The Management of Masturbation as a Sexual Health Issue in Dar es Salaam, Tanzania: a Qualitative Study of Health Professionals’ and Medical Students’ Perspectives

Abstract

Background: Across Africa, there are strong cultural taboos against masturbation. Aim: As part of a broader study investigating sexual health training needs of the health providers, researchers conducted a study to investigate how masturbation is addressed as a clinical issue in clinics in Dar es Salaam, Tanzania. Methods: An exploratory qualitative study design conducted in June 2019 involving 18 focus groups among healthcare providers and students in the health professions (midwives, nurses, medical doctors). A total of 61 health care students and 58 health providers were interviewed. The study participants were purposively selected and the design was purposively stratified to examine findings across the three main healthcare providers and by experience (clinicians versus students). A semi-structured interview guide in Kiswahili language was used. The study participants were presented a case scenario of a 14-year-old boy who was found masturbating in his room by his father, and asked how this case would be handled in a clinical setting. Data were transcribed in Kiswahili and Translated to English. Outcomes: Inductive-deductive thematic analysis was performed. Major themes and subthemes were identified. Results: Two main themes emerged: (1) knowledge about the management of masturbation and (2) views about the effects of masturbation. Clinical interventions providers would try include normalization of masturbation as a pubescent behavior combined with advice to stop the adolescent from masturbating, a recommendation to watch for negative effects immediately post-masturbation, and referral to a psychologist for treatment. Across providers and students, masturbation in adolescence was seen as clinically problematic, potentially leading to multiple issues in adulthood including sexual dissatisfaction with a spouse, psychological dependency, and erectile dysfunction, loss of sexual sensitivity in intercourse, premature ejaculation, and penis size reduction. Several participants mentioned they received no training about masturbation to guide their clinical practice. Clinical Implications: These findings affirm the need for comprehensive sexual health training in Tanzanian universities. Strengths and Limitations: Use of stratified design by profession and experience allowed to explore if there appear to be differences between students and experienced providers. The findings cannot be generalizable to all health professional students and providers across Tanzania. Conclusion: When designing sexual health curricula for Tanzania, it is important to include accurate information about masturbation as a normal and healthy sexual practice to address widely held myths about its effects on health, and to train providers in how to counsel when concerns and inaccurate information are brought to the clinical encounter