[5 min read] Managing women’s sexual health in primary care

Women often feel more comfortable approaching their primary care practitioner for their sexual health needs than visiting a sexual health clinic, so the general practitioner must be comfortable discussing sexual health.

For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in Women’s Health.

Women’s sexual health in primary care can be broadly categorised into:

  1. Taking a sexual history
  2. Determining pregnancy risk
  3. Discussing contraceptive needs
  4. Testing and treating sexually transmitted infections (STIs)
  5. Sexual problems

A sexual health consultation begins with the practitioner obtaining a basic history, including underlying health conditions, family history, regular medications and allergies. Taking a sexual history also involves asking the woman if she is sexually active and, if so, with whom. Having multiple sexual partners is associated with a higher risk of sexually transmitted infection. It is also prudent to establish if the woman is using any form of contraception, particularly barrier contraception.

It is important to ascertain what type of sex the woman is engaging in, e.g. vaginal, oral or anal sex. This is important when considering which types of tests to offer for STIs. A timeline should also be established, being mindful of window periods, the timescale during which an acquired STI may not produce a positive result. Window periods are typically two weeks for chlamydia and gonorrhoea but can be up to 12 weeks in the case of syphilis and hepatitis.

All sexually active women should be offered testing for HIV, which has a typical window period of 45 days for most fourth-generation tests. It is useful to be familiar with the treatment of common STIs such as chlamydia and where to refer for more complex conditions such as HIV and hepatitis.

A pregnancy test should be offered for any woman known to have had any unprotected vaginal intercourse since her last menstrual period. Most pregnancy tests may not produce a positive result for up to three weeks, so the woman may require recall for a follow-up test. For the woman who has recently had unprotected intercourse, she may be offered emergency contraception in the form of the “morning after pill” or the copper intrauterine device (IUD).

Discussing contraceptive needs should also be considered. As a general practitioner, it is important to understand the types of contraceptives available, their mechanisms of action, side effects, benefits, risks, and contraindications. It is also useful to know which contraceptives are available via government subsidies.

For the woman who is not planning pregnancy, long-acting reversible contraception (LARC), sometimes known as the “set and forget” methods, are highly effective and convenient. LARC includes the IUD, the hormonal intrauterine system (IUS), the contraceptive implant, and the contraceptive injection.

Other methods of contraception include combined hormonal contraception (available as a pill, patch and vaginal ring) and the progestogen-only pill (POP). These are less effective in the real world than LARC, as they require more user input; however, they remain some of the most popular methods in Australia.

The Family Planning Alliance Australia has some excellent resources for clinicians and patients to facilitate making the right choice.

Sexual problems are a common reason for a woman to visit her general practitioner. The most common sexual problems are painful or uncomfortable sex, reduced libido, and orgasm disorders. Often these conditions have a psychological component and may be best addressed by a psychosexual medicine practitioner; however, a basic understanding of psychosexual medicine may aid in an initial consultation.

Sexual health consultations generate significant anxiety in patients, and therefore the practitioner must maintain an open and non-judgemental attitude when conducting these consultations.

Dr Samantha Miller, MBChB

Read another article like this one: How to manage pelvic pain in primary care


References

  1. Royal College of General Practitioners. E-Learning: Sexual Health in Primary Care https://www.rcgp.org.uk/learning/online-learning/ole/sexual-health-in-primary-care.aspx
  2. Australian STI Management Guidelines (2021). https://sti.guidelines.org.au/
  3. Marie Stopes Australia (2022). Contraception. https://www.contraception.org.au/
  4. Department of Health, State Government of Victoria, Australia (2021). Better Health Channel: Contraception – Choices. https://www.betterhealth.vic.gov.au/health/healthyliving/contraception-choices
  5. Gallagher J, Beattie V, Vrahmides, J (2014). Tips for GP trainees working in family planning. British Journal of General Practice. 64 (618) 52–54. https://bjgp.org/content/64/618/52/tab-article-info
  6. Family Planning Alliance Australia (2022). https://www.familyplanningallianceaustralia.org.au/fpaa/
  7. Sexual Health and Family Planning Australia (2022). http://shfpa.org.au/
  8. Faculty of Sexual and Reproductive Health (2016). UK Medical Eligibility Criteria (UKMEC). https://www.fsrh.org/ukmec/

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