Nursing Times blogger Martin Jones reflects on the changing attitudes towards sexual health in middle age
We’re about to enter Sexual Health Awareness Week with this year’s slogan, “The Middle-age Spread (Sexually Transmitted Infections in the over 50s)”. As I’m the age of the target population and have worked in sexual health since the mid-eighties it’s a good moment to reflect upon some of the changes in sexual health and sexual health nursing over that time.
I entered genitourinary medicine nursing in 1986, a male nurse seeing male patients who entered through the male entrance, sat in a men-only waiting room and passed along men-only corridors through the clinic. With heavily suggested incomprehension, a colleague on the ward I was leaving said: “That’s not a job you’ll want to do for long.” The nursing role was perfunctory: following doctors’ instructions to take blood, genital swabs, urine samples, and to paint ano-genital warts.
We saw men in cramped, curtained cubicles through which my patient and I could hear the entire exchange in the cubicle next door - while my colleague and his patient eavesdropped on ours. The men who attended were generally there because they had unignorable symptoms of sexually transmitted infection. They were unlikely to be teenaged and came with a mixture of reluctance and shame.
Evidence based practice was thin on the ground as my more experienced colleague expounded on the magical diagnostic powers of the ‘two-glass test’, twirling first-catch and midstream urine samples in the light to discern evidence of urethritis. Resistant gonorrhoea was still around the corner, patients treated on the spot with high dose amoxicillin with probenecid.
Today’s sexual health nurses are university trained, multi-skilled practitioners working with increasing levels of autonomy in well-appointed modern clinics. Today’s patients are younger, more likely to be asymptomatic, seeking STI screening as a straightforward matter of looking after themselves and their sexual partners.
So what about us middle-aged targets? Recent Health Protection Agency statistics indicate that most STIs were diagnosed in younger people: two-thirds of the new diagnoses of chlamydia were in women aged 15-24. (Although this speaks to me as a great success for chlamydia screening programmes.) So what is it with my generation?
The campaign is based upon the premise that we grew up in a condom-free world, free from the worries of STIs and are ill-equipped for the consequences of the sexual adventures of our middle age. The Sexual Health Awareness Week posters feature a range of period photos, in the style of the birthday cards I now receive with derogatory captions reflecting the passage of years. The posters evoke nostalgia for our youth with the slogan, “remember wearing this? Then remember to wear this” with an inset picture of a condom.
Can my generation embrace the condom? Well gay men have - but some may be abandoning it in an upsurge of bare-backing (unprotected anal sex). Middle-aged heterosexuals move away from concerns about controlling fertility - which, vasectomy apart, was often seen as a woman’s business. The stigma of the ‘clap clinic’ has been supplanted by increasing openness about STI screening and acknowledgement of its value.
Nowadays, amongst the younger patients I see more and more men of my age attending clinic because their new partners insist upon using a condom and getting checked for STIs. Preventing the middle aged from spreading STIs is surely a good thing. We’re slowly catching up with the generation behind us.
Martin Jones, Clinical Nurse Specialist HIV, East Sussex Downs & Weald. He has worked in sexual health and HIV since 1986.