I’m a sexual health nurse, AMA!

[WhackingPhoenix]

As it says in the title

Yes I've always wondered that as well.

How are you trained to work with survivors of child abuse and sexual abuse who do not like intimate examinations?

Long, sorry!

A few years ago (with good reason) I was in the full throes of a real phobia of HIV. I was also seeing someone with a dubious past-and I was also a stripper.

I must hvae been at the GUM clinic every couple of weeks at times, or at least once a month. Every time I had a dodgy looking customer. Every time I had suspicions about my ex. Allll the time.

Do you think the nurses would have thought I was a prostituted woman?
I am not bothered particularly if they did. But I have just always wondered.

Second question if I may-why do you think nobody talk about the fact that you can catch hepitatis (arguably more life-debilitating than HIV in developed countries) through sexual activities? I understand it's rare, but it isn't impossible?

Sorry, I must add, I am not an unintelligent person and I 'knew' that dancing for someone who may or may not have been playing with themselves in the loo is not a possible way to catch HIV. But phobias don't work that way as we know. :)

Please clear this one up - there was a thread last week.

If someone in a relationship of 10+ years tests positive for HPV, does it mean their partner cheated on them?

@WhackingPhoenix I’m not the person who originally asked but services are definitely inaccessible in my area! You have to ring up at 8 to try and be added to a list for a nurse to call you to triage you and arrange the appointment (this is for my implant being replaced so necessary but not urgent- could have easily been booked a few weeks in advance). Half the time by the time you get through the list is full, and the other half the nurse is off and for some reason the reception staff can’t just give people appointments for basic things. After about 3 weeks of this I gave up

A post birth question- how soon is it okay to have an implant inserted after giving birth? Do I need to wait for a period of time or can I get it done as soon as possible?

Why do HCP make it so difficult for queer women to access contraception? LARC such as implants and coils have a wide range of things to treat, not just prevention of pregnancy, most people trained to fit them work in GUM settings but whenever I need one replacing I get brushed off and told to use a condom for 6 months until someone will see me even when I explain its not for contraception, but for other medical reasons and my GP has referred me to them.

I am genuinely tired of having to lie about having heterosexual intercourse for treatment.

@SandraDeee TV is actually one of the only STIs that can be caught in hot tubs etc.!

@Gingerkittykat several confirmed cases, all have recovered well

@dustandroses we’ve seen a few, sadly.

@BOOTS52PollyPrissyPants we've noticed HIV rates falling (in the male homosexual population, at least) due to the advent of PrEP medication. There are HIV testing campaigns running all the time but they are a lot more inclusive now. We’re trying to move far, far away from the stigma of the 80s.

@rwalker we ask those questions to identify routes of infection so we can decide which sites to swab and which tests to run, which partners you would need to inform and if we need to perform any non-standard testing associated with some sexual practices or lifestyle factors. ‘Standard’ testing is HIV, syphilis, chlamydia and gonorrhoea but some people may need testing for other things such as hepatitis or M.Gen depending on their answers to the questions we ask. Also we might swab from different sites if heterosexual women report having had anal sex, for example. We also need to know dates to identify pregnancy risk and window periods for repeat testing if necessary, as it takes some infections longer to show up than others. There are genuine reasons for all the questions

@SuePerdupa usually their name, when you call them in the waiting room and they don’t turn their head because they’ve forgotten what name they gave you

@DropOfffArtiste that’s sadly the case with many GPs. We offer diaphragms within our service

Not a question, just wanted to say thank you for the important work that you do.

I react badly to hormonal contraception and so I have been using the withdrawal method since I got married at 22. I am 30 this year and I have never gotten pregnant. There are times when I think I should get the copper IUD but at the same time, I also think that I might be trying to get pregnant within the next few years and what if the NHS is in such a state at that time that I can't get anyone to remove it. Furthermore I have had no hiccups in 8 years and even if I did get accidentally pregnant, its not the end of the world as we own our flat, are happily married and do want a child eventually. Is this really weird that I haven't gotten pregnant so far?

Second page!

@something2say exploitation and safeguarding workshops, working with clinicians who have previously been trained to work with patients who have been abused or assaulted, and being very flexible/creative in your approach when you actually have the patient in front of you. The questions we have to ask are hard and can be very upsetting for some patients, and they get a lot of TLC from us as well.

@SillySexQuestion not at all, and you would never be judged if we suspected you might have been, we would ask more questions and arrange more in-depth testing to keep you safe. We see a lot of anxious clients though, many of them frequent attenders due to anxiety and we can help them manage that, too. With regard to hepatitis, we identify that as a risk every day! We screen patients who we think may be at risk depending on what they’ve said during the consultation. We also vaccinate those who are high-risk.

@Cosycover I read that thread but I deliberately didn’t comment on it because it’s impossible to say whether or not someone’s partner cheated on them and it would be unprofessional of me to plant that idea without proof. HPV can lie dormant in the body for many years.

@riotlady we also work on a triage system, but our triage line is open 8-5 and you’re added to a list for a nurse to call you throughout the day, but you will be called back some services have an online booking portal for things like implant exchange, ours does.

@OurChristmasMiracle you can have it fitted immediately after birth, if you have it within 21 days of birth you have instant contraceptive cover, if fitted after 21 days then you’ll need to use condoms for a week after fitting before it becomes effective.

@Mindmyownbusiness we are governed by a very strict set of guidelines and we are only able to offer LARC for contraceptive purposes due to the guidelines we have to work under. GPs can and should provide LARC for non-contraceptive reasons.

Copper coils are a fab form of contraception and easy to remove with immediate return to fertility, GUM services will always be available to help

I don’t know your personal medical history or circumstances so I couldn’t comment on why you haven’t fallen pregnant but if you do start actively trying and haven’t conceived within a year, I would advise you to see your GP.

@Summerhillsquare thank you

No question from me, just thank you for providing the service. I went to a community sexual health clinic 6 years ago to have my second copper coil removed (the first one dropped down of its own accord and had to be replaced by hospital gynae team). Both coils caused me so much continual discomfort but no one believed me, only the nurse at the clinic. She was so kind and reassuring, plus she was the first HCP who didn't make me feel like a weirdo hypochondriac for having pain from a device that "can't cause pain". I did have a difficult time accessing the service as I was over 24, but that's a funding issue and not the clinic's fault.

Do lesbians who never have and never will have sex with men really need to have smear tests?

When I was diagnosed I asked my clinic if there was anyone "like me" I could talk to and was told no. I'm not in a high risk area though as I learnt later there is a local charity. I went online and found my own support and after realising how many others felt/feel the same and feel intensely isolated and alone which increases self stigma I now volunteer in peer support.

Is HIV peer support something you offer at your clinic, in person, via a local charity or online?

PS to @BOOTS52PollyPrissyPants re. HIV diagnoses although they might be reducing in MSM which has been helped by PrEP, late diagnosis generally and diagnosis in women and heterosexual couples, say post divorce and dating, is certainly something that needs more awareness raising. It's just getting to those who might be impacted by this. Awareness raising can be too tied to communities that are already aware or the larger towns.

Are patients generally aware of what is included in a standard std test?

Do sexual healthcare practioners speak to patients about the risks of passing on oral herpes simplex through oral sex, given that hsv1 accounts for more than half of all new genital infections recorded by the NHS now?

Thanks for answering me. The only good answer tho is, sexual abuse victims shouldn't have to be retraumatised in their medical care. If I could never have an internal again in my entire life, that would suit me, and I'm likely to refuse treatment for anything that crops up in my old age. There is no 'creativity' around making survivors of trauma comfortable with being retraumatised.

@WhackingPhoenix Thanks for the reply. No hot tubs or swimming pools, but what about toilet seats, towels etc? Can it be transferred this way?

Thank you for your reply and that is great that there has been such progress. Watched a tv doc about Irish Vincent Hanley who brought us teenagers at the time MTUSA and so sad the stigma in Ireland at the time, shocking to see so many had to leave Ireland and went to London or New York where aids was in full force. Nearly cried at end of doc as he came back to Ireland to die and the papers were shocking in how they reported.

To HIVpos thank you and yes that is the kind of thing I was thinking of as many young people and as you said post divorce etc can be not so aware. I am glad you found a support network and hope you are keeping well as that must have been a shock to you. I am sure you are a great support to many also.

OP I think your job sounds brilliant. Can I ask what qualifications you need to do the job?

@CurbsideProphet I’m glad you had a good nurse!

@SapphosRock HPV is a virus which can be spread by having sexual contact with a carrier of the virus. We’d always encourage you to have your smear but it’s ultimately your choice, same for heterosexual women.

@HIVpos we do offer peer support to anyone who would like it, yes I’m not one of the HIV nurses but we do have some crossovers, they do a brilliant job.

@something2say sorry if my choice of words upset you. By ‘creative’ I mean self-taken swabs etc., which would avoid the need for a physical examination.

@SandraDeee there’s some evidence to suggest that it might, but it is generally sexually transmitted.

@RoseWindow I have a nursing degree, I worked as a ward nurse and then decided I wanted to specialise but there are many routes into sexual health! We have a nurse apprentice at the moment who started as a healthcare assistant and will be a registered nurse at the end of her apprenticeship.

Thank you, you are very kind.

Data is released annually - in 2019 28% of women accounted for new transmissions of HIV. I tend to raise awareness on here where I can and correct any myths if needed - did my own AMA on MN at one point and shared my story, thankful to have had great support from family and friends. www.tht.org.uk/hiv-and-sexual-health/about-hiv/hiv-statistics

You mentioned Ireland and stigma - it can be particularly bad there for some. I met a group of Irish people offering peer support following the course I did a few years ago with the charity Positively UK. They are quite spread out there and also the clinics which can create challenges especially with isolation.

only asking for the health advice from a human rather than Google, my question, Can too much anal, business cause a prolapse or is it more the size of butt plugs used that results in the prolapse ?