Interviewing a Sexual Health Consultant

Written by Chloë S, an interview with Dr Naomi Sutton

Dr Naomi Sutton at Sexpression:UK's 2024 National Conference in Birmingham

This Sexual Health Week, I had the immense pleasure of interviewing sexual health consultant, and friend of Sexpression:UK, Dr Naomi Sutton. We discussed all things sexual health, and in this blog I have transcribed the interview so you, too, can learn what I did during our 40 minute Zoom call.

Included in this blog post:

• What can people do to be more aware of their sexual health this sexual health week?

• This year's theme for Sexual Health Week is Chronically Online. What do you think are the key impacts the online world has on people's sexual health?

• What advice would you give to people checking out their own external sexual organs and body part?

• What are the key signs you may see if your body isn’t looking like your normal?

• What are the main STIs?

• What does the process look like when testing for STIs?

• How can people work out which contraceptives are the right ones or one for them?

What can people do to be more aware of their sexual health this sexual health week?

‘First of all, I'd always think, is there something that you're feeling insecure about or unaware about? And if there is something that you really want to question or explore, this week is a great time to do it. And another really important thing is to use this week to go and get screened for STIs.

You can't tell by looking at somebody whether they've got an STI. All sexually transmitted infections can be there without any symptoms, including HIV, syphilis, gonorrhea, chlamydia, trigeminalysis, HPV, HSV. My list could go on. So just use it to think, right, I'm going to have a health MOT this week. I'm going to prioritize myself. And I would do this for me. And I think that's a really important message.

We go to the dentist every 12 months, whether we've got something wrong with us or not. And I think we really should think of sexual screening like that if we're changing partners. And even if we're not, you know, once in a while, just go. Even if you are thinking that you know “well, I haven't had sex with anybody else” it's still worth just considering getting tested for your own peace of mind.

And then if you are a female who's having heterosexual sex, again, think about contraception. If you're a man who's having sex with men, there's things like extra vaccines that you can have, such as PrEP, which is pre-exposure prophylaxis. Now doxyPEP is coming on the horizons, that's prophylaxis against syphilis. So again, depending on what the type of sex you are having is, think individually about what you need for your own sexual health.’

This year's theme for Sexual Health Week is Chronically Online. What do you think are the key impacts the online world has on people's sexual health?

‘I think people are viewing things and accessing things that they're not emotionally aware or mentally ready to see and once you've seen something once, you've viewed something you can't erase. I think there's probably a lot of trauma surrounding sex for young people who have viewed these things, especially when they can't then talk to an adult because they're not supposed to have watched in the first place. Everything goes underground and so people are getting their sex education from this kind of porn exposure, and it's often very misogynistic. It's very violent. There's nothing about pleasure or intimacy or love or care.

For example, choking is seen as pretty much standard. There is no safe way to choke anybody. No one should be choking anybody. Young people often have no idea that putting their hands around someone's neck could actually kill them, or damage them, or cause brain damage, or fracture bones, or do anything else like that.’

What advice would you give to people checking out their own external sexual organs and body part?

‘It’s important to know your own normal. And that's not just your anatomy. It's your skin. If you're a female, it's your own discharge. It's how you normally bleed. If you're a male, checking that everything's working. And, if you can't see everything, get a mirror, have a look. Check what you look like and also fall in love with yourself as well, because I think a lot of people are influenced by what they see on social media and porn. And we have a very unrealistic expectation of what we're supposed to look like. And I promise I've seen so many thousands of genitals, there is not one that is the same as the other one.

And again, I think it's about loving ourselves, which can be really difficult, especially when we're younger. Growing to love your body is a really important skill. But people being exposed to a lot more genitalia that maybe doesn't look like your own doesn't mean that yours is wrong or bad. And if it is porn that you're seeing, so especially if you're a heterosexual woman, you're rarely going to see other vulvas unless you are looking at porn. And often they've undergone labiaplasties and other surgeries. So, they might not look like your labia. A really, really great resource to look at is labia libraries. It has all sorts of different ethnicities, sizes of labia lips, etc. You will find you or something similar on that site.’

What are the key signs you may see if your body isn’t looking like your normal?

‘If you think your skin's changed or doesn't look the same as something else, you've got a blister or a lump or an ulcer, or your discharge changes, you've got any abnormal bleeding, things like that. They're the kind of things: visual changes in your skin. Often it's nothing, but I would want someone to have a look at it if you were concerned. Sometimes it's just ingrown hair or something. But I'd rather be able to say it's nothing rather miss something that potentially could be relevant for them.’

What are the main STIs?

‘Gonorrhea, chlamydia, and syphilis are the most common bacterial STIs.

HPV, so human papillomavirus, that's the most common viral STI. There's also herpes simplex virus.

Trichomoniasis is a parasite. A parasite is a living organism, so trichomoniasis can be seen under the microscope and it wiggles around. It's mainly symptomatic in women, and can cause profuse discharge, and can often make women really sore. You can also have this with no symptoms.

And then obviously HIV and hepatitis are both viral infections as well.’

What does the process look like when testing for STIs?

‘You can go to your GP or sexual health clinic and see somebody. So if you've not got any symptoms, it's possibly easier just to do it online or bob in and do self-taking swabs or you collect your urine or something. So you don't show your genitals to a professional. If you have a vagina, you do a self-taken vagina swab. If you have a penis, you do a first pass urine in a bottle. If you're having anal sex, you do an anal swab. If you're having oral sex, you do a throat swab. They can all be self-taken and they would all test for gonorrhea and chlamydia.

Trichomoniasis is often only done if you have symptoms.

And then HIV and syphilis should also be added, but that's a blood test. In most situations you can sometimes get a finger prick test, and they will often be available for free online. I would recommend you look up your local service and see what they offer.’

How can people work out which contraceptives are the right ones or one for them?

‘First of all, I just want to say some basics. The biggest risk of a heterosexual woman having sex is pregnancy. 85 and 100 women will get pregnant on average in a year if you're not using any contraceptive. You need to approach contraceptive knowing that, if you don't use contraceptives and you get pregnant, you then either have to have a baby, which can have a massive impact on your health, both mental and physical, or have a termination, which again has huge impacts on your health, mental and physical.

When we think about contraceptive, if you want it to stop getting pregnant, you need to think of the efficacy of it, so how well it's going to do that job. The most efficacious contraceptive is the implant. It's a little rod, three centimeter rod that goes into your arm, and lasts for three years. If you use that, the rates that the FSRH quote are less than one in a thousand chance that you're going to get pregnant. So this is the best contraceptive with regards to efficacy.

Then, it's the coils. You've got copper coils and hormonal coils. They're less than one in 100 chance of pregnancy. And on a lot of them you will ovulate with. A lot of hormonal contraceptives will stop ovulation. That's why sometimes people can feel a bit off off on them or complain of weight gain or all other things with the low dose hormonal contraceptives. When on low dose hormonal coils and the copper coils, you will carry on ovulating. If you are very sensitive to hormones, this is a really good option.

Then, injectable contraceptives, which can sometimes delay fertility a little bit. So, if you're wanting to get pregnant in the next few months, it's not the best option. There's also more caveats to that, as in you wouldn’t want to give it to somebody who's very young or underweight, just because it can reduce your bone density and it is the only contraceptive that has any link with weight gain. It's given every 13 weeks. And sometimes for people who have persistent bleeding on all sorts of other contraceptives, it can sometimes totally stop bleeding altogether.

And then pills. Everyone's heard of contraceptive pills. There's two types, one with just progesterone in, one with progesterone and oestrogen in. Now, pills are great and they're the most commonly prescribed drugs. But they have a failure rate of 9%. So, 9 in 100 women are going to get pregnant on them because we forget to take them. So that's why I would always start thinking, when you start your contraceptive journey, start thinking about your long-acting reversible contraceptives, which is your implants, your coils or your injectable contraceptives.

In terms of male contraceptives, condoms are still a really good thing for people with penises to get good with. I would encourage all people with penises to practice putting condoms on and ejaculating with them without a partner, because then it makes them much more likely to be used in a partnered situation. And then, you know, vasectomies. When people are finished with their baby-making life, you know, a vasectomy is a really good option, which is permanent.’