STIs: types, testing and treatments

This blog post describes the various main types of STI’s, symptoms, testing and treatment. They are generally categorised as bacterial, viral or parasitic.

Lets start with the most common…

  1. Chlamydia: bacterial. Represents 49% of all new STI diagnoses in the UK in 2018, and is most prevalent in the under 25s age group. Testing at least 2 weeks after unprotected sex.
  • The reason why it is so important to test for chlamydia is that many people are asymptomatic – 70% of women are, and they also account for a higher amount of chlamydia infections (PHE, 2019)
  • Chlamydia testing has gone down by 22%, although infections increase
  • This is an infection you can get in the throat, and eyes, where it can be irritable, swell, cause pain, have discharge (FPA, 2019). It is less frequently passed on through oral sex (NHS, 2018)
  • Symptoms for people with vulvas: bleeding between periods and/or heavier periods (including if you’re on hormonal contraception), after sex; pain and/or bleeding when you have sex; lower tummy pain (from the pelvis); pain from vaginal discharge when weeing
  • Test: a swab (like a massive cotton bud) inserted into the vagina, circling 5-10 times inside (FPA, 2019)
  • Symptoms for people with penises: a white/cloudy/ watery discharge from the penis; pain when weeing; rarer: pain in the testicles (FPA, 2019)
  • Test: urine sample. Throat/anus swab for people with penises having sex with each other
  • Treatment: antibiotics for anywhere between 3-12 days. Repeat test 3 months after
  • Long term: can affect fertility (Brook, 2020)
  1. Gonorrhoea: bacterial. Second most common in the UK, a 26% increase (PHE, 2019) owing to drug-resistant strains (known as XDR-NG). Testing at least 2 weeks after unprotected sex.
  • Commonly transmitted through oral sex (NHS, 2018)
  • Similar to chlamydia, infections can be in other parts of the body. Same tests
  •  Symptoms for people with vulvas: any abnormal vaginal discharge could be thin/watery/yellow/green; painful when peeing; lower tummy pain/feels tender; occasional bleeding between periods or heavier periods (including if you’re on hormonal contraception) (FPA, 2019)
  • Symptoms for people with penises: An unusual discharge from the tip of the penis – the discharge may be white, yellow or green; painful peeing; rarely, pain or tenderness in the testicles
  • Treatment: antibiotic injection, and then a tablet (ibid). It is becoming increasingly treatment-resistant
  • Long term: can affect fertility (Brook, 2020)
  1. Genital warts: viral. Caused by the HPV (human papilloma virus). 
  • Two types of virus (6 and 11) that cause warts, but not cancer (FPA, 2019). HPV (other forms) can cause cervical cancer. 56% decrease due to the introduction of the HPV vaccine as young women were vaccinated before this data was collected
  • Can be spread skin-skin. More likely to be passed on if someone has visible warts. It is less frequently passed on through oral sex (NHS, 2018)
  • Symptoms: see here for the list of where they develop on the body. Can be itchy, inflamed. Some people might bleed from the anus and urethra
  • Most people don’t develop visible warts. Clears from the body over time, but can grow and are infectious
  • If they do, at least 3 weeks to show, but you can get tested immediately. Main test is visual
  • Treatment: cream (specific for genital warts), freezing, heat, surgery, laser (local anaesthetic) (ibid)
  1. Genital herpes: viral. Caused by herpes simplex. Two types: HSV 1 and 2. Accounts for 8% of 2018 STIs (Brook, 2020).
  • Commonly transmitted through oral sex (NHS, 2018); see here for more information on transmission (it’s quite complex)
  • Outbreaks can last 2-4 weeks
  • Virus becomes inactive over time
  • Symptoms: people tend to get a stinging/itching in the genital/anal area, owing to small blisters which burst and leave sores (FPA, 2019)
  • Test: visual, swab, occasionally blood test for antibodies
  • Treatment: antiviral tablets within 5 days of the first outbreak. Can take them again if more outbreaks for 1-3 days. >5 outbreaks/year = longer course of treatment. Tips for soothing treatment and ways to prevent outbreaks found here (useful for everyone to know!)
  • Long term: there is no cure, so you can get more outbreaks. They tend to be less severe, and your body will produce antibodies against it (Brook, 2020; FPA, 2019)
  1. Syphilis:  Bacterial. 7,541 diagnoses of syphilis reported in 2018, a 5% increase since 2017 (PHE, 2019).
  • Commonly transmitted through oral sex (NHS, 2018)
  • Stages: early (primary and secondary syphilis), latent, late (FPA, 2019). The latent has no symptoms. It can appear 2 weeks – 3 months after contact
  • Having syphilis means you can be at a greater risk of contracting HIV
  • Primary symptoms: ulcers anywhere on the body, but tend to be around/on the genitals.they are very infectious, can take 2-6 weeks to heal (ibid)
  • Untreated syphilis develops to a second stage after 4-10 weeks of any ulcers showing (ibid)
  • Secondary: more symptoms. Painless rash, wart-like growths, flu-like illness, patchy hair loss, white patches on tongue/cheeks/roof of mouth (ibid)
  • Latent: no symptoms but a positive blood test. Can pass on
  • Later syphilis has more serious health implications, but is much rarer in the UK (ibid)
  • Testing: if you think you might have it, get tested as soon as possible. Blood test and physical examination to look for bodily symptoms such as ulcers/growths. Swabbing ulcers 
  • Treatment: antibiotics. Often with penicillin. Let your healthcare professional know if you have a penicillin allergy. Primary, secondary, latent syphilis can be cured. Late phase can cause longer-term damage
  1. Trichomoniasis: Parasitic; the parasite is called Trichomonas vaginalis. 

 (When I started my job, I had never heard of this one. And I’d already been teaching sex ed at uni. So no worries if you’re confused. Again, around half of people don’t get symptoms for this one. It’s rarer in men (FPA, 2019).

  • Mainly spread through unprotected vaginal sex, affecting the vagina or urethra
  • Symptoms: burning during urination, discharge (can be frothy, yellow, thick, thin, strong smell), itches, pain from soreness/inflammation. They can show up a month after contracting
  • Testing: can be asap if you’ve been in contact with someone you think might have trichomoniasis. Swab in the vagina, or tip of the penis. They can be looked at under a microscope in real-time or sent off for testing. Takes 10 days
  • Treatment: antibiotics. Can be one dose or over a week

7. Scabies: Parasitic (tiny mites) Can take 6 weeks for symptoms to show (FPA, 2019).

  • Passed on with close body/sexual contact with someone who already has scabies. They live for up to 72 hours away from the body, so can exist on clothing/bedding
  • Symptoms: itching (often noticed at night), itchy red rash, tiny spots, inflammation, broken skin
  • Again, if you think you might have it, get a checkup ASAP. Can be tested visually/microscopically. Likely to receive treatment immediately even if it’s only suspected
  • Treatment: neck-down whole body overnight lotion treatment for 12 hours. Hot wash affected clothing/materials

8. Public lice: Parasitic. Sometimes called crabs. Tiny lice that live in pubic hair (Brook, 2020).

  • Can take weeks to show symptoms. It is less frequently passed on through oral sex (NHS, 2018)
  • Symptoms: itching in affected areas. Brown eggs, sky-blue spots after a few days, tiny specks of blood (ibid)
  • These can be found in the hair on the body such as on the armpits, legs, chest, but they are different to head lice (FPA, 2019)
  • ASAP testing again like with scabies
  • Treatment: lotions/shampoos/cream for pubic lice. They vary for how long they’re left on, usually need to be repeated within the week – depends on brand etc. (ibid), also need to hot wash things in your house that have made contact with your body

9. Bacterial vaginosis. This can develop after having sex, but isn’t only sex-related. If you have unusual discharge from your vagina, this is thought to be the main cause. Only affects people with vaginas, of which 1 in 3 will get this across their lifetime (FPA, 2019).

  • Symptoms: discharge becomes thin, watery, changes to a different greyer colour and can smell ‘fishy’, which can be amplified after having sex (ibid). See ‘typical’ female discharge info here
  • It can be that people get BV often, and sometimes have to do extensive research to find out the causes
  • Essentially, someone has less of the usual vaginal bacteria – called lactobilli – and the vagina becomes more alkaline (FPA, 2019). When people say people with vaginas shouldn’t use ‘Femfresh’ hygiene products, this is because the vagina cleans itself and usually regulates its own environment (Brochmann & Dahl, 2017)
  • It can, unfortunately, be more common if: you use medicated/perfume soap when cleaning yourself which introduces unfamiliar bacteria, ‘douche’, clean your underwear with a particularly potent laundry cleaner, or you are a smoker (FPA, 2019). It is also thought that: “hormonal changes during the menstrual cycle, receiving oral sex, semen in the vagina after sex without a condom, an intrauterine contraceptive device (IUD) and genetic factors may also play a part” (FPA, 2019)
  • Test: an examination, a swab and/or a pH test of discharge from the vagina
  • Treatment: antibiotics in pill form or creams or gels. Different treatments

10. Thrush. From a “yeast fungus” (FPA, 2019). The fungus inflames mucous membrane (Brochmann & Dahl, 2017), which cause the symptoms. Similar to BV that it doesn’t always come from having sex but can be brought on by increased sexual activity. 75% of people with vaginas will get this over their lifetime. People with penises don’t often get it (FPA, 2019).

  • More likely to get thrush if: wearing tight clothing, synthetic underwear, on antibiotics, pregnancy, chemo, illnesses that affect your immune system. Similar irritants affect BV like feminine hygiene products (ibid)
  • Symptoms: itchiness, feeling sore, red area, fissures (similar to the feeling of paper cuts (ibid)), thick white, “cottage-cheese like discharge” (ibid), the same can happen on the penis, with painful foreskin
  • Test: examination and swab. As some of these symptoms might be similar to other STI’s, it’s good to get tested at the same time
  • Treatment: antifungal cream for your genitals, pessaries (pills inserted into the vagina), pills – or a big ol combination

11. UTIs. these are caused by bacteria from the anus making their way into the urinary tract (includes infection of the bladder, kidneys, urethra (NHS, 2017). 

  • The risk is at least 60% higher than normal in the two days following intercourse for women < 30 (Brochmman & Dahl, 2017)
  • See more: non-gonococcal urethritis, cystitis, urethritis
  • Symptoms: needing to wee a lot, burning when weeing, bloody/smelly/cloudy wee, tummy pain, feeling ill (NHS, 2017)
  • Go and see a GP, they might need a urine sample from you to test; treatment is usually prescribed antibiotics and it should clear up in a few days

12. Hepatitis B. viral. It has flu-like symptoms. It can be long term and is treated with antiviral medication. Blood tests. Longer-term it can affect the liver (Brook, 2020). There are also other forms of Hepatitis (C is most common in the UK but mainly transmitted by the sharing of needles (ibid)). No ‘cure’ if you get a longer-term infection, but it tends to ‘go away’ for most people (NHS, 2019).

13. HIV (human immunodeficiency virus) viral. 108,800 people have HIV in the UK, 7,500 of those are reckoned to be undiagnosed (THT, 2020).

  • The virus stays in the body for your lifetime. There is a difference between HIV (virus) and AIDS – it “stands for acquired immune deficiency syndrome” (FPA, 2019)
  • Testing: blood test checking for antibodies. Window period: 1 – 3 months for the infection to show (Brook, 2020)
  • People get symptoms soon after (two weeks) an infection, called the ‘seroconversion illness’ (Brook, 2020). They can be flu-like, or much more severe like meningitis and other hospitalisable conditions (Brook, 2020; FPA, 2019). Sometimes after this people do not have symptoms for a long time: this causes long term damage where people experience weight loss, more serious “life-threatening illness” (Brook, 2020)
  • As I’m not an HIV expert, see the below: “HIV lives in the blood and some bodily fluids, so to get HIV, one of these fluids from someone with HIV, has to get into your blood. The virus exists in blood, semen (including pre-come) and vaginal fluids. The commonest way for HIV to be transmitted from one person to another is through having unprotected vaginal or anal sex” (Brook, 2020)
  • Rarely transmitted orally but if it was, this could be with an infected person and someone who had a mouth ulcer
  • Now treatable, but there is no long term cure. People can have an “undetectable load” (FPA, 2019) meaning that they can’t pass the virus on if they are on anti-retroviral medication and their infection has been treated and ‘caught’ early. This medication stops the HIV growing and working, which gives the immune system a chance to repair (Brook, 2020)
  • Certain communities more at risk in the UK: MSM (men who have sex with men) and heterosexual Black African people (ibid)
  • PrEP: ”a medication taken by someone who’s HIV negative to prevent them from acquiring HIV. PrEP has proven to be effective for people who are at especially high risk of acquiring HIV” (ibid)
  • PeP: post-exposure, 28 days of strong medication (Brook, 2020)

Where to now?

I hope everyone learned something new, and feels a little more reassured about the various STIs that can be transmitted. Apologies if this information has overwhelmed anyone; it’s kind of a mini dissertation. Shows how much we all need to know, and the more you know, the more powerful you are!

Believe it or not, this isn’t even the FULL list, just the most heard of/tested for. It is thought there are at least over twenty. Check how STI treatment affects having sex/condom use when you go and get treatment; it differs for all of them and depends on the severity of the infection. 

Further, one of my colleagues will do an LGBT sexual health special, so keep your eyes peeled. I hope that in the future, young people persist with their sexual health, even if they are obstacles in their way.

References

Brochmann, N & Dahl, E. S. (2017). The Wonder Down Under: A user’s guide to the vagina. Great Britain: Yellow Kite

Brook. (2020). Sexually Transmitted Infections. Topics Webpage. (Accessed online: https://www.brook.org.uk/topics/stis/ 27/04/2020) 

FPA. (2019). STIs Overview. STIs Webpage. (Accessed online: https://www.sexwise.fpa.org.uk/stis/stis-overview 27/04/2020)

NHS. (2017). Urinary Tract Infections. Conditions Webpage. (Accessed online: https://www.nhs.uk/conditions/urinary-tract-infections-utis/ 27/04/2020)

NHS. (2018). What infections can I catch through oral sex? Sexual Health Webpage. (Accessed online: https://www.nhs.uk/common-health-questions/sexual-health/what-infections-can-i-catch-through-oral-sex/ 01/05/2020)

NHS. (2019). Hepatitis B Treatment. Conditions Webpage. (Accessed online: https://www.nhs.uk/conditions/hepatitis-b/treatment/ 27/04/2020)

PHE. (2019). Sexually transmitted infections and screening for chlamydia in England, 2018. (Accessed online: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/806118/hpr1919_stis-ncsp_ann18.pdf 27/04/2020)

THT. (2020). HIV statistics. About HIV webpage. (Accessed online: https://www.tht.org.uk/hiv-and-sexual-health/about-hiv/hiv-statistics 27/04/2020)

A Comprehensive History of Sexual Health

With a UK focus…

Why sexual health?

Sexual health is something that we are all encouraged to engage in and might have been taught to most of us in some skeletal form of sex education. Which at worst would have been scaremongering and misleading (n.b 2010 circulations of a ‘blue waffle disease’ which was actually a photoshopped image of other STIs), and at best involved a discussion of the bare minimum such as STIs, reproductive biology and pregnancy. Although some of you might have been taught a curriculum discussing consent, LGBT identities or female pleasure (which is least discussed even in wider society), I can assure you; you were the lucky few. 

Many of us might have self-educated, learned with experience, or dabbled with pornography (a blog topic coming later). Whilst none of these are necessarily bad options (provided they are done safely and legally), there is overwhelming evidence that the less sex education we receive, the less likely we are to enjoy sex, more likely to have earlier pregnancies, be at risk of abuse, and display higher rates of STI infections. This is a large issue in the UK at the moment – STIs increased by 5% between 2017-18 across all population groups, with 16-24-year-olds being the most affected age group (displaying a 24% increase in gonorrhoea infections alone). 

Sexual health is imperative to address, especially if you are engaging with a large number of new partners. It must also be seen as an empowering and radical form of self-care. This is particularly important in a neoliberal and austerity policy-oriented climate such as the UK, where sexual health funding continues to be cut (by as much as 14%). It is likely that the current coronavirus pandemic will also influence allocation for sexual health services, as funds are being diverted elsewhere. Taking care of sexual health also reduces anxieties around actually having sex; alleviating the fear of contracting an STI or having children at an ill-timed moment in life doesn’t have to be a consistent source of stress.

So; given we know what sexual health is, that it is necessary, and empowering to take care of:

What is its history? Who were the prominent figures that brought it to the stage it is at now in the UK? What can we consider for the future?

Timeline 

3000 BC Condoms created in Egypt, thought to be made of animal hide (DeNoon, 2003) 

1855 Reusable rubber condoms were designed by an American man, Charles Goodyear (Moss, 2018) 

1909  The first IUD (intrauterine device, often referred to as the coil) was designed, using “a ring of silk-worm gut” (FPA, 2010) 

1914 – 1918 During World War 1 there was a massive increase of STIs in the UK, where approximately 5% of men in the army were infected (Carlin, 2017)

1921 First UK contraception clinic was founded in London by Marie Stopes (FPA, 2011)

1930s Latex condoms were produced (FPA, 2010)

1951Carl Djerassi, a chemist in Mexico City, creates a pill by synthesizing hormones from Mexican yams. On a chemical level, the pill has been invented, but Djerassi isn’t equipped to test, produce or distribute it”. (Nikolchev, 2010). Djerassi was Austrian born Bulgarian-American chemist 

1957 Men and women were tested on for a combined hormonal contraceptive pill by Gregory Pincus in the first stages of developing ‘the pill’ (Extance, 2016) (part of the Catholic scientist team) 

1961 First contraceptive pill licensed in the UK (Moss, 2018) but only to married women. “Each pill used in the 1960s was roughly equivalent to seven of today’s pills” (FPA, 2010)

1964 Helen Brook founded the first Brook Advisory Centre exclusively for young unmarried women who were not able to access contraceptive advice elsewhere (FPA, 2011)

1967 Homosexuality is decriminalised (LGBT Foundation, 2017) and an Abortion (with restrictions) Act is passed, coming into effect the next year (Parliament, 2020) 

1969 Formal training of doctors and nurses in contraceptive techniques started (FPA, 2011); the copper coil (IUD) also gets introduced (FPA, 2010)

1973 Brixton Black Women’s Group was formed. They campaigned against “the discriminatory practice of the contraceptive drug Depo Provera being prescribed to black women on a long-term basis” (British Library, 2020) 

1974 Unmarried women get access to the pill (Moss, 2018) on the NHS, as opposed to getting it from clinics such as FPA and Brook. Under 16s can access confidential advice (People’s History of the NHS, 2020); Depo-Provera (the injection) was licensed in the UK for short-term contraceptive use (FPA, 2010)

1975 What is now the LGBT Foundation (a health and community charity) is formed in Manchester (LGBT Foundation, 2017)

The late 1970s/early 80s cases of HIV/AIDS emerged in MSM (men who have sex with men) communities in San Francisco (AVERT, 2019), going on to become a global sexual health pandemic (which is still prevalent today across all population groups, maintaining hold in places such as countries in Southern Africa) 

1983 The Terrance Higgins Trust (THT, 2020) was formally set up, the UK’s leading HIV and sexual health charity, in memory of one of the first people in the UK to die from an AIDS-related illness

1984 Emergency contraception (often known as ‘the morning after pill’) gets licensed in the UK (Moss, 2018)

1990 Saheli, a non-hormonal weekly contraceptive pill makes it onto the Indian market (Balasubramanian, 2017)

1992 Femidom becomes available in the UK (FPA, 2010)

1993 The contraceptive arm implant is introduced (FPA, 2010)

1996 Intrauterine Systems (releasing hormones, also known as IUS) introduced (FPA, 2010)

2001 Women can purchase emergency contraception without needing a prescription (Laurance, 2008) 

2003 The contraceptive patch is made available (FPA, 2010)

2005 Non-latex condoms produced (FPA, 2010)

2013 Online STI testing becomes available in London boroughs (SH:24, 2020); sexual health services become decommissioned to local authorities

2017 A Swedish ‘rhythm method’ app, Natural Cycles, gets approved as an EU official method of contraception (despite usability issues reported by UK women) (Sudijic, 2018)

Jan 2019 The Faculty of Sexual and Reproductive Health announces that there is no need for a break in the pill; the original scientists did so to cater for the acceptance from the Catholic Church (Forrest, 2019) 

March 2019 Reports of male contraceptive pills and body gels having been tested with good results. It could be at least a decade until this becomes available on the market (Roberts, 2019). 

September 2019 New RSE is recommended this year in primary and secondary schools (level-dependent), and will become mandatory in September 2020 (GOV.UK, 2020) 

October 2019 Abortion is decriminalised in Northern Ireland (Connolly, 2019)

Early March 2020 PrEP to be made available on the NHS for those at high risk of contracting HIV (Taylor, 2020)

Late March 2020 During the 2020 coronavirus pandemic, women can take abortion pills at home to maintain lockdown measures (RCOG, 2020)

I have included here some of the key events that contributed to the historical transformation of sexual health; such as introducing the combined contraceptive pill (used by 151 million women globally), and the other long-acting methods of contraception. Take a look below at the most popular contraceptives in the UK:

 Retrieved online at Revealed: pill still most popular prescribed contraceptive in England

Speaking to my grandmother (in her 80s, radical leftist and very committed to the feminist movement), she describes the social landscape of the 60s where many women were overly ostracised for merely asking about contraception. Further, she stipulates that if anything ‘happened’ (pregnancy, STI transmission) it fell on the shoulders of female partners. These are unfortunately unsurprising sentiments to hear, even today.

Despite this, activists such as Marie Stopes (there are now 60 abortion clinic services under her name in the UK) and Helen Brook (Brook is now a nation-wide, leading sexual health charity providing both clinical and education services for young people), fought for clinics to be made available for women. Margaret Pyke, another significant founding member of the FPA, originally helped offer contraceptive advice to women. 

 In 1970 the FPA commissioned this famous advert, to highlight dual responsibility concerning sexual health

Unfortunately, upon further research, it appears Marie Stopes was also considered a eugenicist, who believed that certain ‘classes or races’ of people should use birth control in order to not have more children. Her organisation also previously advocated for ‘state forced sterilisation’. In many ways, despite the liberating availability of contraception for women in terms of creating reproductive choices, this has come at a significant cost for many communities.

The Brixton Black Women’s group campaigned against the use of the contraceptive injection, as it was found to be over-prescribed and unknowingly tested on women of colour from certain communities. Further, side effects such as rapid weight gain and increasing risk of osteoporosis, especially for under 25s raised even more concern. Their work was crucial in highlighting inequalities in reproductive health; and such issues are still the case globally, where underprivileged women are in ways targeted to use this type of contraception despite other safer methods being available. Now, groups such as Decolonising Contraception work to highlight the racism that has and unfortunately continues to exist in sexual and reproductive health. Such work is vital given that it can take some digging to unpick these injustices; they argue that in ways contraception exists as a ‘tool of oppression’ for some women rather than others (see further reading and resources below on this). 

Image retrieved online at The Black Women’s Movement – Black Cultural Archives

In the last couple of years, we can also see developments that again, signify an even further trajectory of sexual health in the UK; such as the availability of PrEP. This medication has been campaigned for by the LGBT community for a long time (PrEP stands for pre-exposure prophylaxis treatment; this medication prevents someone from contracting HIV). Despite advancements, many LGBT people still find that sexual health services don’t cater to them, and with the withdrawal of dental dams (barrier protection for oral sex on vulvas) from global markets, it can seem that barrier methods and contraceptives available are heteronormative, and do not cater to the plethora of sexual and gender identities in existence. It is important in these considerations to note that with sexual health services continuing to be cut, young people and gay men will be the most affected.

Many people also feel that male (reproductive system) contraceptives should be made more available. They have also been tested for decades, in various global locations, although there is speculation that a big enough market wouldn’t exist. For some food for thought, see my Instagram poll below on whether people with a male reproductive system would be willing to take it (I also highlighted the side effects first, which were thought to be a contributing factor to why the drug hasn’t gone to market): 

Poll conducted on my Instagram (@ffiennes) in April

Ultimately, the history of sexual health and the key figures are important to learn about; I for one definitely wasn’t taught this at school. Sexual health is the responsibility of all sexually active people and their partners, and deserves to be spoken about in more open and caring ways. Nevertheless inequalities exist in access, funding and education across a variety of intersections.

I look forward to see how we can address this in the post-COVID-19 future!  

Resources

Reading: 

Listening:

Dr. Annabel Sowemimo on Hannah Witton’s podcast

Watching:

References

AVERT. (2017). History of HIV and AIDS overview. History Webpage. (Accessed online: https://www.avert.org/professionals/history-hiv-aids/overview 06/04/20)

Balasubramanian, D. (2017). On conception and contraception: The story of Saheli. Science Webpage. (Accessed online: https://www.thehindu.com/sci-tech/science/on-conception-and-contraception-the-story-of-saheli/article19140909.ece 09/04/2020)

British Library. (2020). Timeline of the Women’s Liberation Movement. Sisterhood Webpage. (Accessed online: https://www.bl.uk/sisterhood/timeline 07/04/2020)

Carlin, E. (2017). Sexual health – what happened 100 years ago was remarkable. Blogging 4 Bashh Webpage. (Accessed online: https://www.bashh.org/news/blogging-4-bashh/sexual-health-what-happened-100-years-ago-was-remarkable/ 06/04/2020) 

Connolly, M-L. (2019). Northern Ireland abortion law changes: What do they mean? (Accessed online: https://www.bbc.co.uk/news/uk-northern-ireland-50125124 09/04/2020)

DeNoon, D. (2003). Birth Control Timeline. Women’s Health Center Webpage. (Access online: https://www.medicinenet.com/script/main/art.asp?articlekey=52188 06/04/2020) 

Extance, A. (2016). What happened to the male contraceptive pill? Contraception and Family Planning Webpage. (Accessed online: https://www.theguardian.com/society/2016/jul/23/what-happened-to-the-male-contraceptive-pill 07/04/2020) 

Forrest, A. (2019). Contraceptive pill can be taken every day, NHS says in new guidance. Health Webpage. (Accessed online: tindependent.co.uk/news/health/contraceptive-pill-every-day-nhs-guidance-break-catholic-church-pope-a8737456.html 08/04/2020) 

FPA. (2010). Contraception: Past, Present and Future factsheet. Factsheets Webpage. (Accessed online: https://www.fpa.org.uk/factsheets/contraception-past-present-future 06/04/2020)

FPA. (2011). A history of family planning services factsheet. Factsheets Webpage. (Accessed online: https://www.fpa.org.uk/factsheets/history-family-planning-services 06/04/2020)

GOV.UK. (2020). Relationships education, relationships and sex education (RSE) and health education. Publications Webpage. (Accessed online: https://www.gov.uk/government/publications/relationships-education-relationships-and-sex-education-rse-and-health-education 08/04/2020) 

Laurance, J. (2008). How Britain Learnt to Love the Pill. Indy/Life Webpage. (Accessed online: https://www.independent.co.uk/life-style/health-and-families/features/how-britain-learnt-to-love-the-pill-1099148.html 06/04/2020)

LGBT Foundation. (2017). Our History. About Us Webpage. (Accessed online: https://lgbt.foundation/about-us/our-history 24/04/2020)

Moss, S. (2018). The Brief History of Contraception. My Morning After Blog Webpage. (Accessed online: https://www.mymorningafter.co.uk/blog1/2018/11/13/the-brief-history-of-contraception 06/04/2020)

Nikolchev, A. (2010). A brief history of the birth control pill. Health Webpage. (Accessed online: https://www.pbs.org/wnet/need-to-know/health/a-brief-history-of-the-birth-control-pill/480/ 06/04/2020)

Parliament. (2020). National Health Service (Family Planning) Act 1967. Parliament and the 1960s Webpage. (Accessed online: https://www.parliament.uk/about/living-heritage/transformingsociety/private-lives/relationships/collections1/parliament-and-the-1960s/national-health-service-family-planning-act/ 06/04/2020)

RCOG. (2020). Coronavirus (COVID-19) – Information for women requiring abortion. Guidelines Webpage. (Accessed online: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-abortion/information-for-women/ 09/04/2020)

Roberts, M. (2019). Male pill – why are we still waiting? Health Webpage. (Accessed online: https://www.bbc.co.uk/news/health-47691567 08/04/2020)

SH:24. (2020). SH:24 – Online Sexual Health Service. Health Innovation Fund Webpage. (Accessed online: https://www.gsttcharity.org.uk/what-we-do/featured-projects/health-innovation-fund/sh24-%E2%80%93-online-sexual-health-service 07/04/2020)

Sudjic, O. (2018). ‘I felt colossally naive’: the backlash against the birth control app. Contraception and family planning webpage. (Accessed online: https://www.theguardian.com/society/2018/jul/21/colossally-naive-backlash-birth-control-app 09/04/2020)

Taylor, P. (2020). NHS England will make PrEP for HIV available in April. Pharma News Webpage. (Accessed online: https://www.pmlive.com/pharma_news/nhs_england_will_make_prep_for_hiv_available_in_april_1329238 08/04/2020)

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Article cover photo by Benjamin Moss on Unsplash. The image here is of the EllaOne emergency contraception pill. You can access it at pharmacies, sexual health clinics and in emergencies from emergency hospital departments.

Introduction

Hey there: for anyone who doesn’t know me personally, my name is Francesca!

So: why did I decide to write this blog? The title, Sexual Health and the City, describes many things for me. I would say excuse the pun, but since my impossibly cool twin Sicily approves, we’re running with it. 

Firstly, I currently work for a sexual health organisation in London, so I literally teach sexual health in the city, in varying formats. Before I got this job, I had just graduated from studying Social Anthropology and Sociology at the University of Manchester. When I left school in 2014, I did a couple of terms of Midwifery training. Whilst working in a hands-on clinical role didn’t suit me professionally, I remained enthralled in women’s story-telling. This often revolved around reproductive and sexual health, and I would often get told off for chatting to all the new mothers instead of remembering to take their blood pressure.

Fast forward to my final year of uni in 2018, I’m a school’s officer on the Manchester Sexpression: UK committee; a wonderful, national, student-led sexual health charity, which runs a combination of free school and university sex education sessions (this volunteering role helped me get the job I have now!) in the respective local communities.

Secondly, my introduction to sex, female pleasure, sexual health and general female empowerment came from the TV show Sex and the City. My twin and I used to watch this with my open and sex-positive family, oftentimes with some very influential best friends around (Molly(s), I’m talking about you). We must have been around twelve when we saw our first episodes, though obviously we didn’t understand all of the sexual references. Fast forward to the present day and much of the 2010s have opened up conversations that elucidate many an issue with the show: notably, the lack of cultural diversity, the lavishness of lifestyle (despite proclamations of a ‘broke’ woman who can somehow afford Louboutins), and in some ways the sexist and misogynistic undertones that the characters adhere to or more, the writers feed into. Other recent TV shows, such as Issa Rae’s Insecure shroud Sex and the City by being more diverse, current and realistic. However, ‘woke’ Charlotte on the Instagram account @everyoutfitonsatc provides some respite to the show’s downfalls. During this unprecedented global pandemic (if anyone reads this in the future I’m referring to the COVID-19 lockdown of 2020 – wild times), some SATC memes have given me food for thought and genuine belly giggles. See below.

Retrieved from Instagram

Thirdly, I believe that sexual health and wellbeing are a collective concern; it might occupy the domain of the private, but really, we are embedded and move through and between communities, spaces, countrysides and countries etc. Our connectivity and collectivity offers us the chance to incorporate sexual health in a macro manner. Hence, I will be looking at sexual health broadly, as opposed to speaking about my personal sexual health and experiences by taking a wholly objective approach.

In December 2019, I got an article published based on my dissertation on Restless Mag, which focused on how women discussed their experiences of sexual violence on Twitter, and how underreporting influences whether victims are believed or not (read the piece, Believe Her here). Now I find myself in the privileged position of having extra time at home, I was forced to stop listening to the imposter syndrome voices in me and get on with it. Whilst such voices are at times self-protective, they can hold us back. So, I began properly writing and researching again. 

Before we get more stuck into the blog and the journeys it will take us on, it is necessary to highlight that I will be working with the WHO definition of sexual health, which holds that it is: 

“…a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.” (WHO, 2006a) 

Taking a holistic view of health, and significantly of sexual health, means that we can consider how society and culture has and continues to influence our sexuality and sexual lives. The compartmentalisation of medical from social leads to unuseful divides, yet informs much of the way we might access sexual healthcare vs. how we talk about and relate to sex. Why is it that we know that sexual health is important, but we know so little about orgasms, or what having STI treatment feels like?  Why has there been so much controversy/illusion/smoke around sex, reproductive history, empowering sexual health messages, as if gasp knowing more about sex could be some kind of good thing?! 

The sex-positives of us may reach out and saturate our lives with podcasts, books, events, films etc. But what about those who could know more, but don’t actively seek this information out? Those who feel like they should know more, but weren’t offered the tools to be able to build new knowledge? Although I will inevitably focus slightly more on people who are women/have female reproductive systems (whose sex lives have also been most policed throughout time), this content is intended for any young adult to read: for the individual, partners, friends, family, colleagues etc. Many young adults might have had the bulk of their formal sex education, but find themselves at their most sexually active in life thus far. Keeping this in mind, I will keep the blog as inclusive and accessible as possible so that anyone regardless of their experiences, sexuality or gender will be equipped with empowering tools and information. 

Although I want to use this blog to compile some fun resources for young adults, I will also look to academia to describe some of the phenomena we see, as the nerd/perfectionist in me needs to write cohesively. As a rule of thumb, medical anthropology will be an interesting academic field to draw upon. 

In order to continue my own education, delve into some academia and crunch it into genuine and enjoyable content, this blog will aim to: 

  • Analyse wider societal topics that relate to sexual health, sex education, and sex in general 
  • Reflect on some of my professional experiences, and aim to draw out useful themes 
  • Collaborate with and interview people who are knowledgeable and passionate about sexual health and related topics, and need to offer their voices online as well

We’ll see where this leads us… and remember: your sex education never has to end.


So here we are… Sexual Health and the City.