A student’s guide to sexual and reproductive healthcare
Kate Stedman (she/her) and Rosie Luo (she/her)
On a scale of 1-10, how comfortable do you feel talking to your doctor about your sexual health? As medical students currently on our sexual health and obstetrics and gynaecology placements, we set out to bust some misconceptions and share some facts so that if your answer was 1, by the end of this article, it will have jumped to a cool 10.
In the COVID pandemic, we’ve accepted that getting regularly tested, vaccinated, and treated wherever possible is part and parcel of living in a community—this is how we should approach sexual health, too. Taking care of yours benefits you and your future sexual contacts. Of course, not everyone fucks, but everyone definitely knows someone who fucks. You never know when this information might come in handy!
The best ways to prevent transmission of sexually transmitted infections (STIs) are well-known: condoms for penetrative sex, dental dams for oral sex, and keeping sex toys clean. Pre-exposure prophylaxis (PrEP) is a recent development in the field of preventative sexual health. It’s a once-daily pill that drastically lowers your risk of contracting HIV. If you’ve just been exposed to HIV, you can take post-exposure prophylaxis (PEP).
Despite the many preventive tools available, catching an STI is incredibly common, and should never be blamed on immorality or promiscuity. This only discourages people from getting the tests and treatment they need. If you’re sexually active, you should get tested every three to six months because even if you don’t have symptoms, you could still have and pass on STIs. Suzanne, a sexual health nurse practitioner, has a simple message to anyone worried about having an STI: “The most important thing is to know what’s going on, and you cannot know that unless you get tested or speak to a professional.”
What if you test positive? “For me, it wasn’t really that scary,” says Spar, who has tested positive for syphilis, gonorrhoea, and chlamydia on separate occasions. He admits having a prior understanding of STIs helped him to remain calm. “I was like, okay, now I can go get treated. If I didn’t have the knowledge I would’ve freaked out.”
Alan*, on the other hand, described his experience as “very traumatic”—he found out he was HIV positive over the phone from his doctor. Since learning of his diagnosis, he has grown in self-acceptance and confidence, despite the stigma and misunderstanding surrounding HIV. Thanks to antiretroviral medication, his viral load has become undetectable. This means Alan is uninfectious and unable to pass HIV on to any sexual contacts. He stresses that like all other STIs, HIV is manageable. “It’s not what it used to be—now you can have a healthy and normal life.”
Many people Suzanne sees at the sexual health clinic are concerned about telling their sexual partners about their diagnosis, but most people really appreciate the courtesy of hearing about it as soon as possible. The sooner you know your status, the sooner you can get the right treatment and minimise the infection’s spread. There is also the option of using anonymous contact tracing offered by your provider.
We are lucky in Aotearoa to have a wide variety of funded contraceptive options. However, no contraception is bulletproof; like all medications, each type carries its own success rates, risks and benefits. Family Planning is the most well-known reproductive health service—their appointments are free for all Aotearoa residents under 22 years old. You can go to them or your doctor for personalised advice about what might be the best option for you, but ultimately the decision is yours.
If you’re happy taking a pill every day there are two kinds: the combined oral contraceptive and the progesterone-only, if the former isn’t suitable for you. If, like me (Kate), you’re so absent-minded you’d lose your limbs if they weren’t attached to your body, long-acting reversible contraceptives (LARCs) are a good option—you can set and forget! There are a wide variety of fully-funded LARCs, ranging from both hormonal and non-hormonal intrauterine devices (Mirena and copper IUD respectively), three-monthly hormonal injections (depo-provera), and a hormonal implant that sits under the skin in your arm. The resources below are a great starting point for finding out more about these options.
Barrier contraceptives have the fantastic benefit of also protecting against STIs. Doctors and Family Planning can prescribe condoms, the OG, up to 60 at a time. Another hack is to fill your prescription at Chemist Warehouse, where they don’t charge for prescriptions. Heyo: FREE CONDOMS! At almost $20 for a small pack at the supermarket, maybe free condoms are where you can get that extra bit of $$ for that hazy first-home dream. Female condoms are another option, but they’re more expensive, at $3 apiece.
The emergency contraceptive pill/plan B, that can prevent pregnancy if taken within three days of unprotected sex, is available at pharmacies without needing a prescription. In Tāmaki Makaurau, the Auckland Medical Aid Centre and Epsom Day Unit are two clinics you can self-refer to for pregnancy termination. This is one of the safest and most common medical procedures. By the end of 2022, the Ministry of Health will also be launching a telehealth abortion service. If you become pregnant and/or intend to have a baby, getting in touch with a trusted midwife or doctor will help keep yourself and pēpi healthy through pregnancy and birth. Family Planning can help you find a lead maternity carer (LMC).
Even in the best of circumstances—you’re aroused, comfortable and equipped with confidence and a good sex partner—sex isn’t straightforward for everyone. Pain during sex can sometimes be alleviated with good foreplay and lube (which also prevents abrasions or scratches that STI bugs can get into), but if it persists it’s not something you have to put up with. Craccum has an article on vaginismus if you’re interested in reading more.
Painful periods are common. Some people manage with painkillers and good old TLC, but your pain should always be taken seriously. Debilitating, persistent pain during your period may be a sign of endometriosis. If this sounds like you, talk to your doctor and don’t hesitate to get a second opinion. Always speak to a doctor about any bleeding outside of your period you are concerned about, like bleeding after sex or between periods.
When asked what she would consider the best service for students to go to about sexual health, Suzanne says, “The student health services wherever they’re studying are often the best place they can go to.” These services understand their patients’ needs and tend to be well-versed in matters of sexuality and gender identity. They can take you through the whole process of prevention, testing, and treatment. “If you’ve got an urgent specific need, Auckland Sexual Health Service can see you because it could be a public health issue,” recommends Suzanne. You should expect that most health workers will be like Suzanne—well-informed and happy to discuss your sexual and reproductive health in a respectful way.
If you’re not comfortable seeing your regular doctor, there are plenty of community-based services. For men who have sex with men, Body Positive and the NZAF Burnett Centre are good places to get STI testing done. Check out the list of resources at the end for more. No matter where you go, your health information is confidential and should not be shared without your consent.
While we’ve covered a lot, we’ve glossed over many topics like fertility, pap smears, menopause, and erectile discomfort—this article is NOT comprehensive. We hope that no matter your problem or circumstance, you’ll feel comfortable seeking advice from a professional.
Our most important message about sex comes from Spar: “I would say actually just enjoy sex!” Suzanne agrees, “sex is an incredibly normal part of life.” Sex is an opportunity to explore and learn more about yourself and your consenting sexual partner(s). We wish all Craccum readers a happy sex life, whatever that looks like for you!
*Some names have been changed to protect individuals’ privacy
Information about STIs and testing locations: healthysex.nz
Auckland Sexual Health Service: ashs.org.nz
Information about abortion and provider locations: abortion.org.nz
Information about STIs, contraception, pregnancy and more: familyplanning.org.nz