Dr Phil Hammond, GP and broadcaster

The British are notoriously prudish about sex. Public discussions of sexual health rarely rise above seaside postcard level, and serious attempts to demystify sex in the media are often heavily censored or banished to midnight.

When I demonstrated injection techniques for male impotence using a rubber penis on BBC2's Trust Me, I'm a Doctor, it was cut because the penis 'wobbled offensively'.

Similarly, I doubt any programme will have the balls (if you'll excuse the pun) to demystify what's involved in a visit to a sexual health clinic. Sadistic fisherman's tales abound of metal umbrellas thrust deep inside and ripped outwards.

There's no smoke without fire and some of yesterday's instruments could indeed make your eyes water for months. But these days, nothing larger than a half-size cotton bud is dipped in. It's not the most fun in the world but it's hardly torture.

How do I know all this? Because I'm a swab king, me. In my latest job, working as a clinical assistant in a GUM clinic in Bristol, I've yet to make a grown man cry. It helps that these days Chlamydia testing is done on a urine sample so you don't need to go down deep and twist. Often the biggest barrier to attendance isn't umbrella phobia but the fear and guilt of admitting what you've been up to.

It doesn't help that sexual health clinics used to be anonymously named and tucked away shamefully at the back of the hospital or down in the basement. This was no fault of the staff, but rather another example of our inability to take sex seriously.

Many of the key decision makers in the NHS are white, middle-class men who don't like talking about infections 'down below' and feel that those who get them are not 'people like us' and only have themselves to blame.

After the arrival of HIV, sexually transmitted infections suddenly appeared on the political agenda, and many departments used the opportunity to press for more funds and revamp the service.

In Bristol, alas, the requests fell on deaf ears and the service still operates out of hugely cramped temporary accommodation built on top of an old typhoid pit. Many of the consulting rooms are windowless and the absence of natural light and ventilation can make the job heavy going on a hot day.

The staff, however, are incredibly committed and enthusiastic, which is just as well considering that infection levels across the UK are at their highest for a decade. Since 1995, Chlamydia infections have risen by 76%, gonorrhoea by 55%, syphilis by 54% and genital warts by 20%.

Not that you'd know it. HIV aside, sexually transmitted infection tends to be poorly represented in self-help groups, and precious few patients self-disclose their ailments. I doubt if anyone's ever penned a letter to The Times about the treatment of his genital warts, and if he has, I bet they wouldn't print it.

Some of the doctors I've met are a trifle more candid, with several even admitting to patients: "I've had that – how d'you think I got interested in the job in the first place?"

Recently I chaired a meeting of GUM physicians and drug reps and asked them, via keypads, how many had experienced at least one STI. The answer – 40% of the doctors and 30% of the reps. No wonder most of them carry a 'conference pack' full of the best drugs and condoms.

Most patients have something that needs treating, most can be sorted out and most are effusively grateful – a real change from general practice. And you hear some great stories.

But there's still a huge amount of ignorance and most people still believe that if you have a sexually transmitted infection, you'll know about it. But those with symptoms are just the tip of a very nasty iceberg – a fact not lost on the Swedes, who started Chlamydia screening and education two decades ago.

With typical British irony, we pioneer hugely expensive IVF in this country and then lament the fact that it isn't freely available to all. But had we spent just a fraction of those IVF resources preventing the infections that cause infertility in the first place, far fewer couples would have need for it.

Guidelines in Practice, October 2001, Volume 4(10)
© 2000 MGP Ltd
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