It’s burning down there: How shame is keeping SA girls from looking after their sexual health

A burning sensation. An itch that won’t go away. A rash. Yellow, brown or white discharge. For many teenage girls and young women in South Africa, these are things you don’t talk about. They’re symptoms to hide — from friends, partners, parents and even healthcare providers. That’s what research my colleagues and I at the South African Medical Research Council found when we talked to nearly 5 000 girls and young women aged 15 to 24 across the country about sexually transmitted infections (STIs) and vaginal infections. South Africa has one of the highest rates of STIs in the world, with adolescent girls and young women more likely to have STIs than older women and boys and men of the same age. Yet fewer than one in five of the girls we spoke to said they had ever been diagnosed with an STI such as chlamydia, gonorrhoea or syphilis by a health professional, even though many said they had at least one symptom of either an STI or vaginal infection, such as thrush (candidiasis) or bacterial vaginosis (BV) in the previous year. BV happens when the normal balance of bacteria in the vagina gets disrupted. Normally, the vagina contains mostly “good” bacteria that keep the environment slightly acidic and protect against infection. With BV, other types of bacteria grow too much, upsetting the balance. Common signs include a thin, grey or white vaginal discharge, a strong fishy smell, especially after sex, or mild itching or burning. Our study, which was published in the International Journal of Sexual Health earlier this year, found that shame, embarrassment and misunderstanding affect how young women understand and deal with STIs and other infections. Although one 2022 study estimated that one in four women in South Africa have a curable, bacterial STI (which, unlike viral STIs such as HIV or human papillomavirus [HPV) can be treated), a quarter of the girls and young women we spoke to chose not to answer the question about STI symptoms. That silence is as deafening as it is