Sexuality of women attended in family health program: a social poetic production

Abstracts

O conceito de promoção da saúde é um dos eixos centrais das atuais políticas de saúde no Brasil. A adoção desse marco conceitual implica em reversão do modelo assistencial, envolvendo a valorização de maior autonomia dos sujeitos para atuarem na melhoria de suas condições de vida. A partir dessa perspectiva, diversos elementos das práticas de saúde precisam ser revistos, entre eles o da sexualidade. Sendo assim, objetivou-se, aqui, produzir conceitos de sexualidade a partir dos saberes das mulheres atendidas numa unidade de saúde. O estudo é qualitativo, utilizando a abordagem sociopoética. Os resultados apontam para a diversidade de afetos que envolvem o conceito de sexualidade, que vão além do aspecto biológico. Entende-se que este estudo pode trazer contribuições para o profissional que atende mulheres em unidade de saúde, à medida que amplia o conceito de sexualidade, permitindo reflexão acerca da prática desenvolvida pela enfermagem na saúde comunitária.

sexualidade; métodos; enfermagem em saúde comunitária

El concepto de promoción de la salud es uno de los ejes centrales de las políticas actuales de la salud en Brasil. La adopción de este marco conceptual significa revisar el modelo asistencial, valorizando una mayor autonomía de los sujetos para actuar en la mejoría de sus condiciones de vida. Consecuentemente, diversos elementos de las prácticas de salud necesitan ser revisados, entre ellos el de la sexualidad. Siendo así, el objetivo fue producir conceptos de sexualidad a partir de los conocimientos de las mujeres atendidas en una unidad de salud. Es un estudio cualitativo, que utiliza el abordaje socio poético. Los resultados indican una diversidad de afectos que se refieren al concepto de la sexualidad, los que van más allá del aspecto biológico. Entendemos que este estudio puede ayudar al profesional que atiende mujeres en la unidad de salud, ya que amplía el concepto de sexualidad, permitiendo una reflexión sobre la práctica desarrollada por la enfermera en la salud comunitaria.

sexualidad; métodos; enfermería en salud comunitaria

ARTIGO ORIGINAL

Sexuality of women attended in family health program: a social poetic production

Maria Elidiana Araújo Gomes^I; Lia Carneiro Silveira^II; Sandra Haydeé Petit^III; Georgia Maria Viana Brasileiro^IV; Arisa Nara Saldanha de Almeida^IV

^IRN, M.Sc. in Nursing, e-mail: [e-mail]

^IIRN, Ph.D. in Nursing, Faculty, Ceará State University, Brazil, e-mail: [e-mail]

^IIIPh.D. in Education, Faculty, Federal University of Ceará, Brazil, e-mail: [e-mail]

^IVUndergraduate Nursing student, Ceará State University, Brazil, e- mail: [e-mail], [e-mail]

ABSTRACT

The concept of promotion of health is one of the main axes of current health policies in Brazil. The adoption of this concept implies a change in the care model involving valuing a greater autonomy of subjects to work improving their conditions of life. From this perspective, several elements of health practices have to be reviewed, sexuality among them. Thus, we aimed at producing sexuality concepts as of the knowledge of women cared for in a health unity. This is a qualitative study adopting a social poetic approach. The results pointed out several affections that involve the concept of sexuality going beyond the biological aspect. We understand that this study may help professionals caring for women in a health unity because it broadens the concept of sexuality allowing for reflection on the nursing practice in collective health.

Descriptors: sexuality; methods; community health nursing

INTRODUCTION

The current social situation put forward discussions on the rupture of the biomedical care model that is centered on healing and medicalization as health promotion measures⁽¹⁾. This change in the model implies transforming the way to deal with several fields of human experience⁽²⁾. Among them, there is the one involving sexuality as one of the most important aspects to be re-discussed from the view of health promotion.

When the issue sexuality is approached, there are several aspects influencing our lives, and it is not restricted only to a biological view. Sexuality "reflects all emotional expression of our lives", incorporating, at the same time, the influence of the historical moment we are living in. This "emotional expression" can be also manifested by silence, built many times due to inflictions of the social environment, that present norms and regulations regarding sexuality especially for females⁽³⁾.

Our concern on this issue came from experiences we had as members of a family health team caring for women in a family planning program While the guidelines and routines developed in this area by the Ministry of Health are geared to technical issues regarding the use of contraceptive methods, the demand of the population we care for is for affective issues regarding sexuality.

Much more than distributing contraceptive methods, we faced daily issues on sexuality not in this biological or reproductive sense, but rather in its broader and existential aspect. Manifestations and sadness expressions, low self-esteem, and loneliness in the women we care for were constant. Because of that, several issues regarding the practice came up: how to open a listening space that deals with the problems of these women? How to develop a practice that favors autonomy and participation of these people in the health issues they experience, especially regarding their sexuality?

From this questioning, we have developed the present study to enable building a concept of sexuality from users cared for in a family health unit, thus, enlarging possibilities to discuss this issue, and favoring autonomy of these women.

METHODOLOGY

Qualitative research developed from a deconstructive epistemological point of view. This form of producing knowledge questions radically ways of knowing centered on scientific knowledge and their truth codes. Thus it tries to rebuild knowledge opening up possibilities of autonomous relationships of human beings and their social institutions⁽⁴⁾.

Among the approaches considered in this epistemological point of view, we have adopted the social poetic approach that tries to articulate these principles to trigger a creative process to produce knowledge and life, believing that this could be made as a poetic happening. The objective is to provide a critical analysis of the social reality and its desires and powers⁽⁵⁾.

Social poetics has its roots on Paulo Freire's Pedagogy, in the Institutional Analysis, and schizoanalysis, among others. In the pedagogy of the oppressed by Paulo Freire, social poetic is inspired by valuing equality of knowledge, suggesting collaboration, and fighting against imposing one kind of knowledge over another. Freire's referential also inspire the creation of a group-researcher method where knowledge is produced collectively⁽⁵⁾.

Social poetics inherited from Lourau's institutional analysis, the notion of device understood as tactics or collections that lead to innovations, differences, and singularities. With schizoanalysis, proposed by Deleuze and Guatarri, social poetics brings the dimension of singularity, heterogeneous, opposed to standardization of individuals in modern societies⁽⁶⁾.

Last, we present the discussion of data presented through the philosophical analysis as proposed by social poetics. Initially, "confections" produced by the group are identified in the cross-sectional analysis. The term "confections" refers to concepts produced by the researcher-group that are different from the common sense because they are in a level where concepts and affections are mixed, losing territory and forming a reality of new desires⁽⁷⁾. Next, "confections" of the group are correlated with concepts and discussions from the renowned philosophical-scientific literature, establishing a communication that enables to notice its convergence, complementarities or oppositions. Following, we have presented the stages proposed by social poetics and how each was performed in our study^(5-6).

STAGES OF THE RESEARCH

Negotiation: we decided to develop this research in a Family Health Unit in the district of Barra do Ceará, a popular district in Regional I, in the city of Fortaleza. Individuals of the research were women cared for in the family planning program of the health unit mentioned. To select individuals, inclusion criteria were: being a woman, enrolled in the family planning program in the last two years; women enrolled in previous years were excluded. Women were invited to take part in the negotiation meeting that was held on August 9th, 2006, when the theme of the research was presented: sexuality. This stage was to discuss with the people invited if they wanted to take part in the research on the issue, and to form what we call the "researcher-group", that is, the group that would, together with the official researcher, produce data. After this stage, 12 women accepted our proposal.

Data production: the second stage of the research is called "data production", since in social poetic research the aim is for knowledge production rather than just collect data through pre-established speeches. This production is made through workshops where the researcher-group discusses the theme. In the research we held 4 workshops with several research devices, that is, artistic and creative techniques that encourage senses to rescue knowledge from reason, intuition and emotion thus leading to new knowledge. On the first workshop, production technique using touch was used⁽⁴⁾. Participants were blindfolded and, then, they felt objects of different textures, weight and form. As they had sensations, they were asked to associate them with sexuality. The second workshop used the technique "building the collective body". In this workshop we gave several art materials (paper, glue, ink, brushes, pens, etc.) and we asked co-researchers to choose a part of their bodies that was most associated with sexuality and to build this part using the material available. On the third workshop, we have used the technique "sexuality bug" in which each co-researcher chooses an animal that, in their understanding, is most related with sexuality. Then, each individual builds their animal using clay. The last workshop was inspired by the tale "The wolf woman"⁽⁸⁾, where each co-researcher was invited to imagine the sculpture of their sexuality and draw using inks. After each production, co-researchers presented their production verbally. Speeches were recorded and transcribed with the authorization of participants.

Data analysis: in social poetics, the process of data analysis also has the active participation of subjects forming the researcher-group. Material produced was assessed by the group in a workshop dedicated to this stage. The group performed the analysis talking about data produced, and bringing elements of their knowledge that started to be used as reference for analysis. Additionally to group analysis, social poetics proposes 3 stages of analysis performed by the official researcher: classifying, cross-sectional and philosophical analysis.

Counter analysis: this stage is to return analysis conducted by the official researcher to the researching-group. The purpose was to give the group suggestions, reviews, changes or even to agree with their suggestions.

Regarding ethical aspects of the study, we highlight that the study was approved by the Ethical Research Committee of the Federal University of Ceará, under protocol # 06126774-0, following the recommendations of regulation 196/96 dealing with research with human beings⁽⁹⁾.

PRESENTATION OF CATEGORIES OF EACH WORKSHOP

Next we present a picture with the categories that came up from the group in each workshop. It is a classifying analysis where group speeches are divided into categories according to sense units. Later, we have observed, in each speech the differences, oppositions, ambiguities and paradoxes. Speeches in this category will form next the text of the cross-sectional analysis.

In the next topic we have chosen to show an example of cross-sectional analysis made by researcher from the speech of the group. It is worth remembering that data presentation at this time is freer; closer to a literary text. The following example is the imaginary story of a concept character, a creation where the group stop talking about themselves and talk about an utterance agent, to see and develop themselves on a level that pass through several places⁽¹⁰⁾. This way, using the technique of collective body, "Marciana" was born; her body was very different from the body of Terrestrial women, and because of that difference, she was unhappy. This construction of the group opened spaces for several discussions on the perfect body demanded by our society and by the prejudice suffered by those who do not fit into the standard.

Cross-sectional analysis of the second workshop: aiming at producing sense out of sexuality, each individual tried to find it in their parts of the body. That is how we found breast, butt, waste, hands, belly, vagina, shoulders and hair. They are parts of the body that produce sensations when touched. Hands are related with sexuality when they care for the body, such as the breast self-examination. It can also be the hands of the other, giving pleasure with touch. Valuing the body is important to happiness of people, even with the importance given to certain parts of the body. During the discussion, Marciana was born (also known as android). She is a 25-year-old-girl that came from Mars to the Earth searching for the other that would be her complement, and the reason for her happiness. When she arrived on Earth, she realized that she was weird, because her body was different, with several repeated parts. However, she remembers that there are many different people without all body parts that know how to enjoy and live in this situation. Marciana found someone to love, even though she was different from him. They could both relate with each other because they loved each other. They had a son, but even though Marciana knew herself physically through touch and sensation, she was not completely happy because she could not accept that her body was different. She also needed feelings such as love, and tenderness to overcome, or not, the fact that she was "physically different". A possible solution to Marciana's problem would be to take her partner to live with her in Mars, because when people love they can go anywhere. Despite the difficulties Marciana had to face to live with her partner, we have to remember that she could be happy living alone, as long as she was feeling good. But can she be happy and accept herself being different? Some people think she can, others think she cannot.

OUTCOMES DISCUSSION - PHILOSOPHICAL ANALYSIS

Among the several meanings produced by the researcher-group on sexuality, we noticed at firs that the theme was associated with "genitality" and with the issue of sexual intercourse, men/women intercourse was the most frequently present in the speeches. This thinking links the experience of sexuality to "genitality" and to the heterosexual relationship which is the prevalent thinking, making it difficult to open spaces to new productions.

This view of sexuality as strictly related with intercourse has passed through the contemporary process of subjectivity. This was shaped by speeches from an orthopedic disciplinary order. This order aims at "shaping", "organizing", and "making body individuals" to have power over them⁽¹¹⁾. In health, this stereotyped view of sexuality was an instrument to have control on subjectivity, through sexology, sexual education, and practices of body care⁽¹²⁾.

When we noticed this difficulty in breaking with this paradigm, we designed the second workshop aiming at creating a device that could lead to new experiences. So, in the second workshop, this sense was different and other productions were built. Next, we will present the several "confections" of sexuality produced by the group. However, we remind that these productions, although they try to give a different concept to sexuality, cannot always get away from the hegemonic view of sexuality/"genitality". They are heterogeneous fields, with very different levels that are, sometimes, contradictory.

One of the affections discussed was sexuality/body with several parts. This confection has a conceptual character called Marciana. She came from Mars, with an irregular body with some duplicated body parts and, for that reason, she could not be happy. According to the group, although she is not a person who leads to dissatisfaction, Marciana could only be happy if she looked "normal". Our character had a relationship with someone physically different from her. However, she could not stay in this society, that gives importance to looks, and so she came back with her partner to her birth planet. This demand for body normality enabled the group to render problematic standardization of body which is a characteristic of our consumption society. We live in a society marked by "exteriority" and "performance" of bodies and, many times, people cannot reach or fit into the beauty prototype that is created and demanded⁽¹¹⁾.

Also regarding sexuality/body it was interesting in the group marking breasts and hands as sexuality elements. This called our attention since it breaks with the historical path built on female sexuality and, at the same time, controls and reduces it to a field of Biology and reproduction of the species. However, exploring this further, we see a side where it goes to the speech of medical knowledge, when the group comes with the notion of self-examination of breasts as part of the sexuality. It is a way to care for the body, but it also provides knowledge of the sensations coming from touch.

Other body parts have been emphasized by the group connected with stereotypes of the media considered as symbols of sexuality: butt, waste, and belly. This meaning is related with fetishism of the body as is maintained through inventions of technology, pharmaceutical industry, and alternative therapies⁽¹²⁾.

Other production line of the group refers to a sexuality/small balls where several symbolisms are given to sexuality. This group of symbolism is related with the genital organ which is metaphorically known as: "little balls", "small eggs" and "things". We have realized that embarrassment when referring to this organ led to new meanings, since it is through things that are not explicitly revealed that we find meanings, that is, the effect of culture and the social guiding the unique forms of each individual⁽¹³⁾. Another symbolism that we have identified in the group's production was the preparation rituals related with foreplay. This ritual starts at the time they take a bath, get perfumed, beautiful. Then comes the time foreplay starts.

Another "confection" produced by the group was that of sexuality/myself. This "confection" is a time when representation referring to genitality is broken. This occurs with the definition of the confection of "myself". In this production, sexuality is seen as one's own subjective experience.

Going on with the group production, we have now the concept of sexuality/pleasure. This concept involves meanings of pleasure referring to sexuality. It is an experience of going to heaven, almost unexplainable and that is the meaning of pleasure. The energy that leads to excitation is called libido. Freud differentiates it from the other psychological energies, because its effect can reach all parts of the body with pleasure⁽¹⁴⁾.

Sexuality/companionship is also approached by the group. In this perspective, sexuality is present in all aspects of a couple's life: dialog, the need for mutual understanding, every day life, love, respect, and companionship. Thus, we can say that these representations of sexuality would be examples of the process of singularization, or disregarding normative models. However, the group acknowledges that this mutual understanding is not always present, since relationships, many times, are only for appearance.

Another production resulting from the devices used was sexuality/snake; bear; cat. This concept shows an opposition: on one side, a tender, cute and fussy animal (generally a cat). On the other side, ferocious animals, that harm, kill, and face challenges (the snake or the bear). This duality refers to the gender stereotype where the passive role, waiting for the other to give the first move, helpless, obedient, taking care of the home, is given to women. Men have the virility, they are warriors that face challenges, they are brave, active, pioneering, geared to external activities, they are the ones who have to take action and achieve goals. Thus, the roles of each gender are inserted into the every day life and appear on speeches, and behavior of each individual, and in the way they live.

However, because of the counter-analysis workshop, the group made it clear that things are not necessarily that way, and that women, many times, prefer to be the snake... Women have the flexibility of being "good" or "bad", according to the moment they are living. This was also associated with the "snake" side of women. That is, it is attributed to them a characteristic of versatility needed in current days. This snake-woman knows how to defend herself and, in situations of violence, seek for the Law "Maria da Penha". This law was approved by the president of Brazil in 2006, and it was one of the mechanisms to fight violence against women. The law enables immediate arrest of aggressors, or they may have their preventive custody requested, also, punishment cannot be replaced by alternative sentences⁽¹⁵⁾.

The group mentioned that animals considered ferocious and violent also need affection and grouping. That is, the rattle snake found another snake and developed a friend relationship, and the bear fell in love and ended up with a female bear. We observe in these extracts that, despite the roles of aggressiveness and passivity, taken differently by genders, they are not static and may vary according to the situation.

Another concept presented is that of sexuality/Bercia. According to the group, Bercia is the connection between the pelvis (anatomical part of the women's body) with cradle, used to rock babies. In this aspect, we have found in Freud's work that the fulfillment of feminine nature is related with maternity⁽¹⁶⁾. However, later, this assumption was criticized by Lacan, that stated that female sexuality is not reduced to motherhood and their desire goes beyond the phallic issue⁽¹⁷⁾.

Despite all the discussion on the dimension of women's desire, we have noticed, on the speech of the group, a persistent trait of sexuality/need. In this level is the need for being loved, respected, and satisfied in their desires. This situation comes from the fact that, historically, Western women (mother, wife, daughter, sister, aunt, lover, grandmother) have a position demanding love. However, we have noticed the need for spaces where women can talk and be responsible for their desires and their subjectivity, leaving this demanding position to a more active role⁽¹⁸⁾.

After this path, we have seen that the devices used broke the homogeneous speech, favoring an escape from understanding sexuality as only connected to organic aspects. The group multiplies this meaning, showing that sexuality also encompasses body, the symbolic, affectivity, the individual discovery, pleasure, maternity and, even, an animal sexuality. These passages refer to the fact that the concept of sexuality was enlarged and taken to a more complex dimension.

FINAL CONSIDERATIONS

The researcher-group went through several unexpected "affections". We have noticed how much this practice was needed for questioning crystallized concepts on sexuality, previously brought by co-researchers.

Making a brief retrospect of this process, we have observed that initially, the group presented a designed concept of sexuality. This concept was connected with genitality and to sexual intercourse. During the first workshop, there was a shy attempt to break with this homogeneous idea, when the group mentioned that sexuality also involves forgetting about the partner, and trying to find pleasure in foreplays. Another point that was mentioned as related with sexuality, was the importance of understanding the couple's relationship, and the unhappiness brought to both when they try to keep the "appearances", and do not deal with the conflicts that exist.

We have observed that, in later workshops, concern about the possibilities of conceptualizing sexuality increased in a different perspective. Thus, the group began to relate sexuality with their own physical image, and the importance of feeling good about themselves. We understand that this physical form is not only connected with perceived aspects of body/matter, but also with the psychological body.

Regarding the psychological body, the importance of talking about oneself was mentioned. It was also mentioned that all workshops were offering an opportunity for them to rethink about themselves, and, thus, helping in their every day lives. The group remembered that we keep our faults and that they are not present in the physical body, but "hidden" somewhere in the psychological body.

From these reflections of the group, they proposed that group activities continued, because it was being considered as a therapy. At that time, we noticed how important it is for us, health professionals, to be sensible to notice diverse and not crystallized aspects of the care experience, opening spaces for the production of new practices.

We also have to make sure that spaces are opened to listen carefully to the desires, anguish, repression, creations, joys, victories and affections influencing human relations.

Recebido em: 20.5.2007

Aprovado em: 26.2.2008

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Publication Dates

• Publication in this collection
  30 July 2008
• Date of issue
  June 2008

History

• Received
  20 May 2007
• Accepted
  26 Feb 2008