Tuesday, 8 May 2012

Sexual health


Again, I am sorry for the late post. A stubborn essay and other things in life keep delaying me from posting on the weekend Sunday as previous, and have even delayed me past a bank holiday Monday this time! 

This week I start my sexual health rotation, and get the chance to get 'stuck in' right away... (sorry)... The best part of this week was spending some time at a sexual health clinic, where I tok histories from patients on my own (after seeing one done) but didn't carry out any examinations. I was very happy with this turn of events, as talking with people was very easy once I had explained that I wouldn't be carrying out the examination afterwards.

I really enjoyed my week, not because of the subject matter, but I think it was because it is so accessible for a medical student. If someone has a sexually transmitted infection, if can only be one of a handful of causes. The most common can be counted on one hand, and even an extended list is very simple compared with, say, a list of possible cardiac problems. As well as a small list of possible causes, a sexual history is very structured, comes written on a proforma that you need to fill in, and is all in all quite simple. You need to ask around their symptoms, their general health and their history of sexual contact (i.e. who did you last have sex with, what type of sex, did you use protection, who was the person before that, etc). The hard part here is asking these questions without embarrassing them, yourself, or seeming as though you are being judgemental. Obviously the medical profession do not judge people at all, but it can be hard to ask about the sex that a patient is having with his girlfriend 20 years younger than him, while cheating on his wife, without the patient thinking you sound judgemental (especially if they feel guilty about it themselves).

I saw some very interesting cases this week. I met actors from the adult film industry attending to have certificates proving they were clean from sexually transmitted infection (and let them continue to act), though these people did not need much of a history as they were attending more for a screen than with symptoms. There was a woman younger than me, who had come in with recurrent genital warts, and seemed very relieved that it wouldn't be me doing the examination (I suppose it is bad enough exposing yourself to someone for an examination, and when you don't feel you 'look right' down there it would be even harder). The most interesting was a middle aged man, who looked a little like Clooney. He insisted that he had been with his wife for 10 years, and she was the only person that he had had sex with in this time, but he just wanted to come in for a sexual health check up. There was clearly something fishy about this, but however tactfully I asked it (the usual way is something like "when was the last time you had sex with someone other than your wife") I couldn't get him to disclose whether he had had sex with someone else. I was sure that he had, but what can you do? He just got the tests, and I hope he is clean, or he will have a problem explaining to his wife how they both have an STI despite the fact he has been faithful. I suppose its possible he feels his wife has been cheating on him, but it isn't really the sort of question that you can ask a stranger (not that many of these questions are things you can ask strangers!) 

For examinations, there is ALWAYS a chaperone present - to protect the doctor as much as the patient!

All in all, the interest here comes from the history, learning about people and trying to read between the lines, rather than the complexities of disease and pathology like other disease specialities. As I said before, I really enjoyed this as a medical student, but I am not sure how much I would enjoy it as a qualified doctor, as I may feel it gets a little same-y. None the less, I did get to try the genital-warts-freeze-spray on my hand (the nurse offered for me to try it, and I didn't want to look like a wuss in front of her [after all, patients get it sprayed on their genitals]) which I didn't think was too bad... Until I was at a social playing laser-tag afterwards - it really burns! Not enjoyable, and I can only imagine what it would be like 'down there'... At least now I can tell patients that it will hurt, and I am sorry, but I have 'tried it out' myself... 

As well as histories and examinations, the sexual health clinic also looks at samples right then and there under a microscope, which can spot diseases such as candida by spotting yeasts. I have a look at some of the slides with one of the nurses who is working on this (everyone here seems very friendly) and its amazing how many bacteria you get in an average vagina. There are hundreds and hundreds of Lactobacillus on each slide that was made up from a swab from a vagina. The 'friendly' bacteria that live down there, stopping nasty infections from getting hold... gross... 

A slide of Lactobacillus (the rod-like-things) - a bacteria found in vaginas... and yoghurt...

To finish things off, one of the nurses told me that women who wash out their vagina with washing products (shower gel etc) are much more prone to infections because of washing away all this Lactobacillus (you should use water)... Telling women this doesn't really get results, though, and people tend to do it. The tactic that is used, she tells me, is telling women that some men who attend the clinic ask why their new girlfriend smells 'so bad' down there, and if there is anything they can do. These men, the nurse tells the over-washing-woman, are suffering because their girlfriends use washing products 'down there' which end up making it 'smell worse'. As no-one wants to be smelly there, this leads to many more women washing themselves properly than just telling them they will get more yeast infections. A wonderful example of people being manipulated for their own good...


  1. Yay sexual health! It's my fave :-)

    What a shame you aren't doing examinations though? How else are you going to learn what the conditions look like (and importantly, how to do one without it being awkward)?

    The history can be really good I think. There's a lot of psychosocial involved and it's a great opportunity to educate patients, too!

  2. Thanks for the reply :)

    As it was my first week on this rotation, I think I can start off slow and then move into examinations when I have the histories slick, hopefully putting patients more at ease.

    During my gynae (and urology surgery) rotations we learnt to do examinations (hopefully) without awkward patients/us, so hopefully that will be less an issue!