Good sexual and reproductive health is a state of complete physical, mental and emotional wellbeing in all matters relating to the reproductive system.

It implies that people are able to have a satisfying and safe sex life, the capability to reproduce, and the freedom to decide, if, when and how often to do so.

What people need is accurate information, safe, effective, affordable and acceptable contraception method of their choice.

In addition people need to be empowered to protect themselves from sexually transmitted infections.

When women decide to have children, they must have access to services that can help them have a fit pregnancy, safe delivery and healthy baby. (UNFPA)

Contraception

Contraception means prevention of pregnancy and there are a number of different methods.

There are some consideration that need to be taken when choosing a method such as effectiveness in pregnancy prevention, ease of use, side effects, benefits other than contraception, cost and availability, reversibility and protection against sexually transmitted infection.

The most effective reversible methods are the fit and forget long acting reversible contraceptives- Intrauterine Device (IUD) and contraceptive implants.

IUD and Implants

Suitable for women of any age

Can be used by most women even if they have significant health issues

Can be removed easily by trained health professional and easily reversible

Involve insertion/removal procedure by a doctor

Provide no protection against STI’s

The hormonal IUD- Mirena

Small t shaped device fitted inside uterus

Over a five year period, slowly releases small amounts of progesterone hormone into the uterus

Periods usually become lighter or stop

Is 99.8 per cent effective

Copper IUD

Small device made from plastic and copper that is fitted inside the uterus.

Stop sperm from reaching the egg and any fertilized egg from sticking to the wall of the uterus

They have no hormones

Periods may become heavier

99.2 per cent effective

Need to be removed every five-10 years

Contraceptive Implant

Contraceptive Implant is inserted directly under the skin, above the elbow on the inner arm

It releases a low dose of progesterone hormone into the blood stream over a three year period

Works by preventing Ovulation (release of egg from ovary)

Needs to be replaced every 3 years

Can change usual bleeding pattern

99.9 per cent effective

Depo-Provera

Injection into the muscle every 12 weeks

Prevents pregnancy by stopping ovulation

Periods may stop while using the injections

There may be a short delay in return to fertility

94-99.8 per cent effective

Combined Oral Contraceptive Pill

Oral contraceptive taken daily

Contains the hormones estrogen and progesterone

Similar to the hormones produced by the female body

May also help with acne or heavy bleeding

Need to be taken daily to be effective

With perfect use 99.7 per cent effective, with real life use 91 per cent effective

Condoms

The male condom is a sheath made of latex or polyurethane, which is rolled onto the erect penis before sex.

82-98 per cent effective for pregnancy prevention and consistent use is required

Can be used in conjunction with other methods of contraception.

Condoms are the only method that offer protection from both unintended pregnancy and STI’s

Emergency Contraception

Emergency Contraception is used after unprotected intercourse or when contraception might not have worked properly.

Single dose of emergency contraceptive pill taken within 72 hours of unprotected intercourse

Insertion of a copper IUD within 5 days of unprotected intercourse

Sexually Transmitted Infection (STI)

Sexually transmitted Infections are diseases that are passed on from one person to another through sexual contact and sometimes by genital contact- the infection can be passed on by vaginal, oral and anal sex

Common STI’s are chlamydia, gonorrhea, syphilis, trichomonas vaginalis, herpes, hepatitis B, HIV

Chlamydia

Common STI caused by a bacteria affecting both men and women

Most people with chlamydia have no symptoms and hence can pass on infection without knowing it.

In women it can affect the cervix and urethra. Some possible symptoms include vaginal discharge, burning sensation when passing urine, bleeding after sex.

If left untreated it can spread up into the uterus and fallopian tube causing pelvic inflammatory disease- fever and lower abdominal pain

It can block/damage the fallopian tubes leading to infertility, ectopic pregnancy and chronic abdominal pain.

Pregnant women with chlamydia may be at risk of having smaller or premature babies. It may pass from mother to baby during birth.

In men it can infect the urethra. Symptoms- pain when passing urine, watery of milky discharge from penis, most men have no symptoms

Untreated it may spread to the testes, prostate, and tubes that carry sperm which may result in infertility or chronic pain.

It is spread by having sex with someone who is infected

It cannot live long outside the body and hence cannot be caught from toilets, swimming pool, and spas.

You can reduce your chance by using condoms every time you have sex

It is easily treated with a single antibiotic- azithromycin

Gonorrhea

Sexually transmitted bacterial infection

Can infect throat, rectum, urethra, cervix and eyes

Many women and some men have no symptoms

Men may experience- pain when passing urine, discharge from the penis, pain in the testes, redness around penis, anal discharge or discomfort

Women may experience – unusual vaginal discharge, pain when passing urine, pelvic pain, pain during sex, irregular bleeding

Sometimes affects joints

If untreated in women it can spread to the uterus and fallopian tubes and cause pelvic inflammatory disease and infertility

Spread by having unprotected sex with an infected person- oral, vaginal anal sex

You can reduce changes by always using a condom

Test for infection by swab or urine test

Treat with an injection of ceftriaxone, and at the same time patient needs to be treated for chlamydia

Important to avoid sexual intercourse till a week after treatment

Sexual partners of the last 2 months need to be contacted, tested and treated.

Syphilis

Serious STI which can cause problems if not treated

4 stages

Primary syphilis- 10-90 days after infection- painless sore or sometimes multiple sores in the mouth, anus, penis, vagina, or cervix. Can have pus coming out of it.

Clears up after two-six weeks but infection remains

Secondary Syphilis – seven-10 weeks after infection. Red Rash on palms, soles, chest or back, fever, enlarged glands in the armpit or groin, hair loss, headache, tiredness. Rash is lumpy but not painful

Latent Syphilis- no noticeable symptoms, still infected

If syphilis is not treated at this stage, it may remain latent for life or develop into tertiary syphilis

Tertiary syphilis- bacteria can affect any part of the body- heart, brain, spinal cord, eyes, and bones resulting in mental illness, blindness, deafness, heart disease

Syphilis is transmitted during skin to skin contact during oral, vaginal anal sex

Highly infectious in primary and secondary stages

A pregnant woman can pass it on to her baby causing birth defects, seizures, miscarriage /stillbirth

Use condoms to protect yourself

Tested through a blood test

Can be cured with antibiotics- penicillin, and repeat Blood tests

Syphilis is a notifiable disease- contacts need to be tested and treated

Trichomonas Vaginalis (TV)

Infection caused by a parasite

Affects vagina, cervix, urethra

Symptoms in women- frothy/yellow green vaginal discharge/fishy odour, bleeding after sex, discomfort when passing urine, or no symptoms

In men- burning or discomfort when passing urine, penile discharge, mostly no symptoms

Condoms reduce chance of TV

Tested by a swab or urine test

Treated with antibiotics

Sexual contacts should be tested and treated

TV can cause low birth weight in baby- if mum is infected

Genital Herpes

Caused by herpes simplex virus

2 types- HSV 1 mostly caused cold sores, HSV 2 mostly genital herpes

Passed from one person to another through close genital contact, sex

Virus can stay dormant for a very long time

Symptoms- stinging or tingling in genital area, small blisters

First episode can be severe with flu like symptoms, swollen glands

Test through swab

Treat with antiviral within 72 hours

Virus remains in the body

Condoms reduce risk of transmission

Blood Born Viruses

Hepatitis B

Hepatitis C

HIV

All transmitted through sexual contact, blood transfusion, mother to baby, IV drug use

Overcoming Barriers to Safe Sex

Be prepared for safe sex, carry condoms in your wallet or purse

Learn how to use condoms

Prioritise your sexual health- it is important

Don’t think you can tell is someone has an STI just by looking at them. Most STI’s don’t have any obvious signs.

Educate yourself about STI’S. Anyone who has sex is at risk.

Be mature about STI’s and reassure yourself and your partner that an STI is not a moral judgment of character, but an infection like any other. Having an STI does not mean you are dirty or cheap.

Have STI tests if you are in a relationship and you want to have sex without a condom. Both partners should be tested. Think of STI testing as a sign of respect for each other

As you can see you must use contraception to prevent unwanted pregnancy and its important to be aware that only condoms will reduce your risk of STI’s. Sexually transmitted infections are incredibly common however there is much stigma surrounding them.

The only real cure for stigma is better sex educations. People need to learn how common these diseases are. They also need to learn how easily they are treated.

Then maybe we can work on making screening more common. So please visit your doctor if you have any symptoms, or even better get yourself screened. Regular checkups are very important.

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