COMBINED PILL

• The Combined pill is usually referred to as ‘the pill’.

• It contains two hormones – oestrogen and progestogen.

• There are many different types of Pill to choose from

The Pill is one of the most effective methods of contraception. If taken properly the pill is more than 99% effective. This means it is very effective at preventing pregnancy but gives no protection against sexually transmitted infections.

How effective is the pill/ How well does the pill work?
If taken properly the pill is more than 99% effective. This means that less than one woman out of every 100 using the pill will become pregnant each year.

What makes the pill less effective?

• Missing two or more pills

• Taking your pill more than 24 hours late.

• Severe and prolonged diarrhoea and vomiting

• Some medications e.g. antibiotics may stop the pill working properly

• Some complimentary therapies e.g. St Johns Wort may stop the pill working properly

Considerations
There are risks associated with taking the pill, they are however uncommon. For most women the benefits of taking the pill outweigh the possible risk.

When you attend a clinic for the Pill, a full medical history will be taken to assess your suitability for this method of contraception.

If you are taking the Pill it is very important to see a doctor if you have any of the following symptoms:

• Chest pain

• Breathlessness

• Painful swelling in your leg

• Unusual headaches or migraines that are worse than usual

• Any visual disturbances e.g. flashing lights

• Jaundice – yellow skin

PROGESTOGEN-ONLY PILL

• Often referred to as POP or the ‘mini pill’

• Contains the hormone progestogen

• There are several different types of POP to choose from

The POP is 99% effective if taken properly. It gives no protection against sexually transmitted infections

What makes the POP less effective?

• Missing one or more pills

• Taking your pill late

• Some medications may make the POP less effective

Considerations

The POP is particularly suitable for women who:

• Breastfeed

• Have a strong family history of breast cancer, heart attack or stroke

• Smoke and are over the age of 35

COMBINED ORAL CONTRACEPTIVE PILLS

Advice for women missing combined oral contraceptive pills

1) If one or two pills have been missed at any time
OR
If one pill is missed when using a 20mcg pill (Loestrin 20, Mercilon or Femodette)

Take the most recent missed pill as soon as you remember and continue taking the remaining pills daily at the usual time – this may mean taking two pills on the same day or even at the same time

You should not require emergency contraception

2) If three or more pills have been missed at any time
OR
If two or more pills have been missed when using a 20mcg pill (Loestrin 20, Mercilon or Femodette)

Take the most recent pill as soon as you remember and continue taking the remaining pills daily at the usual time – this may mean taking two pills on the same day or even at the same time. You require to use condoms or abstain from having sex until you have taken pills for seven days in a row
BUT

Extending the pill free interval is risky so:
a) If the missed pills are in the first week of the packet – days 1-7
emergency contraception should be considered if you have had unprotected sex in the pill free interval or in the first week of pill taking

b) If pills are missed in the second week of pill taking – days 8-14
there should be no need for emergency contraception

c) If pills are missed in the third week of pill taking – days 15-21
miss out the pill free interval by finishing the pills in your current pack and starting a new pack the next day (ie run two packs together)

CONDOMS

• A barrier method of contraception

• Male and female condoms available

• Non-hormonal

Female condom – 95% effective if used properly
Fits inside the vagina

Male condom – 98% effective if used properly
Fits over an erect penis

Gives protection against sexually transmitted infections
Available free from:
The Corner
Family Planning Clinics
GPs
GUM clinic
Tayside Condom Initiative outlets (see website)

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Considerations

Never use oil based products such as body creams, lotions, lipstick on a condom as this will damage the rubber and make it much more likely to burst

How do I use a male condom?

Follow the detailed instructions on the condom packet or in the leaflet inside the pack. Your doctor, nurse or pharmacist will also be able to advise you. Otherwise you can follow these instructions:

1.  Check that your condom isn’t past its use-by date. Be careful how you take it out of its foil wrapper.

2. Pinch the teat or closed end before you put the condom on.

3. Holding the teat or closed end, roll the condom right down to the base of the penis.

Remember you must use a new condom every time you have sex. Make sure the ‘use by’ date on the packet is not out of date. Be careful not to tear the condom on sharp fingernails and jewellery when you take it out of the packet.

How do I use a female condom?

The packet will contain a leaflet with detailed instructions on how to use a female condom. Your doctor, nurse or pharmacist will also be able to show you.
Remember to use a new condom every time you have sex and check the ‘use by’ date on the packet. Be careful not to tear the condom on sharp fingernails and jewellery when you take it out of the packet.

DIAPHRAGM / CAPS

• A barrier method of contraception

• Often known as ‘The Cap’

• Non-hormonal

• Fits inside the vagina and covers the cervix (neck of womb)

The diaphragm, if used properly, with spermicide is 92 – 96% effective at preventing pregnancy. It may provide slight protection against sexually transmitted infections.

An initial visit to the Family Planning Clinic is required to ensure you are fitted with the correct size of Diaphragm.

Considerations

The size of diaphragm you require may alter due to fluctuations in weight or pregnancy

Yearly check ups are recommended to ensure your diaphragm is fitting correctly.

INTRA UTERINE DEVICE (IUS)

• A small plastic device containing progestogen that is fitted inside the uterus (womb)

• Often referred to as the ‘Mirena’ or the ‘hormone coil’

• IUS provides contraception for 5 years

The IUS is over 99% effective at preventing pregnancy. It provides no protection against sexually transmitted infections.

A qualified clinician, normally within the Family Planning Clinic or within your GPs fits an IUS. An IUS check is recommended 6 weeks following insertion.

Considerations

Your periods may become erratic initially, this usually settles within 3 to 6 months. Thereafter your periods will normally become shorter and lighter.

This method is considered a treatment for women who have problems with heavy, painful periods.

An IUS can also be used through the menopause.

CONTRACEPTIVE IMPLANT (IMPLANON)

• Sometimes referred to as ‘the rod’

• Contains the hormone progestogen

• Works for up to 3 years to prevent pregnancy

The Implant is 99% effective at preventing pregnancy. It provides no protection against sexually transmitted infections.

A single rod will be fitted into your upper arm, using local anaesthetic by a trained clinician

Considerations

Periods may be erratic initially, this usually settles within 3 to 6 months. Some women may find that their periods stop completely.

Once the Implant is removed you are at risk of pregnancy immediately

CONTRACEPTIVE PATCH

• The patch available in the UK is called ‘Evra’

• Contains two hormones, similar to the combined pill, oestrogen and progestogen

• 5cm x 5cm beige coloured, sticky patch

If used correctly Evra is over 99% effective at preventing pregnancy. It provides no protection against sexually transmitted infections.

Considerations

• A careful medical history will be taken to ensure it is safe for you to use Evra.

• You have to remember to re-new the patch once a week

• If you are using Evra it is very important to see a doctor if you have any of the following symptoms:

• Chest pain

• Breathlessness

• Painful swelling in your leg

• Unusual headaches or migraine that are worse that usual

• Any visual disturbances e.g. flashing lights

• Jaundice – yellow skin

EMERGENCY CONTRACEPTION

Two methods available:

Hormonal:

You will be asked to take one pill at the family planning clinic/chemist/GP
Can be taken up to 72 hours after unprotected sex
Often referred to as ‘the morning after pill’
More effective the sooner it is taken
May affect timing of next period

IUD (Coil):

Can be fitted up to 5 days following unprotected sex
Can remain in place for continuing contraception
See IUD information

Considerations

If you are sick within two hours of taking the pill you will need a second dose

Advisable to have a pregnancy test 3 weeks after taking the emergency contraceptive pill if you have not had a normal period.

CERVICAL SMEAR

What is it?

How important is Cervical smear?

What are the advantages?
What are the disadvantages?

Where can I get a smear

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ABDOMINAL, VAGINAL AND BREAST EXAMINATIONS

What is it?

Where can I go for information on ?

LINKS: CONTRACEPTION

These are links to other websites which may be of interest to you. Please contact us if you find any broken links or suggestions for other sites you would like to see included.

Contraception and Reproductive Health

http://www.nhsdirect.nhs.uk/
NHS general information, support and advice

http://www.fpa.org.uk/
Comprehensive information and resources

http://www.bpas.org/
British Pregnancy Advisory Service (BPAS) is a charity which offers information and choices on unplanned pregnancy.

CONTRACEPTION

What is Contraception?

Contraception is used to prevent pregnancy.

There are several different types of contraception available and people choose different methods to meet their individual needs.

How effective any contraception is depends on how carefully you used the method you have chosen.
Types of Contraception:

INFERTILITY TREATMENT – IVF

What IVF

Advice for the treatment

Pregnancy

Current health problems

INFERTILITY ULTRASOUND TESTING

Infertility ultrasound testing

In-house ultrasound scan for instant results.

ANTENATAL SERVICES

If you prefer to see a Obstetrician, please ask for an appointment. Clinica will ensure – when possible – that all requests are met promptly.

Services include the following:

• Antenatal services

• Pre pregnancy check test

• Early pregnancy scans

• Dating and Gender scan

• Down’s risk screening

• Blood tests

• Basic Health check

Please ring Clinica on 020 7258 3341

PELVIC FLOOR REPAIR

Pelvic Pain:

It is not uncommon to experience discomfort in the pelvis at various stages of the menstrual cycle. Ovulation (release of the egg) may be associated with discomfort usually to one side or the other and may last a day or two. Some women may have central, low discomfort before or during the period. More severe pain at these times, or pain associated with intercourse may be as a result of gynaecological problems such as infection, ovarian cysts, endometriosis, adhesions, fibroids, bladder irritation or polyps and this does require investigation.

Treatment:

The lesser types of discomfort often resolve with simple pain killers and do not necessarily require any investigation

Treatment:

The lesser types of discomfort often resolve with simple pain killers and do not necessarily require any investigation. For severe discomfort, consultation and examinations should be carried out, swabs are often taken to rule out infection, a urine sample tested, and a pelvic ultrasound performed. If these initial tests are not helpful, further investigations to look for adhesions or endometriosis by exploratory surgery, (laparoscopy / hysteroscopy), may be required. Treatment of pelvic pain is often not straightforward and needs to be carefully tailored to the circumstance and preference of the individual woman.

For advice and further information please ring Clinica on 020 7258 3341

CHIROPRACTIC & PAIN MANAGEMENT

Edwin Joyce BSc DC Chiropractor

The natural informed choice for the relief of:

• Discs and sciatica
• Low back pain
• Headache and migraine
• Neck pain and stiffness
• Whiplash
• Knee and ankle problems
• Neuralgic pain
• Numbness and tingling
• Trapped nerves
• Shoulder pain
• Tendonitis and inflamed muscles
• Acupuncture available
• Covered by most Insurers

ENERGY MEDICINE & HEALING

Winifred Marr BRCP; BSc (Hons); PhD (Doctor of Biochemistry)

ENERGY MEDICINE
Good energy levels are fundamental to health and wellbeing and for challenging modern lifestyles. Whether you are undergoing orthodox treatment for major or minor health problems, recovering from illness or simply want to boost your energy levels, energy medicine can help support you.

Energy therapists believe that imbalances or blockages in the body’s energy systems can contribute to mental and physical disease. At the clinic a range of non-invasive devices are available to analyse and rebalance the body’s energy field, restore inner harmony and support health recovery :

• Electrocrystals – pulsed sound frequencies with crystals
• Light therapy – light emitting diode (LED) with crystals
• Inergetix CoRe System – computer-based information & energy medicine

HEALING
Hands on healing is available to support recovery from a wide range of health problems.

TREATMENT OF ENDOMETRIOSIS

What is endometriosis?

The lining of the womb is called endometrium; if endometrial-type tissue is found outside the womb it is called endometriosis. Endometriosis is most commonly found in the pelvis notably on the ovaries and behind the uterus (Figure 23.2). It can involve the bowel and urinary tract. The diagnosis is confirmed by direct visualisation usually by laparoscopy. There is a very large spectrum in the severity of endometriosis: It may consist of no more than a few tiny spots or at the other extreme, there may be extensive disease with cysts filled with a chocolate-like material and scar tissue around the pelvis. The chocolate cysts are derived from blood released by the endometriosis at the time of menstruation. Endometriosis is essentially a condition occurring in the pelvis. There are rare occasions when it may occur elsewhere such as in the lung.

Staging of Endometriosis:

There have been numerous classifications to describe the severity of the condition. The American Society for Reproductive Medicine revised the classification in 1997 to take account of the latest observations. A score is obtained according to the number of sites and the size of each deposit. Assessment of the severity of endometriosis using the revised American Fertility Society classification allows a degree of comparison although a study of the laparoscopic videotapes of 20 patients with endometriosis showed considerable variation of scoring between observers and also by the same observer on re-evaluation of the same patient.

• http://www. Asrm.org

Photographs of endometriosis can be seen at:

• http://www.layyous.com

When there is severe endometriosis, there can be little doubt that there is a disease process. The relevance of minimal and mild endometriosis is more often a matter of debate. Some suggest that endometriosis is so commonly found in association with pelvic pain that the possibility of its presence should always be considered. Others are more sceptical as to its significance. At a meeting of the European Society of Human Reproduction and Embryology in 1991, a group of experts concluded that ‘Endometriosis does not exist; all women have endometriosis.’

There is no way of looking at endometriosis and deciding whether or not it is the cause of symptoms. Ultimately a trial of therapy may seem appropriate. If symptoms respond our goal has been achieved. If symptoms do not respond the assumption must be that cause and effect have been refuted and a different causation must be sought (Q4. 3). Even when symptoms respond to treatment, this does not necessarily confirm that the endometriosis has been causative; suppression of the menstrual cycle could not only affect the endometriosis but also other conditions that are cyclically related including bowel disturbance as in the irritable bowel syndrome (39). The failure of symptoms to respond should be recognised as evidence that the endometriosis is probably not a factor in the pain.

TRAVEL HEALTH/VACCINATIONS

Clinica will provide you with complete travel health services and vaccinations for whatever destination you choose to visit. You can call us or fill in this form to arrange for an appointment. You can also visit the clinic and see the doctor or the nurse on the same day.

Stop Press: Hajj Vaccine – now available at CLINICA

Meningococcal Meningitis ACWY
http://www.nathnac.org/pro/factsheets/menigitis_vaccine.htm

Indications for use of vaccine

Meningococcal meningitis vaccine should be considered for

Travellers who will be living or working with local people in an area of risk
Long stay and rural travellers visiting areas of risk
Travellers visiting an area of risk during an outbreak
Requirements for Saudi Arabia

All pilgrims visiting Saudi Arabia for the purpose of Hajj or Umrah require proof of vaccination against meningitis ACWY. Children between the ages of six months and two years need two doses of vaccine with an interval of at least three months between them.

Meningitis ACWY Guidelines for Travellers to the Hajj or Umrah Pilgrimage in Saudi Arabia

Contraindications

Current febrile illness
Allergy to constituents of the vaccine
History of hypersensitivity following a previous dose of ACWY Vax
Interactions with Conjugate C meningococcal meningitis vaccine
If a child has recently received Men C conjugate vaccine, an interval of at least 2 weeks (or longer where possible) should be allowed before administration of the meningitis ACWY vaccine. This allows some response to be made to the Men C conjugate vaccine before a further dose is given.

Adverse Events

Adverse events following meningococcal vaccine are most commonly mild and transient. They include erythema, induration, tenderness or pain at the injection site. Very rarely headache, fatigue and fever have been reported. Miscellaneous neurological reactions have been reported rarely, but no causal relationship to ACWY Vax has been established.

Meningococcal Meningitis ACWY Vaccine Schedule

VaccineManufacturer/distributorSchedule

ACWY Vax

GlaxoSmithKline

Single dose

Length of Protection

5 years for adults and children from age 5 years A second dose should be offered after 2- 3 years to children first vaccinated at less than 5 years of age if at high risk

Minimum age

2 years and over.

 

Can be given from 2 months of age, although the protection rates against serotypes C, W135 and Y are lower and decline more rapidly.

INFERTILITY

• Infertility treatment IVF

• Infertility consultation

• Infertility Ultra Sound (Instant results)

Infertility is usually defined as involuntary failure to conceive after one year of unprotected sexual intercourse. In its wider sense, infertility refers to couples who are having difficulty achieving parenthood and would, therefore, include pregnancy problems such as recurrent miscarriage. Between 80-90% of couples who will achieve a pregnancy without assistance, succeed within the first year of unprotected intercourse and about 95% within two years. The central theme of biology is reproduction, and for those unfortunate couples who have difficulty achieving parenthood there may be feelings including anxiety, frustration and despair.

Primary infertility usually refers to patients with no history of a successful pregnancy. Secondary infertility indicates that there has been a previous successful pregnancy. It may also be appropriate to consider whether the infertility is primary or secondary for each partner as well as for the current partnership.

Infertility is perceived as a disease by less than half of people surveyed (38%), in contrast to the accepted medical opinion; (ii) awareness about the definition and incidence of infertility is relatively low, despite the fact that half of the people polled claimed to know someone affected by infertility.

Related Medical Abstracts – Click on the paper title:-

• Public perception on infertility and its treatment: an international survey. (2000-01)

• Estimates of human fertility and pregnancy loss (1996)

• Background pregnancy rates in an infertile population (1996)

How Prevalent Is Infertility?

It has been estimated that one couple in six will have been concerned about their fertility and about 10% of couples are currently experiencing fertility difficulties. In a Danish study of 3,743 randomly selected women aged 15 to 44 years, 27.2% of those planning a family had experienced fertility delays.

Infertility increases with advancing age as indicated by the following two graphs:

 

Both of the line graphs are for women with normal reproductive function, after having unprotected intercourse for one year.

Related Medical Abstracts – Click on the paper title:-

• The epidemiology of infertility in a rural population. (1997-01)

• Infertility prevalence, needs assessment and purchasing.(1994-01)

• Infertility-epidemiology and referral practice (1991)

What are the causes of infertility?

The essential requirements for a couple to be fertile are healthy sperm which must be deposited at ejaculation at the cervix, ovaries that are releasing eggs (ovulation), fallopian tubes that are open and healthy and womb capable of nurturing a pregnancy (Figure 9.1).

The three most common causes of infertility are:

• anovulation (eggs are not being released).

• tubal factor (Fallopian tube disease).

• male factor infertility

 

Infertility remains unexplained in about 25% of couples following investigations to identify obvious problems in these three areas.

The following graph shows the main causes of infertility in those having IVF in Canada:

Primary Diagnoses for Assisted Reproductive Technology Procedures

This chart shows the primary diagnoses responsible for infertility among couples who had an ART (Assisted Reproductive Technology) procedure. Please note that some couples have more than one cause of infertility.

Additional Information
Please call Clinica on 020 7258 3341 for an appointment or click below to fill in and email the Enquiry Form.

MINIMAL ACCESS SURGERY

Vaginal Tightening

This is a surgical operation whereby the vagina is tightened up by thinning out or reducing the soft tissues and tightening the vaginal muscles.

Why does my vagina feel loose or wide?

This may be due to giving birth to one or several children. The vaginal muscles and ligaments become weakened and start to sag. This leaves the bladder, bowel and womb (uterus) so unsupported that they can literally begin to push through the vaginal wall. This leads to problems with the body’s ability to pass urine and stools.

A widened vagina may be age-related. As you get older, your body’s muscles begin to slacken and lose their elasticity 

This happens to all muscles throughout the body, due to a reduction in the production of oestrogen (a hormone that provides muscles with elasticity.

What are the problems with a wide vagina?

There is a loss of sexual pleasure during intercourse because there is little or no friction between the penis and the vaginal wall. The result may be that sex becomes less satisfying for you and your husband or partner.

Can my vagina be restored to normal?

Yes, or as near normal as possible.

Will there be complications?

If any complications arise it may be that during the tightening up procedure, your bowel is accidentally punctured.

If your vagina is of normal width or just slightly widened but you still want it tightened to heighten sexual pleasure, you may experience problems. Your vagina may end up feeling too tight, making sexual intercourse painful. There may also be the possibility of ongoing urinary tract infections.

What does the surgery involve?

The operation involves tightening the vaginal muscles and ligaments in the back wall. You will require a general anaesthetic for this.

How long does the surgery take?

Surgery usually takes approximately 1 hour to perform. You may be required to stay in overnight for observation.

What will happen in the recovery period?

Your vagina and the surrounding area will be quite swollen and feel sore afterwards. As the swelling and soreness lessens, you will be able to walk more comfortably.

What is the recovery time?

Barring any complications, you should be fully recovered in 4 weeks. You may be able to return to work about 1 week after surgery.

When can I resume sexual intercourse?

You may resume sexual intercourse within 1 to 2 months.

What can I expect from the surgery?

You can expect your vagina to feel tighter. Your confidence should be increased as you may find sexual intercourse more pleasurable for both you and your partner. If the problem was that your internal organs, i.e. bladder, womb and bowel had dropped out of position, things should feel better. You should no longer have problems urinating or passing stools as your organs will be back in their normal position.

SEXUALLY TRANSMITTED INFECTIONS

Sexually Transmitted Infections & Genito-Urinary Medicine Clinics

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What is an STI?

A sexually transmitted infection (STI) is an infection that can be passed from person to person when having sex. You can get an STI by having vaginal sex, anal sex, or oral sex. There are several different types of STI.

What are the main STIs?

The ten most common STIs in the UK are: anogenital warts, chlamydia, genital herpes, gonorrhoea, HIV, hepatitis B, hepatitis C, pubic lice, syphilis, and trichomonas. These are briefly described below.

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Anogenital warts are small lumps that develop on the genitals and/or around the anus (back passage). They are sometimes just called genital warts. They are caused by a virus called the human papillomavirus (HPV). However, most people infected with HPV do not develop visible warts. You can be a ‘carrier’ of the virus without realising it, and you may pass on the virus to others who then develop warts. Treatment options include applying chemicals to the warts or freezing the warts to destroy them.

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Chlamydia is caused by a bacterium (germ) called Chlamydia trachomatis. It is the most common STI in the UK. Symptoms include a vaginal discharge in women, and a discharge from the penis in men. You can be infected with chlamydia for months, even years, without realising it as it often causes no symptoms. However, even if you have no symptoms, you can still pass on the infection and complications may develop if it is left untreated (such as pelvic infection and infertility in women). A short course of an antibiotic clears chlamydia in most cases.

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Genital herpes is caused by the herpes simplex virus. Once you catch this virus it stays with you for life but lies dormant without causing symptoms for most of the time. In fact, many people who are infected with this virus never have symptoms. If symptoms occur, they can range from a mild soreness to many painful blisters on the vulva or penis and surrounding area. A first episode of symptoms can last 2-3 weeks, but may be shorter. Recurrent episodes of symptoms then develop in some cases from time to time, but are usually less severe than the first episode. (It is similar to having ‘cold sores’ on the genitals from time to time.) Antiviral medication can ease symptoms when they develop.

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Gonorrhoea is caused by a bacterium called Neisseria gonorrhoeae. Symptoms include a vaginal discharge in women, and a discharge from the penis in men. Again, some people infected with gonorrhoea do not develop symptoms. However, even if you have no symptoms, you can still pass on the infection and complications may develop if it is left untreated (such as pelvic infection and infertility in women). A short course of an antibiotic clears gonorrhoea in most cases.

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HIV (human immunodeficiency virus) is most commonly passed on by sexual contact. HIV attacks cells of the immune system. Over time (usually several years) the immune system ‘weakens’ so that you cannot defend your body against various bacteria, viruses and other germs. This is when AIDS develops (acquired immunodeficiency syndrome). Many infections and conditions can develop if you have AIDS. Treatment with antiretroviral drugs can reduce the ‘viral load’ of HIV and allow your immune system to work effectively. However, treatment does not clear the virus from the body. Therefore, if you are infected with HIV you will need monitoring for the rest of your life, and treatment is long-term.

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Hepatitis B is a virus that primarily attacks the liver. The virus is mainly passed on by sexual contact, sharing contaminated needles to inject ‘street drugs’, or from an infected mother to her baby. The hepatitis B virus can cause a short term (acute) infection, which may or may not cause symptoms. Following an acute infection, some people develop a persistent infection called chronic hepatitis B. Many people with chronic hepatitis B remain well, but can still pass on the virus to others (as they are ‘carriers’). Some develop serious liver problems. If needed, antiviral medication may prevent or reduce the severity of liver inflammation and liver damage.

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Hepatitis C is is a virus that primarily attacks the liver. Most cases occur in people who share needles to inject ‘street drugs’ that are contaminated with traces of infected blood. There is a small risk that an infected person can pass on the virus whilst having sex. Some people clear the infection naturally. Some people with persistent infection remain free of symptoms, but some have symptoms. After many years of infection some people develop cirrhosis (a severe scarring of the liver), and some develop liver cancer. Treatment is difficult but it can clear the infection in up to half of cases.

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Pubic lice (often called ‘crabs’) are tiny insects about 1-2 mm long (smaller than a match-head). They lay eggs which hatch into lice after seven days. Pubic lice attach strongly to hairs, and do not wash or brush off with normal cleaning. Pubic lice are passed on by close bodily contact, especially when having sex. The main symptom is itch, usually in the pubic hair area. However, you may not have any symptoms, but may still pass on the lice to others. Treatment with a lotion or cream usually clears the lice.

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Syphilis is caused by a bacterium called Treponema pallidum. If it is not treated, it can spread in the bloodstream from the genital region to cause various symptoms and problems in different parts of the body over many years. A short course of antibiotics usually clears syphilis infection.

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Trichomonas is a protozoan, which is a tiny germ similar to bacteria. It can cause an infection that is not normally serious but symptoms can be unpleasant. Symptoms include a vaginal discharge in women, and a discharge from the penis in men. Some people infected with trichomonas do not have symptoms but can still pass on the infection. A course of antibiotics usually clears trichomonas infection.

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There are some other STIs that are uncommon in the UK. For example, donovanosis and chancroid.

Other conditions that are sometimes thought of as STIs

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Scabies

Scabies is a common skin rash that is caused by a mite (a tiny insect). It is usually very itchy. You need close skin-to-skin contact with an infected person to catch scabies. Most cases are probably caught from holding hands with an infected person. The hand is the most common site to be first affected. However, sleeping in the same bed, and sexual contact are other common ways of passing on the mite which is why some people regard scabies as an STI.

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Molluscum contagiosum

This is a common skin rash that is caused by a virus. It is passed on by skin-to-skin contact. The rash consists of small lumps which are pearly-white or slightly pink. Each lump (‘molluscum’) looks like a small wart and is round, firm, and about 1-5 mm across. Sometimes the virus is passed on during the close contact of having sex. So, some people regard molluscum contagiosum as an STI. If it is passed on whilst having sex then the first mollusca to appear tend to be on the skin around the penis or vagina.

However, many cases of molluscum contagiosum are not caused by a sexual contact but by simply touching other affected people. It is a common condition that is seen both in adults and children.

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What are urethritis, balanitis, PID, and vulvitis?

 

These terms describe the site of a problem rather than a particular cause of the problem.

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Urethritis

Urethritis means inflammation of the urethra. The urethra is the tube that passes out urine from the bladder. If you have urethritis you may develop a burning sensation when you pass urine, and men may have a discharge from the end of the penis. Urethritis is usually caused by a sexually transmitted infection, but not always. For example, it can be caused by chlamydia or gonorrhoea (see above) but can also be caused by injury and some other causes.

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Balanitis

Balanitis means inflammation of the tip of the penis. Balanitis is sometimes caused by an STI. However, it is most commonly caused by non-sexually transmitted infections, and skin conditions. Balanitis is common in young children due to non-sexually transmitted infections.

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Pelvic inflammatory disease (PID)

PID is an infection of the uterus (womb). Bacteria that cause the infection usually travel into the uterus from the vagina or cervix (neck of the uterus). An STI is a common cause of PID. Most cases are caused by chlamydia or gonorrhoea. However, some cases are not due to an STI.

Symptoms of PID include pain in the lower abdomen, fever, abnormal vaginal bleeding and a vaginal discharge. Possible complications include: infertility, persistent pain, and an increased risk of an ectopic pregnancy if you become pregnant.

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Vulvitis

This means inflammation of the vulva. (The vulva is the ‘lips’ and skin just outside the vagina.) There are various causes of vulvitis including some STIs.

Conditions that are not STIs

The genitals (vagina and vulva in women, penis in men) can be affected by various other conditions. Some people are confused as to what is and what is not caused by a sexually transmitted infection. For example, the following are not usually due to a sexually transmitted infection:

• Thrush. This is an infection caused by a yeast called Candida. Small numbers of Candida commonly live on the skin and around the vaginal area. These are usually harmless. However, when conditions are good for Candida, it multiplies and may invade the vagina and cause symptoms such as a vaginal discharge.

• Cystitis (bladder infection).

• Bacterial vaginosis. This is a common condition of the vagina. It is caused by an overgrowth of various bacteria that are normally found in the vagina. It is the most common cause of a vaginal discharge

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What are the symptoms of an STI?

Symptoms of each STI can vary from local symptoms affecting the genitals, to symptoms that affect various other parts of the body. The following is not a full list of all possible symptoms. However, these are the common symptoms to look out for:

• A vaginal discharge.

• Abnormal vaginal bleeding.

• A discharge from the penis.

• A sore, ulcer, rash, or lump that appears on the penis or around the vagina, vulva or anus.

• Pain when you have sex.

• Pain when you pass urine (although the common reason for this is a urine infection and not an STI).

• Swelling of the glands in your groin.

But remember, in many cases of STI, no symptoms may develop. However, you can still pass on the infection to others even if you have no symptoms. Therefore, if you think that you may have an STI, it is best to get it checked out.

What should I do if I suspect that I have an STI?

If you have a symptom that you think is due to an STI, or if you have no symptoms but are worried you have caught an STI, then you should see a health professional. You can:

• See your own GP. Your GP can give advice and may examine you. However, if your GP suspects that you may have an STI, he or she is likely to refer you to a GUM clinic (genito-urinary medicine clinic). Some GPs may do tests and manage the situation without a referral to a GUM clinic, …OR

• Go to a GUM clinic directly. You do not need a referral from your GP to go to a GUM clinic.

Until you are checked out, and treated if necessary, you should not have sex. This is to prevent you passing on any infection.

What can I expect when I attend a GUM clinic?

Registration

When you arrive at a clinic you will have to register. You will be asked your name, address, date of birth, contact telephone number, and the name of your GP. This information is treated confidentially. The clinic will not contact you at home or contact your GP without your permission. Also, any records from GUM clinics will not go on your main medical record without your permission.

However, if you have a concern, you do not have to give any details. You can even give a false name. The important thing is that whatever name you do use, you should use the same name for any follow up appointment to avoid any confusion. For example, when you return for the result of any tests. To help identify you as the correct person for any follow up, you will be given a card with your clinic number on which you should bring back to any follow up appointment.

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Initial assessment

You will be seen initially by a doctor, or nurse, or sexual health adviser. They will ask you some questions to try to assess the situation and to determine what tests (if any) you may need. Examples of questions that you may be asked include:

• What symptoms and/or concerns do you have?

• How many people have you had sex with in the last few weeks and were they male or female?

• What type of sex have you had – vaginal, oral, anal sex?

• Have you previously had an STI?

• What is the state of your general health?

• Do you take any regular medication?

• Do you have any allergies?

If you are a woman you may be asked about the date of your last period and whether there is a chance that you may be pregnant as this might affect treatment options.

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Examination

A doctor will usually examine you. You can ask for a male or female doctor, but you may have to return at a different time (or even to a different clinic) if a doctor of a particular sex is not currently available. The examination includes looking carefully at your genitals for signs of discharge, redness, lumps or ulcers. The doctor may also feel your groins (the top of your legs) to check for enlarged or tender lymph nodes (glands). If necessary, the doctor may also do a general examination to check on your general health.

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Tests

Depending on the initial assessment and examination, the doctor may advise on some tests and ask for your consent to do the tests. Tests may include:

A urine test. This can detect some infections of the urethra such as chlamydia. For this test you will be asked to pass some urine into a sterile pot. (It is best not to go to the toilet just before attending a clinic in case you are asked for a urine sample.)

Swabs. A swab is a small ball of cotton wool on the end of a thin stick. It can be gently rubbed in various places to obtain a sample of mucus, discharge, or some cells. The sample can be looked at under a microscope and sent away to the lab for testing.

Depending on what is suspected, a swab can take a sample from: just inside the urethra, inside the vagina, the cervix (neck of womb), throat, and rectum (back passage). For women, to see the cervix and to make sure the swab sample is taken from the correct place an instrument called a speculum is used. This is a small plastic or metal device that is gently pushed into the vagina to hold open the vagina whilst the swab sample is taken from the cervix. Swabs are used to detect chlamydia, gonorrhoea, trichomonas and genital herpes. A swab sample can also detect thrush, bacterial vaginosis and various other bacteria which may not be sexually transmitted infections.

Blood tests. A sample of blood from a vein may be taken. This is mainly used to test for syphilis, hepatitis B, hepatitis C and HIV. Note: sometimes you may be advised to delay having a blood test. For example, following an initial infection of HIV it can take several weeks for a blood test to become positive. So, for example, if you had sex with someone who is HIV positive within the last few days, you may be advised to wait several weeks to have a blood test to see if you have become infected.

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Diagnosis

Sometimes a doctor will be able to diagnose an STI from the examination. Sometimes you will need to wait for the results of some tests. Some test results can be available quickly – during your time in the clinic. For other tests it takes a few days for the results to come back from the lab. You may be given an appointment to come back for the results of tests, or in some situations you may be able to phone for the results.

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Advice about sexual partners

If you are diagnosed with an STI then the clinic will encourage you to tell any current or recent sexual partners that you have an infection. You are not obliged to do this or to give out any information about other people. However, it is best that any recent sexual partners should know that they might also be infected. They should be offered testing, and treatment if necessary, to prevent the infection being spread any further. This telling of sexual partners is sometimes called ‘contact tracing’. If you prefer, clinics can contact people anonymously if you do not wish to tell them yourself.

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Treatment

The treatment that you will be offered depends on what STI is found. For example, a short course of antibiotics can usually clear away chlamydia, gonorrhoea, syphilis, and trichomonas. A cream or lotion can clear pubic lice and scabies. Topical treatments can usually clear most anogenital warts. Treatments for genital herpes, hepatitis B, hepatitis C, and HIV are more involved and complex. You will be given advice about what treatment options you have and given time to ask questions. Also, there are separate leaflets for all of these conditions that gives details about treatment options.

If you are prescribed antibiotics then it is important to finish the full course of tablets, or else the infection may not be fully cleared. If you develop side-effects then seek advice from the GUM clinic or from your GP as to what to do. Do not simply stop taking the medication. For some infections you will be asked to return after a course of treatment to check that the infection has gone.

Do not have sex again until the time advised by the clinic. Depending on the infection, this may be for a certain length of time after treatment is finished or it may be until you are given the ‘all clear’ from a repeat test. The aim is to prevent you from passing on the infection to others.

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Advice from a sexual health adviser

Most clinics will have a sexual health adviser. You are likely to be seen by the advisor in addition to being seen by a doctor or nurse. A sexual health adviser is specially trained and can:

• Tell you more about STIs and how to avoid catching them in future. For example, the risk of infection increases with the number of changes of sexual partner. Wearing a condom during sex helps to prevent against STIs.

• Give you tips on how to cope with any current symptoms.

• Offer you free condoms which can help to prevent STIs.

• Give advice about what to tell your sexual partner or previous partners.

• Help you with contacting previous sexual partners who should be tested or treated. For example, you may be given a card with a number on it, plus a printed message advising the person who is given the card to visit the clinic and to bring the card along. This helps to match them with your notes.

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Other services

In addition to diagnosing and treating STIs, if needed, a GUM clinic can also usually:

• Do a pregnancy test.

• Arrange counselling if you are pregnant and are not sure what to do.

• Arrange counselling about the decision to have an HIV test.

• Provide advice about contraception.

• Provide emergency contraception.

• Do a cervical smear test on women if one is due.

• Diagnose and treat some other conditions of the genitals that are not sexually transmitted. For example, a urine infection, thrush, and some skin conditions affecting the genital area.

Further help, information and advice:

Sexual Health Information Line

Helpline: 0800 567 123 Textphone: 0800 521 361 Provides information on all aspects of STIs including contact details for GUM clinics.

FPA

Helpline: 0845 310 1334 Web: www.fpa.org.uk Provides information and advice on all aspects of contraception and sexual health.

British Association for Sexual Health and HIV (BASHH)

Web: www.bashh.org

BASHH is a professional association but their website includes contact details of GUM clinics.

SEXUAL HEALTH – TEST

If you are worried about your sexual health or in need of special tests, here at Clinica we offer a variety of tests. Call us today or fill out this form to arrange for an appointment.

• Chlamydia, Gonorrhoea and others

• 1 Minute HIV test (at £75)

• Completely confidential

• Screening tests (blood, urine or swabs) – charged according to the level of testing required

GYNAECOLOGIST

General consultations

At Clinica, we offer both general consultations and consultations with specialist practitioners. Our private clinic in a central London location provides a professional, yet friendly atmosphere, with helpful and experienced staff available to perform private consultations.

We are also proud to offer home visits for consultations to patients residing within London, at competitive prices. In addition to private consultations with our doctors and home visits, we provide referrals to hospitals when needed.

In our private London clinic, we have two types of consultations; standard consultations (up to 20 minutes) for £70, and extended consultations (up to 30 minutes) for £100.

Consultations generally last 20 minutes, apart from certain situations such as health screens, full medicals and psychological assessments, when a double appointment could be required. If longer appointments are requested, then we shall endeavour to meet your needs.

All patients are treated with the utmost confidentiality and professionalism, and our experienced and knowledgeable GPs will aspire to provide you with a private consultation at our clinic, once requested, on the same day or, should this not be possible for any reason, within 24 hours. Prescriptions are included following a consultation when applicable.

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Home visits

Here at Clinica, we are happy to provide home visits within the London area at a very competitive rate – starting from £150 per visit depending on distance from the clinic and time of day.

These private home consultations are performed to the same exceptional standards as our in-clinic consultations, and as always patients will be treated with respect and care.

Patients, especially those living abroad or outside London can request appointments by email or fax.

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Price Overview

· Standard consultation (up to 20 minutes) – £70

· Extended consultation (up to 30 minutes) – £100

· Home visit (within London area) – starting from £150, depending on distance from clinic and time of day

SEXUAL HEALTH

What is Sexual Health?

Being healthy is about feeling good physically, mentally and emotionally. Being sexually healthy means that we avoid infections, illnesses and take responsibility to ensure that we protect ourselves and others, emotionally and physically.

In this way, sexual health is an important and integral part of overall health. When we are sexually healthy we make the best decisions for us that we can with regard to our sexual partners and sexual practice.

For people who choose to be sexually active, sex can be enjoyable, safe and should based on mutual respect and agreement.

The World Health Organisation (WHO) defines sexual health as:

• Equality and mutual respect

• To negotiate with your sexual partner(s) to ensure that the sex you have is the sex you want

• Protecting yourself and protecting others

• Protecting yourself and others from sexually transmissible infections, unintended pregnancy etc.

• Awareness of emotional and psychological reactions

• Be aware of the emotional and mental health difficulties which could arise from undue pressure to have sex or to engage in a sexual activity which makes you feel uncomfortable

• Embracing diversity

We should acknowledge different sexualities without discrimination, prejudice or judgement.

 

This website has been developed to allow you to do just that. It contains all kinds of information on a wide variety of sexual health issues. It also has information about organisations and specialist services that can help with very detailed and personal enquiries.

For many people sex is an important and healthy part of our lives. Sex can be fun, exciting, wonderful and loving. Being sexually healthy means making a happy, chosen and healthy decisions about your sex life. Being sexually healthy also means protecting yourself and your partner/s from sexually-transmitted infections (STI’s).

Sexual Problems

Sexual function is dependent on both physical and emotional factors.

Sexual problems are common in men and women and can cause great distress.

Types of sexual problems include:

• Loss of sex drive

• Inability to maintain an erection

• Pain with sex

• Inability to reach orgasm

• Premature ejaculation and many more

Sexual function can be affected by illness, stress, medication and by relationship problems.

Information taken from NHS Tayside Sexual Health and Wellbeing website – http://www.sexualhealthtayside.org/index.php

For further information:

http://www.direct.gov.uk/en/HealthAndWellBeing/HealthyLiving/DG_4002934

http://www.bbc.co.uk/relationships/sex_and_sexual_health/

http://www.nhs.uk/chq/Pages/category.aspx?CategoryID=118