From every single detail of what will happen at an STI clinic to the reasons that our sexual health is so important in the first place
In all honesty, we love sex as much as we love sleep. And with good reason! Sex can have a hugely positive effect on our wellbeing. But having sex can, understandably, also impact our sexual health – or at least leave us with questions about it.
With so much (and at times, conflicting) information out there, it can be tricky to know where to turn to, so – with help from wonderful experts – we’ve done the research to answer the most googled questions on sexual health just for you. Whether you’ve been wondering something very basic or something that you feel is embarrassing, help is now at hand. There's no place for embarrassment, shame or misinformation here.
What is sexual health?
Sexual health refers to physical, emotional, mental and social wellbeing in relation to sexuality. It’s not just about being without STIs (though that is of course a massive part), but also the possibility of having great sex free from coercion, discrimination and violence. Further down the line, sexual health also means that unintended pregnancies are avoided and that intended pregnancies (and, eventually, childbirth) are safe.
Why is sexual health important?
Sexual health is important because poor sexual health may result in an increase in STIs. These are “infections of the genital tract most often caused by bacteria and viruses, but also by fungi, yeasts and protozoa,” says sexual and reproductive health specialist, Dr Deborah Lee. Good sexual health also helps prevent unintended and unsafe pregnancies and poor sexual relationships, which are often linked to violence, assault and abuse.
There will be no symptoms for 50% of men and 70% of women with an STI, but they can have serious consequences. Left untreated, chlamydia, for example, is the most common cause of infertility, chronic pelvic pain and painful sex. It can also cause ectopic pregnancy, which can be life-threatening. HPV (the human papillomavirus), the cause of genital warts, is also a major cause of cervical cancer. And, although HIV can now be treated, it’s still a chronic and incurable infection.
Unintended pregnancies are often linked to poverty and social exclusion. Impoverished young women around the world who become pregnant at an early age are less likely to complete their education which might mean they remain in poverty. Because unintended pregnancies aren’t always detected as quickly as intended ones, they might not get the benefits of early pregnancy advice, such as to consume more folic acid. Not knowing you’re pregnant might also mean that you’re more likely to smoke and drink alcohol during the pregnancy. For all these reasons, babies born as a result of an unintended pregnancy tend to have lower developmental scores than their peers.
What does a sexual health check involve?
Before we get into what a sexual health check involves, Dr Lee is keen to remind us to “try not to feel embarrassed or intimidated - the doctors and nurses are trained to work in sexual health and have seen it all before. There's nothing you could do or say that could shock them.”
All sexual health checks start at the reception desk. You'll need to register with the clinic so that your samples can be correctly labelled and filed, as well as provide contact details so that you can get your results. You'll then be seen by a doctor or nurse who will ask you a lot of personal questions. “They will want to know about any symptoms, for example, vaginal discharge, abdominal pain, painful sex or abnormal bleeding,” says Dr Lee. “They will ask a set pattern of questions about when you last had sex. This is called a sexual history and allows the doctor to make a judgement as to your degree of risk,” she continues.
Then, the tests!
“If you don’t have any symptoms, you can take swabs into the toilet and do them yourself,” says Dr Lee. This can be in the form of a vulvovaginal swab. These are PCR tests for chlamydia and gonorrhoea. You will also be offered blood tests for syphilis and HIV.
If you do have symptoms, though, you'll need to be examined. This requires taking off your bottom clothes and lying on the examination bed. “The doctor will do all they can to maintain your dignity,” Dr Lee reassures us. At this point, a speculum might be used, which is a metal or plastic object resembling a duck’s beak that is inserted into the vagina to get a view of the cervix. “This is uncomfortable, rather than painful, but if you can try and relax, it can be done very quickly and does not last long,” says Dr Lee. While the speculum is in, the doctor will take swabs to assess what’s going on down there. These specimens may be looked at with a microscope, which is useful for diagnosing things like bacterial vaginosis, cervicitis (inflammation of the cervix) and pelvic inflammatory disease. A vaginal examination, in which the doctor inserts two fingers into the vagina with one hand and places the other on top of the abdomen, might also be needed to look for signs of infection like swelling and tenderness.
If you have a penis and are symptomless, a first-pass urine sample will be your first port of call, which is a PCR test for chlamydia and gonorrhoea. You will also be offered blood tests for syphilis and HIV. If you do have symptoms, your penis will be examined on the examination bed to check for any rash, discharge or lumps and bumps. If there is discharge, a swab will be taken. And, even if there’s no discharge, a specimen can also be taken to detect the presence of white cells in the urethra, which will make the diagnosis of urethritis, inflammation of the urethra.
Afterwards, any findings of the examination will be explained to you, but it can take several days or even a week for test results to come back via text, which explains why it’s important to get an STI test sooner rather than later so that it can be treated as quickly as possible and its effects on your health minimised. Most of the time you will be told by the clinic to abstain from sex – even with a condom – until your results are known. “Your GP will not be informed of your visit to the sexual health clinic unless you give your permission for the clinic to do so,” says Dr Lee.
All in all, this should take about an hour, but if you’re symptomless and only need to test yourself, you could be out of the clinic in less than 20 minutes.
How do sexual health clinics work?
“Sexual health clinics are community clinics, run by your local sexual health team, which will be staffed by doctors and nurses specialising in Sexual and Reproductive Health (formerly called Family Planning) and Genitourinary Medicine (STIs),” says Dr Lee. “In the past, these were separate services, but they have now come together as integrated sexual health services, meaning you can now get STI testing and treatment – plus contraceptive care and advice – all at the same visit.”
Why is reproductive health important?
Reproductive health is important because it concerns your fertility. As with your sexual health, it can also be affected by STIs.
For example, in women, “inflammation due to STIs can result in a blockage of the fallopian tubes” meaning that the egg cannot pass through and become fertilised, says Dr Lee. Even if an egg does become fertilised, scarring in the fallopian tubes can mean that this fertilised egg cannot pass into the uterus to implant as it’s meant to, instead it implants in the tube and causes a potentially dangerous ectopic pregnancy.
In men, STIs can result in semen that is full of white blood cells, meaning that “sperm find it difficult to swim,” Dr Lee explains.
“It's not uncommon for men and women to find when they do start trying for a pregnancy, that their fertility has been damaged by previous undiagnosed sexually transmitted infections,” says Dr Lee. This is why sexual health tests, regardless of any symptoms, are so important.
Where can I get a sexual health check?
You can get a sexual health check at any sexual health clinic or your GP. “Although both are good, most GPs do not have the facilities to do the same depth of screening as the sexual health clinic,” says Dr Lee. “GPs are also under considerable pressure dealing with the COVID-19 pandemic. If you have symptoms, complex problems, or significant risk factors, it's probably advisable to attend the sexual health clinic,” she advises.
What are the best ways to protect your sexual health?
The best way to protect your sexual health is to “have regular STI screens and get your results before having unprotected sex with a new partner,” says Dr Lee. “If you think you might have an STI, get to a sexual health clinic as soon as possible.” Always use a condom too, “not instead of, but as well as other reliable contraception,” she continues.
For some people an alternative option is to purchase STI test kits - Boots Online Doctor is a great tool for getting advice on your sexual health as well as access to sexual health home testing kits. (Subject to availability and clinician approval. Eligibility criteria and charges apply).
Can a sexual health clinic prescribe the pill?
“Yes – most sexual health clinics now run integrated sexual health clinics. This means you can get contraception, such as the pill, and also STI testing and treatment, all in the same clinic,” Dr Lee says.
Can you have a sexual health test on your period?
“You can do self-taken swabs or have an STI screen when you are having a menstrual period,” says Dr Lee. However, your genital secretions will not be able to be looked at under a microscope “as the blood obscures the cells,” she continues. “Ideally, book your appointment when you are not bleeding to avoid this.” But, if you happen to be on your period and need a test right away, don’t be put off from going to a clinic. GP Dr Toni Hazell also notes that “you can't have a cervical screening (smear test) for the HPV virus done on your period,” which might explain any confusion.
How often should you get a sexual health check?
In England, it’s recommended that sexually active women under 25 get tested once a year and when they have sex with a new or casual partners. For sexually active men, the recommendation is to have a test once a year if they’re having unprotected sex with new or casual partners. All young people aged 25 and under are advised to have a chlamydia screening at least once, even if they don’t – like most people – have any symptoms.
Basic sexual health tests (to detect gonorrhoea, syphilis, HIV and chlamydia) should be done if you have STI symptoms, have changed sexual partners, if a partner tells you they have tested positive for an STI, if you or your partner have been unfaithful, if you are pregnant or trying, if you have been sexually assaulted or if you have had casual sex while abroad or intoxicated.
Home testing kits for a range of STIs are available from the Boots Online Doctor service. (Subject to availability and clinician approval. Eligibility criteria and charges apply).