Adolescent, maternal and Women's Health 1 Flashcards
Define Non-volitional sex
Any sexual behaviour that violates a person’s right to choose freely when and with whom to have sex and what sexual behaviours to engage in.
Subcategories of non/volitional sex
rape, forced sex, childhood sexual abuse, sexual violence, unwanted sex trafficking.
consequences of poor sexual health
- Unplanned pregnancies and abortions
- Psychological consequences, including from sexual coercion and abuse
- Poor educational, social and economic opportunities for teenage mothers,
young fathers and their children - HIV transmission
- Cervical and other genital cancers
- Hepatitis, chronic liver disease and liver cancer
- Recurrent genital herpes
- Recurrent genital warts
- Pelvic inflammatory disease (subsequent ectopic pregnancies and infertility)
- Adverse pregnancy outcomes (maternal and neonatal)
WHO Sexual health definition
A state of physical, mental and social well-being in relation to sexuality. it requires a respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and save sexual experiences, free of coercion, discrimination and violence
prevention of poor sexual health
Prevention: ■ Contraception ■ HPV immunisation ■ HIV prevention ■ Education/ Health Literacy
Clinicians role in preventing poor sexual health through contraception
Prevention:
■ Contraception
Clinicians’ role:
■ Provide information around contraception options
■ Educate patients about risks and consequences of unprotected sex
■ Facilitate prompt access to contraception and sexual health services
Which preventative measure acts as protection against all STI?Give an area of concern related to the use of this?
- Barrier protection prevents against all STls
- Low usage and survey suggest young people may not know it is the best protection against STI
Population health approaches to sexual health?
- addresses knowledge gap
Prevention:
■ Education / health literacy
In 2019 was made compulsory for school pupils:
■ Primary Schools: Relationships Education
■ Secondary Schools: Relationships and Sex Education
why is it important to prevent unplanned pregnancies
Preventing unintended pregnancies using contraception is essential for improving multiple health outcomes ■ 1 in 6 pregnancies are unplanned ■ More common in young, single women ■ Smoking, drug use and depression more common in women who report unplanned pregnancies
Why is it important to address teenage pregnancies
■ Mostly unplanned and 50% result in abortion
■ Less likely to finish education and more likely poverty
■ Higher risk of poor antenatal health
■ Lower birth weight babies
Higher infant mortality rate
■ 3x more likely to suffer post-natal depression
Which Individuals are more vulnerable to poor sexual health and
to coercive and exploitative sexual relationships
Conception under the age of 18: ■ In or leaving care ■ Homeless ■ Involved in crime ■ Low educational attainment ■ Social deprivation
Approaches as clinician to sexual health
Non-judgmental
Empathetic
specific preventative interventions targeting at risk groups in sexual health (HPV)
Girls and boys aged 12 to 13 years are offered the human
papillomavirus (HPV) vaccine as part of the NHS
immunisation programmes
The HPV vaccine helps protect against cancers caused by HPV, including:
■ Cervical cancer
■ Some mouth and throat (head and neck) cancers
■ Some cancers of the anal and genital areas
■ It also helps protect against genital warts
specific preventative interventions targeting at risk groups in sexual health (HIV)
HIV prevention:
■ Pre-exposure prophylaxis (PrEP) is a course of HIV drugs
taken by a HIV negative person to lower the chance of
becoming infected with HIV in the future
■ Post exposure prophylaxis (PEP) is anti-HIV medication
that is prescribed to a HIV negative person, after a potential
exposure to HIV, to protect them from being infected with HIV
How can we tackle stigma which arises when using specific preventative interventions
-Building an honest and open culture where people can make
informed and responsible choices about their sexual health
has been crucial to the success of these interventions - tackle stigma
Essential components of dealing with STI
Test, Diagnose, Treat
- opportunistic approach
Diagnosis of STIs highest in which groups
- highest in heterosexual people aged 15-24 years old
- BAME populations
- living areas of deprivation
- Men sex with men - MSM
Most common STIs
Percentage of all new diagnosis of STIs
Chlamydia = 49%
Gonorrhoea = 15%
First episode genital warts = 11%
First episode genital herpes = 7%
National Chlamydia screening programme
- Chlamydia most common STI especially amongst young people
- asymptomatic
- serious health consequences
- proactive and opportunistic approach
- screens for asymptomatic infections
Gonorrhoea
common in MSM (male homosexuals)
- reemerged
- second most common STI diagnosis
- resistant to previous first-line antibiotic
- ongoing monitoring of anti-microbial resistance essential for effective treatment
How to use MECC (make every contact count) principles in sexual health
■ Initiate conversations about sexual health ■ Increase screening uptake ■ Increasing subsequent diagnosis and treatment of STls
Impact of open access to sexual health services that provide rapid treatment
- reduce the risk of STI complications and infection spread
- digital services reduce pressure on NHS
- online diagnostic test kits
NOTE: services may not spread equally across society
Impact on lifestyle choices on sexual health
Smoking
Prolonged alcohol misuse
—->Sexual dysfunction
Stress Poor mental health Drug and alcohol use ----> Risky sexual behaviour, sexual assault, Drug and alcohol use inter-partner sexual violence
NATSAL SUMMARY
- 45000 respondents
- decline in age at first sexual intercourse
- increase in lifetime sexual partners
- varied sexual practices
- increasing acceptance of same sex partners
- increasing disapproval of non-exclusivity in marriage
- older people - lower satisfaction in health
- poor health - lower health satisfaction and decreased sexual activity
- only 25% of men and 20% of woman sough help when health affecting sex
- increased prevalence of HPV and increased risk of cervical cancer
- chlamydia peak in younger age groups - 1% of population
- gonorrhoea and HIV affect less than 0.1% and affected these with high risk factors\
- sexual health clinic attendance and HIV testing increased
- 16.2% unplanned pregnancies especially among 20-34 year olds
non volitional sex more in woman and at younger age - normally known by individual - 33% of men and 42% of women told someone about non volitional sex
- only around 10% reported to police
- public health embrace change to ensure services are appropriate for lifestyle and consistent with definition of sexual wellbeing
What is the first stage for intervention when taking a life course approach
Pre-Conception
What is the most prevalent STI according to NATSAL?
HPV
Non-volitional sex is more common, though not exclusive to, one of the below groups. In which group is non-volitional sex more common?
Women
What are the main changes in attitudes to sex, according to the NATSAL video?
The data shows that people between 1990-2010 might be more sexually explorative than previous cohorts, with a decrease in age of first intercourse and and increase in sexual repertoire. There has also been a change in attitudes towards non-monogamous interactions. Do you think these trends will continue in the same way in the next NATSAL study?
Broader definition of sexual well-being
“Sexual and reproductive health is a state of physical, emotional, mental and social well-being in relation to all aspects of sexuality and reproduction, not merely the absence of disease, dysfunction or infirmity.
Therefore, a positive approach to sexuality and reproduction should recognize the part played by pleasurable sexual relationships, trust and communication in promoting self-esteem and overall well-being.
All individuals have a right to make decisions governing their bodies and to access services that support that right.”, and advocates for it’s inclusion as a human right.
Why is maternal health important (as part of a health across the lifecourse approach)
- Pre conception is first stage for intervention
■ Pregnancy can be a time when mothers are amenable to change. Long lasting behaviour change
Why is maternal nutrition important
Maternal nutrition plays a crucial role in
maintaining the health of the developing foetus
eg. obesity
some nutrients are essential and some to be avoided
Role of folic acid supplements in pregnancy
■ Folic acid 4oomcg OD recommended prior to conception and up to 12 weeks of pregnancy/ 40 to reduce the risk of neural tube defects such as spina bifida
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Role of vitamin D supplement in pregnancy
■ Vitamin D 1omcg OD throughout pregnancy and during breast feeding to promote bone health in foetus and reduce risk of rickets