Integrated sexual health services
Milne Centre for Sexual Health, Bristol Royal Infirmary, Bristol, UK
Integrated sexual health services are designed to overcome the problems of
the separation of medical specialisation – across most of Europe – between
Gynaecology and (Dermato)-Venereology, which had disadvantages for women’s
health. An holistic approach takes the patient’s needs as the central
consideration, combining care for contraception, sexually transmitted infections
(STI), unwanted pregnancy, sexual assault etc., thus putting women’s sexual
health under one roof.
This logical, commonsense approach has little formal evidence base as public
health policy, apart from substantial work on acceptability to patients,
particularly among adolescents, and is being investigated as an appropriate
model of service delivery in Britain, the Russian Federation and elsewhere.
This paper reviews the existing evidence base, with particular emphasis on
the case of need for joint contraception & STI services demonstrated by a
precisely inverse relationship between gonorrhoea rates and live birth rates
when preferred contraceptive method changes from hormonal methods to condoms.
The paper also identifies potential therapeutic advantages of the integrated
clinical approach, with an increasing recognition of the need to consider
hormonal influences on genital infection in the management of conditions such as
recurrent bacterial vaginosis and genital herpes.