Dr Naomi Sutton will never forget the day a patient ejaculated all over her hands in her Rotherham clinic. The sexual health consultant was examining the man on a bed, when he suddenly said: “Oh god I’m going to wee!” Before she could move away, he came. In her 16 years as a doctor, she’s seen a lot of erections – but never this. “It was a shock, but thankfully I was wearing gloves,” she laughs, unphased.
Trained in genitourinary medicine (GUM), Sutton works three days a week running clinics for contraception, STI testing and HIV treatment. She also sees women who are victims of domestic violence and assault and, because of her seniority and the nature of her work, she gets 30 minutes with each patient.
Her schedule is the envy of senior sexual health advisor Kevin Turner from Bournemouth and senior sexual health nurse Sarah Mulindwa, who has worked at London’s Dean Street clinic for 12 years. Both get just 10 minutes a patient. But while the trio, who all feature in E4′s The Sex Clinic, work in different places, their days run very much the same – non-stop from the moment they get in.
“My day starts really early,” Turner says. “The phone is ringing. I’ve got to get through six people an hour. There are 900 HIV patients who need medication and people panicking about STI symptoms that need talking to. I barely have time to ask what their name is,” he jokes.
For Mulindwa, running Europe’s biggest sexual health clinic involves overseeing staff rotas, handling complaints, giving out emergency contraception and testing those with symptoms (Dean Street is the only place in the world that gets results back in less than six hours). Like the others, she also spends time dealing with PrEP: the drugs recently confirmed to stop the transmission of HIV between partners.
They can never predict what each day will hold. They might, like Sutton, have to tell a 91-year-old widower he has caught gonorrhoea from a sex worker. Or, they will be there when tests confirm someone’s partner has cheated on them. “We might be testing for STIs, but we’re actually like life counsellors helping people through those tough times,” says Mulindwa.
STI rates in England have been rising for years and are up 5% in the last 12 months alone. Some STIs are more prevalent than others: syphilis and gonorrhoea are up 70% and 26% respectively year on year, according to Public Health England statistics.
This rise is happening against a background of nationwide structural changes and funding cuts: in 2013, sexual health was made the responsibility of local councils, rather than NHS England. This means they share a funding pool with speed bumps and bin collections. This move has seen a reported £64m less being spent on services, equivalent to 10% of their overall budget, according to the British Association for Sexual Health and HIV.
In February 2019 the Commons Health and Social Care Select Committee was warned the cuts have left local authorities at “tipping point”, unable to go on – something Sutton, Turner and Mulindwa have all been impacted by.
Turner says the clinic turns away more patients than it is able to see – even if they have symptoms – because demand completely outstrips capacity. “We would never have done that before,” he says.
There’s already a queue around the block when Mulindwa arrives at work at 7.45am – and she knows 60-70% of those people will not be seen. “There really is nowhere else [they can go], because Dean Street is the biggest clinic in London – so if we can’t see you, who can?” Sutton has halved the number of staff on her books, unable to pay their wages. “If someone calls in sick it is a complete disaster, we exist on a shoestring.”
“For every politician who cuts our funding, I wish they’d come and spend a day in our shoes. See what we really do.”
The NHS cannot run on good will alone, says Turner, who estimates he works an extra 10-12 hours every single week unpaid. “We love our jobs and they trade on that, but for every politician who cuts our funding, I wish they’d come and spend a day in our shoes. See what we really do.”
The impact of funding cuts is a major concern, but so is their patients’ tendency to Google-diagnose and self-medicate. In the Bournemouth clinic, Turner sees many patients who’ve holidayed in Ibiza and, on the plane home, order medication from high-street pharmacists so they don’t have to go for a STI screening. This casual attitude to sexually-transmitted infections fuels a future epidemic of antibiotic resistance, he says.
The problem with people self-medicating is that people guess what might be wrong and often end up altering the balance of other bacteria in their body as a result, Sutton explains. When she started her career, she says doctors used to just give an oral dose of cefixime for gonorrhoea, “then we went to a higher dose given in the bum and now, even that doesn’t work.”
“There’s an attitude, especially among young people, that it doesn’t matter whether it’s chlamydia or gonorrhoea, just take a pill and fix it,” adds Turner. “But we’re entering an era of antibiotic resistance. It’s happening already.”
For some, self-medicating is often down to a lack of awareness around STIs – but sex education in Britain has also come under increasing scrutiny for leaving teens unprepared for the wider world of sex and relationships. Some students don’t even have classes if they fall foul of the postcode lottery, and are left to teach themselves via porn or playground rumours. The new mandatory curriculum in September 2020 aims to address these gaps, but sexual health workers still see the consequences of uninformed ignorance.
Sutton met a man who had a (potent-smelling) infection under his foreskin because he’d never been taught he needed to wash there. She also has weekly visits from women who are worried about entirely normal discharge in their knickers –“women who were never told that’s just how their vagina cleans itself.”
Mulindwa has even seen people putting themselves in danger of contracting diseases because of a lack of knowledge. “One adult man said he only used condoms with partners for vaginal sex not anal because he thought he was safe from STIs,” she says.
All three wish that, as a society, we were more open about sex. Perhaps then, they wouldn’t encounter unnecessary embarrassment from people who visit the clinics. “Everyone is always apologising for hair on their legs or genitals, and smelly feet,” says Sutton. “Everyone is worried about how they look naked.”
Turner says he’s been banned from dinner parties because all he wants to do is talk shop – but that doesn’t stop concerned friends from sending him photographs of their genitals in lieu of visiting a clinic. “I guess it’s a bit like when you’re a hairdresser and everyone wants a free haircut,” he laughs.
In fact, it’s a misconception that Sutton, Turner and Mulindwa spend their days looks at people’s genitals – and also that they’ll be “dynamite” in the bedroom as a result of their job. “Everyone thinks I’m some Korean contortionist who is going to make them come in two seconds,” jokes Turner.
Actually, their day-to-day is far less about the physical treatment and more focused on the mental side of it. “The medical bit is dead easy – you get chlamydia, you have some antibiotics, boom, it’s done,” says Sutton. “It’s all the emotional stuff linked to it that actually needs addressing.”
“We live in a world of secrecy and shame and it’s our job to help people talk about what they’re going through.”
Turner says he always asks patients “Why are you having sex?”, as he finds it a quick way to get to the root of what they need to talk about. “Sex is a really cheap way to self-medicate but it’s a temporary home,” he says.
The best thing he can give patients is his time, not treatment. “Often the presenting issue is not actually relevant, this is all about why they’re having sex and the communication issue,” he says. “People just want me to listen to them.” Many worry they’re the only ones who are lonely or struggling to make a relationship work. We all just want to be vulnerable sometimes.”
The hardest group to work with are straight men, they tell me. “They are so paranoid and don’t want to open up – that culture of masculinity is damaging them,” says Turner. “But really, they just want someone to talk to about why they can’t get it up or are suffering with premature ejaculation. In the end, they’re always the ones that overshare with you.”
And when people do overshare, they often end up telling stories they’ve never shared with anyone else – something all three say is a “huge privilege” in their job. Mulindwa has even met people who come back to visit – those who have moved abroad and “never found anywhere as good as Dean Street”.
“We live in a world of secrecy and shame and it’s our job to help people talk about what they’re going through,” she says. It is this that they agree will be their legacy. Sexual health isn’t just about curing someone’s genital warts. It’s not only about diagnosing chlamydia or assessing sore genitals. It’s about being a shoulder to cry on when people feel they have no one else to turn to.
“That girl who came in for a test but ended up talking about why she feels pressured to have sex – that’s the real work,” says Sutton. “That’s the long-term impact of funding STI clinics.”
Dr Naomi Sutton, Sarah Mulindwa and Kevin Turner will appear in the second series of the The Sex Clinic on E4. You can watch the first series here.