1. The Advantages of a Fully Integrated Family Planning (FP) and Genito-urinary Medicine (GUM) Service By Alison Bigrigg GLASGOWUK

2. There have always been beliefs and Taboos About Sex…… Permissible Positions Permissible Positions Anything other than missionary is unnatural Anything other than missionary is unnatural 3 yrs penance for women on TOP 3 yrs penance for women on TOP Beastly position blurred boundary between men and animal Beastly position blurred boundary between men and animal Official Handbook for Priests 1215

3. There have always been beliefs and Taboos About Sex….. Doctors thought sex was necessary for health Doctors thought sex was necessary for health A hundred thousand men died there because from women they abstained they had not perished thus had they not been abstemious Ambrose, Poet Historian of the Third Crusade

4. Beliefs and Taboos of Late 20 th Century STI clinics are for STI clinics are for dirty old men in raincoats And are always located in damp dark hospital basements FP patients are nice married ladies or at least in monogamous relationships so there is no need to talk about sex FP patients are nice married ladies or at least in monogamous relationships so there is no need to talk about sex

5. Beliefs and Taboos about Sex in Late 20 th Century I felt dirty nice girls dont Im scared only seedy, seedy people prostitutes and like get STIs prostitutes and like get STIs you dont think it will happen to you it will happen to you

6. Who Goes to Which Clinic? Subtle differences between women who use GUM clinics or attend FP clinics, but much cross over of use More men do use GUM clinics than FP, but it would be advantageous to increase men (and boys) attending FP

7. Characteristics of Women presenting to GUM and FP Services in Glasgow (1) Characteristics FP Attenders GUM Attenders Use of contraception or condoms 86%74% Always use condoms 22%14% 2+ partners in last year 24%50% Ever been forced to have sex? 6%9% Partners of same sex 1%3% Psychosexual problem 6%12%

8. Women presenting with Vaginal Discharge (2002) Diagnosis FP & RH GUM No abnormality detected 3936 Candida albicans 2832 Bacterial vaginosis 3033 Neisseria gonorrhoea 01 Trichomonas Vaginalis 20 Chlamydia Trachomatis 79 Other Streptococci 710

9. Characteristics of Women presenting To GUM and FP Services in Glasgow (2) Client Concern FP Attenders GUM Attenders Periods22%20% Due a cervical smear 29%22% Urinary Incontinence 5%14% Menopausal Symptoms 2%3% Previous Miscarriage or Termination 8%8%

10. What are the Consequences of Combining GUM and FP Clinics? Do men stay away from womens clinics or abortion clinics? Do men stay away from womens clinics or abortion clinics? Do women stay away from those dirty men in long grey raincoats? Do women stay away from those dirty men in long grey raincoats? Do users worry about confidentiality? Do users worry about confidentiality?

12. Combining FP and GUM Clinics (1) More people of both genders attend once clinics merge (UK experience) 40% increase in new GUM attendances in 2 years 10% increase in overall FP attendances in 2 years

13. Combining FP and GUM Clinics (2) Client satisfaction with services rises (Glasgow experience) Significant improvement in % of clients who: thought the clinic was sufficiently confidential were happy with overall care rated the facilities as excellent

14. Combining FP and GUM Clinics (3) Staff satisfaction rises Staff in Glasgow think + services were more frequently good or very good after merger + better environment for clients and staff

15. …… in the 21 st Century lets blow away the taboos and provide comprehensive sexual and reproductive health services in bright modern buildings!

16. Barriers to Combining GUM and FP Clinics Not the users but can be the staff! + different professional backgrounds + fixed way of doing things + communication problems – larger services + Egos : big fish in little pond

17. Different Professional Backgrounds

18. GUM Physicians oHospital based since World War I oPhysicians oDisease orientated approach with multiple tests oConcentrate on one to one care FP Doctors/Community Gynaecologists oRoots in voluntary movements in community. Only into NHS in 1974. oSurgical background oPromote client focused approach with minimal tests oMore whole population approach CLASH OF CULTURES BUT EACH CAN LEARN FROM OTHER

19. Fixed Ways of Doing Things

20. Examples of how clinician views changed in Glasgow (i)GUM on-site microscopy no longer undertaken for asymptomatic women (ii) FP : Improved sexual history taking, identifies need for chlamydia testing (iii) FP : Understands importance of partner notification (iv) GUM : Change from fixed number of patients to drop in sessions + many other examples of improved resource use and clinical care

21. Much Larger Services

23. Larger Services Larger knowledge and skill base e.g. information from this seminar Larger knowledge and skill base e.g. information from this seminar Larger pool of preferred tasks and strengths e.g. IT, media skills, specialist clinical knowledge (herpes) Larger pool of preferred tasks and strengths e.g. IT, media skills, specialist clinical knowledge (herpes) Greater influence – by speaking with one voice Greater influence – by speaking with one voice New friends New friends

24. Conclusion Learning together improves communication and knowledge but working together changes the way we perform to the benefit of clients and staff alike

25. I would recommend working side by side with GUM physicians and encourage you to do so