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Rapid Responses: Rapid Responses published:
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Britain's blind spot in sexual health
- Trevor G Stammers (14 July 2003)
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Sexual Health - Letter to the Editor
- Sati Ariyanayagam (14 July 2003)
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medical student sexual health awareness is poor
- Tessa Fayers (30 July 2003)
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Sexual Health - Need for cultural and behavioural change
- Abayomi A Opaneye, Tayal SC (31 July 2003)
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Trevor G Stammers, Senior Tutor in General Practice St. George's Hospital Medical School, London
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Among many other important points, Prof. Michael Adler (1) highlights the contribution of the nation’s changing sexual behaviour over the past decade to our sexual health crisis– “decline in the age of first intercourse, increase in total number of lifetime partners and concurrent relation ships, a decline in safe sex practice, particularly among homosexual men …….”. (1) Is this really surprising however when, even though “sex and relationship education is patchy”, where it does occur, it is too little, too late and too liberal? To take just one example, The Sexuality Project, (2) produced by the Brighton and Hove PHSE advisory team, teaches pupils “You can be heterosexual ....or bisexual. It’s all perfectly natural. As in all areas of sexual activity, people want to makes rules about sexuality. The truth is there are no rules”. If this is the ethical basis of sex education, no wonder that STIs are increasing in the UK at such a rapid rate. One of the rules surely is that the more partners you have, the greater the risk of catching an STI – or do Brighton, Hove and others deny this? The Health Select Committee Report is keen to advocate Sweden and Holland as role-models, though bizarrely its introduction admits that “sexual ill health is increasing rapidly even in countries where such good practice is found”. (3) In fact in Sweden, the chlamydia rate has risen 60% in the past 4 years. (4) So what exactly makes Swedish practice “good” with results like that? No mention is made in the report of programmes which seek to delay intercourse among young people and in particular the growing success of such programmes in countries such as the USA and Uganda. (5) Instead the Committee ignored the evidence presented to this effect by myself and Robert Whelan of the Family Education Trust, but rather declared “We see no benefit in preventative approaches based primarily around promoting abstinence.” (6) They may not see it, but it there to be seen in those countries whose governments are not so ideologically opposed to the concept as our own. References 1. Adler M Sexual Health BMJ 2003 327 62-3 2. PHSE Advisory Team The Sexuality Project Brighton and Hove City Council 2000 3. House of Commons Health Select Committee. Report on sexual health. June 2003. www.parliament.the-stationery- office.co.uk/pa/cm200203/cmselect/cmhealth/69/6902.htm p9 4. http://www.eurosurveillance.org/ew/2002/020627.asp#2 5. Stammers T Abstinence under fire Postgrad Med J 2003 79 1-3 6. House of Commons Health Select Committee. Report on sexual health. June 2003. www.parliament.the-stationery- office.co.uk/pa/cm200203/cmselect/cmhealth/69/6902.htm p78 Competing interests: Trevor Stammers is a Trustee of Family Education Trust and a consultant to www.loveforlife.org.uk, the largest abstinence based website in the UK |
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Sati Ariyanayagam, Consultant Physician BH&R Hospitals NHS Trust
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Dear Sir Sexual Health Professor Adler’s1 reference to the report of the select committee is an endorsement of the findings of Djuretic ET al 2 Between 1991 and 2001 diagnoses and workload at gum clinics increased
by 99%, workload accounted for 54% and 51% of episodes seen in males and
females 3
The problem highlighted by the select committee 5 is that of a failure to transform policy in to practice. The deterioration of sexual health services as a speciality has been evident since the recommendations of Health of the Nation. There appears to be a serious deficiency in translating the well-intended intention of the government to viable and visible improvement. There are major problems in the realisation of the sexual Health strategy. Primary care trusts are unlikely to grasp the nettle against competing political demands for the following reasons. 1 The gap between investment and improvement
For understandable reasons primary carers are less interested in the field of sexual health medicine particularly in the context of sexually transmitted infections. The attempts by the government to create “fund managers” have added to the bureaucratic layers that impede progress. 1 Adler M Sexual Health. BMJ 2003; 327; 62-63 2 Djuretic T, Catchpole M, Bingham JS, Hughes A, Kinghorn G.Genitourinary Medicine Services are failing to meet current demand. Int J STD AIDS 2000; 12; 571-2 3 PHLS report Sexually transmitted infections in the UK: New episodes seen at Genitourinary Medicine Clinics 1991 – 2001; 20 4 PHLS report Sexually transmitted infections in the UK: New episodes seen at Genitourinary Medicine Clinics 1991 – 2001; 3 5 House of Commons Health Select Committee. Report on sexual health June 2003. Www.parliament.the - stationary- office.co.uk/pa/cm200203cmselect/cmhealth/69/6902.htm (accessed 4 Jul 2003) Dr Sati Ariyanayagam Competing interests: None declared |
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Tessa Fayers, sho ophthalmology royal bournemouth hospital
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EDITOR – Adler’s editorial describes the worrying state of sexual health services in England. One of the main recommendations of the Department of Health’s national strategy for sexual health and HIV is for sex education to become a core part of the national curriculum. One might expect medical students to be more knowledgeable about sexual health issues than the general population since they are highly educated young people who receive specific teaching on genitourinary medicine (GUM). A recent survey of sexual health knowledge amongst Bristol University medical students showed their awareness of sexual health issues relating to sexually transmitted infections (STIs) and contraception to be alarmingly poor. The majority of the 213 respondents were final year students. They had received a total of 29 hours of teaching on GUM spread out over 5 years of training (the majority in year 4). The results were worrying: 96% underestimated the failure rate of condoms; less than half correctly answered that the prevalence of chlamydia has risen by more than 10% in the past 3 years, with the rest believing that it had risen by a smaller percentage, had not changed, or even fell; almost half the respondents overestimated the proportion of women in whom chlamydial infection is symptomatic; 85% greatly underestimated the lifetime risk of having an abortion. These findings have alarming implications for the sexual health of future doctors and their patients. Since medical students and doctors often act as unofficial educators on health matters it is of concern that inaccurate factual knowledge about important sexual health issues is promulgated. Since medical students lack sexual health awareness despite dedicated teaching the education of the general population is likely to pose a major challenge. Tessa Fayers Competing interests: None declared |
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Abayomi A Opaneye, Consultant Physician The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, Tayal SC
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Sexual health - need for cultural and behavioural change We read with interest the editorial on sexual health by Professor M. Adler (1). The worsening statistics for sexually transmitted infections in our area (Cleveland, UK) despite efforts to stem the tide have always been of concern to us. Our findings and concerns have been previously published (2). While we applaud the parliamentary discussions and recent fund allocations – pump priming and recurrent (3), it is our belief that a lot more needs to be done. The Primary Care Trusts and Hospital Trusts have to show more genuine commitment to all aspects of sexual health. Genitourinary Medicine is not a popular or glamorous specialty and, culturally people do not feel at ease to talk about sex – at home or at school. We are aware of PSE (personal and social education) in schools. Nevertheless, risky sexual activities are portrayed and glamorized in various ways in the media – from selling cars to selling ice cream! Although several people go on holidays for sun, sand and sea, a significant proportion indulge in risky sex. So, while healthcare workers in the primary or secondary sectors need to put sexual health matters high on their agenda, ordinary people need behavioural change. Opaneye A. A, Tayal SC.
References: 1. Adler M. Sexual health. BMJ. 2003; 362: 62-63. 2. Tayal S. Opaneye A. Gonorrhoea in pregnancy: time for action. Sexual Health Matters. 2003; 4 (3): 48-49. www.sexualhealthmatters.com 3. Resource and cash limit adjustment in respect of improvements to genito -urinary medicine services. Gateway ref: 1454. Department of Health: 12th June 2003 Competing interests: None declared |
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