(Ceská Republika and Slovenská Republika)
Demographics and a Historical Perspective
1. Basic Sexological Premises
2. Religious and Ethnic Factors Affecting Sexuality
3. Sexual Knowledge and Education
4. Autoerotic Behaviors and Patterns
5. Interpersonal Heterosexual Behaviors
6. Homoerotic, Homosexual, and Ambisexual Behaviors
7. Gender Conflicted Persons
8. Significant Unconventional Sexual Behaviors
9. Contraception, Abortion, and Population Planning
10. Sexually Transmitted Diseases
11. HIV/AIDS
12. Sexual Dysfunctions, Counseling, and Therapies
13. Research and Advanced Education
References and Suggested Readings
Jaroslav Zverina, M.D.*
*Partial translation byAnton Ros, M.D., and Lynne Ros.
A. Demographics
On January 1, 1993, the seventy-four year old Czech and Slovak Federal Republic ended peacefully when the Czech and Slovak Republics were established as separate nations. The two republics are located in east central Europe. Together, the two republics are about the size ofthe state ofNew York, with 49,365 square miles.
The Czech Republic is bordered by Poland on the north, Germany on the north and west, Austria on the south, and Slovakia on the east and southeast. The 30,450 square miles of the Czech Republic are divided between hilly Moravia in the east and the plateau of Bohemia in the west surrounded by mountains. The 1995 population of 10.4 million had an age distribution of 21 percent below age 15, 69 percent between ages 15 and 64, and 10 percent age 65 and older. Three quarters of the people live in the cities. Ethnically, 94 percent are Czechs, 3 percent Slovaks, 0.6 percent Polish, 0.5 percent German, and 0.3 percent Gypsy. This official number of Gypsies is probably incorrect because many Gypsies reported themselves as Czech or Slovak. A more realistic estimate would be about 100,000 or approximately one percent of the population in the Czech Republic, double that of the Polish and German minorities. In terms of religion, 39.8 percent are atheist, 39.2 percent Roman Catholic, and 4.6 percent Protestant. Czech life expectancy at birth in 1995 was 70 for males and 77 for females. The birth rate was 13 per 1,000 people and the death rate 11 per 1,000 population, for a natural annual increase of 0.3 percent. The Republic has one hospital bed per 98 persons, one physician per 323 persons, and an infant mortality rate of nine per 1,000 live births in 1995. Literacy in 1993 was 100 percent with ten years of compulsory education. The 1993 per capita gross domestic product was $7,200.
Slovakia is bordered by Poland on the north, Hungary on the south, Austria and the Czech Republic on the west, and the Ukraine on the east; the Carpathian mountains are in the north and the fertile Danube plain in the south. Slovakia has about half the population of the Czech Republic, with 5.4 million people. Its 18,933 square miles makes it about 62 percent the size of its former partner. Ethnically, 86 percent of the people are Slovak and 11 percent Hungarian. The official number of Gypsies in 1991 was 80,627 or 1.5 percent; the actual figure is probably double this, somewhere about 150,000 or 3 percent of the population. Sixty percent are Roman Catholic and 8 percent Protestant.
The 1995 birth rate was 15 per 1,000 population, the death rate nine per 1,000 population, for a natural annual increase of 0.5 percent. The infant mortality rate was ten per 1,000 live births in 1995. Literacy in 1993 was 100 percent. The 1993 per capita gross domestic product was $5,800.
B. A Brief Historical Perspective
Slovakia was originally settled by Illyrian, Celtic, and Germanic tribes and became part of Great Moravia in the nineth century. It became part of Hungary in the eleventh century. After being overrun by Czech Hussites in the fifteenth century, it returned to Hungarian rule in 1526. The Slovaks dissassociated from Hungary after World War I and immediately joined the Czechs of Bohemia and Moravians to form the Republic of Czechoslovakia. This union ended December 31, 1992.
The Czech Kingdom has a long tradition as a self-standing European country dating from the ninth century, when Bohemia and Moravia were part of the Great Moravian Empire. This later became part of the Holy Roman Empire. Under the kings of Bohemia, in the fourteenth century, Prague was the cultural center of Central Europe. Bohemia and Hungary became part of the Austro-Hungarian Empire until 1918.
In 1939, Hitler dissolved the state of Czechoslovakia, made protectorates of Bohemia and Moravia, and proclaimed Slovakia independent. Soviet troops entered Prague in 1945 and the communists seized power in the elections of 1948. Communist rule ended with Vaclav Havel’s “velvet revolution” in November 1989. Because these two countries were one nation for eighty years, they are treated together in this chapter.
A. Character of Gender Roles
The prevailing character of gender roles in the republics is traditionally European, with masculinity connected with social dominance. While the Communist dictatorship verbally proclaimed and endorsed full female emancipation during its forty-year rule, the socioeconomic status of women was low. The number of women employed was very high, but their role in family care and child rearing was commonly underestimated.
B. Sociolegal Status of Males and Females
In both civil and criminal law, both genders are fully equal. Basic schools, colleges, and universities are coeducation. Both men and women have the same political rights.
C. General Concepts of Sexuality and Love
According to Christian tradition, love is a basic ethical category in sexuality. Most couples base their relationship on romantic love. Under the forty-year Communist dictatorship, the erotic and sexual were kept out the mass media. With the growing impact of AIDS and the changing political atmosphere after the 1989 revolution, there came a shift to more open discussions about sexuality and sexual morality.
A. Source and Character of Religious Values
Christianity is the dominant religious influence in both Republics, with Roman Catholics in the majority in both countries. In the Slovak Republic, 60.3 percent are Catholic, 30 percent other, mainly Protestant, and 9.7 percent not church-affiliated. In the Czech Republic, 39.7 percent are not church-affiliated, 39.2 percent are Catholic, and 21.1 percent other, mainly Protestant. Religiosity is a much stronger influence in Slovakia than it is in the Czech Republic.
B. Source and Character of Ethnic Values
Except for the Gypsy population, the other ethnic minorities, Hungarian, Polish, German, and Ukrainian, blend homogeneously with each other and with the 54 percent Czech and 31 percent Slovak majorities.
A. Government Policies and Programs
Basic knowledge about sexual anatomy and physiology is provided as a part of the basic school curriculum. However, information about contraception, sexual hygiene, and safer sex practices are only rarely and inconsistently covered. Almost universally ignored are topics like homosexuality, paraphilias, and sexual assaults (exhibitionism, rape, incest, and sexually motivated murder).
B. Informal Sources of Sex Education
As a consequence of the lack of formal education, children and young people get the greater part of their information about sex from peer groups. The most important sources of sex information for the young are parents, books, television, and other mass media sources.
In 1990, an unusual and curious national political party was founded with a main goal of promoting sex education and spreading information about human sexuality. This Independent Erotic Initiative (NEI) publishes a party magazine, the NEI-Report, which has become one of the successful and popular magazines in the Czech Republic. NEI-Report includes tasteful and tasteless exotic articles: cartoons; articles by sexologists dealing with sexual problems and dysfunctions, contraceptives, sexual hygiene, STD, and AIDS; articles by celebrities; letters from readers about their exotic experiences; and explicit photos that give the magazine commercial value. The articles are written by journalists, physicians, educators, and other experts, as well as celebrities and ordinary readers.
Data from a 1994 representative sample of 1,719 men and women over age 15 years in the Czech Republic indicated that 45 percent of the men and 35 percent of the women learned about sex from their peers, 26 percent of both sexes from books, 12 percent of men and 21 percent of women from parents, 15 percent and 14 percent respectively from newspapers and magazines, and 12 percent and 9 percent from television, films, and radio (Zverina 1994).
Self-pleasuring is seen as an important and natural part of normal sexual activity and motivation. Myths about the unnaturalness and harmfulness of autoeroticism are rarely mentioned, although letters from readers to sex publications indicate that, despite negative beliefs and fears, people do engage in autoeroticism. This applies to both children and adults. Only rarely do parents complain to physicians about the sexual practices of their children.
In a representative sample of 1,719 Czechs over age 15 years, 83 percent of the men and 50 percent of the women reported masturbating sometime in their lives, with the average age for first masturbation being 14 years for men and 17 years for women. Five percent of the men and 10 percent of the women said masturbation poses a health risk (Zverina 1994a).
A. Children
The sexual games of children are usually played in secret, and ignored if discovered by parents. They are not the objects of special sanctions in most families.
B. Adolescents
Puberty Rituals
There are no special or institutionalized rituals that recognize either puberty or the initiation of a nonmarital sexual relationship.
Premarital Sexual Activities and Relationships
First sexual intercourse usually occurs between ages 17 and 18. Criminal law sets the minimum age of consent to sexual intercourse at age 15 for both men and women. This law applies equally to both heterosexual and homosexual intercourse. Premarital sexual intercourse is very common, with 98 percent of women having had sexual intercourse before marriage. Premarital sex is accepted, and quietly tolerated, but not openly accepted or endorsed by parents for women under age 18. The average number of premarital sexual partners is one or two for women and two to four for men.
In a representative sample of Czech adults over age 15 years, the average age reported for first coitus was 18.1 years for men and 18 years for women. More than 40 percent of these first experiences occurred in a cottage or outdoors; without contraceptives for 57 percent of the men and 64 percent of the women; and with an “occasional partner” for 34 percent of the men and 12 percent of the women (Zverina 1994a).
In 1993, a representative survey of Prague youths, ages 15 to 29, was sponsored by the MF DNES newspaper and carried out by the author of this chapter with the collaboration of DEMA, the Institute for Social Investigations. Seventy-eight percent of the men and 83 percent of the women reported having had sexual intercourse, with the average age for first coitus 17.3 years for men and 17.4 for women. In this same survey, sexually active men reported an average of 8.1 coital partners while women reported an average of 6.6 partners. Nearly two thirds of the men and 73 percent of the women reported having a sexual partner in the previous year. Only one sexual partner was reported by 9 percent of the males and 18 percent of the women. One in five males and 12 percent of females reported having had more than ten sexual partners in their lives. The most common sexual expression was vaginal coitus: 96 percent of sexually active men and 99 percent of sexually active women. Fellatio was refused by 16 percent of the women surveyed, while anal heterosexual intercourse was reported by 22 percent of the men and 16 percent of the women (Zverina 1994b).
C. Adults
Premarital Courtship, Dating, and Relationships
Courtship and dating customs are similar to those in other Eastern European countries and are based on the romantic model. There are no major differences in the dating and courtship patterns of young Czechs or Slovaks living in the cities or rural areas. There are no special courtship customs such as Fensternl, or window courting, which occurs in rural Bavaria, or similar customs in the Scandinavian countries.
In both republics, the age of first marriage is relatively low, about 21 years, for most men, with their brides generally being about a year younger. Two socioeconomic factors have contributed to this relatively low age of first marriage. During the forty years of communist rule the government supported early marriage with a system of government benefits and loans. Under communism, and down to the present, it has been extremely difficult for a single man or woman to obtain a flat or apartment. In addition, marriage and having a first child is an important social signal of having grown up and achieved adult status.
Marriage and the Family
As in most parts of the world, heterosexual monogamy is the dominant pattern of sexual behavior in the Czech and Slovak Republics. As is occurring elsewhere in Europe and North America, serial or successive monogamy is becoming a common modification. The 1990 Czech marriage rate was 8.8 per 1,000 inhabitants; the divorce rate 40.81 per 100 marriages. The average age of first marriage was 23.7 for men and 21.3 for women (Zverina 1994a). In Slovakia, the marriage rate was 7.6 per 1,000 inhabitants; the divorce rate 35.2 per 100 marriages.
In the 1994 study of Czech adults over age 15 years, men reported an average of 12.2 sexual partners, women 5.1 partners, with 1.8 and 1.9 partners respectively for the previous year. The average coital frequency in heterosexual partnerships was 8.4 times monthly. Three-quarters of the men and 82 percent of women reported being “fully satisfied with their sexual life” (Zverina 1994a).
Sexual promiscuity is unusual, and most extramarital heterosexual activities are situational or have a pairbonding character. Several studies indicate an incidence of extramarital intercourse at between 25 percent and 35 percent of husbands and wives, with extramarital sex more frequent for men. Most of these extramarital activities are short-lived and infrequent. Reasons for extramarital sex have not been studied, although it is likely that sexual variety and the attraction of a new experience are common motivations. Eighteen percent of men and 31 percent of women held that extramarital sex is “ethically unacceptable behavior” (Zverina 1994a).
In recent decades, there has been an escalating problem of single parent families, mostly divorced mothers with children. More than 70 percent of marriages ending in divorce have a minimum of one minor child. Single mothers have a state-guaranteed minimum standard of living and the economic support from the father of their children. Czech and Slovak society is not hostile to unwed mothers or divorced women.
The birthrate in both republics is relatively low, and still decreasing. The birthrate in 1978 was 18.4 per 1000 inhabitants. In 1992, it had dropped to 12.2 per 1000. Most married couples plan to have one or two children. Planning for more than two children in a family is unusual. Surveys suggest that coital frequency for most married couples is one to three times per week.
Sexuality and the Physically Disabled and Aged
Sexual behavior and sexual problems of mentally and physically handicapped persons are only rarely mentioned in public. The same is true for medical sexologists and marriage counselors. Since the dissolution of communist control in the “velvet revolution” of 1989, there has been a growing activity of different nongovernment organizations seeking to promote the care and well-being of the physically handicapped.
As elsewhere, there are more single women than single men over age 60. Older women are less likely to find an acceptable partner than older single men. We know that interest in sex in the later years has a direct connection with the availability of an appropriate sexual partner. An additional problem in the republics is that the living standard in state facilities for older persons is not conducive to couples’ maintaining intimate relationship. In most cases, the state facilities for the elderly are based on a collectivist model.
Incidence of Oral and Anal Sex
Oral sex is widely accepted and practiced by Czechs and Slovaks. Respondents in several surveys indicated that about 70 percent of men and women engage in oral sex as a part of their sexual intimacy. The frequency of anal intercourse, on the other hand, is low among heterosexuals, with only about 5 percent of heterosexual women reporting this experience. In most cases where reported, the activity was exceptional and infrequent.
Sexual practices in both republics are not the object of legal regulations. The sexual behavior of consenting adult partners is free from any restriction by criminal law.
A. Children and Adolescents
Same-gender sexual experiences may be a natural part of the sexual play and exploration of children. However, their prevalence does not appear to be high. Only about 10 percent of men and 5 percent of women in the heterosexual population report having had same-gender experiences in childhood and early adolescence. In the population of gay men and lesbians, such experiences are, of course, more common.
B. Adults
Attitudes towards homosexuality among the greater part of the population are hostile or ambivalent. Homophobia and hostility towards homosexual people are more common among people in the lower socioeconomic classes. The pandemic of AIDS has brought some changes, mostly in the attitudes towards gays. It seems there is a greater tolerance of stable gay partnerships and couples, and the existence of gay clubs and associations. However, 33 percent of men and 41 percent of women in the 1994 adult survey considered homosexuality a disease. Twenty-two percent of both Czech men and women fully accept homosexuality. Only 2 percent of the men and 1 percent of the women reported a homosexual experience; 1 percent of both male and female respondents self-identified as homosexual, with another 1 percent unsure (1994b). In the adult Czech survey (1994a), 3 percent of men and 4 percent of women reported a homosexual experience. In more than 60 percent of male homosexual coitus, condoms were not used.
In the new penal law code, which went into effect in the republics in 1990, no distinction is made between heterosexual and homosexual behaviors. The ages of majority and of legal consent to sexual intercourse, 18 and 15 years respectively, are the same for both heterosexuals and homosexuals. This new code revoked the criminalization of homosexuality that existed in the previous code. At present, there is a movement to reduce the intolerance and inequities homosexual persons experience socially. These involves paying more attention to the situation of homosexual men and women in the workplace, in schools (both students and teachers), and in the army.
Most gay and lesbian associations are engaged in a movement to legalize the unions or marriages of homosexual couples. Some kind of legalization of long-term homosexual partnerships is supported by important politicians. The attitudes of the Catholic Church on homosexuality is at present still fundamentally rigid and hostile. Some Protestant Christian churches, on the other hand, are traditionally more liberal and less rigid. Coming out appears to be more of a problem for gay men than for lesbians.
Bisexual behavior is more common among homosexual persons than among the heterosexual majority. About 60 percent of the homosexual men surveyed and more than 70 percent of the lesbians reported having had heterosexual intercourse at some time in their lives. Among heterosexual men and worn en surveyed, only 12 percent of the men and 5 percent of the women reported some same-gender sexual contacts. Most of the same-gender contacts reported did not involve coitus.
While homosexual men tend to be more sexually promiscuous than lesbians, the frequency of anonymous sexual contacts under poor aesthetic conditions is decreasing. One hope: that this is connected with the increasing sex and AIDS-prevention education programs. The prevailing pattern at present is stable, long-term gay and lesbian relationships.
Sexual practices among homosexuals in the republics is the same as in other parts of the Western world. Among homosexual men, active and passive (receptive), anal intercourse is common. Condoms and lubricant gels are used with growing frequency.
Fetishistic transvestism is a paraphilia with seemingly low incidence among males in the two republics. In some cases, transvestite males bring their problems to sexological counseling centers. Most of these problems are connected with the partner’s/wife’s hostility toward the client’s cross-dressing and its impact on their sexual practices.
The prevalence of transsexualism also appears to be low, as in other European countries. Interestingly, the sex ratio of transsexuals in the republics’ sexological centers is the opposite of what it is in western Europe.
In the records of the Institute of Sexology at the Charles University in Prague, for instance, there are three times as many female-to-male transsexuals as male-to-female transsexuals. In most western European gender clinics, twice as many male-to-female transsexuals are reported as female-to-male. Colleagues in Poland report a ratio similar to that in Prague. Different social conditions and gender viewpoints in east and west European countries may be a factor in this difference in ratios.
Treatment for transsexual persons follows the common step-by-step practice in respected gender clinics around the world. Initial counseling and screening is followed by months of psychotherapy and sociotherapy. In allowing the client to adapt better to a reversal in gender role, it is possible to change the patient’s name to a gender neutral one; in Czech and Slovak, the given and family names usually indicate the person’s gender. However, some names are gender neutral and the same for either a male or a female.
Following months of hormone treatment, the decision for anatomical sex-reversal surgery can be made. Sex-reassignment surgery, which involves plastic surgery and gonad removal with consequent infertility, is required for an official and complete sex-reversal procedure.
Sex-reassignment surgery is available for both female-to-male and male-to-female transsexuals as part of the health insurance system. From a medical point of view, transsexuals are seen as people with inappropriate development of secondary sexual characteristics. In the Czech republic, about eight patients a year request official sex-change surgery.
A. Coercive Sex
Sexual Abuse, Incest, and Rape
The statistics on criminal sexual delinquencies are low in both republics when compared with most west European countries. Twelve percent of women in the 1994 adult Czech survey reported an experience with rape, while 5 percent of the men admitted forcing sex on a woman. The victimization of women, according to our experience, is lower than in western Europe. For example, approximately 18 percent of women in our surveys stated that they had been the object of sexual abuse as a child. In our 1994 preliminary results, 5 percent of the men and 8 percent of the woman reported sexual abuse during childhood. About 20 percent of the women reported having experienced some sort of sexual aggression from men. Most of these assaults are not reported to the police or other authorities. Sexual victimization of males is less frequent, probably about 8 percent to 10 percent.
Sexological investigations of criminal sexual delinquents requested by the police and courts are generally grouped in three main categories: (1) indecent exposure, (2) sexual molestation or abuse of children and minors, and (3) rape and other sexual assaults.
In recent years, greater attention has been paid to sexual abuse and incest. The common experience is that the most threatened individuals in terms of sexual abuse and incest are children in single-parent families. The most frequent perpetrator is a step-father or the boyfriend of the mother of the victimized child.
A woman who reports a rape is subjected to a very careful and long investigation by the police. Hearings and questioning of the woman can last up to five hours or more. Once a charge is made, the woman cannot withdraw it. Nor can she discuss the accusation with anyone other than the police. If she does, she can be prosecuted for false accusation. At the court hearing, the woman has to answer questions from the court, the defense attorney, and the accused male, in what can be a very traumatizing experience. Similar procedures are followed in cases of child abuse.
At present, there are no special centers for counseling and support of the victims of rape and sexual abuse, although establishment of such centers is being considered.
When apprehended, perpetrators of sexual assault are examined both from psychiatric and sexological perspectives. In cases of psychopathological or paraphiliac motivation, the court can commit the perpetrator to compulsory treatment in a hospital psychiatric department or in an outpatient clinic. Specialized sexological departments in most psychiatric hospitals are staffed with personnel trained in treatment of dangerous sexual delinquents.
Sexual Harassment
Men can be sued for comments and sexually explicit (dirty) language, but accusations and court cases involving accusations of men making sexual advances to women, using indecent language, or sexually harassing women are rare.
[A 1996 report by J. Perlez, suggests that Central European countries and corporations are being slowly influenced by Western concepts of sexual harassment. In a high-profile case in the Czech Republic, a manager at Komercni Banka, a major state bank, was dismissed after a secretary filed a sexual harassment complaint against him. In a 1995 case involving the same manager, the bank refused to act. (See additional comments in Section 8A of the chapter on Poland) (Perlez 1996). (Editor)]
B. Prostitution
Little is known about prostitution in the Czech and Slovak Republics. There are probably several thousand prostitutes working in Prague. Some work in massage parlors and exotic clubs, but most frequent hotels, bars, and restaurants. Since the collapse of the Communist regimes, there has been a migration of Czech and Slovak prostitutes to West Germany, and from Eastern European countries to the Czech and Slovak Republics.
Nine percent of men and no women reported paying for sex, while no men and only 3 percent of the women had engaged in sex in exchange for money (Zverina 1994a). Among young Czechs, ages 15 to 29, 14 percent of males reported intercourse with a female prostitute, with a 60-percent use of condoms in these contacts. Three percent of the young women reported having sex for money, with a 50-percent condom use (Zverina 1994b).
C. Pornography and Erotica
The republics have no indigenous pornographic publications, but Playboy-like hard-core magazines are imported from Scandinavia, Germany, and Austria. These magazines are not available in regular stores, and where they are available, they are labeled “Not for Minors.” The situation is similar for sexually explicit videos.
In our 1994 preliminary results, 4 percent of the men and 8 percent of the women thought that pornography should be prohibited; 11 percent and 20 percent respectively thought pornography to be dangerous.
D. Paraphilias
Paraphiliacs, at present, have more opportunities for communication and contact than they had under the communist rule. Some sexual contact magazines and advertisement services now exist for these people. Most of the interest is in sadomasochism and fetishistic practices.
Some people with ego-dystonic paraphilias seek help at the counseling centers and sexological departments. More frequently sexologists are called on to treat paraphiliacs who have been arrested as perpetrators of some sexual crime. In such situations, consultation with a psychotherapist is required, and treatment can be paid for by the national health insurance.
A. Contraception
The birthrate in the Czech republic is very low. In the Slovak republic, it is comparable with some more successful countries from this point of view in Europe. About 49 percent of all children are not planned, but only 1.4 percent of all newborns are placed for adoption.
Data on the use of contraceptives in the two republics demonstrates a major problem, in that almost half of all pregnancies are unwanted. Withdrawal, coitus interruptus, is by far the most common contraceptive method, being relied on by 40 percent of the Czech women at risk and 51 percent of the Slovak women at risk (1991 data). Barrier methods, particularly the condom, are used by 31 percent of Czech women and 24 percent of Slovak women. The hormonal contraceptive pill is used by 8 percent and 6 percent respectively; sterilization by 2 percent and 5 percent respectively. The low incidence of hormonal contraception and surgical sterilization is a national problem. This is compounded by the seemingly high frequency of condom use. This datum should be understood as an artifact of the surveys because the 31 percent and 24 percent of women reporting condom use does not mean regular and consistent use, but rather occasional and even one-time use. In reality, condom popularity is both republics is very low in comparison with western European countries.
In preliminary data from Zverina (1994b), 39 percent of young Czech males reported condom use with a stable partner and 40 percent with a casual partner. Women reported condom use in 36 percent of coitus with a stable partner and only 20 percent with a casual partner. Forty-one percent of men and 35 percent of women reported using a condom with occasional partners. Condom use in anal intercourse and fellatio was the exception. Among Czech adults, male and female contraceptive use is shown in Table 1.
Table 1
Male and Female Contraceptive Use Among Czech
Adults
|
Method |
Men (Percent) |
Women (Percent) |
|
Withdrawal |
41 |
38 |
|
IUD |
17 |
23 |
|
Condoms |
19 |
22 |
|
Oral contraceptives |
16 |
22 |
|
Natural/Rhythm |
|
12 |
The number of pregnancies in women under age 15 is low. In 1989, for example, the Czechoslovakian figure was 110 pregnancies in this age group, 0.03 percent of all pregnancies in that year. Seventy percent of these pregnancies were terminated by abortion, mostly legal induced abortions; forty ended in childbirth.
In the same year, 42,145 women age 15 to 18 years were pregnant, 10.8 percent of all pregnancies that year. Close to two thirds of these pregnancies ended in childbirth. Slovak and Czech teenage women have very little access to contraception. Contraceptive pills can only be obtained from a gynecologist, and the attitude of many gynecologists toward hormonal contraception for young women is inappropriately negative. Contraception counseling centers for teenagers promote abstinence in place of other contraceptive methods. Some counseling centers for teenagers, however, work under the supervision of British family planning organizations and provide contraceptive without charge.
C. Abortion
Laws regulating induced abortion were liberalized in 1956. Between 1956 and 1986, women seeking an abortion had to present their request to special “abortion commissions.” From 1987 on, pregnant women could obtain an abortion simply by requesting it. Induced abortion is legal until the twelfth week of gestation. Abortion for medical reasons or to protect the woman’s health is legal up to the twenty-fourth week of gestation. Illegal abortions are rare. In the 1994 adult survey, 60 percent of women and 58 percent of the men were fully “pro-choice.” Three percent of both men and women believed induced abortion should be prohibited by law.
In the last two years, the number of legally induced abortions has declined. More than 80 percent of all abortions in the two republics are performed in the first two months of gestation, as “mini-interruptions.” RU-486 is not available. The number of legally induced abortions per 1,000 women in 1991 is shown in Table 2.
Table 2
Rate of Legally Induced Abortions (per 1,000 Women), Czech
Republic and Slovakia, 1991
|
Age Group |
Czech |
Slovak |
|
Under 19 |
24.6 |
14.9 |
|
20-24 |
76.1 |
58.9 |
|
25-29 |
81.2 |
67.0 |
|
30-34 |
63.6 |
52.6 |
|
35-39 |
42.8 |
35.6 |
|
40-44 |
15.1 |
12.1 |
|
45 plus |
1.4 |
0.9 |
In recent decades, the government has made some efforts to promote population growth. All of these efforts utilized economic incentives. Money was provided for the support of each additional child at above the standard of normal living. Families with three or four children received increased support and benefits. All of these efforts had only a temporary effect, and no substantial long-term success.
At present, the state population policy is relatively liberal. The goal is to enhance the social and reproductive responsibility of the people. The state supports some sexual education programs. Nongovernmental organizations also sponsor activities including education programs aimed at improving contraceptive use and lowering the number of legally induced abortions for nonhealth reasons. It is estimated that more than 70 percent of all pregnancies in the two republics are unwanted and unplanned. This is the greatest problem in population policy for both countries.
A. Incidence, Patterns, and Trends in STDs
At present, the incidence of STDs and AIDS is relatively low. In the young Czech survey, only 7 percent of males and 16.5 percent of females reported some experience with a sexually transmitted disease. This is due to forty years of communist policy, which, in a substantial way, restricted the free movement of people. After the frontiers were opened in 1989, the movement of people into and out of the country increased. This new mobility and migration is already increasing the number of STD cases in the larger cities and in regions near the western frontier.
In the 1980s, no more than four cases of syphilis were reported annually per 100,000 inhabitants. In 1991, the rate of new syphilis cases was 1.3 per 100,000, with more women than men affected.
In the 1980s, the annual incidence of gonorrhea had been under 100 cases per 100,000 inhabitants. In 1991, 71 percent of all cases were men between ages 15 and 24. In 1992, the incidence of gonorrhea increased significantly in some regions, on the north and west frontiers, and in Prague. This is one of the first signs of a new STD epidemic developing under new social conditions.
Our own clinical experience reveals a remarkable increase in the incidence of all other STDs, including genital warts, papilloma virus infections, genital herpes, nonspecific urethritis, pelvic inflammatory disease (PID), chlamydia, and cervical carcinoma.
B. Availability of Treatment and Prevention Efforts
The law requires that all new cases of classical venereal diseases be reported to the state Dermatovenereological Department. Infected persons are also required by law to give health professionals information about all sexual partners. Diagnosis and treatment for STDs is easily available in all the larger cities, at dermatovenereological departments, clinics, and gynecological and urological departments.
The main factor in the primary prevention of STDs is responsible sexual behavior. Sexual education should be started at a very young age and should include information of the health risks of sexual behavior. Some particular groups, “at-risk populations,” need special attention to sexual education programs, for example the propagation of safer sex information among promiscuous heterosexuals, homosexuals, prostitutes, and highly mobile minorities (tourists and professional drivers). Sexologists in both countries are not completely satisfied with the present situation in sex education. The involvement of the mass media, radio, and television, is very small in this area.
A. Incidence, Patterns, and Trends
Thus far, the incidence of HIV infection in the republics is low. At the end of 1992, there were 143 known cases of HIV infection in the Czech republic, 93 of them being homosexual or bisexual men, and 30 hemophiliacs or blood-transfusion recipients. Only one IV drug user has registered. Ten cases involved heterosexual transmission and 9 cases had unknown sources. Of the 143 known cases, 11 were women and 7 were children under age 15. Persons with suspected HIV infection or AIDS are protected under a special law guaranteeing their personal freedom to seek or refuse testing.
AIDS is still a very rare diagnosis. At the end of 1992, only 32 cases of AIDS were known in the Czech republic. Twenty-six of these were homosexual or bisexual men, 3 transfusion recipients, 2 heterosexual men, and 1 foreigner.
The low incidence of HIV infection in both republics is well demonstrated by the results of several preventive and anonymous screenings for HIV. In one study of 66,095 patients with an STD, only 23 persons were found to be HIV positive, In another anonymous testing of 2,554 persons, only nine persons were HIV positive.
For 96 percent of the Czech men and women, the main source of information about HIV/AIDS is the mass media. Knowledge about HIV/AIDS has resulted in safer sex practices for 22 percent of the men and 14 percent of the women (Zverina 1994a).
B. Treatment, Prevention, and Government Policy
There are centers for HIV/AIDS investigation and treatment in both capital cities, Prague and Bratislava. Anonymous testing for HIV is available in all larger cities free of charge. Government policy fully respects the international standards of the World Health Organization.
National centers for HIV/AIDS have been operating in both countries for several years. The respective Ministries of Health Care have been coordinating governmental activities with nongovernmental organizations and institutions. An AIDS-Help society, SAP [Spolecnost AIDS Pomoc], was founded in 1991. Sexual education is actively promoted by the sexological societies and by the Czech and Slovak Family Planning Associations (SPRSV [Spolecnost pro Planovani Rodiny a Sexualni Vychovu] in Czech and SPR [Spolecnost Planovaneho Rodicovstva] in Slovakia). Many hot lines and telephone counseling services are operating with varying professional standards.
Programs for training counselors and health professionals are just being organized. Work with “at-risk” populations does not have a long tradition, because such groups were not acknowledged by the communist government. An organization for prostitutes was started in 1992. Propagation of safer sex information among promiscuous homosexual men and promiscuous heterosexuals is possible with the collaboration of gay self-help groups like the Lambda Klub, and through erotic magazines and video-rental clubs.
The author’s 1993 survey of 984 residents of Prague (N = 485 males; 499 females) between the ages of 15 and 29 contained thirty questions about past and present sexual behavior designed to elicit information of the risk of HIV infection. The most frequent sources of information about HIV/AIDS were books and magazines (more than 50 percent of males and females). Parents and school were the main information source for less that 10 percent of the respondents. More than 90 percent of the male and female respondents were appropriately informed about HIV transmission, although 20 percent believed that the virus could be spread by insects, kissing, or sneezing. Five percent of the males and 2 percent of the women believed that hormonal contraception protects against HIV infection. One in four males and females felt threatened by the risk of infection. One in four males and one in five females had changed their sexual behavior as a result of this fear, with a decrease in sexual partners and increase in condom use being the most common changes.
Twenty-nine percent of males and 16 percent of women stated they would break with a partner if they learned that he/she was HIV-positive. Twenty-three percent of the men and 17 percent of the women believed persons with HIV/AIDS should be kept in isolation. Eleven percent of males and 20 percent of the female respondents had been tested for HIV infection at least once.
Preliminary results of the survey of Prague youth indicates that approximately a third of the youth of Prague are at very low risk for the infection, because of their monogamous lifestyle, avoidance of risky sexual practices, regular use of condoms, or complete sexual abstinence. Approximately 5 percent of the men and women were at high risk because of a combination of sexual promiscuity, risky sexual practices, coitus with IV drug users, and failure to use condoms. Now that information about this risk group is on the record, it can become the subject of a government-sponsored prevention campaign.
The investigation and treatment of sexual dysfunction has a long tradition in Czechoslovakia. Since the founding of the Institute of Sexology at Charles University in Prague in 1921, sexual dysfunctions have been a primary interest. Czech and Slovak sexologists have adopted a psychosomatic approach to couple sexual problems and sexual dysfunctions. Strong emphasis is given to the quality of the therapeutic contact and to psycho-therapeutic activities. Most of the clinical sexologists came into sexology from psychiatry.
Prague has a long tradition of investigating the vascular etiology of erectile dysfunctions. One of the pioneers of surgical treatment of vasculogenic impotence is Professor Vaclav Michal at the Institute of Clinical and Experimental Medicine in Prague.
About one in six Czech men and women reported experiencing some sexual dysfunction in their lives (Zverina 1994a). Counseling and psychotherapy for sexual problems are available at some psychological centers in the health system and in social institutions, particularly marriage counseling centers that operate in all the larger cities in both countries. Medical diagnosis and treatment of sexual dysfunctions in both men and women are free of charge at present for all ages and social groups. Some medications, of course, are provided with partial payment by the patients.
The main center for sex research has traditionally been the Institute of Sexology at Charles University in Prague, founded in 1921. Research in this Institute has centered on behavioral sexology and on some andrological problems. The founder of the Czech School of Medical Sexology, Professor Josef Hynie, spent some time at several of the world-renowned centers of early sexology, particularly the Magnus Hirschfeld Institute of Sexology in Berlin. Professor Jan Raboch has made important investigations in both andrology and behavioral sexology. In 1977, Raboch was president of the International Academy of Sex Research (IASR). Prague has twice been the site of an annual meeting of the IASR.
Czech psychiatry is well known for its sexological research. In the early 1950s, Kurt Freund began his studies using penile plethysmography to investigate male sexual orientations. Ales Kolarsky and Josef Madlafousek, at the Prague Center of Psychiatric Research, extended Freund’s work in penile plethysmography with important publications. Research on social aspects of sexology are just beginning at a new center founded by the Faculty of Philosophy of Charles University.
In early 1993, the Czechoslovak Sexological Society separated into two different and independent societies in Prague and Bratislava. Milan Zaviacic and colleagues at the School of Medicine, Comenius University, Bratislava, have carried out pioneering anatomical and physiological research on female ejaculation (urethral expulsions) and the so-called Graffenberg spot.
Undergraduate programs in sexology are included in some Medical, Pedagogical, and Law Faculties. Postgraduate study is possible only in medicine, in the medical sexology program. Admission to this postgraduate specialization is limited to those who have successfully completed the program in psychiatry or gynecology. Rarely are admissions made from other medical specializations.
The main sexological institutions in the Czech and Slovak Republics are:
Sexuologigky Ustav. Address: 1. Lekarske Fakulty, Univerzity Karlovy, Karlovo Namesti 32, 120 00 Praha 2, Czech Republic
Sexological Society. Address: Karlovo Namesti 32,120 00 Praha 2, Czech Republic
Spolecnost pro planovani rodiny a sexuaini vychovu, SPRSV - National Family Planning Association. Address: Podoske Nabrezi 157. 140 00 Praha 4, Czech Republic
The Sexological Institute and The Slovak Sexological Society. Address: Polna, 811 08 Bratislava 1, Slovak Republic
The School of Medicine. Comenius University, Bratislava. Address: Sasinkova 4, 811 08. Bratislava 1, Slovak Republic
Perlez, Jane. 1996 (October 3). “Central Europe Learns about Sex Harassment.” The New York Times, p. A3.
Zverina, Jaroslav. 1991. Lekarska Sexuologie (Medical Sexology). Prague: H&H.
Zverina, Jaroslav. 1994a. Sexual Behavior of Men and Women in the Czech Republic, 1994. Some preliminary data supplied by the author. (In press.)
Zverina, Jaroslav. 1994b. Some Preliminary Results on the Sexual Behavior of 984 Young People (15-29 Years; 485 Men and 499 Women) in Prague: A Representative Sample. Some preliminary data supplied by the author. (In press.)
