeguard their well-being. This protective measure should begin even before departing for a new country. How can you look after your sexual and reproductive health?
Sexual and reproductive health explained
The World Health Organization (WHO) describes sexual health as a "state of physical, mental, and social well-being in relation to sexuality." This concept extends beyond simply avoiding disease or dysfunction. It promotes a positive and respectful approach to sexuality and sexual relationships, advocating for enjoyable and safe sexual experiences free from coercion, discrimination, and violence. Importantly, it includes the protection of individual sexual rights by states.
On a similar note, the 1994 International Conference on Population and Development (ICPD) Action Plan, also endorsed by WHO, defines reproductive health as "a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes." This aspect of health emphasizes the freedom to decide if and when to have children, underpinning the concept of "responsible sexuality."
Under the broad category of sexual health, reproductive health encompasses the development of access to quality health services, including contraception, assisted reproductive technologies (ART), options for voluntary termination of pregnancy, infertility prevention, and reproductive health education for both youth and adults. Despite these definitions, it is essential to recognize that they are not universally accepted in every country, nor is the protection of sexual and reproductive health consistently upheld.
Navigating sexual and reproductive health abroad
Many expats overlook their host countries' sexual and reproductive health policies, which often remain obscure to both foreigners and residents. Typically, the discourse in countries facing demographic challenges—such as China, Japan, South Korea, Italy, and France—centers on declining populations, aging citizens, and falling birth rates, with policies aimed at increasing birth rates.
However, when expats consider entering into romantic relationships or planning for children, they are suddenly faced with the realities of these policies. It is crucial for them to become acquainted with the local sexual and reproductive health environment. Understanding these policies and their practical implications can significantly impact personal decisions and plans in a new country.
Protection against sexually transmitted infections (STIs) while abroad
Engaging in sexual activities in a foreign country doesn't imply limiting or avoiding certain practices. The adventure of living abroad can lead to intimate encounters, whether fleeting or developing into more permanent relationships. Every expat has the right to freely explore their sexuality. However, it's crucial to recognize that not all countries offer equal levels of prevention and access to healthcare.
A primary concern is the protection against sexually transmitted infections (STIs). It's essential for expats to understand that anyone who is sexually active is at risk of contracting an STI, regardless of where they live. The risk increases significantly during unprotected sex, sexual encounters with new or multiple partners, or when under the influence of drugs and alcohol, which can impair judgment and lead to riskier behaviors.
Recommended vaccinations for expats
Before traveling abroad, expats are strongly advised to receive vaccinations for hepatitis A (HAV), hepatitis B (HBV), human papillomavirus (HPV), and mpox. It's important to note that hepatitis B vaccination is mandatory in several countries. Timing is crucial for these vaccinations; for example, the HPV vaccine requires a series of three shots spread over six months. Therefore, it is essential to plan these vaccinations well in advance of your departure date to ensure full protection.
STIs for which there is no vaccine
It's important to recognize that many sexually transmitted infections (STIs) currently have no vaccine. This list includes HIV, as well as syphilis, genital herpes, chlamydia, and gonorrhea. While studies in countries like the United Kingdom and France have shown some vaccines to be effective against gonorrhea, a specific vaccine targeting this infection is not yet available.
In the event of an STI infection, it is crucial to inform your partner and adhere to medical guidance. This underscores the importance of being familiar with the sexual health resources available in your host country, including access to necessary medications. As a preventive measure, using a condom during every sexual encounter, whether vaginal or oral, is essential to protect against STIs for which no vaccine exists.
Genital herpes: A global health issue
Genital herpes is a prevalent viral infection that affects over one in five adults worldwide, according to the World Health Organization (WHO) as of December 11, 2024. There are two types of the herpes simplex virus: HSV-1, which is primarily transmitted through oral contact, and HSV-2, which is mostly transmitted through sexual contact. Both types can cause genital herpes, but HSV-2 is often associated with more severe consequences, including more frequent symptoms, a threefold increased risk of contracting HIV, and the potential to spark epidemics.
There has been an observed increase in genital infections among adults, often with mild symptoms. However, severe cases can result in hospitalization for millions of people each year. While there are antiviral medications available that treat herpes by clearing up the lesions, they do not cure the virus. The virus remains dormant in the body, and the medications do not prevent future outbreaks.
Managing contraception while living abroad
Accessing contraception as an expat can be challenging, and it's important not to assume that the availability and types of contraceptives will mirror those in one's home country. In many places, even where sexuality isn't a taboo topic, the reality of contraceptive access can vary significantly.
Firstly, the preferred methods of contraception might differ significantly between your home country and your host country. For instance, some countries might favor certain types of contraceptives, like IUDs or implants, over others. While condoms and emergency pills are generally available without a prescription, most other contraceptives require one, which can introduce an additional barrier.
Moreover, using contraceptives like the pill, which requires consistent dosing at regular hours, can be complicated by factors such as jet lag, which may disrupt the menstrual cycle. An IUD might be a preferred alternative; for example, it is widely used in Switzerland. However, choosing between a copper IUD, which can increase menstrual flow, and a hormonal IUD, which can have side effects, depends on individual tolerance and health conditions.
Another consideration is the logistics of obtaining contraceptives. It's advisable to begin your journey with a sufficient supply of contraceptives, as regulations on the importation and possession of medications can vary, often allowing only a month's supply or a limited number of boxes. Check if it's possible to obtain a waiver from your home country to carry more medication, ensuring continuity in your contraceptive use while abroad.
Condoms: Pay attention to quality
When traveling, it's tempting to buy just any condom when your preferred brand isn't available. Purchasing from the internet is a common quick fix that is usually cost-effective. However, be mindful of quality. Condoms have expiration dates, and not all are reliable. Be aware of counterfeits and remember that improper storage can degrade quality, thus reducing effectiveness—for example, storing condoms in direct sunlight. The same precautions apply at home: avoid places that are too warm. It's also advisable to keep condoms in hand luggage when flying, as low temperatures in the cargo hold can damage them. Always avoid using a condom that isn't suitable, whether due to size issues, tears, or being past its expiration date.
Contraception for male expats: What to choose?
There's often discussion about various novel methods like the heated slip, a method some travelers might consider for contraception. However, the World Health Organization (WHO) does not recognize this method, nor other "thermal systems" such as the male contraceptive ring, as effective forms of contraception. These methods are still in the research phase. Similarly, research continues into male hormonal contraceptives, including pills and injections.
Currently, the only method internationally recognized as a reliable contraceptive for men that also provides protection against sexually transmitted infections (STIs) is the male condom.
Expatriation and reproductive health: Essential tips
Reproductive health encompasses state policies that support individuals through services like assisted reproductive technologies (ART) and abortion. However, significant disparities exist between countries. ART is often an expensive and complex process. Coverage for expatriates depends on the health insurance system of the host country, and many may need to secure private insurance that specifically covers their ART needs. The same is true for abortion services, which are not universally recognized and vary widely by country. The recent changes in U.S. abortion laws serve as a reminder of these international differences.
Pathologies impacting expats' reproductive health
According to the World Health Organization, approximately one in six people globally suffers from infertility, representing 17.5% of the population in 2023. This issue affects individuals regardless of their geographic location. In men, infertility may arise from hormonal disorders, sperm anomalies, or testicular issues, such as an absence of sperm production. In women, factors include ovarian disorders like polycystic ovary syndrome (PCOS), uterine conditions such as endometriosis, or hormonal dysfunctions related to reproduction.
External factors also play a significant role in infertility for both sexes. Key among these is the increasing age of first-time parenthood, influenced by societal changes such as economic crises, extended education periods, and discrimination against women. Fertility naturally decreases with age: in men, sperm quality declines starting at age 40, and in women, the reserve of oocytes diminishes beginning at age 38.
Environmental influences like pollution, endocrine disruptors, smoking, drug use, excessive alcohol consumption, and poor diet also contribute to infertility. These factors are often considered by couples planning to have children when choosing their expat destination.
Challenges in accessing care for expats
For expats dealing with infertility, finding appropriate medical and psychological support can be challenging. Despite infertility affecting both genders, women are often perceived as the primary cause across various cultures. Moreover, many countries' reproductive health policies do not adequately address infertility treatments, often allocating minimal funding to this sector. As a result, procedures like in vitro fertilization (IVF) remain expensive and inaccessible in numerous parts of the world.
Before moving to a foreign country, it is prudent for individuals to consult with their gynecologist and undergo a comprehensive health check-up if possible. Those planning to conceive should familiarize themselves not only with the costs associated with fertility treatments but also with the complexity of the treatments and the bureaucratic processes involved, especially if considering assisted reproductive technologies (ART) in their host country.
Useful links:
Canada: sexual health and travel
France: sexual and reproductive health; Questions about sexuality
United Kingdom: sexually transmitted infections (STI); NHS: check if it's an STI
United States: STI – prevention, information.
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