Sexual health

What is sexual health

Sexual health refers to a raft of topics relating to gynaecology and urinary medicine (GUM), reproduction and family health and sex and relationship education. Governments are concerned with how people use sexual health services, commonly accessed through GP surgeries, family planning centres, GUM clinics, pharmacies and smaller initiatives such as school nurse schemes. The government is concerned by levels of STIs and unwanted pregnancies and as such policy makers tend to recommend access to contraception, abortion and education services.

Background

Britain's sexual health is not good, with the British Medical Association (BMA) going so far as to warn of a sexual health crisis, driven in part by rising rates of STIs.

In an attempt to reduce the number of STIs and unwanted pregnancies - a stated policy of the Department of Health - contraception is freely available to both men and women on the NHS, although many public health campaigners warn sexual health services are not fit for purpose.

Unlike other health services, abortion is not available 'on demand', either on the NHS or privately. Instead women must obtain the written consent of two doctors and match criteria set down under the Abortion Act 1967.

In 2008 the total number of abortions carried out in England and Wales fell by 1.6% to 195,296 compared with 198,499 in 2007. The abortion rate was highest for women age 19 at 36 per 1000, the same as in 2007. The under-16 and under-18 abortion rates were both lower than in 2007.

One of the most common sexually transmitted infections is chlamydia. According to official figures there was a seven per cent increase in chlamydia diagnoses at GUM clinics between 2006 and 2007; a rise of 8 per cent in men, and 6 per cent in women.

Worryingly for sexual health professionals, recent years have seen the return of syphilis. Among high-risk groups, cases of the infection have increased by 1,949 per cent.

Although treatable, STIs like chlamydia are a serious concern for the health service because they can develop into more serious long-term illnesses or conditions such as infertility.

Many STIs are also recognised as favouring the spread of HIV, a considerable concern for public health professionals. An estimated 83,000 people in the UK were infected with HIV at the end of 2008, of whom over a quarter were unaware of their condition.

In November 2009 a new national campaign called 'Sex: Worth Talking About' was launched by the DoH and the DCSF with the aim of helping young people to become better informed about how to look after their sexual health, avoid unwanted pregnancies, and access treatment for STIs.

The first phase of the campaign focused on contraception and the full range of contraception choices now available. The second phase, launched in January 2010, shifted the focus to chlamydia, warning that this infection often has no symptoms and so can be passed on unknowingly. In February 2010 the third phase moved the focus back to contraception.

Adverts for the campaign, which was targeted at 16-24 year olds and their parents, appeared across a wide range of media including TV ads on terrestrial and satellite channels, in cinemas before films such as Avatar and Sherlock Holmes, on posters, in women's magazines and online.

The government said research had shown that "a lack of knowledge, and misinformation, coupled with poor attitudes and communication" was hindering safer sexual behaviour.

Controversies

The factors behind Britain's poor sexual health have been hotly debated and no single suggestion provides a complete picture. Christian groups and many on the right-wing complain that culture, and increasingly sex education, promote promiscuity, which in turn makes it more likely people will transmit STIs or experience an unwanted pregnancy.

Others complain current education policies fail to adequately equip young people to promote their own sexual good health and some campaigners argue Britain needs to foster a more open attitude towards sex to encourage safe sexual behaviour. Moving from prevention to cure, a lack of resources for sexual health services has also been blamed for failing to reverse rising rates of infection.

The DoH admits sexual health services need modernising and has set itself targets to cut the number of unintended pregnancies and reduce the spread of STIs. But it is also keen to draw attention towards positive achievements.

Some two and a half million people now use NHS specialist community contraception services (family planning clinics) each year, with oral contraception the most common primary method chosen by 44% of women attending the clinics. Use of Long Acting Reversible Contraceptives (LARCs) continues to increase.

The British Medical Association (BMA) adopted a more negative view of sexual health services, warning of a sexual health crisis in Britain and calling on the government to urgently reduce rates of STIs. The BMA warned GUM clinics would be unable to cope with rising rates of STIs without considerable government support. GUM clinics saw their workloads rise by nine per cent between 2004 and 2005 and demand shows few signs of diminishing.

The health select committee warned in 2003 that the system was in a "state of crisis" and in February 2007 the BMA said sexual health services were still "woefully inadequate". Despite DoH claims towards improvement, the BMA argued services were in a worse state than 90 years ago. It noted that during World War One, the government oversaw a free, rapid and confidential service to target sexual health. Now, patients could find themselves waiting up to six weeks for treatment, with many continuing to have unprotected sex.

The government maintains access to GUM clinics has improved and this appears to be supported by statistics. The percentage of 1st attendances seen within 48 hours as a proportion of the total number of 1st attendances was 89.2% for November 2009, an increase of 0.6% from October.

Sex and relationship education remains a persistent source of controversy in the UK. The Children, Schools and Families Act passed in April 2010 placed Personal, Social and Health Education (PSHE) on a statutory footing and stated that all young people must receive at least one year of sex and relationship education (SRE).

Religious schools were adamant that these topics should be taught within the context of their particular beliefs. Oona Stannard, chief executive and director of the Catholic Education Service, said: "Catholic schools uphold the teachings of the Church in all that they do. This applies, in particular, to all work about sex and relationships education. They robustly teach, for example, about the sanctity of life and do not and would not promote abortion."

This attracted criticism from gay rights and non-religious groups who were concerned that religious schools would be able to promote homophobia and deny pupils access to information about contraception and abortion.

Statistics

72 per cent of men have never had an STI screen, significantly more than women (62%).
13 per cent of men admit to having unprotected sex with different partners, almost double that of women (7 per cent).
In terms of STIs for which men are being screened, the most common was HIV (38 per cent), followed by chlamydia (34 per cent) and gonorrhoea (20 per cent).
13 per cent of men buying chlamydia tests from Lloydspharmacy Online Doctor have tested positive compared to only six per cent of women.
Source: ICM poll of 3001 adults conducted for Lloydspharmacy - March 2010

There has been a national reduction in the under-18 conception rate of 11% and a 23% decrease in the under-18 birth rate.
Approximately half of conceptions end in abortion, highlighting the fact that many of the pregnancies are unintended.
There continues to be considerable variation in progress around the country.
Some local areas reduced their under-18 conception rates by more than 26%. A few other areas have failed to make any impact and their rates remain relatively unchanged.
Source: Teenage Pregnancy Independent Advisory Group's sixth annual report on the Government's Teenage Pregnancy Strategy - December 2009.

During 2008, there were 7,298 new diagnoses of HIV in the UK.
New diagnoses among men who have sex with men remained high in 2008, and four out of every five probably acquired their infection in the UK.
New HIV diagnoses among those who acquired their infection heterosexually within the UK have risen, from an estimated 740 in 2004 to 1,130 in 2008.
Preliminary data for the first six months of 2009 indicate that one in five men who have sex with men, and one in ten heterosexuals newly diagnosed with HIV were likely to have acquired their infection within the last six months.
Source: Health Protection Agency - November 2009.

There was an 11% decrease in the total number of new gonorrhoea infections diagnosed in the UK from 18,649 infections in 2007 to 16,629 in 2008 - the lowest number of new infections recorded since 1999.
Syphilis also showed a 4% decrease from 2,633 new cases recorded in 2007 to 2,524 new cases in 2008.
Overall, STIs increased by 0.5%, from a total of 397,909 new cases recorded in 2007 to 399,738 new cases recorded in 2008. This was mostly due to increases in genital herpes and genital warts.
The greatest burden of STIs continues to fall among young people (aged 16 to 24 years), who are disproportionately affected by STIs. While just 12% of the population are aged 16 to 24 years old, this age group accounts for more than half of all new STIs diagnosed in the UK.
Source: Health Protection Agency - July 2009

Quotes

"Sex still seems to be taboo - too many of us are holding back from having the open and honest conversations that young people need to make informed decisions, including about when it's right to have sex. There is a method of contraception to suit the lifestyle of everyone, and it's right to talk about these options."
Gillian Merron, Public Health Minister - November 2009

"Embarrassment is a huge barrier to testing and so we hope that removing the need to see a GP or GUM clinic face-to-face will encourage men to test themselves regularly. We can provide accurate tests for a wide range of genital infections anonymously and discreetly through the Online Doctor."
Clare Kerr, Lloydspharmacy's head of sexual health - April 2010