Sexual behaviour at the millennium

Abstract

Your sex at the millennium series provides a solid basis for the need of elaborate strategies to control sexually transmitted diseases (STDs), especially for chlamydia. Ralph DiClemente1DiClemente RJ Development of programmes for enhancing sexual health.Lancet. 2001; 358: 1828-1829Summary Full Text Full Text PDF PubMed Scopus (23) Google Scholar suggests that medical staff have an important and influential opportunity for sexual-health promotion during the provision of health care. Most opportunities will occur in a primary-care context.However, seizing the chance to bring up sexual-health matters is not easily done. STD counselling in primary care is rarely done and is frequently inadequate.2Temple-Smith MJ Mulvey G Keogh L Attitudes to taking a sexual history in general practice in Victoria, Australia.Sex Transm Infect. 1999; 75: 41-44Crossref PubMed Scopus (73) Google Scholar, 3Haley N Maheux B Rivard M Gervais A Sexual risk assessment and counselling in primary care: how involved are general practitioners and obstetrician-gynecologists?.Am J Public Health. 1999; 89: 899-902Crossref PubMed Scopus (55) Google ScholarWe carried out a survey in Antwerp, Belgium, to identify difficulties family physicians encounter in relation to STD counselling. 75·6% of physicians reported they provide STD advice once monthly or less. Absence of genital symptoms was pointed out as a major barrier by 78·8% of respondents.This finding is crucial, and suggests that the shift towards largely symptomless STDs such as chlamydia, HIV, and hepatitis B, has left physicians unadapted to their new role in STD management. Physicians, trained to diagnose and treat well defined clinical STD syndromes, are now faced with patients without or with insidious genital complaints, with whom it is difficult to raise sexual matters seemingly out of the blue. Substantial skills are needed for sexual counselling under such circumstances.For primary-care-based STD control programmes to have a chance of success, education of physicians must change. Whether establishing intensive training facilities would be cost effective has yet to be studied. Alternatives such as family physicians referring patients to a telephone service with trained doctors are worth considering. Your sex at the millennium series provides a solid basis for the need of elaborate strategies to control sexually transmitted diseases (STDs), especially for chlamydia. Ralph DiClemente1DiClemente RJ Development of programmes for enhancing sexual health.Lancet. 2001; 358: 1828-1829Summary Full Text Full Text PDF PubMed Scopus (23) Google Scholar suggests that medical staff have an important and influential opportunity for sexual-health promotion during the provision of health care. Most opportunities will occur in a primary-care context. However, seizing the chance to bring up sexual-health matters is not easily done. STD counselling in primary care is rarely done and is frequently inadequate.2Temple-Smith MJ Mulvey G Keogh L Attitudes to taking a sexual history in general practice in Victoria, Australia.Sex Transm Infect. 1999; 75: 41-44Crossref PubMed Scopus (73) Google Scholar, 3Haley N Maheux B Rivard M Gervais A Sexual risk assessment and counselling in primary care: how involved are general practitioners and obstetrician-gynecologists?.Am J Public Health. 1999; 89: 899-902Crossref PubMed Scopus (55) Google Scholar We carried out a survey in Antwerp, Belgium, to identify difficulties family physicians encounter in relation to STD counselling. 75·6% of physicians reported they provide STD advice once monthly or less. Absence of genital symptoms was pointed out as a major barrier by 78·8% of respondents. This finding is crucial, and suggests that the shift towards largely symptomless STDs such as chlamydia, HIV, and hepatitis B, has left physicians unadapted to their new role in STD management. Physicians, trained to diagnose and treat well defined clinical STD syndromes, are now faced with patients without or with insidious genital complaints, with whom it is difficult to raise sexual matters seemingly out of the blue. Substantial skills are needed for sexual counselling under such circumstances. For primary-care-based STD control programmes to have a chance of success, education of physicians must change. Whether establishing intensive training facilities would be cost effective has yet to be studied. Alternatives such as family physicians referring patients to a telephone service with trained doctors are worth considering.