'I can ask questions that might earn a me a punch in everyday life'

I spent most of today teaching practice nurses and GPs at Duncan Bannatyne’s eponymous luxury hotel in Hastings. The Sexually Transmitted Infections Foundation (STIF) Course is a two-day event in which I ran a workshop with the enticing title ‘Male Dysuria’. Four times.

So much has changed in sexual health over the years and one of the most refreshing things is the willingness of so many in primary care to take on STI screening. Sexual health clinics have probably met them halfway, overwhelmed by demand that is driven by government targets aimed at reducing STIs. Additionally there are extra payments to practices that deliver sexual health services. The STIF course takes best practice in sexual health clinics adapts this as a pragmatic approach for primary care and identifies when to refer.

The Male Dysuria workshop takes 45 minutes, involving role play by participants. A ‘health worker’ takes a history from a ‘man’ with dysuria and I facilitate the ensuing discussion, drawing out the learning points.

Sexual health clinic is an inverted world where I can ask questions that might earn a punch on the nose in everyday life: “When was the last time you had sexual intercourse?”, “Was your partner male or female?” Etc.

Rather than plunge straight in, the workshops agreed that we should develop the consultation following introductory greetings with ‘safe’ questions: “how can I help you today?”, “have you noticed any changes?” Etc. After identifying the presenting issue and gathering a relevant history a ‘bridge’ to the sexual history is helpful: “Sometimes what you are describing may be caused by sexually transmitted infection. I’m now going to ask some questions about recent sexual activity.” This acts as a ‘permission’ to proceed to ‘less safe’ questions.

I drove away reflecting on how much has changed since the mid-eighties. The patients are different: twenty-five years ago many were propelled into clinics only when they developed symptoms. Asymptomatic screening of well-patients, concerned to maintain good sexual health has become the norm. Where most young men presenting with dysuria in primary care were swiftly referred to ‘the special clinic’, a spirit of enterprise sees a great deal of good work by skilled practitioners in general practices. I well remember a GP saying to me that the genitourinary medicine consultant might as well be on the moon. Now we’re working together to improve the nation’s sexual health. Long may that continue.

Have your say

You must sign in to make a comment.