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Healthy Sexy & Wise - January 2005

Volume 3, Issue 1, 2005

Editors Note

Welcome to the first edition of Healthy Sexy & Wise for 2005.

If you would like future issues of Healthy Sexy & Wise emailed to you Contact Us

In this issue:

Please feel free to circulate and distribute this newsletter to anyone you know that may benefit from the information. They can go on the mailing list by emailing me their details.

If you have any suggestions, ideas or comments about the newsletter, you can email me – be sure to let me know if there are any topics you would like to see covered in the future. The next edition of Healthy Sexy & Wise will be out in April.

Rebecca Smith
Editor

National Condom Day - February 14

Romance and passion are usually on the agenda for Valentine’s Day…and what do these things often lead to? Sex.

Cupid

So what better time to remind people to always use a condom to help prevent getting or passing on a sexually transmissible infection (STI).

On National Condom Day, FPWA wants people to think about the consequences of having unprotected sex and to take responsibility for their sexual health by always using condoms and having regular sexual heath checks.

The statewide campaign aims to not only raise awareness about practicing safe sex, but to make people feel that condoms are a normal thing to talk about and to help them become comfortable bringing up the subject with their partner. The more comfortable people feel talking about condoms, the more likely they are to use them.

If your organisation would like to be involved in National Condom Day, FPWA will provide you with condoms, posters and other promotional material to give away.

Please phone Rebecca Smith, Public Relations Officer, on 9227 6177

New group for young people

Quarry Health Centre for under 25s in Fremantle now has a group for young people aged 17 and under who are same sex attracted or questioning their sexuality. Young people are encouraged to come along, meet some friends and have fun in a safe environment. It is free to take part in the group and relevant information for young people is available.

Experienced staff are on hand to talk about a wide range of issues, and can also point young people in the direction of other relevant services. While the young people taking part in the group decide what they want to discuss, some topics may include relationships, safe sex, and drugs and alcohol.

The group meets on Tuesday afternoons from 3:30pm – 5pm at 7 Quarry St Fremantle. For more information phone Quarry on 9430 4544.

The low down on STI tests

by Dr Angela Cooney, FPWA Medical Consultant

Many people are ‘put-off’ having an STI (sexually transmissible infection) test as they are not sure what it involves.

STI tests are designed to detect if a person has an STI, whether or not they have symptoms. The type of test or tests you have will depend on if you have symptoms at the time and the type of sexual activity you have been involved in. Different tests (eg blood tests, swabs and urine tests) are used for different types of infections.

For women, an STI test usually includes samples of vaginal secretions, taken with what looks like a long cotton bud. This can be done at the same time as a Pap smear (see article below for more information). In some situations a urine test may be needed for women.

Men who have no symptoms of an STI will have a urine test. Where a man has symptoms such as discharge from the penis or pain or swelling in the testicles, swabs are taken from the opening at the end of the penis.

If you have had anal or oral sex, your doctor may also recommend testing these areas. If you have an ulcer in the mouth or genital area which could be caused by an STI, samples might be taken directly from the ulcer itself.

Depending on your risk, you may also be offered blood tests for STIs like syphilis, HIV/AIDS and hepatitis.

Test results usually take about a week to come back, but someone with symptoms of an STI can be given treatment without waiting for results.

Many STIs are easily treated with antibiotics, but can have serious consequences if left untreated. If results show you have an infection, sexual partners also need to be tested and treated, otherwise reinfection can occur. Check with your doctor for more details.

If you think you have an STI or if you’ve had unprotected sex in the past, get tested by a doctor or at FPWA.

Speculum self-insertion: a pilot study

Authors
Deborah Wright, Ba Soc Science, RGN RM Advanced Practice Nurse and Manager Quarry Health Centre 7 Quarry Street Fremantle and FPWA 70 Roe Street Northbridge.
Jennifer Fenwick, Phd, Associate Professor of Midwifery, Curtin University of Technology and King Edward Memorial Hospital, Perth WA.
Pam Stephenson Grad Dip Human Services RGN RM (FPWA), Advanced Practice Nurse, Quarry Health Centre 7 Quarry Street Fremantle and FPWA 70 Roe Street Northbridge WA 6003.
Leanne Monterosso, PhD, Bluey Day Senior Research Fellow, School of Nursing and Public Health, Churchlands Campus, Pearson St Churchlands WA 6018.

Acknowledgments
The authors would like to acknowledge the financial assistance provided by Edith Cowan University through the new career researchers scheme and the Cancer Council of WA. We also value the contribution of our research assistants, Kelly Hughes, Belinda Edmonds, and Address Malata, and would like to acknowledge and thank the participants, both clinicians and women alike, who so generously agreed to participate.

Abstract
Background: Research demonstrates that pelvic examinations are considered by most women to be unpleasant and are routinely associated with embarrassment, apprehension, fear and often some level of discomfort and/or pain.

Aim: The purpose of this pilot study was to determine whether self-insertion of a speculum by women undergoing a Pap smear would lead to an improvement in satisfaction and decrease anxiety associated with this procedure. The study also aimed to identify whether self-insertion was acceptable to women.

Participants: One hundred and ninety eight women attending Family Planning WA sites in Northbridge and Fremantle in Western Australia between September and December 2003 were invited to participate in the study. One hundred and thirty three women agreed to self-insert their own speculum.

Design: The study was conducted in two phases using quantitative and qualitative data collection techniques. Phase I tested the newly developed Speculum Self-Insertion Satisfaction Questionnaire (SSISQ) for content validity, internal consistency and clarity. Phase II pilot tested the technique of speculum self-insertion. Women’s general level of anxiety was measured using the State Trait Anxiety Inventory (STAI), both before and after they performed the self-insertion procedure. Women's satisfaction and acceptance of the procedure was measured using the SSISQ tested in phase 1 of the project. Women’s perceptions of the speculum self-insertion experience was also captured by interviewing every eighth woman.

Results: Levels of anxiety, as measured by the STAI, were high for all women recruited into the study. STAI scores were significantly reduced after self insertion of speculum. The results of the study demonstrate that speculum self-insertion was acceptable to most women, especially younger women. Mean scores (out of 5) ranged from 4.2231 to 4.7538 on the SSISQ indicating that a majority of women rated all the questions very positively. Nearly 91% of women agreed or strongly agreed that they were satisfied with the experience of self-insertion with 93.8% women agreeing or strongly agreeing that they would choose to self-insert the speculum again. This included the women who had not previously had a speculum examination. The quality of specimen collected was not detrimentally affected by speculum self-insertion. Clinicians required training and support to integrate this change into their clinical practice.

Conclusions: The results of this pilot research, while needing to be replicated in a larger study, demonstrate that offering women the opportunity to self-insert a speculum during a routine pelvic examination is an acceptable, innovative, simple and cost-neutral change in clinical practice that increases women’s satisfaction and potentially makes sexual health screening less threatening to women of all ages. This may encourage their attendance at clinics for regular screening, and in so doing increase the numbers of women diagnosed with cervical cancer, STIs and Pelvic Inflammatory Disease (PID). Early diagnosis and treatment will result in better health outcomes for women, families and the community at large.

Discussion
Initially some women expressed anxiety when they read about speculum self-insertion. For the most part this was due to self-insertion being ‘something different’. The analysis suggests that the information they received from the clinician was important in medicating their anxiety. Women described feeling reassured by the clinician and validated in their ability to self-insert the speculum. This supports the notion that the attitudes and behaviours that are reflected in a clinician’s interpersonal communication style play a role in client decision making and perception of quality care.

Acceptability and satisfaction
The results demonstrate that speculum self-insertion was acceptable to most women agreeing to participate in phase II of the study, especially younger women. It was also acceptable to women who were coming to the clinic for their first Pap smear examination. Older women, however, many of who had been using the services of FPWA for some time, found self-insertion to be less acceptable. These women described being comfortable with their previous experiences.

Women who participated in self-insertion reported high levels of satisfaction using the newly developed SSISQ. They reported greater control, increased levels of comfort and found it much easier than having the clinician insert the speculum. A considerable percentage of women stated that they would request to self-insert their own speculum at their next appointment. The positive SSISQ results were confirmed by the qualitative analysis. It would appear from the findings of this study that the simple cost-effective intervention of speculum self-insertion was not only acceptable to the majority of women, but increased their satisfaction with the experience.

It is likely that the increase in physical comfort women experienced with speculum self-insertion could, in part, be attributed to the reduced need for clinicians to manipulate the blades of the speculum to bring the cervix into view. Nearly 55% of women inserted the speculum so that the clinician could, in the first instance, clearly view the cervix. A further 39% required only a minor adjustment. Clinical experience and anecdotal evidence would suggest that this is less than the average number of manipulations needed in a routine insertion of a speculum by a clinician. Future work, however, needs to ensure that this data is collected on both groups of women so that comparisons can be made and results generalised across a larger population. Of critical importance, however, for both women and the clinicians was the fact that the quality of specimen obtained from the self-inserted group was not detrimentally affected.

Conclusion
The results of this pilot study demonstrate that speculum self-insertion is a simple cost-neutral clinical intervention that has the potential to make sexual health screening less threatening to women of all ages. Although further research is needed to confirm these results women reported self-insertion as a positive experience that was more comfortable and easier for them, and something they would want to do in the future. It is a practice that health care professionals can add to their clinical repertoire, while being cognisant of the fact it will not be suitable to all women. Specimen quality and clinic times were not detrimentally affected by offering women the opportunity to self-insert their own speculum.

Future studies will need, however, to incorporate measurement of women’s anxiety levels before and after the pelvic examination for those women who self-insert and those where the clinician inserts the speculum. There is a need to accurately compare whether self-insertion does allow for quicker visualisation of the cervix with less speculum manipulations compared to current clinician-inserted practice. Longitudinal work will also need to be undertaken to identify and measure the effect on attendance patterns.

The way in which speculum self-insertion was discussed and offered by the clinician to the woman was noted to influence her willingness to try ‘something new’. Future work needs to explore clinician’s perceptions of this intervention and identify possible reasons why it may not be considered appropriate. Clinicians require support and encouragement to change their clinical practice, with some clinicians finding clinical change easier than others.

The knowledge gained from this small study has the potential to make a significant contribution to clinical practice both nationally and internationally. Increasing women’s satisfaction with pelvic examination, particularly teenage clients, is one strategy that could increase the rate of health screening and decrease the potential for long-term sequelae.

If you are interested in obtaining a copy of the full study please contact FPWA on (08) 9227 6177

Women encouraged to have STI test with Pap smear

LipsWith levels of infections at an all time high, women are being encouraged to get tested for sexually transmissible infections (STIs) every time they have a Pap smear.

An STI test can be taken at the same time as a Pap smear, so if a woman is going to see a doctor for a Pap smear anyway, she should also ask for an STI test, just to be on the safe side. As STIs are becoming more and more common in the community, people need to take responsibility for their sexual health and get tested regularly, especially if they have changed partners or had unsafe sex.

Regular Pap smears are also important as they help detect early warning signs of cervical cancer, and it is recommended that women have one every two years after first having sex.

Despite what many women believe, a Pap smear doesn’t automatically test for STIs, and women need to ask their doctor if they want to be tested. Women often delay having an STI test as they are embarrassed - doctors do these kind of tests every day, so there is no need to feel this way.

If you’ve had unprotected sex or notice any unusual symptoms however, don’t wait for your next Pap smear to find out if you’ve got something – get tested straight away. If left untreated, STIs like chlamydia can have serious consequences, such as infertility.

The problem with STIs like chlamydia and gonorrhoea is that many people with the infection don’t show any symptoms, so they accidentally pass it on to their partners through unprotected sex.

Learning to negotiate safe sex is important when it comes to looking after your sexual health. Don’t have sex with a partner who refuses to wear a condom – having unprotected sex even once still puts you at risk of contracting an STI.

New pages on the FPWA website

The FPWA website has recently had several new new pages added to it. Click on the link to view Guide to STIs for men who have sex with men or click here to view new information on men’s sexual health issues.

New FPWA brochure for young people

Click on the link to view FPWA's new brochure for young people, The Ins and Out of Relationships, or click here to access the PDF version with graphics.

Copies can be ordered by phoning 9227 6177.

Book reviews

by Andrew Kelly, Library Technician

The Penis Dialogues: Handle With Care
by Gabriel Constans

What they say: “This book lays bare the facts, myths, experiences and stories of that part of men’s bodies by which they are so often defined. It goes beyond the cliches, jokes and comparisons of male virility and power as men speak from the heart with honesty, curiosity, shock, bemusement and surprise.”

What I say: Eve Ensler watch out! This is a funny yet interesting insight into the world of the penis. This book is mainly collections of short stories from men and their experiences with their penises. It is interesting for both men and women to see how the penis affects men’s lives and outlook on life. Look out for sections such as “women’s eye view”, “if your penis could talk”, “penis facts” and “sing along with dick”. A great read.

Rosy and Jack
by Nicole Reading

What they say: “Sometimes people do bad things. And sometimes people try to hide these bad things by creating secrets. Some secrets are bad. This is a picture book for anyone who needs courage to make a stand against bad things. This is a story about sexual abuse and what can be done to stop it. ”

What I say: This book is about Rosy and Jack, who are being sexually abused in their home, and the story of how they stop it. Written as a picture book, it gives children the confidence and knowledge to help bring sexual abuse to an end. Good for children to read alone or have read to them, it helps children and parents/guardians deal with emotions and explain what is happening. A very sad story, but well worth the read.

For more information on books available for loan at the FPWA library, please phone 9227 6177.

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Page last updated Mon, 12 Jun 2006 14:30