Healthy Sexy & Wise - October 2003
Volume 1, Issue 4, 2003
Editors Note
Welcome to the October edition of Healthy Sexy & Wise.
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. This is the last edition for this year, but keep an eye out for the first edition for 2004 in January.
Rebecca Smith
Editor
Filling the gap in men’s sexual health services: FPWA and the WA AIDS Council join forces
FPWA and the WA AIDS Council have joined forces to offer more services to gay men and other men who have sex with men (MSMs) in Perth.
In response to the increasing incidence of sexually transmissible infections (STIs) both here and in other capital cities in Australia, FPWA and the WA AIDS Council have been working together to expand the sexual health services available to this group.
As a result, the Northbridge Clinic now provides clinical services for gay men and MSMs. Doctors and nurses at the Clinic offer confidential consultations on sexual health issues such as HIV screening (including pre and post discussions), STI testing and treatment, and sexual difficulties.
With gay-friendly staff and a wide range of appointment times, the Northbridge Clinic is also a low-cost service. The annual administration fee of $25 ($12 concession) covers unlimited clinic visits and use of the library. Pathology is free with a current Medicare card, and condoms and lube are available over the counter at budget prices.
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FPWA has provided sexual health services, information and training in Western Australia for over 30 years. By
teaming up with the WA AIDS Council, both organisations have been able to use their joint resources, sexual health
expertise, and knowledge of the gay men’s community to develop first rate, non-judgemental and sexuality sensitive services.
Expanding services to gay men and MSMs in Perth is vital, as there has been huge increases of STIs and HIV among gay men all over Australia. HIV diagnoses in 2002 increased by 13% in NSW, 20% in Queensland and 7% in Victoria.
In WA, there have been significant increases of other STIs, including oral infections. Perth had a slight decrease in HIV diagnoses last year, however, it also has the lowest reported testing in Australia and there is suspicion that some infections are not being diagnosed.
The Northbridge Clinic is an alternative to the WA AIDS Council’s Sauna Clinics - the Clinic provides Medicare bulk billing services and the Sauna Clinics offer services for guys who prefer not to use their Medicare card or who want to remain anonymous.
As part of a national campaign, FPWA and WA AIDS Council staff have been working together on a collaborative STI awareness campaign which includes a new STI information booklet, condom packs in venues and cruise cards promoting awareness of STIs and safer sex.
This partnership provides the opportunity to offer services to men who may feel uncomfortable seeing their family GP and are looking for a gay-friendly service. FPWA has dealt with sexual health and sexuality issues for many years and understands that providing a non-judgemental and accepting environment is important for everyone when they are in need of sexual health services.
FPWA
70 Roe Street, Northbridge
Phone: 9227 6177
Northbridge Clinic times opening hours:
Monday 9am – 6pm
Tuesday 8am - 5.30pm
Wednesday 9am - 6pm
Thursday 8am - 7.30pm
Friday 8am - 12.30pm
Saturday 9am - 12.15pm
WA AIDS Council
664 Murray Street, West Perth
Phone: 9482 0000
www.waaids.com
New contraceptive device on trial in WA
Remembering to take the contraceptive pill may soon be a thing of the past for some women, with a new contraceptive device currently on trial in WA.
Nuvaring is a soft plastic ring containing the same hormones as the combined contraceptive pill and is worn inside the vagina for 3 out of 4 weeks to give reliable contraception. It is currently available in the USA and other parts of the world.
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| Picture courtesy of Contraception Online |
FPWA Medical Consultant Dr Angela Cooney is coordinating the six-month trial. There are currently 13 women taking part and so far everything is running smoothly, with participants reporting positive experiences.
Using Nuvaring is similar to being on the pill in that for three weeks women get hormones and for one week their body is resting. Women will have a small period as they would get on the sugar pills in the pack, then the ring goes back in.
The upside is that instead of having to remember to take a pill every day, women only need to remember to insert the ring twice a month. The level of hormones in Nuvaring is equivalent to the lowest-dose pills available, and because the hormones don’t have to go through the stomach, side effects such as nausea are much less common.
Sexual activity should not be affected by the use of the ring. The ring lies against the vaginal wall and its position is not important to its effect. Though it is not necessary, the ring can be taken out during sex if desired, but if removed it should be reinserted within 3 hours to maintain contraceptive effect.
The safety and reliability of the vaginal ring has already been demonstrated in other trials overseas. FPWA is hoping to assess the acceptability of this method by WA women, and look at their experience with its use and any problems that they may encounter.
For more information about Nuvaring, see a doctor or FPWA clinician.
Lesbians at risk of sexually transmissible infections
Many lesbians are unknowingly putting themselves at risk of contracting a sexually transmissible infection (STI) as they are unaware that infections can be passed on through female to female sex.
As many lesbians and their partners have had sex with men in the past, they may also have been exposed to the Human Papilloma Virus (HPV) at some stage, which is one of the main causes of cervical cancer.
Regular Pap smears help detect early warning signs of cancer, but as many lesbians think they don’t need to access sexual health services, they are less likely to have cancers detected at an earlier, more treatable stage. Figures show that each year around 1,000 Australian women develop cervical cancer and over 300 die – many of these cases could be prevented through early detection.
HPV and other STIs can also be passed on through female to female sex, so lesbians should use female condoms to protect themselves and their partner. Dental dams are another option for safe sex practices in situations where there can be an exchange of body fluids, such as during oral sex.
Earlier this year the first case of female-to-female sexually transmitted HIV was documented, with the main risk thought to be overly vigorous use of sex toys leading to blood exchange. If people do share toys they should cover them with a condom, and put a new condom on before a new person uses their toy. There is also a risk of transmitting hepatitis C when sharing sex toys that might cause tiny nicks or cuts, especially during menstruation, so always practise safe sex and use a condom.
It is particularly important for lesbians planning a pregnancy to maintain their sexual health. Some blood borne viruses like HIV and hepatitis can be transmitted to the baby during birth. Careful management during pregnancy and delivery can help protect the baby from infection.
Other infections like chlamydia, which is quite common but easily treatable, can make it harder to fall pregnant, and can cause chest and eye infections in newborn babies. It is a good idea to get tested before pregnancy - as some STIs have no symptoms, it is possible to have one and not even know it.
Smoking also increases the risk of cervical cancer, miscarriage and premature birth, so all women should seriously consider quitting before they get pregnant.
With STIs such as chlamydia and herpes on the rise, it is important that people take responsibility for their sexual health and always practise safe sex to reduce the risk of contracting or passing on HIV and other STIs.
Helpline service available in rural WA
People living in rural and remote areas of WA can access sexual health information over the telephone, thanks to FPWA’s Sexual Health Helpline.
The Sexual Health Helpline, which is funded by the Department of Health’s Sexual Health Program, provides information, advice and referrals to individuals seeking confidential information about their sexual health. Callers can request information from qualified staff on a range of issues, including sexually transmissible infections, contraception and abortion.
The service is not only utilised by members of the general public, but also by health professionals with information queries about sexual and reproductive health issues.
Consultations are often given over the phone to rural and remote clinicians requesting up-to-date information to assist them in helping clients. The helpline is also a quick and convenient way to access sexual health information, particularly for people who find it difficult to access health services due to their location and who often have to wait several weeks to get an appointment with a doctor.
The helpline is available from 7am-7pm during the week and is open on Saturdays, so callers are able to access the service outside normal working hours. Calls to the helpline are free, and sexual health queries can also be answered via email - alternatively people can visit the FAQ section of FPWA’s website. More information about the Sexual Health Helpline
Sexuality in later life
by Dr Angela Cooney, Medical Consultant
Despite what many people may think, getting older doesn’t have to mean the end of a satisfying sex life. Most older people want and are able to enjoy an active, satisfying sex life. Normal aging brings about physical changes in both men and women, but with a few small adjustments, there is no reason that sex can’t still be a satisfying and loving part of life.
Most older women will notice changes to their vagina, including having less lubrication. Vaginal dryness can often affect sexual pleasure, and over the counter lubricants may be helpful. Pain during sex is often encountered by older women, and can be easily managed by simple hormonal creams or pessaries which are not associated with the risks of other forms of hormone treatment.
Impotence in men becomes more common as they get older, and some men may find they need more foreplay to get and maintain an erection. Over time everyone may notice a slowing of response, so couples may find it helpful to give their partner pleasure in ways other than the quick methods that did the job before.
Most men will have erection problems at some time in their lives, and one bad day doesn’t mean it will happen again. But ongoing problems with erections do not have to spell the end of good sex. Before the arrival of Viagra and other related medicines, many couples still managed to have a lot of fun with a "softie" penis. Your doctor will be able to advise which erection treatments are appropriate for you.
While health problems often come with age and can have the ability to affect sexual pleasure, even the most serious of health conditions don’t usually stop people from having a satisfying sex life. After a heart attack or stroke, a person may be required to abstain from sex and all activities which cause exertion for some time. Many people who have had an attack are afraid that having sex will cause another one, but the risk of this is very low. Always ask your doctor when it is safe to return to sexual activity. In general, sex with the usual partner is not seen as a risky activity.
Loss of bladder control or leaking urine is more common as we get older, especially in women. While incontinence can cause some people to avoid sex, the problem can usually be treated, so see your doctor.
People suffering from arthritis can find sex uncomfortable if they are still trying to use the athletic positions they enjoyed years ago. Exercise and warm baths beforehand, cushions and pillows for supported positions, and adopting more relaxed positions for sex can be helpful. Appropriate pain relief before sex is also important – if you take a couple of Nurofen before walking to the shops, why not have a couple before a romantic evening?
Surgery involving sexual organs is more common in older people and while many worry that their sexual desire will diminish as a result, this does not have to be the case. Having a hysterectomy may interfere with a woman’s sexual functioning, and some women feel less feminine after the operation, especially if the ovaries were removed at the same time. It is important to discuss with a doctor if hormone treatment or counselling may be helpful. Similarly, after a mastectomy a woman’s body is still capable of the same sexual responses as before, but some women lose their sexual desire or feelings of being desirable. Again, many women find counselling or joining a help group to be beneficial.
There are several things people can do to help make sure their sex life remains as active as they would like it to be. My advice to older people who wish to maintain their sexual activity is to be flexible, understand that the goalposts have changed, and be prepared to spend more time for both partners to become aroused. Regular sexual activity helps maintain sexual ability, and remember that sex doesn’t have to include intercourse. A great relationship is the best foreplay of all.
Timing is also important for satisfying sex. Try to find times during the day when both partners are well rested and alert. Some couples find that early morning is the best time to make love, after a good night’s sleep, or in the afternoon after lunch.
Don’t forget to always practise safe sex with a new partner – age doesn’t protect people from sexually transmissible infections and a woman can still (rarely) get pregnant for up to 12 months after what seems to be the end of menopause.
See your doctor or a counsellor if you continue to experience sexual problems. Some women enjoy sex more as they get older, as after menopause or a hysterectomy they no longer need to worry about becoming pregnant, while others feel anxious about not being attractive to their partner anymore. Some men worry that they will let their partner down by not being able to get an erection. It is important that both partners reassure one another about their sexual ability and attractiveness.
In the next edition of Healthy, Sexy & Wise, Counselling Consultant Jane Irvine will look at relationship challenges in later life.
Self-insertion of speculum: a preliminary study by Deborah Wright and Pamela Stephenson at FPWA
The number of women under 25 years of age who had cervical screening in Western Australia between January 2001 and December 2002 totals 48,423, with only 53% of the target population for this age group being screened for the period 2000-2001 (WA Cervical Cancer Prevention Program). Conway (1996), in a study on attitudes to Pap smears, found "that negative expectations and attitudes in regard to gynaecological examinations and Pap smears can result in women being reluctant to seek treatment". This research also found that lack of accurate information on why screening is recommended influenced women to attend clinics, and a recommendation was that "women should be encouraged to feel partners in health management".
The small preliminary study recruited 39 women. Some of the findings are as follows:
Of the 36 women who responded they were happy to self-insert the speculum:
- 20 (57%) reported it was less embarrassing this way
- 21 (53%) reported they felt more in control
- 22 (63%) reported it was more comfortable this way
- 12 (30%) reported it was less stressful for them
- 21 (53%) reported it was quicker for them
- 1 (3%) reported they self-inserted because they had experienced prior discomfort with the procedure.
Of the women who responded they were not happy to self-insert the speculum (3 in total):
- 1 (33%) felt less embarrassment if the nurse inserted the speculum
- 3 (100%) did not know how to do it
- 2 (66%) were in a rush and thought it would be quicker if the nurse did it
- 3 (100%) reported it was less stressful for them if the nurse did it.
Assumptions made from findings
- Women who are not familiar with inserting a tampon into their vagina are less likely to feel comfortable with inserting a speculum.
- Clinicians need to learn communication skills so they are able to develop a comfortable easy way of talking to the woman about self-insertion.
- The quality of cell samples collected is not detrimentally affected by self-insertion.
- It is usually easier to locate the cervix when the client self-inserts and is often quicker for the clinician to visualise the cervix.
Findings of this small pilot study have been the incentive to explore self-insertion of speculum further. A collaborative clinical research study, with ethics committee approval involving FPWA and Edith Cowan University commenced this year, and it is anticipated that 250 women will be recruited into the study. It is hoped that this research will provide an opportunity to inform sexual health clinicians of findings that may positively influence their clinical practice.
If you are due for a Pap smear and would like to participate in the self-insertion study, please mention this when you book your appointment at either Northbridge or Quarry Health Centre, so you can be placed with a clinician that is participating in the research.
References
Bewley, Susan. (2000). A doctor who changed my practice: Putting women in Control. British Medical Journal. 321:1454.
Campbell-Rate, A. (2003) Kids and condoms [on-line]. Available www.opendoors.com.au/KidsCondoms/KidsCondoms.htm
Cervical Cancer Screening Prevention Program.(2003). Cervical Cancer Report. Available facsimile: R.Thompson 9237 6991.
Communicable Diseases – Australia. (2003). National Notifiable Diseases Surveillance System. Canberra: Surveillance and Epidemiology Section
Commonwealth Department of Health and Ageing. Conway, K. (1996) Attitudes to Papanicolaou smears. Journal Psychosomatic Gynaecology. Dec;17(4):189-94.
New FPWA Information Sheets
FPWA produces a selection of information sheets on methods of contraception and other sexual health issues. Click on the links to read FPWA's new information sheets on Polycystic Ovary Syndrome, Safe Sex in Toyland and Hormone Therapy.
FPWA's information sheets on 'Planning a Pregnancy' and 'Intrauterine Devices and Systems' have recently been revised - these and other information sheets can be accessed here.
Alternatively, phone FPWA on 9227 6177 to order a sample pack.
Book reviews
Sexual health in obstetrics and gynecology / Wilson, Janet; & Everett, Marian. -- London, UK: Remedica, 2003.
Sexual health in obstetrics and gynecology gives a comprehensive, evidence-based overview of sexual health care delivery. There are chapters on epidemiology of sexual health; sexual history, genital examination and specimen taking in female; vulval and urethral problems; vaginal discharge; upper genital tract complications, complications of infections in pregnancy and infants; non-hormonal, hormonal and emergency contraception; sex, teenagers and health professionals; and unplanned pregnancy. The information is presented in a concise, readable way and is well referenced and illustrated.
Great sex with a bad back / Ross, Joseph. -- Elwood, VIC: SixtyMinuteBooks, 2003.
This little book gives some useful information about different types of back pain and discusses the additional stresses that are placed on the back during various sexual positions. There are pain relief tips, and a clearly explained guide to different positions that may be adopted to make sex more comfortable and enjoyable. The position guide is illustrated by line drawings and has variances depending on whether it is a man or a woman who has the bad back.
Website news
SSAFE in Schools
http://www.ssafeschools.org.au/
SSAFE in Schools, a project of Family Planning Victoria and the Australian Research Centre in Sex, Health and Society at LaTrobe University, aims to support school communities in challenging homophobia and creating safe learning environments for same-sex attracted and gender non-conforming students. The site has resources, strategies and activities to support curriculum development, teacher training, provision of information to parents and the broader community and support for individual students.
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70 Roe Street
PO Box 141
Northbridge WA 6865
Phone: 9227 6177
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Page last updated Mon, 12 Jun 2006 14:34