Those of you who follow my social media (mostly Instagram!) as well as my blog will know that every Thursday (for about 2 months now!) I pop onto the Irish radio station iRadio to chat about a different health-related topic each week. I absolutely love the slot, and get excited every week to shed some light on a new area for those listening. We’ve covered everything from healthy ageing to cervical smear tests to smoking cessation and even social media ‘detoxing’! Doing this weekly chat on The Hub iRadio show always gets me thinking about what health topics I haven’t covered on my blog. Recently, we chatted about sexual health and well-being, and I knew it was an area I 100% wanted to write an article here about. It’s a really important area from an individual and public health perspective, but is too often a ‘hush hush’ topic with quite a bit of stigma attached to it. We need to open up this conversation, because sexual health issues are real health issues, and if we don’t talk about them, then a) we can’t identify who needs to be treated for and helped with them and b) the spread of sexually transmitted infections (commonly referred to as STIs) will increase if we aren’t vocal in educating people on ways in which to practise good sexual health and prevent transmission of STIs. So in this article, I’m going to use the questions I got asked as part of my radio interview as a sort of basic Q&A style article, because I’m hoping that these questions are those which many of you might want to ask about – but are afraid or embarrassed to. This article is by no means exhaustive in terms of it’s content – but I want to communicate the basics on what entails good sexual health and well-being and keep your attention enough to do that!
STIs have significantly increased in the last five years. Why do you think this is? Have we become less sexually responsible?
So, there’s a lot in this first point, and I’m going to break it down into the basics and keeping it brief and concise. Let’s define an STI first – a sexually transmitted infection – infection that is passed on through sexual contact with someone who is infected – remember this can be via unprotected vaginal, anal, oral sex – and via use of sex toys too. Examples of the most common STIs include chlamydia (most common in Ireland), gonorrhoea, HIV, genital herpes simplex and syphilis (there are several more!). In Ireland, numbers of new diagnoses of a number of STIs have increased in the past few years, for a number of reasons:
- First, we are better at reporting them and collecting the data, which means we have a better more accurate record of numbers.
- Second, growing awareness leading to more people getting tested will also increase rates of recorded STI diagnoses.
- Third – outside of those two reasons, there is an observed rising trend in STI diagnoses in Ireland (not all), and I think a big contributor to why this is has to do with the stigma around STIs in Ireland, which can be a major source of fear among people and a barrier to getting tested. If we don’t test for STIs we can’t identify who needs treatment, and without treatment, it’s a lot harder to reduce STI transmission.
- Fourth – certain STIs are clinically silent when initially contracted (i.e. you don’t notice any symptoms or signs) and so people may not be aware they have an STI and unknowingly pass it on to their sexual partner (s).
In terms of the second question, I don’t think we’re sexually irresponsible as such – but we are probably not being as sexually responsible as we could be. In Ireland, STIs are concentrated in two main groups in the population – young people, and men who have sexual intercourse with men (this group is referred to as MSMs in medical literature), and there are gender differences in the distribution of STIs too (Health Service Executive, 2018). For example, in females, chlamydia, genital herpes simplex and another STI called trichomoniasis are more common, while in males we see more diagnoses of gonorrhoea, syphilis and a condition called LGV (lymphogranuloma venereum). It is in these two groups (young people (15-30) and MSMs) that we are seeing the greatest rise in new diagnoses of STIs – in fact, in 2016 almost 70% of STI cases notified to public health departments in Ireland were in people under the age of 30 (HSE, 2018).
I was also asked – are young people more concerned with preventing pregnancy than STIs? My answer was – I think it’s less about young people being more concerned with pregnancy prevention and more about a lack of aware about STI prevention among young people as well as stigma surrounding the topic. However, people may confuse methods to prevent pregnancy with those to prevent STIs, particularly if they don’t discuss these with their healthcare provider, or rely on the dreaded ‘Dr. Google‘ to tell them what to do.
On my radio chat, we spoke specifically about the STI chlamydia, because its the most common STI in Ireland, and also because it is frequently clinically silent when initially contracted. Chlamydia is a bacterial infection, and affects men and women, particularly (in Ireland) young adults aged 15-34 (especially 20-29 year olds), and as we’ve said, females more than males. It is transmitted through unprotected sexual intercourse (and through use of unwashed sex toys, and can also be passed from mother to baby during delivery. It can infect the cervix (neck of the womb), urethra (the tube through which you pass urine), rectum (back passage), pharynx (throat) and sometimes the eyes. We CANNOT get it through hugging, kissing, swimming or sharing towels. (As a side note, the STIs herpes and syphilis can be transmitted through skin to skin contact). As I’ve said, the key thing about chlamydial infection is that while there are symptoms and signs of infection, it can be totally asymptomatic and in fact, half of males and 7 out of 10 of females who get it will be asymptomatic. Most symptoms and/or signs, if picked up, appear in the first 3-4 weeks after sexual contact. In men, this may include penile discharge, pain passing urine, testicular pain and/or swelling, and also bowel symptoms (such as diarrhoea, discharge, bleeding). In females, symptoms and signs may include bleeding after sex, bleeding between your period, changes to the normal vaginal discharge, and pain passing urine or pain in the tummy.
However, the potential long-term impact on health is what needs to be highlighted the most. If left untreated, in women chlamydia can spread from the cervix to the womb and affect ovaries and the tubes that connect the womb and ovaries together, causing inflammation known as pelvic inflammatory disease. This can increase the risk of infertility and having what’s called an ectopic pregnancy (where essentially a pregnancy grows outside the womb where it normally would). In males, untreated infection can cause inflammation with pain and swelling due to spread to the testicles. This is a classic example of where ‘prevention is better than cure’, and why we talk so much about the need to practice good sexual health to prevent transmission of chlamydia (and other STIs of course!) However, if a diagnosis of chlamydia is suspected, testing and treating is very easy to do, and so important to prevent these serious long-term effects on health I’ve mentioned above. I wanted to focus on this STI in particular as it’s the most common and often clinically silent. But, there are of course many other STIs, examples of which I’ve mentioned above, and so if you want to know a little bit more about them (such as gonorrhoea, HIV, syphilis, herpes and more), what the symptoms and signs are, and how they are transmitted, the Irish website www.sexualwellbeing.ie has lots of really helpful information, and I’ve linked their ‘Types of STIs’ booklet here.
Okay. Onto the good stuff. PREVENTION and practising good sexual health.
How can you go about getting your sexual health checked? What’s involved?
First of all – don’t be afraid! Healthcare professionals working in sexual health (and in general, whether in primary or secondary care) are well used to patients coming with many different sexual health concerns and are trained to manage them, and they just want to help and make the process as simple and stress-free for you as possible. In terms of where to start – visit your GP, pharmacist or local STI clinic (your GP will likely know where this is, or check out the Health Service Executive website or the Irish Sexual Well-being website for information) for in person advice about getting tested. Most student health services in Irish colleges and universities also offer STI information and (in some cases) testing or referral on-wards for it. Remember, like any healthcare consultation, its a judgement-free zone – always. If you’re wondering whether you need to get tested, here’s a handy little bullet point summary of when testing is definitely indicated:
- You have any symptoms which suggest an STI
- Your partner has an STI
- You have a new sexual partner
- You have more than one sexual partner
The above points being said – I think everyone should have their sexual health checked at least once in their lives. As as you’ll from the above points, that actually does include almost everyone at some stage in their lives. The type of test will depend on your symptoms, if you have any. For males, generally a urine sample is required and possibly a swab from the tip of the penis (if a discharge present). For females, a vaginal swab will be taken, plus or minus a urine sample depending on the differential diagnosis. Both males and females may also get blood tests (these may be needed for viral or bacterial infections). If you are found to have a diagnosis of an STI, you’ll be offered treatment, the type, duration and route of which depends on the infection. And – if you are are diagnosed with an STI, you should tell your sexual partner (s) so that they can be offered testing and treatment if needed – this is very important, and your doctor/healthcare provider would discuss how to go about this with you in the clinic. It’s important for their health of course, yours and that of the community/general population, because the more people we treat, the lower the chances of ongoing spread of infection. The process of identifying the sexual partner (s) of those diagnosed with an STI is called contact tracing, and it’s a key part of sexual health for healthcare professionals. This process is discussed with the patient at the time of diagnosis of an STI, to ensure their contact (s) are identified, informed of their risk of infection (if present) and (if indicated) offered testing and treatment. Finally, remember – you have to wait until completion of treatment before having sex again (all types!), and your doctor/nurse in the clinic would discuss this specific time frame with you.
The last question I was asked on the radio interview was – how can you practice safe sex? And I tie this question in with an overall answer on how to practise good sexual health, because practising safe and responsible sexual activity is under that umbrella. So I’ve summarised this into a few key points:
- First and foremost – good sexual health and well-being starts with knowing your own sexual health history, and that means getting tested at least once, and definitely if you identify with any of the ‘When testing is indicated’ points I mentioned above.
- Second – Open conversation and honesty between you and your sexual partner (s) about each of your respective sexual histories is essential. I’ve mentioned the stigma around sexual health in society and I do acknowledge it can be a big barrier to honesty between partners about it – but it’s such an important part of your health, and you may suffer the most if you don’t bring it up! On this point, if you have a new sexual partner, it’s really important, as we’ve said above, for both of you to have an STI test before having any form of sexual intercourse without a condom – remember, you and they may be asymptomatic, as may your and their previous partners.
- Third – Condom use (i.e. barrier protection) during sexual intercourse for STI prevention essential and don’t be afraid or feel silly about asking your partner about this!
- Fourth – Just as a side note, although this isn’t an article about menstrual health and pregnancy, I do want to mentioned that in terms of preventing an unwanted pregnancy, there are many, many options (e.g. the oral contraceptive pill, patches, injections, implants and intra-uterine devices) so it’s best to make an appointment to speak with your GP to explore which of these will work best for you, as they can follow you up on your use of them going forward and monitor you for any unwanted side effects.
- Fifth – This may sound like common sense, and it is, but common sense is often the first thing to go out the window on a night out! So be prepared, be sensible and be safe – don’t put yourself in a position of vulnerability that may compromise your sexual and overall health – for example, when drinking on a night out when your judgement will be impaired. Additionally it is extremely important NOT to use illicit substances in general, but if you do (and I 100% do not condone it), please be aware that mixing these with alcohol intake impairs your safety even further.
- Finally – an important point worth mentioning is with regard to HIV in particular. If you think you may have been exposed to HIV (such as through sexual contact, or a needle stick injury if you are a healthcare worker), there is a course of HIV medication called PEP (post exposure prophylaxis) that aims to prevent HIV infection if given within 72 hours of exposure. More recently, PrEP (pre-exposure prophylaxis) has become available in Ireland. This is pre-exposure prophylaxis taken before sex to prevent HIV infection, and I wanted to mention it, although further discussion on it is beyond the scope of this article. The bottom line here is that if you are concerned regarding the possibility of exposure to HIV infection, please immediately seek consultation with a healthcare provider (whether that is your general practitioner or your local hospital emergency department). It’s also worth mentioning that there is an increased risk of HIV transmission in presence of other STIs.
And that folks, is a wrap! I hope you found this article helpful, and I’ve linked at the bottom some really helpful Irish resources for more information. Please take the time to have a think about your sexual health and well-being, and don’t be afraid to make it a priority in your life! In fact, be proud to do so! As always, I would love to hear your feedback on this article – leave a comment, send an email or send me a message on Instagram (@theirishbalance)!
Ciara 🙂 x
References and Web-links
- Health Service Executive (2018) Sexual health in Ireland: What do we know? Available at: https://www.sexualwellbeing.ie/for-professionals/research/research-reports/sexual-health-in-ireland_june2018.pdf
- STIs in Ireland: https://sexualwellbeing.ie/sexual-health/sexually-transmitted-infections/