Tips for Adding Sexual Health Services to Your Midwifery Practice

Sexual health is considered to be a state of wellness with physical, emotional, mental, and social dimensions. Sexual health can contribute to our overall well-being in each of these dimensions. However, despite the intrinsic importance and positive aspects of sexuality in our lives, the United States presently faces significant challenges related to the sexual health of its citizens, including human immunodeficiency virus, other sexually transmitted infections, viral hepatitis, unintended pregnancies, sexual violence, sexual dysfunction, and cancers in reproductive tracts with serious disparities among the populations affected. In particular, high rates of poverty, income inequality, low educational attainment, stigma, racism, sexism, and homophobia can make it more difficult for some individuals and communities to protect their sexual health. Given that many pressing public health issues in the United States are related to sexual health and that sexual health has been increasingly recognized as an important national health priority, now is the time to energize and focus our efforts on optimal sexual health of the population.

Currently, the United States faces significant public health challenges that impact multiple facets of sexual health-related morbidity, including human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), viral hepatitis, unintended pregnancy, sexual violence, sexual dysfunction and cancers in reproductive tracts. Despite progress in some areas, current sexual health morbidity exceeds rates for most other developed nations. Today, the United States shows a high prevalence of sexual assault on college campuses. Meanwhile sexual dysfunction remains prevalent across age groups. Disparities in sexual health outcomes exist for many, including sexual minorities and communities of color. Stigma is a prominent impediment to efforts to improve sexual health and reduce related morbidity.

Adding sexual health services to your midwifery practice is a good way to help not just your practice but also it will give a great impact to your clients and the community. Midwives play a significant role in improving sexual health not just in the US but all over the world. As a primary care provider, we do not only provide services which is useful short term, but we must help the community have long term health care sustainability. Here are some tips you must know before adding sexual health service to your midwifery practice.

1. Be aware of socioeconomic status
Socioeconomic status can often have profound effects on a person’s health. Neighborhood, behavior, and community all affect infection rate It may be surprising to hear that having low socioeconomic status reduces a person’s access to healthcare which, in turn, negatively impacts their health. This includes their sexual health and their vulnerability to any number of sexually transmitted infections (STIs), including HIV. Having a low socioeconomic status not only influences how, when, and if an STI gets treated, but it also increases a person’s risk of getting an STI—in part because the infection is not being controlled within their community.

2. Screen for infections when providing contraception
When seeing a patient for a contraceptive check, asking them these questions can help you check whether to offer them sexual health screen.
• Have you ever used prescriptions for contraception?
• Have you ever had or needed sexual health screen?
• Have you ever had a change in partner since your last screen?
• We offer everyone sexual health screen which is a self-swab and a blood test for infections
such as HIV, hepatitis, syphilis. Would you like to do any of these?

3. Use self-swabs
According to the Centers for Disease Control and Prevention (CDC), most reported cases of chlamydia (70%) and gonorrhea (62%) occur in men and women between the ages of 15 and 24 years. Both the CDC and the US Preventive Services Task Force recommend annual chlamydia screening for all sexually active women younger than 25, and for older women with risk factors, including having multiple sex partners and living in communities with a high burden of disease. Annual gonorrhea screening is recommended for sexually active women with risk factors, as well.

While some studies have found self-collected vulvovaginal samples to be as sensitive as clinician-collected endocervical samples for the diagnosis of chlamydia and gonorrhea, samples are still often collected by clinicians. Collecting endocervical swabs is uncomfortable for patients and time consuming for clinicians, and evidence suggests that patients prefer noninvasive sampling.
4. Update your knowledge of HIV and Offer HIV testing

• HIV testing is integral to HIV prevention, treatment, and care. Knowledge of one’s HIV status is important for preventing the spread of disease, yet 15% of people with HIV do not know they are infected. Studies show that those who learn they are HIV positive modify their behavior to reduce the risk of HIV
• Overall about half (46%) of nonelderly adults in the United States (U.S.) have ever been tested for HIV, including 8% in the last year. The Centers for Disease Control and Prevention (CDC) recommends routine HIV screening in health-care settings for all adults, aged 13-64, and repeat screening for those at higher risk.
• Early knowledge of HIV status is critical for linkage to medical care and treatment that can reduce morbidity and mortality and improve quality of life. Treatment guidelines recommend starting antiretroviral treatment as soon as one is diagnosed with HIV. Individuals with HIV who have an undetectable viral load, typically as a result of effective antiretroviral therapy, cannot sexually transmit HIV to others.
• Most people with health insurance – both public and private – have access to HIV testing, often at no cost. And, for those without insurance, HIV testing can often be obtained at little or no cost in community settings.

5. Consider the needs of lesbian, gay, bisexual and transgender people

The relationship between users and health services is considered essential to strengthen the quality of care. However, the Lesbian, Gay, Bisexual, and Transgender population suffer from prejudice and discrimination in access and use of these services.

The non-heterosexual orientation was a determinant factor in the difficulties of accessing health care. A lot must still be achieved to ensure access to health services for sexual minorities, through the adoption of holistic and welcoming attitudes. The results of this study highlight the need for larger discussions about the theme, through new research and debates, with the aim of enhancing professionals and services for the health care of Lesbian, Gay, Bisexual, and Transgender Persons.

6. Refresh your knowledge of emergency contraception guidance

Emergency contraception, also known as postcoital contraception, is therapy used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. Common indications for emergency contraception include contraceptive failure (eg, condom breakage or missed doses of oral contraceptives) and failure to use any form of contraception. Although oral emergency contraception was first described in the medical literature in the 1960s, the U.S. Food and Drug Administration (FDA) approved the first dedicated product for emergency contraception in 1998. Since then, several new products have been introduced. Methods of emergency contraception include oral administration of combined estrogen–progestin, progestin only, or selective progesterone receptor modulators and insertion of a copper intrauterine device (IUD). Many women are unaware of the existence of emergency contraception, misunderstand its use and safety, or do not use it when a need arises.

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References:

Alencar Albuquerque, G., de Lima Garcia, C., da Silva Quirino, G., Alves, M. J. H., Belém, J. M., dos Santos Figueiredo, F. W., da Silva Paiva, L., do Nascimento, V. B., da Silva Maciel, &E., Valenti, V. E., de Abreu, L. C., & Adami, F. (2016, January 14). Access to health services by lesbian, gay, bisexual, and Transgender Persons: Systematic Literature Review – BMC International Health and Human Rights. BioMed Central. Retrieved May 30, 2022, from https://bmcinthealthhumrights.biomedcentral.com/articles/10.1186/s12914-015-0072-9
Elizabeth Boskey, P. D. (2022, April 20). Socioeconomic status affects individual health. Verywell Health. Retrieved May 30, 2022, from https://www.verywellhealth.com/socioeconomic-status-ses-3132909 Ford, J. V., Barnes, R., Rompalo, A., & Hook, E. W. (2013). Sexual health training and education in the U.S. Public health reports (Washington, D.C.: 1974). Retrieved May 30, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562751/ Mawson, D. R. (2021, January 15). Top tips: Sexual and reproductive health. Guidelines in Practice. Retrieved May 30, 2022, from https://www.guidelinesinpractice.co.uk/sexual-health/top-tips-sexual-and-reproductive-health/453845.article
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