Sexual health Flashcards
When may confidentiality between a Dr and a young person be breached?
Child abuse
Serious crime
Factors which affect young people’s perception of a confidential service?
Severity of the condition
Proximity of the service provider to a young person’s familiar environment e.g. neighbour
Previous experience
Attendance with a parent
Relationship between service provider and other people known to the patient e.g friends/parents
Risks to babies born to teenage mothers
More likely to have:
Low birth weight
Be born prematurely
Have a higher risk of dying during infancy
as they grow up they are at a greater risk of educational failure, juvenile crime and becoming a teenage parent
Factors associated with increased risk of teen pregnancy
Low socio-economic group
Lack of expectation of being in education at 20
Expectation of being a parent at 20
Belief that over 50% of peers are sexually active
Intention to skip school
Being drunk more than once a month at 13
Types of post-coital contraception
Emergency hormonal contraception within 3-5 days
Emergency insertion of IUCD if intercourse happened more than 5 days before consultation
Types of pregnancy termination
Early medical terminations (drugs induce uterine contractions which expel contents - up to 9 weeks)
Suction termination 6-13 weeks
Dilation and evacuation 13-20 weeks
Late medical terminal 13-23
Medical criteria for an abortion
Continuing the pregnancy risks the life of the pregnant woman
Termination would prevent permanent injury to the physical or mental health of the pregnant woman
Substantial risk that if the child were born it would suffer from a physical or mental abnormality that would make it seriously handicapped.
Social criteria for termination
Pregnancy has not exceeded 24 weeks and continuing the pregnancy would involve increased risk of injury to the physical or mental health of the pregnant woman
Pregnancy has not exceeded 24 weeks and continuing pregnancy would involve increased risk of injury to the health of any existing children.
Name 5 asymptomatic STIs
Chlamydia Genial warts Genital herpes Hepatitis HIV Syphilis Trichomonas
Major differences between healthcare in a GUM clinic vs. primary care
GUM attenders perceive themselves at risk
GUM attenders expect questions about sex
Primary care attenders do not expect questions about sex
Testing in GUM is anonymous, in a GP it will be in the patient’s notes
Treatment in a GUM clinic is free
Advantages of providing sexual healthcare service in GP practice
People who are asymptomatic are unlikely to present at a GUM clinic (do not know they have STI)
The GP practice may be closer to where the patient lives and may be more accessible
The patient may prefer to talk about her/his sexual health with someone he/she knows rather than attending a GUM clinic
Patients may feel that they would be better supported in GP practice
It is possible to test for STIs at the same time as providing other care e.g. cervical smears
Factors affecting access to healthcare in young people
Knowledge of services
Confidentiality
Being able to overcome barrier to healthcare
Skills to become an active participant in healthcare rather than passive
Issues of consent
Independence from parents
Reasons why STI diagnosis may by increasing
Social reasons: increased sexual activity People are more aware of STIs Easier to access services Better diagnostic tests Artefact
Approach to GUM clinic consultation
Provide reassurance Establish rapport Take a sexual history Identify if the person is at risk Explain tests for STIs and offer tests Offer a separate test for HIV Offer counselling
4 approaches to introducing sexual history into a consultation
Introduce sex with a statement, then ask question.
Ask the patient what he/she thinks about risk of STI based on symptoms
Normalise “we ask all young people questions about their sexual health”
Offer resources e.g. condoms then ask about sexual health
Share knowledge of incidence and prevalence. “A lot of people your age have STis, could I ask you a few questions?”
Why is partner notification required for some STIs?
Protect patient from re-infection
Offer sexual partners tests for STIs
Offer sexual partners treatment
Inhibit further spread to the community
Name 4 STIs where use of a condom gives protection
HIV Chlamydia Gonorrhoea Syphillis Hepatitis B
Name 2 STIs where use of a condom does not prevent transmission
Hepatitis A
Pubic lice
What influences sexuality
Sexuality - who one has sex whith, what way, why, under what circumstances and with what outcomes. Influenced by:
Rules imposed by society Gender Age Economic status Ethnicity
Components of sexuality
Practices
Partners
Pleasure/pressure/pain
Procreation
Balance of power in a sexual interaction determined outcome
Factors which affect Women’s vulnerability re: sex
Culture of silence around sex
Dictates good women are expected to be ignorant about sex and passive in sexual interactions
Makes it difficult for women to be informed about risk reduction
Makes it difficult for them to be proactive in negotiating safer sex
Women’s economic dependency means they could accept risky sex for money
Women tend to discuss testing with their partners before accessing sexual health service, creates a barrier to access
Factors which affect Men’s vulnerability re: sex
Men are expected to be more knowledgeable and experienced about sex
Do not seek information or admit lack of knowledge about sex or protection
Experiment with sex in unsafe ways and at a young age to improve their manhood
Believe it is essential to men’s nature to seek multiple partners for sexual release
Questions to ask in a sexual history
Sexual experiences (what, who, how) Partner's sexual history Assessment of condom use Past STIs Symptoms
Give 4 examples which indicate a patient may have no apparent risk of an STI
Never had sexual intercourse
First sexual relationship for both him and his partner
Always used condoms perfectly
No risks since last test for an STI
Risk factors for contracting an STI
Unprotected sex
Multiple sexual partners
Early onset sexual activity
Drug/alcohol abuse
