Health Promotion: Sex

There are huge numbers of words which can be confusing - first, the interchangeable title of this subject:
STD - Sexually Transmitted Disease
STI - Sexually Transmitted Infections
GUM - Genito-Urinary Medicine

Then there are quite a few slang terms for the conditions themselves- clam, the clap, crabs, Hi-Five (HIV), cold sore, the pox and many more…

Sexual health services comprise both sexually transmitted infection (STI) testing and treatment and contraception services.
Our surgery provides the full range of contraceptive services.

Here is some general information about NHS Sexual Health Services

Sexual Health services for Brent - including STI and HIV testing and care - are available locally:

• The Patrick Clements Clinic, Central Middlesex Hospital (Tel 0208 453 2221) or book online.
• The Caryl Thomas Clinic, Wealdstone HA1 4UQ (Tel 0203 893 8575)

There is also a limited range of contraceptive services only available from Chalkhill Clinic, Wembley Park and Edgware Community Hospital.

You can also use the new online testing for STIs - register online and a kit will be sent for you to post samples back to the lab and receive a result within a few days.

Any concerns about symptoms which could be an STD?

You need to visit an STD clinic if:

• you have symptoms of an STI
• a sexual partner has symptoms of an STI
• you're worried after having sex without a condom
• you are starting a new relationship or have had a one-night stand
• under 25 and sexually active? Get tested every year! (chlamyia is very common)

NOTE: Many STIs have no symptoms at all, like HIV. The only way to know for sure is to get tested.

Possible symptoms which could be an STI:

• unusual discharge from the vagina, penis or anus
• pain when peeing
• lumps or skin growths around the genitals or anus
• a rash
• unusual vaginal bleeding
• itchy genitals or anus
• blisters and sores around the genitals or anus

What happens at a sexual health clinic

A doctor or nurse:

• will ask you some questions about your sex life
• may ask to take a look at your genitals or anus
• will tell you what tests they think you need
• Our local clinics offer home testing kits for some STIs.

If tests show you have an STI, you MUST tell your sexual partner and any ex-partners so they can get tested and treated as well. If you don't want to do this, the clinic can usually do it for you without naming you.

Why a sexual health clinic might be better than coming to our surgery

You can see a GP, but they'll probably refer you to a sexual health clinic for a complete check and especially if they think you might have genital warts.

• Sexual health clinics are specialists in treating problems with the genitals and urine system.
• Sexual health clinics offer a walk-in service where you do not need an appointment.
• They can be anonymous if you prefer, meaning you don't have an STD on your medical record (though we do prefer having this information to make your medical care holistic)
• They'll often get test results quicker than GP practices, and you do not have to pay a prescription charge.

STDs include:

• HIV and AIDS
• Syphilis
• Chlamydia (the No.1 STD in the UK)
• Gonorrhoea
• Trichomonas
• Herpes simplex (HSV)
• Hepatitis B
• Genital Warts
• Pubic Lice
• Scabies

What is safer sex?
'Having sex with less chance of catching or passing on a potentially life-changing sexually transmitted infection'.
STDs are passed on in different ways in different circumstances between different people and it is important to be aware of how to reduce the risks.

How do I make sex safer?
You can reduce the risk of all infections by:

• Using condoms for all types of penetrative sex (vaginal, anal sex especially; you may also want to consider condoms for oral sex)
• Having non penetrative sex (such as body rubbing and mutual masturbation)
• Being tested for STIs before having sex with someone new, and advising that they also get tested.
• Reducing the number of partners you have sex with. Getting vaccinated against certain infections.
• For example, hepatitis B (and A). If you are at risk - ask a doctor, nurse or health advisor about this.
• Planning on how you will protect yourself and your sexual partners from infections when under the influence of alcohol or other recreational drugs.

How risky is oral sex?
Oral sex can include fellatio (sucking a penis), cunnilingus (licking female genitals) or oro-anal contact (anal licking or "rimming")

• Herpes, warts, gonorrhoea, chlamydia, syphilis, HIV, hepatitis B and, possibly, other infections can be transmitted through oral sex.
• For most infections (except herpes), the risk of catching an infection is greater for the oral partner (the one giving oral sex).
• Most people do not use protection (condoms or dental dams) for oral sex.
• The risk of catching an STI through unprotected oral sex is lower than for unprotected vaginal or anal sex, but is not zero.

How do I make oral sex safer?

• Reduce the number of partners with whom you have oral sex.
• Avoiding oral sex with ejaculation reduces the risk of HIV (and possibly other infections)
• Insertive fellatio (being sucked) is lower risk than receptive fellatio (sucking a penis).
• Avoid brushing teeth or flossing before having oral sex.
• Avoid oral sex if you have oral cuts or sores, or a sore throat.
• Use condoms for fellatio.

Other sorts of sex:

• No form of sexual contact is entirely without risk of STI transmission.
• Non penetrative contact (body rubbing, mutual masturbation without penetration) carries the lowest risk. Herpes can be transmitted through kissing, and it may be possible to transmit other STIs (including syphilis and Hepatitis B) in this way, although the risk is lower than for penetrative sex.
• If you are fingering, using sex toys or fisting your partner, the risk of transmission is related to the degree of trauma - how much damage is done to the delicate lining of the vagina or anus.
• Use latex or non-latex gloves for digital penetrative sex if there is a risk of trauma.

What if my partner(s) or I are living with HIV?
All the previous advice applies to you.

• If you are living with HIV, staff at your clinic will be able to give you detailed advice on safer sex.
• Taking effective antiretroviral therapy (ART) and having an undetectable plasma/blood HIV viral load significantly reduces the risk of HIV transmission during sex.
• Even with an undetectable viral load, there is still a small risk of HIV transmission.This is higher for anal sex than for vaginal or oral sex.
• Continuing to use condoms for vaginal, anal (and oral) sex will further reduce any remaining risk of transmission.
• Poor adherence (missing doses of ART) may increase the risk of HIV transmission.
• If you are living with HIV or you have partners who are or may be HIV positive, have an STI check regularly depending on your sexual activity, and at least once a year if you're sexually active.

Safer Sex Advice from British Association for Sexual Health

(from British Association for Sexual Health)

Do condoms work?
Yes - for heterosexual (straight) couples and men who have sex with men (MSM), using condoms every time you have sex reduces the transmission of HIV and other STIs.

Condoms are thought to be almost 100% effective in preventing HIV transmission if used perfectly all of the time. In real life most people do not use condoms perfectly, or for every type of sex, so protection may be less than this.
Condoms also reduce the risk of catching or passing on chlamydia, gonorrhoea, herpes, warts and syphilis.

Whilst they do help, no method is perfect, so using a condom cannot guarantee that you will not catch an STI.

Condom advice:

• Practice using a condom - most failures are through misuse!
• Use a condom every time you have vaginal or anal sex to minimise the risk of transmission of HIV and other STIs.
• Consider using condoms for oral sex, especially if you have lots of sexual partners.
• Even if you don't use a condom every time, or for every type of sex, use one as often as possible - this is safer than not at all.
• Even if you occasionally did not use a condom that does not mean it is not worth using a condom every time in future.

Which condoms should I use?
Use a "kite marked" condom that is within its sell-by date. A "kitemark" is a mark of safety and quality and looks like a kite.

• All kite marked condoms (male latex, male non-latex and female condoms) are very effective, so the important thing is to use the type that suits you and your partner.
• Non latex condoms are a good choice for some men, but are a bit more likely to break than latex condoms.
• Use non-latex condoms if you have a latex allergy (or if you are using creams or treatments that damage latex condoms).
• Female condoms are at least as good as male condoms at preventing STIs.
• You get better at using condoms the more you use them. Practising opening and using a condom alone, and in the dark, might make it easier to do when you have sex.

Does size matter?
Yes, with condoms size matters!

• Make sure you or your partner use a condom of the right size.
• Condoms are more likely to split if too tight.
• The girth (thickness/width) of the penis may be more important than penis length.
• Try a range of condom sizes (such as Trim, Standard, Large/XL and Superking/XXL) to find what fits you best, or measure round your erect penis using a strip of paper to find the correct diameter of condom for you.

How to use condoms

• Open the packet carefully - don't use your teeth and avoid damaging the condom with your nails, jewellery or piercings.
• Put the condom on before you start having sex and leave it on all the way through.
• Remove all the air from the condom before putting it on
• Hold the condom during withdrawal (pulling out)
• Don't unroll it before putting it on
• If you put it on the wrong way by mistake, use another one - don't just flip it over

More on using condoms from NHS.UK

Using condoms for anal sex

• Ordinary condoms are no more likely than thicker condoms to break or slip off during anal sex.
• Some people feel safer using thicker (‘Extra' or ‘Strong') condoms for anal sex, but there is no proof that they are any safer than regular condoms.
• You can use female condoms instead of male condoms for anal sex: remove the ring at the end of the condom and place on the penis like a male condom.
• Using lubricant with condoms

Anal sex:

• Put a water or silicon based lubricant (NOT an oil based one) all over the condom and inside the anus (but not inside the condom) before anal sex.

Vaginal sex:

• Lubricant can make vaginal sex more comfortable or pleasurable, but you do not need to use extra lubricant for vaginal sex routinely. Lubricant does not make sex safer and increases the chance that the condom will slip off.

NHS.UK has 30 useful Q&As here answering a variety of questions on sex and sexual practices
Patient.Info has a wide range of information
British Association for Sexual Health has a good range of Patient Leaflets