Sexual and Reproductive Health at a Glance

Catriona Melville

• Publisher: Wiley-Blackwell
• Year: 2015
• ISBN:
  9781119235163
• Edition: 1
• Topic: Medicine
• Subtopic: Diseases & Allergies

Sexual and Reproductive Health at a Glance provides a highly-illustrated, visual introduction to all aspects of sexual and reproductive health, from basic clinical examination skills to the management of acute Sexually Transmitted Infections (STIs) and unplanned pregnancy. Covering topics which are often difficult to access as an undergraduate or junior doctor, Sexual and Reproductive Health at a Glance focuses on the fundamental principles in delivering effective contraception and sexual health care. It features high-yield information on the essential clinical topics covered in the Community Sexual and Reproductive Health (CSRH) curriculum. Presented in the familiar, easy-to-use, at a Glance format, Sexual and Reproductive Health at a Glance:

•Provides a quick revision of basic anatomy, physiology and clinical skills
•Offers balanced coverage of both male and female GU pathology, STIs and contraception
•Includes material on practical gynaecological procedures performed in the out-patient setting
•Presents a holistic approach to issues dealt with in this specialty
•Takes a global perspective by addressing SRH issues in different cultures and resource-limited settings
• Includes a companion website at www.ataglanceseries.com/sexualhealth featuring a selection of case scenarios and interactive flashcards for self-test

This brand new title will provide an invaluable resource for medical and healthcare students, junior doctors, SRH trainees and busy clinicians working in other specialties.

Part 1
Principles of sexual and reproductive health

Chapter

1. 1 Sexual and reproductive health fundamentals

Don't forget to visit the companion website at www.ataglanceseries.com/sexualhealth where you can test yourself on these topics.

Chapter 1
Sexual and reproductive health fundamentals

Background

Sexual and reproductive health (SRH) is a holistic specialty providing a broad range of client-centred clinical care. The cornerstones of SRH services are:

• provision of contraception
• diagnosis and management of sexually transmitted infections (STIs)

Most specialist centres however offer a wide range of services (Figure 1.1).

Historically provision of SRH was fragmented in the UK with most aspects of care being provided by either ‘Family Planning’ clinics (often community based and mainly offering contraception) or Genitourinary Medicine clinics (GUM; primarily hospital based and offering diagnosis and management of STIs). In the mid- to late 1990s the process of integration of services began and this accelerated following the publication of Sexual Health Strategies in England, Wales and Scotland.

Both GUM and reproductive health providers are concerned with preventing the potential adverse consequences of sex – namely STI acquisition and unplanned pregnancy; therefore, integration of the specialities is advantageous both in terms of efficient use of resources (including clinical expertise) and more importantly to enable delivery of client-focused care. Modern SRH services are often community based and offer a variety of choices for client access such as drop-in clinics, telephone advice lines and services for minority and vulnerable groups. In the UK, the specialty has close reciprocal links with many specialties including primary care, gynaecology, dermatology, infectious diseases and urology. Certain aspects of SRH care can be provided in non-specialist settings such as primary care and this is commonplace in the UK.

Globally there is wide variation in the nature and extent of SRH provision. Sexual healthcare is provided by dermatovenereologists in some areas of Europe and elsewhere by primary care physicians, gynaecologists or infectious disease specialists.

Confidentiality

Codes of confidentiality are paramount to SRH services given the sensitive nature of information that clients share with healthcare professionals. There are three areas of law which are relevant to protect personal health information:

• The Human Rights Act 1998: a right to ‘respect for private and family life’
• The Common Law of Confidentiality: general health confidentiality in the UK is a common law duty
• The Data Protection Act 1998: regulates processing of identifiable data

The General Medical Council (GMC) and Nursing and Midwifery Council (NMC) offer guidance on confidentiality including advice on situations when personal information can be disclosed (Box 1.1). The Department of Health's ‘Confidentiality: NHS code of practice’, sets out standards to ensure that patient information is handled as fairly, lawfully and transparently as possible.

Additional statutory regulations exist specifically for services managing STIs. Clients attending these services should be assured that their information will not be shared with anyone outside the service unless specific concerns arise (e.g. child protection issues).

Record keeping

Many SRH clinics use unique clinic numbers in place of the clients name to preserve anonymity. This unique number (usually accompanied by date of birth) is used throughout the patient's written or electronic patient record (EPR) and for any specimens or forms. Concise record keeping is vital for client management, to facilitate audit and to record obtaining informed consent. Standard history proformas are used in many services. They support more complete and timely history taking and facilitate audit. They can also be helpful in documenting minimum data sets which are mandatory in some regions.

Consent

Before any examination or investigation can take place consent must be obtained in keeping with General Medical Council (GMC) guidance. Consent may be given orally or in writing or it may be implied, e.g. by rolling a sleeve up to have a blood test taken.

• Minor investigations: as long as the client understands the nature and purpose of the proposed investigation verbal consent is usually satisfactory, e.g. chlamydia testing
• Complex procedures or those with significant consequences: written consent should be obtained, e.g. vasectomy, abortion

In practice, most of the investigations or procedures undertaken in SRH settings require implied or verbal consent only. Consent should be clearly documented in the client's record along with evidence that the patient was fully coun...