Preventive Medicine Column
Dr. David L. Katz
Coincidentally, just as the eyes of the world are directed toward South Africa for World Cup soccer, one of the more provocative of recent medical stories has issued from there. A female physician in South Africa has invented a condom with teeth designed as a last line of defense against rape.
Before taking the topic any further, let’s acknowledge at the outset that everything about the discussion is somewhat uncomfortable. Specifically, the topic of rape is very uncomfortable- as a husband and father of four daughters, I feel my blood pressure rise just thinking about it. The thought of predatory contraceptive devices may tend to induce a wince. More generally, the underlying issue of acknowledging our vulnerability to bad fate is fundamentally disquieting.
But looking away from a threat does not remove it; it just puts it behind us, where we can neither see it, nor defend against it. So let’s contain our discomfort, and soldier through this.
Media coverage and the quotes contributed by both diverse experts and the general public suggest the invention is controversial, apparently for two primary reasons. First, the device- which painfully latches on to a rapist’s penis and cannot be removed short of a trip to a hospital, yet does no permanent damage (too bad!), has been described as ‘medieval.’ I have given away my bias here: it’s not medieval enough. As far as I’m concerned, a rapist deserves to have the thing snap shut like a bear trap.
Second, the device- inserted like a tampon in anticipation of potential sexual assault- allegedly makes women into ‘victims.’ One female researcher working for the CDC in Uganda went so far, in CNN’s coverage of the topic, as to suggest that the device enslaves women.
I disagree. While I certainly dislike the notion that a woman goes out- anywhere- needing to think she might be vulnerable to rape, such is the reality- much more so in some environments than others. Like the inventor of the Rape-aXe condom- who was inspired to invent by a rape victim she treated decades ago who said “if only I had teeth down there”- I have seen and treated rape victims. The risk, and the victims, are real.
So the question becomes: does acknowledging, and reacting, to a sense of vulnerability make victims of us? As a preventive medicine specialist, I would have to hang up my white coat if I thought it did- our entire specialty is predicated upon a respect for vulnerability, and the capacity to defend against it.
We can consider Rape-aXe in a broader context of things we do because we are vulnerable. One example that springs readily to mind is a bullet proof vest. A police officer or soldier who dons one of these is not enslaved in any way by the vest, or the anticipation of a possible bullet or shrapnel. They are simply being realistic. We hear stories, all too often, about innocent bystanders being shot to death, but very few of us wear bullet proof vests as a result. We gauge our individual risk, and conclude it is low. Those most likely to encounter bullets, however, are prudent to wear the vests that are most likely to save their lives.
We know heart disease happens every day- but by and large, only those of us at somewhat heightened ‘risk’ take medications to prevent it. Taking a daily aspirin, or statin drug to prevent heart disease before it occurs does not make us victims of heart disease- rather it helps us avoid that very fate. But such practices are based on the anticipation of an assault- by a disease rather than a person- that has not occurred, yet could.
Immunization anticipates the infection that has not found us, but might. We tend to be immunized only against those infections we are likely to encounter. The yellow fever vaccine is not routine in the U.S., for instance- but it is in some parts of the world.
The challenge for all of prevention is to gauge vulnerability so we can each decide: do I take pre-emptive action, yes or no? The risk of bullets, or rape, or heart attack will almost never be zero- but it can be low enough that pre-emptive action does not make sense. I certainly hope my wife and daughters spend every day of their lives in places safe enough so that a condom designed to ward off and/or punish rape is never even a consideration.
But many of the world’s women are not so fortunate. I don’t think a condom intended to deter a rapist turns the women who use it into victims. I would hope, even, that the mere risk of encountering such a defense might dissuade some potential rapists from the attempt- and thus help some women from ever becoming victims at all. And when a rape occurs nonetheless, this device can help ensure that the injury of assault is not compounded by the insult of injustice, as it all too often is: it will be difficult for any guy with a condom clamped to his penis to refute his culpability! The device will also help prevent sexually transmitted disease and pregnancy, both potential complications of rape.
We are all vulnerable, one way or another, to one degree or another. When we can avoid the slings and arrows of outrageous fortune altogether, so much the better. But when we can’t, an honest appraisal of our risk, and defending against it, is the next best thing. A condom with teeth is clearly a last line of defense, but better a last line of defense than none.
The power of prevention derives from the uncomfortable act of acknowledging our vulnerability and taking up the requisite arms, or teeth, to defend against it- before ignoring it turns us into victims.
Dr. David L. Katz; www.davidkatzmd.com