Sexual Health http://www.lewishamcepn.community/ - PowerPoint Presentation

Sexual Health http://www.lewishamcepn.community/ @LewishamCEPN Thursday 22nd June 2017

IntroductionWhy are we here today? Lewisham CEPN seasonal events

What does today look like?Introduction to Sexual Health in Lewisham A range of clinical topics led by expert speakersSexual health history takingSetting up a LARC fitting service at your practice HIVFGM and Child Sexual ExploitationSwabs – dos and don’ts Action for practiceFurther training and resources

Mythbusting – Contraception and Sexual Health QuizSheila Bell and Sue Chard

Summer Lovin ’ Quiz True or False

1 If a 15 year old attends to see you regarding painful periods, it is not necessary to ask their mum to leave the room at any point during the consultation, as you have known the family for some time? False

2 If a patient says they have had a full screen for sexually transmitted infections, and all the results are negative, then he/she can be reassured that they do not have an STI? False

False 3 If a woman complains of worsening headaches whilst on the COCP(combined contraceptive pill), we must get her to see a doctor in 3 months for a review?

4 The most effective method of emergency contraception is the newer oral pill ulipristal acetate UPA-EC ( EllaOne )? False

5 Both EllaOne and the copper IUD can be given up to 120 hours following UPSI? True

6 It is not recommended to give emergency contraception more than once in a woman’s menstrual cycle? False

7 If a woman chooses to have an emergency coil fitted at another clinic tonight it is good practice to give her oral emergency contraception now? True

8 Hormonal contraception should be started straight away after taking ulipristal acetate for EHC? False

9 The vaginal ring ( NuvaRing) and transdermal patch (EVRA) contain oestrogen? True

10 The sub-cut injection Sayana Press, is less reliable than IM Depo-Provera ? False

11 A Woman has to wait until she has stopped breast feeding before she can start the COCP? False

http://www.sayanaanswers.co.uk/home

Sexual Health History Taking Sheila Bell and Sue Chard

Sexual health risk assessment© Faculty of Sexual and Reproductive Healthcare + Partner history Condom use

Partner History (1)Do you have a partner at present?(Is it a sexual relationship?) (Is your partner a male or female?)How long have you been together?Have you had any other partners in that time? Has he/she? © Faculty of Sexual and Reproductive Healthcare

Partner History (2)Do you have a partner at present? (Is it a sexual relationship?) (Is your partner a male or female?)How long have you been together?Have you had any other partners in that time? Has he/she? To assess blood borne virus risk:Have you ever had sex with a man? [To men, if not already clear] Have you ever had sex with someone from another country? Which country? Have you ever injected drugs or shared drug-taking equipment ? © Faculty of Sexual and Reproductive Healthcare

Partner History (3)Do you have a partner at present? (Is it a sexual relationship?) (Is your partner a male or female?)How long have you been together? Have you had any other partners in that time? Has he/she?To assess blood borne virus risk:Have you ever had sex with a man? [To men, if not already clear] Have you ever had sex with someone from another country? Which country? Have you ever injected drugs or shared drug-taking equipment? Extra questions to consider: Have you ever had sex you didn’t want/agree to? Have you been so drunk you had sex when you hadn't intended? Have you ever paid for or been paid for sex?

Condom questionsDo you use condoms?Are there times when you haven’t managed to use condoms? Most couples don’t manage to use condoms 100% of the time – do you?Do you have any questions about condom use?Ask about sexual practices? – especially if MSM ever: Have you ever had anal sex?’ Important for a) risk assessmentb) for health promotion i.e. lubricant © Faculty of Sexual and Reproductive Healthcare

Setting up a LARC fitting service in your practiceLesley Nurse Specialist, MSD

HIV critical incidents and lessons for practice Dr Charles MazhudeConsultant GUM/HIV Medicine University Hospital Lewisham

FGM and Child Sexual ExploitationVivienne JohnstoneClinical Nurse/Safeguarding LeadSexual Health Services Lewisham

Safeguarding Young People: FGM and Child Sexual Exploitation

Current Issues in Safeguarding Young People who access Sexual Health Trafficking On-line bullying Digital stalking Child Sexual Exploitation (CSE) Gangs Radicalisation Drug and alcohol abuse Teenage pregnancy Healthy Teenage relationships Honour Based Violence Forced marriage Female Genital Mutilation (FGM) Domestic violence Drug and alcohol abuse Self harming

'Being raped by a gang is normal – it's about craving to be accepted‘ (June 2012)

Child Sexual ExploitationSexual exploitation of children and young people under 18 involves exploitative situations, contexts and relationships where the young person (or third person/s) receive ‘something’ ( eg, food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing, and/or another or others performing on them, sexual activities. Child sexual exploitation can occur through the use of technology without the child’s immediate recognition; for example being persuaded to post images on the internet/mobile phones without immediate payment or gain. Violence, coercion and intimidation are common. Involvement in exploitative relationships is characterised by the child’s or young person’s limited availability of choice as a result of their social, economic or emotional vulnerability. A common feature of CSE is that the child or young person does not recognise the coercive nature of the relationship and does not see themselves as a victim of exploitation (Association of Chief Police Officers CSE Report - 2013).

Warning Signs/Risk Indicators These are the 4 commonest indicators of exploitation; -Going missing from home -Associating with older people -Breaking away form family/friends/key workers -Not attending school

Other Warning signs -Experimenting with drugs and or alcohol -Being more secretive -Involved in offending behaviour -Unexplained mobile phone/phone credit -Accepting lifts in different cars -Travelling to other locations -Sending and or sending inappropriate images -Spending increasing time on social networking sites Multiple STIs

Identifying CSE in Sexual HealthSafeguarding assessment of young person attending services Talking to the young person honestly and working with them (in some instances it may not be appropriate to tell a young person what is happening as it may compromise their safety) Multi agency working and information sharing E.g. MET meeting, linking with other agencies including social care, ATHENA, Safer London, Drug and alcohol services, police, maternity services, youth services, education etc.. Referring to other agencies where appropriateFollow up

Key Questions At Assessment Schooling Mainstream or non mainstream school (Name of School) History of, or current social work involvement. Attends or poor attendance? Any other agencies involved. Friends at school History of physical, sexual , emotional abuse or neglect. Any other agencies involved e.g. CAHMS, school support worker, voluntary agencies. Self harming Accessing porn Sharing images/sexting Home life Sexual History Lives with who? Gets on with Parents/Carers Where did they meet their partner Looked after child (hostel ,foster care ) Consensual sex Other siblings. Do you get on? Where do they have sex Family dynamics e.g. new step parent/family breakup Who instigated sex Age of partner Consider Rewards or favours Gang involvement Number of sexual partners Mobile phones (More than one. Who pays for it) Name of partner What do you do out of school Where does your partner go to school, college, work Is your partner nice? Where does he take you Young carer

FGM Key Points FGM is a cultural procedure. It is not embedded in religionThere are 4 types of FGM To perform FGM or facilitate FGM to happen is illegal in the UKFGM is not necessary in any circumstance and causes significant physical and emotional harm

FGM latest guidance Consider the risks: Guidance includes assessment templates to use when seeing patients Consider the patient and risks to other girls/unborn within the family Refer to an appropriate agency for further support e.g. Medical support, ATHENA, Africa advocacy association, social care, police, MET meeting

Whatever the risk : Talk to patients about the health complications of FGM and refer on if requires further support Tell patients FGM is illegal to perform or to facilitate Consider safeguarding risks if female children under 18 in family and refer if an immediate risk I f the patient is under 18 and has had FGM- Mandatory reporting to the police (101) Ensure that the patient understands that they have done they have done nothing wrong Document what has been discussed

Mandatory reporting duty Ensure the young person knows that they have done nothing wrong and that have to inform police Notify any girl under 18 who has had FGM to the police: Dial 101 Contact s/care and inform re action taken Record the crime number in the notes Record potential risk on CP-IS (NHS National Spine)

Questions?

Swabs & pH paper – dos and don’tsSheila Bell and Sue Chard

Vaginal discharge top 3Physiological CandidaBV © Faculty of Sexual and Reproductive Healthcare White curdy discharge Itch, irritation, soreness, redness Thin grey/white discharge Generally not sore Fishy/offensive odour pH < 4.5 pH > 4.5 pH < 4.5

Update on changes in local sexual health servicesDr Katie ColeConsultant, Public Health

Closing thoughts…Think sexual health!Spread the word - spread the careEvaluation card What will you change after this?Certificate of attendanceTop Tips and presentations will be on the website shortly

Thank you for coming.http://www.lewishamcepn.community/ @LewishamCEPN