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The World Health Organisation defines sexual health as a state of physical, emotional, mental and social wellbeing in relation to sexuality; it is not just the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.
Most adults are sexually active and good sexual health matters to individuals and communities. Sexual health needs vary according to factors such as age, gender, sexuality and ethnicity. However, there are certain core needs common to everyone including high quality information and education enabling people to make informed responsible decisions, and access to high quality services, treatment and interventions.
In England, our definition of sexual health, reproductive health and human immunodeficiency virus (HIV) includes the provision of advice and services around contraception, sexually transmitted infections (STIs), HIV and termination of pregnancy.
The consequences of poor sexual health include:
- unintended pregnancies and abortions
- psychological consequences of sexual coercion and abuse
- poor educational, social and economic opportunities for teenage mothers, young fathers and their children
- cervical and other genital cancers
- hepatitis, chronic liver disease and liver cancer
- recurrent genital herpes
- pelvic inflammatory disease, which can cause ectopic pregnancies and infertility
The Framework for sexual health improvement in England sets out the Government’s ambitions for improving sexual health outcomes. The document aims to provide the information, evidence base and support tools to enable those involved in sexual health improvement to work together effectively.
Facts about sexual health
Findings from the national surveys of sexual attitudes and lifestyles (Natsal) show most young people become sexually active and start forming relationships between the ages of 16 and 24. Young people in these age groups have significantly higher rates of poor sexual health, including STIs and abortions than older people.
Unplanned pregnancy is a key public health indicator. The increasing intervals between first sex, cohabitation, and childbearing means that, on average, women in Britain spend about 30 years of their life needing to avert an unplanned pregnancy. Available evidence shows that unplanned pregnancies can have a negative effect on women and children’s lives and result in poorer outcomes than those that are planned.
In 2015, HIV in the UK 2016 report estimated 101,200 people were living with HIV in the UK of which it is estimated 13% are unaware of their infection and remain at risk of infecting others and are unable to benefit from effective treatment.
The report found HIV continues to be concentrated among men who have sex with men (MSM) and black African men and women.
HPR infection report (PDF, 680KB, 20 pages) found that there were approximately 420,000 diagnoses of STIs made in England, a decline of 4% compared to 2015. The impact of STIs remains greatest in young heterosexuals aged 15 to 24 years, black ethnic minorities and gay, bisexual and other men who have sex with men (MSM).
It has long been recognised that gonorrhoea is at risk of becoming an untreatable disease due to the ongoing threat of antimicrobial resistance.
Core principles for healthcare professionals
Healthcare professionals should:
- know the needs of individuals, communities and populations related to sexual health, reproductive health and HIV
- think about the resources and the services available in the health and wellbeing system to promote good sexual and reproductive health
- understand specific activities or interventions which can prevent poor sexual health, reproductive health and HIV
Healthcare professionals should be aware of the interventions at population level, which include:
- building an honest and open culture where everyone is able to make informed and responsible choices about relationships and sex to reduce the stigma associated with sexual health and HIV
- ensuring children receive good quality sex and relationships education at school, at home and in the community; Statutory guidance and supplementary advice have been produced by the Department for Education
- raising awareness that prescribed contraception and STI and HIV treatment are provided free from prescription charge to reduce the risk of unwanted pregnancy and onward transmission of infection
- ensuring that prevention is prioritised and people are motivated to practise safe sex, including using contraception and condoms
- ensuring testing for HIV and STIs is effectively promoted in at-risk populations
Community health professionals and providers of specialist services can have an impact by:
- ensuring local authorities commission services for the full range of contraception, the testing and treatment of STIs and provision of condoms for the benefit of everyone in the community
- protecting patients from reinfection with partner notification - an essential component of STI management and control
- offering chlamydia testing to young people as a routine part of every primary care and sexual health consultation; the goal of the national chlamydia screening programme (NCSP)
- ensuring easy access to sexual health advice, free condoms, and testing for HIV and other STIs for young people and other high risk groups in a range of accessible settings with condom distribution schemes
Family and individual level
Healthcare professionals can have an impact on an individual level by:
- providing information about the full range of contraceptive methods and promoting prompt access to the method that best suits their needs; see the Sexwise website for downloadable information leaflets
- ensuring that women seeking an abortion have easy, quick and confidential access to services
- ensuring people understand the different STIs, associated potential consequences and how to reduce the risk of transmission; the Sexwise website provides a number of useful resources
- providing information about where to get prompt access to HIV testing
- ensuring people who are diagnosed with HIV receive prompt referral into care and high quality treatment services
Public Health Outcome Framework (PHOF)
There are 3 sexual health indicators in the PHOF that relate to:
- Chlamydia detection rate (15 to 24 year olds) (3.02)
- people presenting with HIV at a late stage of infection (3.04)
- under 18 conceptions (2.04)
Public Health England (PHE)
PHE has developed sexual and reproductive health profiles to support local authorities and others to monitor the health of their populations and the contribution of local public health related systems.
Health and Social Care Information Centre (HSCIC)
The HSCIC has 3 quality and outcomes framework (QOF) indicators in relation to contraception prescribing.
To view these, go to the HSCIC indicator portal and type ‘sexual health’ in the search box in the top left corner.
The Everyday Interactions Measuring Impact Toolkit provides a quick, straightforward and easy way for health care professionals (HCPs) to record and measure their public health impact in a uniform and comparable way.
The sexual health impact pathway is recommended for healthcare professionals to record and measure actions undertaken as part of routine care which impact on adult obesity.
Examples of good practice
PHE and partners published Making it work: a guide to whole system commissioning for sexual health, reproductive health and HIV. This contains a number of case studies which demonstrate models of existing and emerging local practice to illustrate how commissioners are working collaboratively to meet the needs of their local populations and address health inequalities.
In 2016, PHE and Local Government Association (LGA) published Good progress but more to do: teenage pregnancy and young parents. This highlights the importance of a continued focus on teenage pregnancy, the 10 factors for an effective local strategy and examples of case studies illustrating good practice.
NICE guidance and pathways
Contraceptive services for under 25s (PH51) is for NHS and other commissioners, managers and practitioners who have a direct or indirect role in, and responsibility for, contraceptive services. This includes those working in local authorities, education and the wider public, private, voluntary and community sectors.
Long-acting reversible contraception (CG30) is about long-acting reversible contraception (LARC). It offers best-practice advice for all women of reproductive age who may wish to regulate their fertility using LARC methods.
HIV testing: increasing uptake among people who may have undiagnosed HIV (2016) (NG60) This guideline covers how to increase the uptake of HIV testing in primary and secondary care, specialist sexual health services and the community. It describes how to plan and deliver services that are tailored to the local prevalence of HIV, promote awareness of HIV testing and increase opportunities to offer testing to people who may have undiagnosed HIV.
Sexually transmitted infections and under-18 conceptions: prevention (PH3) is guidance is for professionals who are responsible for, or who work in, sexual health services. This includes general practitioners and professionals working in contraceptive services, genitourinary medicine and school clinics.
Free online courses
Women discuss their contraceptive options with many different people: their partner, family and friends and professionals from a variety of backgrounds. Often women are incorrectly told that there are only a few types of contraception that are suitable for them.
The aim of this course is to inform professionals so that they can give accurate information and dispel any myths the patient may have heard. It is not intended to form a comprehensive reference. Details about contraindications and risk factors would always need to be discussed with the prescribing professional.
Module 9 focuses on sexual and reproductive health and covers the following topics:
- sexual behaviour in young people
- sexual assault in young people
- STIs in young people
- teenage parents
- adolescent gynaecology and preventing pregnancy
The RCGP e-learning is definitely best for contraception, but the other topics could be very helpful in increasing awareness and confidence of the workforce. It is free and open to local government as well as NHS practitioners, with individual registration.