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21 Sep, 14 | by shaworth

Readers might be interested to know that Pfizer are sponsoring a series of educational events on womens’ healthcare, encompassing  aspects of sexual health and family planning. These are taking place in England through October and November.

Manchester – Saturday 4th October 2014
Nottingham – Saturday 11th October 2014
Durham – Tuesday 4th November 2014
Blackburn – Wednesday 18th November 2014
Maidstone – Tuesday 18th November 2014

Agendas for the meetings can be found here.

Those attending should be aware that the session feature talks about the prescribing of Depo-Provera, and that this is manufactured by the sponsors.

Crowdsource, Contraception and No Small Potatoes

14 Sep, 14 | by shaworth

Contraception for men has been an area of dashed dreams for many years, so the ongoing trials of potentially reversible vas deferens occlusion by polymer injection represents an interesting development. Reported in the UK press as an “injectable contraceptive for men”, a description that seems grossly inaccurate in some respects as it’s not equivalent to the injectable contraceptives for women which work using high dose progestrogen; although it is injected into the vas itself, Valsagel is currently undergoing testing in animal models with hopes to begin trials in humans if this is deemed to be a success.

Valsagel is not the first polymer injected vas-affecting agent to be developed, and the work was inspired by the ongoing trials of RISUG in India, covered by Wired in 2010 in an extensive article that also details how Valsagel came to be and containing an account of a consenting process that seems less than entirely rigorous. RISUG was passed over by the WHO after phase II trials in 1997, due to production problems, but interest in the project was renewed in India in recent years and Phase III trials continue locally.

Valsagel works slightly differently to RISUG, by occluding the vas deferens using the polymer. Theoretically, the polymer can be subsequently dislodged using another injectable agent; although whether this is true in humans, only time will tell. Interested clinicians can follow the Valsagel trials through the Parsemus Foundation, who are partly funding the trials through crowdsourcing initiatives.

This is not the first crowd-sourced initiative in medial research discussed in the blog, and it also remains to be seen whether this will represent a useful source of funding for medical research in future, by bringing patients and small donors into contact with large-scale projects.

Those following developments in this field may also be interested in the attempt of an American woman, known only as Bailey, who attempted to crowd-fund her termination of pregnancy through the website GoFundMe (which the website subsequently revoked; although she did receive the funds allocated). Bailey was interviewed about her decision in the fashion and design magazine Vice*, where she discusses that her decision to crowd-fund donations was due to being unable to finance the procedure herself, and the use of crowd-funding to help people achieve their goals. She makes reference to the $50,000 raised to produce a single serving of potato salad, something that suggests the world has not yet run out of ways to waste money.

*This magazine contains content, including nudity and profanity, which is probably in violation of your work internet use policy, but you can read the interview here.

Young People And Their Experiences of Anal Sex

21 Aug, 14 | by shaworth

Readers of the Journal may have come across the recent study into teenage attitudes towards anal sex in heterosexual couples by the London School of Hygiene and Tropical Medicine, published last month via their Online First initiative already, but if you’ve not, it makes interesting reading for anyone working in young people’s sexual health.

Existing data suggests that anal sex between heterosexual couples is on the rise, and often increased access to pornographic materials in the digital age is cited as the reason behind this; although the evidence to suggest this is limited. Recent data, according to this study, suggests that 1 in 5 young people has tried anal sex.

The study took place in three centres in England, surveying 130 young people in total with various levels of interviews. Questions involved their perceptions of their own experiences, their partner’s experience and their reasons for trying anal intercourse. The answers seem to confirm some of the previous hypotheses, but with pornographic material being a small factor in why young people explored the idea of anal intercourse; although the belief that anal intercourse would be more pleasurable for the male partner due to a linked believe that “tightness” was integral to male sexual pleasure during penetrative intercourse, and encouragement from peers to try anal intercourse as part of a sexual conquest, were also prevalent attitudes amongst male interviewees.

Perhaps what’s most worrying is the evidence that some men felt that they had a right to coerce partners into trying anal intercourse, despite holding the belief that female partners would find anal sex painful. To those of us interested in the wider climate of sexual equality and sexual behaviour, this isn’t a shocking finding. The idea that some men feel entitled to sexual favours from women, and how this defines their behaviour and attitudes towards them, has been a centrepoint of modern feminist debate in recent years.

The study is of value to those working in sexual health, particularly with young people. It highlights that young people are unaware of the risks to their sexual health with regard to anal intercourse, and suggests that targeted interventions to improve condom use and safe anal intercourse is needed in this group. It also suggests that the worrying disparity between male and female experiences of anal intercourse needs to be addressed, perhaps through initiatives that empower young women to control their own sexual experience, and perhaps through initiatives that educate young men on how to achieve sexual pleasure for their partner as well as themselves.

Sexual Function In Childhood Cancer Survivors

12 Aug, 14 | by shaworth

Journal readers may be interested to know about a recent study published in the Journal of Clinical Oncology, a cohort study of over two thousand women who had suffered from childhood cancer compared with their female siblings, which demonstrated an excess of psychosexual morbidity in those who had suffered cancer as children.

It is known that the treatment of cancer can affect sexual functioning in a variety of ways, from premature menopause to the direct effects on the genital tract; however in these women, it would appear that the effects of the cancer, and treatment, persisted into adulthood. Compared with their sisters, they reported having less sex, less desire for sexual and less satisfaction with sexual intercourse. Speaking to Reuters Health, the study lead Jennifer Ford, expressed her surprised at the persistence of these effects.

About ten percent of women in the study experienced premature menopause, and only half of these were taking some form of hormone replacement; although this did not seem to improve the outcomes measured.

The study did not measure similar outcomes in men, so it is not clear if their experience is similar; however, the study does suggest that sexual function should be addressed in adolescents who have suffered cancer, and opened up for discussion with those who are facing cancer treatment.

HIV and Sex Work: The Lancet Series

28 Jul, 14 | by shaworth

This week saw the publication of the new Lancet series, an ongoing series of analyses of research in HIV with a focus on identifying those at risk and collating the data on prevention strategies. Previous parts of the series have looked at men who have sex with men (2012), and general prevention strategies (2008); however the latest part of the series is a detailed look at the burden of HIV prevention in sex workers.

The series is a detailed look at the studies detailing the HIV burden in sex workers who are female, male and transgender, and as such, gives a fairly broad look at the subject area. It identifies the barriers that are faced in attempts to reduce HIV incidence in this population, and it’s clear from the review that decriminalisation of sex work in order to reduce human rights violations and protect sex workers is a key part of the HIV prevention strategy. For many years, sex workers have been marginalised in attempts to prevent HIV, but it is obvious from the high disease burden in this group that sex workers need to be brought into the centre of HIV prevention strategies.

A particularly interesting part of the report concerning female sex workers comes from a representative of the Dutch police force, who discusses the change in legislation that has decriminalised sex work for those adults who are working voluntarily in this sector, allowing the police to focus their efforts on investigating human rights violations against sex workers and children who are working illegally. The fact that they are still unable to effectively target sex workers who are working illegally in the country remains a point of concern, but it’s hard to doubt that the decriminalisation does allow them to focus their efforts to protect those who chose to be employed in this way.

What’s also fascinating about the series is the study of male sex workers, and the findings that not all of these men identify as gay, potentially undermining public health strategies targeting this group that effectively make this assumption. The understanding of the driving factors behind the choice of these men who have become sex workers is paramount at identifying successful HIV prevention strategies. There’s also a short appendix of local terminology for male sex workers, which may be useful for those looking to work in sexual health abroad.

The inclusion of transgender individuals in the study makes for harrowing reading. Transwomen (the study does not include transmen) have a disproprotionate risk of HIV infection, 13.5 times the risk for natal women. The lack of research in this area, along with a lack of research into effective strategies to prevent HIV in this population undermines our efforts in this area, which is obviously not an acceptable situation to continue.


Coming Over Here: UK and Overseas Sperm Donors

29 Jun, 14 | by shaworth


Sperm donor anonymity was revoked in the UK in 2005, meaning that children born from donor sperm can now trace the identity of their genetic father at the age of eighteen. The same is true of egg donors. The reverse was not true at the time of the change, with gamete donors being unable to request information about any children they may have assisted in the production of; however cases have since been presented to court from sperm donors who are known to the recipient couple seeking access to the children they have produced.

This week there have been articles in the press about the perceived fall in UK sperm donors since the 2005 legislation was introduced; although few are able to prove this allegation, despite the data being available. All fertility clinics in the UK are regulated by the HFEA, who require registration data on all donors whose samples can be used to artificial reproduction techniques (thus excluding those whose samples are donated to research). In 2011, around 2,000 women received donor insemination and over the last few years, the number of embryos produced from donor procedures has remained steady; although this does not, for some reason, include ICSI procedures where sperm is directly injected into an egg, cultured and reimplanted, which somewhat muddies the waters.

In fact, contrary to the media reports, the number of new UK donor registrations with the HFEA has been rising steadily since 2005. New sperm donor registrations were actually lower in the year preceding the anonymity revoking than any other year since 1992. When the figures are broken down by UK and overseas donors, there has actually been a steady increase year-on-year since 2005. Yes, in 2005 1:10 new donors were from overseas, and in 2010 it’s 1:4, but over the same time period the UK new donor registrations have increased by a third, and overseas donors have increased four-fold, rather than a drop in UK donors and overseas donors making up a shortfall.

Of course, the data available to the public goes up to 2011, and it’s now 2014, so it’s possible that data has been selectively leaked to people who are not your humble blogger, and perhaps ICSI requests have risen stratospherically so that we can’t keep up with demand; although that wouldn’t explain why everyone is so quick to blame legislation that’s nine years old on a three year old phenomenon. Perhaps, the story here is not about a looming sperm-famine, but that you can make some good headlines out of unresearched articles produced with a mere flick of the wrist.

Review: The Menopause Exchange

9 Jun, 14 | by shaworth

The Menopause Exchange is an independent organisation founded by Norma Goldman, a pharmacist with a special interest in health promotion, to provide impartial information for patients and health professionals about the menopause. Information is circulated largely through the quarterly newsletters, which are free and through the Menopause Exchange blog. They are also present on Twitter and Facebook. Unlike some other magazines aimed at patients, they are not supported by advertising, and take no funding from sponsors; although there are no conflict of interest decelerations from the writers.

I read the Spring 2014 issue of Menopause Exchange which covers a diverse range of issues from irregular peri and post menopausal bleeding to the NHS screening programs available for women who are going through the menopause. There is also an “ask the experts” section where questions can be posed to those writing for the newsletter which explore fairly diverse subjects such as the length of time HRT can be used, to complementary and alternative therapies.Although Menopause Exchange states that it is for both patients and health professionals, the articles seem to be mainly aimed at the former rather than the latter. This is no bad thing, as patient support and resources are valuable to those experiencing menopause. The articles communicate the concepts they explore well, without jargon.

Whilst the information produced is good quality, the format of the newsletter could be improved. Digital media has leveled the playing field for communicating information, and high quality printers to produce slick and effective print media are available for home use, but Menopause Exchange isn’t taking maximum advantage of this and I felt that the look of the newsletter was dated. Back issues of the newsletter are available by post, paid by cheque (there is an option to pay digitally, but this doesn’t seem like the first choice), which seems absurd in 2014; although perhaps demand has produced this need.

Overall, I’d say that Menopause Exchange has a lot to offer your patients, and mine. If it took full advantage of technological advances, it would find itself a unique and valuable resource.

FSRH Welcomes Nurses at a one day conference

24 May, 14 | by shellraine, e-Media Editor


The FSRH is delighted that from January 2014 nurses are Eligible to become members of the FSRH and to undertake training for the Nurse Diploma in Sexual and Reproductive Health Care (NDFSRH), the Letters of Competence in both intrauterine devices and subdermal implants and the postgraduate qualification in medical education. The organising committee has planned this ‘one off’ meeting to update delegates on FSRH qualifications and to provide a general update on contraception, together with a motivational speaker on communication skills. This event is aimed at all nurses working in sexual and reproductive health in any setting, service managers and lecture practitioners.


Royal College of Obstetricians and Gynaecologists

27 Sussex Place, London, NW1 4RG

 Course Fee £130.

For Nurse Diplomate & Associate members £120

Please make cheques payable to FSRH and send to

Faculty of Sexual and Reproductive Healthcare, 27 Sussex Place, London, NW1 4RG

Full programme




New Guidance From DoH On Abortion Provision

23 May, 14 | by shaworth

New guidance was issued today by the Department of Health in relation to the provision of abortions in England and Wales. Following an independent, covert investigation by the UK newspaper The Daily Telegraph, concern was raised that abortion was being provided in the UK out with the provisions of the Abortion Act, andwhich would obviously be illegal. The reporter for the Daily Telegraph accessed two abortion providers attempting to seek abortion on the basis of fetal sex alone, which is not grounds for termination in the UK and the latest guidance has clarified that this would be an illegal act.

The guidance doesn’t change the law on termination, but is designed to clarify the interpretation of the rather vague conditions specified. Most “social” terminations in the UK are performed under Category C of the Abortion Act which states The pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman. The guidance clarifies that fetal sex alone does not qualify as a valid reason.

The new guidance also does not remove the condition that two doctors must consent to the termination of pregnancy, and in particular, addresses the issue of “pre-signed” forms and whether or not it’s acceptable to have a verbal history from a colleague prior to signing the form: it’s not. According to the clarified guidance, the opinions of each doctor must be formed individually, and viewing the second signature as a “rubber-stamping” exercise goes against the principles of the act.

In addition to the new guidance, the DoH also produced the results of their analysis of the UK birth sex ratios, after the requests for termination of pregnancy on the grounds of fetal sex called in question whether or not the UK is affected by the phenomenon of “missing girls”, something which is well-described in other countries where a higher social value is placed on male children, resulting in female infanticide and termination of pregnancies on the basis of fetal sex. The results suggest that the UK is not affected, even when the results are broken down to assess the ratios on the basis of the ethnicity or country of origin of the mother.

Currently, to terminate a pregnancy on the grounds of fetal sex, the fetal sex must be identified prior to making this decision. Invasive testing such as amniocentesis and chorionic villus sampling have the risk of fetal loss, and ultrasound assessment is user, and fetal position, dependent. As access to these tests become more widely available, and uptake increases, the sex ratio imbalance gets worse in affected countries. It remains to see what effect the development of commercial testing for free fetal DNA in maternal plasma has on this problem. Currently it is possible to ascertain fetal sex for a £400 test from maternal blood, available on the NHS in a limited capacity for reasons such as congenital adrenal hyperplasia. It remains to be seen, as costs for these tests drop over time, what affect this has on fetal sex ratios. Readers of speculative fiction may wish to consider Ian MacDonald’s River of Gods for an exploration of this phenomenon, and the social consequences, in a near future India.

Sexual Health Organisations Put Pressure On Politicians Before Polls

18 May, 14 | by shaworth

England goes to the polls for its local elections on May 22nd, and leading sexual health bodies are challenging politicians to commit to investing in Sexual and Reproductive Health. The combination of BASHH, BHIVA, Brook, FRSH, FPA, MEDFASH, Terrence Higgins, the National AIDS trust, and the National HIV Nurses Association issued a joint statement:

“Sexual and reproductive health and HIV is an important issue for the whole electorate. In February 2013, the Department of Health published a Framework for Sexual Health Improvement in England which set out a series of ambitions that, if achieved, would ensure everyone has the information, support and services they need to lead healthy lives.”

“We call on all those standing for election to provide leadership to achieve these ambitions and to commit to support investment in sexual and reproductive health, including access to all forms of contraception, HIV prevention and testing, and support services.”

Readers will remember that sexual health services in NHS England went out to tender earlier this year. Local services may wish to address their potential representatives about these issues in hustings, or to contact them during free communication sessions locally regarding their commitment to sexual health provision.

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