Healthy Sexy & Wise May 2003
Volume 1, Issue 2, 2003
Editors Note
Welcome to the second edition of Healthy Sexy & Wise, FPWA’s new quarterly e-newsletter. We had a great response to our first edition – I’m glad to hear so many of you enjoyed it.
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. Look out for the next Healthy Sexy & Wise in late July. The next issue will include a Q & A section, so if you have specific questions you would like answered by a health professional, please let me know.
Regards
Rebecca Smith
Editor
FPWA events
Sexpo
In conjunction with the WA AIDS Council, FPWA held a stall at this year’s Sexpo event in April.
Over the four-day expo, FPWA distributed free condoms and safe sex information to over 600 people, encouraging all sexually active people to practise safe sex. While most Sexpo exhibitors had a lighted-hearted approach to the event, FPWA's message was more serious, wanting people to think about the consequences of having unprotected sex and reminding them that safe sex doesn’t have to be less pleasurable – it’s all about being creative when it comes to introducing condoms, dams and lubricant into the bedroom.
Rockingham Adolescent Project (RAP)
Last year from March to November, FPWA’s Quarry Health Centre collaborated with Rockingham Women’s Health Centre to bring a youth safe sex program to Indigenous and culturally and linguistically diverse (CALD) youth in Rockingham. Alice Iaveta from Quarry and Valmae Walley from the health centre presented fun and interactive safe sex programs to Kwinana, Rockingham and Safety Bay senior high schools, and to Kwinana and Rockingham TAFE.
Participants in each of the groups were from different cultural backgrounds. Youth service providers in the area attended free training workshops, and RAP held activities at youth festivals and community events in the Rockingham and Mandurah areas. A RAP wallet card was developed, which provided information about sexual health services in the area for young people. The South Metropolitan Public Health Unit has funded RAP this year, with Derbarl Yerrigan on board alongside Quarry to implement the project from May until December. Sessions are filling up fast, and it seems that RAP is in high demand, not only to assist young people in Rockingham, but also to help service providers update their skills.
For more information on RAP, please contact Deborah Wright, Manager at Quarry Health Centre for under 25s, on (08) 9430 4544.
Are lesbians at risk of HIV?
by Nursing Consultant, Rosie Brown
The short answer is "Yes". In February this year, the first case of female-to-female transmission of HIV was reported in the USA.
The case concerned a young woman who had been sexually active for two years with her only partner. This woman had no history of any kind of drug use, no tattoos or piercings, had never had heterosexual intercourse, and had not received a blood transfusion or organ transplant. She had no known exposure to blood or body fluids, other than in her relationship with her girlfriend.
The young woman’s partner is openly bisexual and is known to be HIV positive. She is very careful to use safe sex practices with her male partners, and never shares razors or toothbrushes with anyone.
The young woman and her partner hadn’t had sex when either of them were menstruating, but had used sex toys vigorously enough to, at times, draw blood.
The HIV testing of both women confirms the genetic pattern of the virus matches, supporting the explanation that in this case, the transmission of the virus occurred through the sharing of infected sex toys.
It is difficult to comment about the level of risk of HIV infection between women who have sex with women, as the data is scarce and inconsistent. It is also difficult to determine whether transmission may have occurred through more traditional means, such as heterosexual intercourse or as the result of drug use. This is further complicated by the fact that many women whose sexual partners are exclusively women have other risk factors for HIV transmission.
This case illustrates that there is a risk of HIV transmission for lesbian women and all women should be counselled to use safe sex practices with their female partners, especially those who are known to be HIV positive.
Chlamydia – information for men
by Clinical Services Manager, Steve Blackwell
Chlamydia is Australia’s most common sexually transmissible infection (STI), and the rates of infection are particularly high in young people. Sexually active young men (and women) can catch chlamydia from unprotected vaginal and/or anal sex.
Oral sex is not seen as a major risk behaviour - it seems that the chlamydia bug does not find the mouth or throat a very hospitable place to colonise (unlike the mucus membranes of the genital and rectal tracts). That is not to say that people cannot catch chlamydia from fellatio (especially for the person sucking the penis), but it is not common and certainly not as risky as unprotected anal or vaginal intercourse. However, because other STIs can be caught via oral sex, people are encouraged to always use appropriate safe sex practices for all sexual activities.
35% of young men are not aware they have come in contact with chlamydia because they do not have any symptoms. Of those that do develop symptoms, these may not appear for two or more weeks after the unsafe sexual activity - so people may not always associate one with the other. Symptoms that men may experience include:
Discharge from the penis (can be clear, white or grey)
- Swollen or tender testicles
- Itching, bleeding and possibly diarrhoea if infection of the rectum has occurred
- Redness, itching and discharge of the eyes if the bacteria has infected the eyes.
Treatment for chlamydia is generally quick and simple as it can usually be cleared up with antibiotics. There are a couple of different ways of taking the antibiotics. The most common method is a singe dose of an antibiotic called azithromycin, which is taken orally. Partners also need to be treated otherwise there is a risk that re-infection can occur. All sexual activity should be safe as treatment does not prevent a new infection of the chlamydia bacteria. It is worth remembering that STIs often travel in groups, so if you have one you may have been exposed to another. Even before the test results are in, the clinician may treat men for both chlamydia and gonorrhoea as both are bacterial infections that cause penile discharge. There may also be a need for an injection to treat the gonorrhoea.
Testing for chlamydia usually involves the doctor or health service collecting a "first void" urine specimen, ie the patient must not have passed urine for at least two hours before they give a specimen. This ensures that the urine will flush the urethra of bugs, which will be collected in the specimen jar to be sent to the lab.
What happens if you don’t get a chlamydia infection treated? If left untreated, chlamydia can lead to prostatitis (inflammation of the prostate glans), scarring of the urethra, infertility (inability to father children) and epididymitis (inflammation of the tube connected to the testes). In some men, untreated chlamydia can lead to a disease called Reiter’s Syndrome, which includes symptoms of arthritis, eye infections and urinary problems. One of the major problems with not knowing if you have chlamydia and/or not getting treatment is that you will pass the infection onto your sexual partners. If your partner is a female, there are serious complications from untreated chlamydia. Like men, many women will not know they have an STI and therefore will not think to seek treatment. Women with untreated chlamydia can develop Pelvic Inflammatory Disease (PID), which is a serious infection of the women’s reproductive organs and can cause infertility.
Prevention is the best way to avoid the complications of chlamydia. Of course, the ideal method of prevention is not to have sexual contact with another person – remembering that this also means no mutual masturbation as the bacteria can get on your fingers and you might then rub your eyes or introduce it into your partner. If this is not possible, reducing the number of sexual partners is a good idea. A monogamous relationship will significantly reduce your risks of contracting an STI.
If these methods are not an option then always practise safe sex. Use male and female condoms to help protect against STIs, including chlamydia. Sexually active individuals are also encouraged to have regular STI checks if they have put themselves at risk of an STI. Remember, some STIs have no symptoms, so until you’re tested, there’s no way of knowing what you do or don’t have.
Contraception news
Emergency contraception
There was a large amount of media attention last month around FPWA supporting the view that emergency contraception (EC) be made available over the counter without a prescription, in an effort to help lower the incidence of unplanned pregnancies. At present in Australia, EC is only available by prescription through doctors, family planning clinics and most hospital emergency departments.
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EC is most effective when taken as soon as possible after unprotected intercourse – there is some effectiveness for up to five days after intercourse, but the longer a woman has to wait before taking it, the less effective it becomes at preventing pregnancy. Seeking a prescription from a doctor means wasting precious time, whereas a woman can usually find an all-night chemist nearby and go straight in.
Another problem with the 'prescription only' method is that not all doctors are willing to prescribe EC. For ethical reasons, some doctors may prefer to refer patients elsewhere, meaning that they lose even more vital time in their search for a prescription. For many young people, it is very difficult to make an appointment to begin with and a rebuff may mean that they give up completely.
In rural areas, where it can sometimes take up to three weeks to get an appointment, women are also limited by the services they can access – if their local GP won’t prescribe EC they find themselves with a problem, a problem which would never have come up if they could get it at a pharmacy.
A new brand of EC now means that doctors no longer have to use many contraceptive pills to make up the pregnancy-preventing dose required for emergency contraception, as was previously the case. Postinor-2 (left) came onto the Australian market mid-way through last year and consists of two pills. The first pill needs to be taken as soon as possible after unprotected sex, within 72 hours, and the second after 12 hours.
Making EC more readily available is important in reducing the incidence of abortion, especially among teenagers where the rate of unplanned pregnancies is high. FPWA wants to see EC available from specially trained pharmacists who would supply users with information about dosage and side effects, in a similar manner to the way many other over-the-counter medications are sold.
EC provides women with a chance to prevent a possible unplanned pregnancy in a way that is convenient and non-intrusive. Some women don’t feel comfortable with their regular doctor knowing they want EC, while others don’t even have a regular GP to start with – for them it means locating a GP before they can even begin the process. EC is currently available over the counter at pharmacies in many Eurpoean countries, as well as in Canada and parts of the US and New Zealand. It is hoped that this will soon be the case in Australia also.
New contraception option listed on PBS
As of February this year, doctors are now able to prescribe the contraceptive intrauterine system (IUS) Mirena on the Pharmaceutical Benefits Scheme (PBS).
The IUS consists of a plastic device that is placed inside the uterus, releasing a progestogen hormone called levonorgestrel. The system works in a number of ways; by making the lining of the uterus very thin so that it is unsuitable for pregnancy, by affecting movement of sperm once inside the uterus and by thickening the mucus around the cervix, preventing sperm from entering the uterus.
The IUS is designed to protect against pregnancy for five years and is a very effective method of contraception (at least 99.7% effective). It may be particularly suitable for menopausal women taking oestrogen who cannot tolerate other forms of progesterone. Mirena can also be used as an alternative to surgical or oral hormonal treatments for women who experience heavy menstrual bleeding.
Mirena has a PBS listing for contraceptive use only - this means that sterilised or infertile women wanting to use Mirena to reduce bleeding still have to pay full price. FPWA hopes that the next step will be listing for heavy bleeding, as such a listing will help reduce the number of hysterectomies in Australia. Despite the restricted listing, the subsidisation is still good news in terms of contraception options for women.
The IUS is referred to as a ‘system’ to distinguish it from a similar contraception method, the intrauterine device (IUD), which does not release hormone. IUDs are small plastic and copper devices. They work mainly by preventing sperm from fertilising the egg. In the rare instance an egg is fertilised, the IUD prevents the egg from attaching to the lining of the uterus so a pregnancy does not occur. They are more than 99.9% effective for between five to eight years.
IUSs and IUDs need to be inserted and removed by a trained doctor and can be taken out at any time. They do not provide protection against sexually transmissible infections (STIs).
Contraception choices for women at all time high
Western Australian women have more choices than ever before when it comes to choosing contraception. The last few years have seen several new varieties of contraception come onto the market, including an implant which offers protection for three years and a very low-dose oral contraceptive pill.
The wide range of contraception on offer means that women wanting to prevent pregnancy can choose a method that suits their individual needs - the needs of a single woman in her early 20s are usually quite different to those of a mother in her mid-30s, with plans for more children.
Women can choose to take one of the many brands of oral contraceptive pills available - the newest one, Yasmin, claims to lead to a reduction in fluid retention. Other women prefer to have a hormone injection every twelve weeks, or use a diaphragm or cap. Femidoms (female condoms) are also an option – like diaphragms and caps, they fit inside the woman and act as a barrier.
It is important for women to discuss the growing number of new options available with a doctor when deciding on contraception. FPWA has found that most women want contraception that is as stress-free and hassle-free as possible - contraception that provides long-term protection seems to be the way of the future.
Both the IUD (right) and the IUS are effective for at least five years, meaning that, along with the contraceptive implant, the days of worrying about a missed pill are over. The contraceptive implant, Implanon, has been a very popular choice with Perth women - when it was released two years ago, it sold out within a couple of weeks and women were forced to go on waiting lists.
For women wanting a more permanent contraception solution, Essure is a new birth control method now available in Australia. Essure blocks the fallopian tubes to permanently prevent pregnancy but, unlike other similar methods of sterilisation, it doesn’t require surgery that cuts the skin.
A woman’s lifestyle needs to be taken into account when deciding which contraception to use. Protection against STIs is an important consideration and many methods of contraception available for women protect against pregnancy only. Male and female condoms are the exception - when used correctly, they also help reduce the risk of transmitting HIV and other STIs.
Australia will see even more options in contraception become available over the next few years, including a contraceptive patch and a hormonal vaginal ring. Weekly dose pills, a contraceptive gel and male hormonal contraceptives are possible developments for the future.
FPWA information sheets - menopause
FPWA produces a selection of information sheets on methods of contraception and other sexual health issues. Click here to read FPWA's new menopause information sheet. Other sexual health information sheets can be accessed by visiting here
Book reviews
It happened to me: a teen's guide to overcoming sexual abuse / Carter, Wm Lee. -- Oakland, Calif. New Harbinger, 2002.
The author of this workbook is a psychologist who has many years experience working with sexually abused teenagers. The workbook attempts to address a wide range of issues that young people will face as they rebuild their lives. There are explanatory passages, personal stories, useful tips and reflective exercises. The activities are designed to inform about trauma recovery, connect individuals to their thoughts and emotions, explore belief systems, allow self expression, and empower and encourage young people to develop healthy relationships.
Men inside out: a look at their hidden mental, emotional and physical lives / Cuthbertson, Ian; Callaghan, Greg. -- [Australia] Choice, 2003.
Men Inside Out contains useful information about significant men’s health issues. Divided into four main sections, it looks at men’s sexual, mental, physical and general health. Topics covered include: circumcision, sexually transmissible infections (STIs), sexual performance and orientation; mental illness including schizophrenia and depression – and where to get help; problems with the prostrate, heart, drugs and alcohol; divorce and separation; fitness for different age groups; and diet, exercise and injuries.
Men Inside Out is available in the FPWA Bookshop for $22
Website news
CIRE ~ New Evidence for Contraceptive Use
www.infoforhealth.org/cire_pub.pl
The CIRE website is a collaborative effort of the World Health Organization (WHO), the US Centers for Disease Control and Prevention, and the Johns Hopkins Bloomberg School of Public Health's Center for Communication Programs.
The CIRE system (Continuous Identification of Research Evidence) enables professionals working in reproductive health to learn of findings as they are collected from the world's scientific literature. The system facilitates the updating of WHO's evidence-based family planning guidance.
Andrology Australia
Andrology Australia, the Australian Centre of Excellence in Male Reproductive Health, is funded by the Commonwealth Department of Health and Aged Care and administered by Monash University, Melbourne.
Their web site provides information on male reproductive health issues for consumers and health professionals. The site also has pages on the male reproductive system and basic anatomy.
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Page last updated Mon, 12 Jun 2006 14:35