The Blog

Sexclamation! - Part Four

Here's the thing - the choice of contraceptives now is quite baffling. I can see the mist of confusion settle on women's faces as I start working my way through the clinic leaflets, all about choice. I'm going to write this from the heart, having had 30 years experience as contraception lead for my team.

Sexclamation! - Part Four

So - how do I feel knowing HuffPost readers are waiting for my STI results with me?

This is day three since I was tested, and I still have another two days to go before I get my results.

If I imagine having to tell my new partner - well we've been together three years so that's not exactly new - that I am HIV positive - I feel this hot, electric, fizz of fear, shame and embarrassment crackle through my limbs and up my spine to my neck. What if I have to do that? What then? Will I lose everything?

Here's the thing. Life presents us all with difficult decisions. How is not having the test, and not being honest about the result going to help anyone? I know - and you only have to recall the recent news topic about huge numbers of people who were infected with HIV from having unsafe blood products in the UK in the 1970's - that not every case of HIV is sexually transmitted. In addition, if I have got it, how do I know he didn't give it to me? We'll have to wait for his test results, and if they are positive, will we ever know who gave it to the other?

I know that there are very skilled teams of health professionals that help and support people with positive STI diagnoses every day. It's their job ( I'm one of them). If I did test positive to anything, I would not be on my own. The care and support available for sufferers of STIs, and that includes HIV, is really superb. I am trying to find comfort in the skill and care of my colleagues. I just hope I won't need to call on them.

While I'm waiting, I need to pass the time productively so I'm going to write today about contraception.

Here's the thing - the choice of contraceptives now is quite baffling. I can see the mist of confusion settle on women's faces as I start working my way through the clinic leaflets, all about choice. I'm going to write this from the heart, having had 30 years experience as contraception lead for my team. I want to help any reader from the HuffPost who isn't sure about contraception, to feel better about making these choices.

First, the most important point: contraceptives are safe! Forget the horror stories. The emotional, psychological and physical consequences of unplanned pregnancies, whatever the outcome of those pregnancies, is likely to be far worse. Don't listen to what happened to your next door neighbour's mother when she had a coil fitted 20 years ago! - When you go into these stories there is usually a reason why something went wrong, and anyway, this was 20 years ago! Modern devices have been precisely crafted and are truly fit for purpose - believe me! (I used a coil myself for about 10 years - if you needed to know that!)

The Faculty of Sexual Health & Reproductive Healthcare (FSRH) ( in the UK, has highly qualified specialist teams who have reviewed up-to-date medical evidence about the safety of all methods of contraception. They recognise that for women who are healthy (that is have a normal BMI, are non-smoking, and have no specific medical conditions or relevant family history) use of any currently available contraception is likely to convey benefit and not harm.

For women who have risk factors, contraception may be used, but this requires an assessment and consultation from a qualified practitioner. We work in our clinics following these guidelines, to ensure women are offered the most appropriate method for them, and are correctly monitored/followed up.

There are now 16 methods of contraception! Yes - 16! So one would hope there is something for everyone! For the sake of brevity, please see the Family Planning Association website (this a non-biased, not-for-profit, charitable organisation) where there is an online Contraception Tool Kit to help you choose the best method for you:

You may like to know that in the UK there has been a campaign to promote the most reliable and effective forms of contraception. These are methods that you can fit and forget, and work supremely well without you having to do anything at all! By this we mean Long Acting Reversible Contraception - known as LARC.

These methods are: the contraceptive implant (Nexplanon), the injection (Depo provera) , the intrauterine device (or "coil") (e.g. Copper T 380) and the so-called hormone coil (Mirena IUS/or the mini device Jaydess) . These methods used to be thought of as "expensive" and were reserved for older women who didn't get on with the pill. But this is NOT the case - read on.

However NICE (the National Institute for Clinical Excellence) in the UK, did a huge piece of work back in 2005. They worked out with statisticians, how many unplanned pregnancies would result from typical use of a variety of methods, compared to typical use of the pill or the condom, and how much the outcomes of dealing with those pregnancies (live births, miscarriages, terminations and ectopic pregnancies) would cost the NHS. They found that use of these LARC methods was highly cost effective, compared to the pill and the condom, even when they had only been in place/in use for one year! Here's the thing - even though they cost more to purchase upfront and insert etc, as they can remain in place for 3-5 years or more, over time they are extremely efficient, and hence they are highly cost effective. The study focused on financial cost because how can you estimate the emotional and psychological effects of dealing with these unplanned pregnancies? But if women use more effective methods, and there are less unplanned pregnancies, this will of course reduce the emotional and psychological burden as well.

So - now in the UK, anyone, including a young person, will be offered the full range of contraceptives, including any of the above mentioned LARC methods, whenever they visit the clinic. In 2015/16, 38% of women attending Sexual & Reproductive Health clinics were using LARC methods1. This figure has shown a steady increase over the past 10 years. About 30% of women aged under 20 will choose a LARC method compared to 50% of those aged 35 and over. Implants are the most popular LARC methods chosen by young people, and coil/IUS use increases in popularity with age.

One important point to make here, is that contrary to popular belief, the coil/IUS is safe for young women and for those who have never had a pregnancy. This has been extensively researched and the FSRH guidelines mentioned earlier, do state this quite clearly. What young girls need is not to be discouraged from using a highly effective contraceptive method like a coil/Mirena IUS, but, to be regularly tested and treated for STI's, whichever method they choose. It is the undiagnosed STI that is likely to do damage, and not the coil/Mirena IUS.

There is a chapter in my book Dating Daisy that refers to the need for Emergency Contraception ("the morning after pill"). If you want to know more, have a look! But I do have to say loud and clear, that if you have had an accident, and don't want to be pregnant, get yourself to the clinic as soon as possible, as there is a lot we can do help you - but only if we see you in time! You need to get there asap! Don't delay, go today or first thing tomorrow morning! Don't leave it to chance!

So - it's day four of our waiting game tomorrow! Let's see what I can write about tomorrow to pass the time!



1. Statistics on Sexual and Reproductive Health Services England 2015/16 Published 19 October 2016

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