Let’s Talk: a new way of talking about your sexual health
Join women’s health specialist Dr Molly and health writer Laura for SH:24’s first podcast! We’ve seen that medical evidence doesn’t always match up with our everyday experience - so we’re on a mission to change the conversation about our sexual health. In the first episode, we put women’s voices alongside clinical research to challenge what we’ve been taught about contraception. And today we’re here with Dr Molly for a day in the life of a busy GP…
Dr Molly Anderson is a GP with a particular interest in women’s health. In this piece, she gives an insight into the many considerations a GP has to make when helping someone make a decision about contraception – all in a ten minute appointment.
I’m in the middle of a busy Monday afternoon clinic when I call in a girl of 16, bitten fingernails holding her long shirt sleeves, head down, cheeks already red with embarrassment. “How can I help you today?” I ask. “Errr.... I want to go on the pill,” she mumbles.
Now, I love talking about contraception. I enjoy talking to women, finding out what they need, and figuring out a solution that works for them. But I understand that women don’t always feel the same. Particularly if you’re new to having sex, it can feel a bit overwhelming and embarrassing. At least that’s how I felt when I was in my teens.
As a GP with a special interest in contraception and sexual health, I see women of all ages. Consultations can be so varied. They can be the easiest or the most difficult appointments of my day, and I have no idea until I get started. From the 5-minute pill check with a happy customer, to a vulnerable 14 year old who turns up already possibly pregnant with a Chlamydia infection, and with a worrying social and sexual history that has me on the phone to social services for the rest of the afternoon.
“Because contraception is never just contraception.”
Because contraception is never just contraception. Whilst listening to the ideas, concerns and expectations of these women (day 1 of GP communication skills training), without freaking them out with too many choices or the rare but important risks I must, ethically and medico-legally, inform them about, I need to assess a ton of other stuff. Not only do I want to figure out what type of contraception might suit them best, I need to know if they have any medical conditions that might rule out certain choices. Any dodgy sounding bleeding that raises alarm bells? Could they already be pregnant? Do they need the morning after pill? STI testing? Are they underage? How old is their partner? How many partners? Are they being groomed and exploited? Are they up to date with their cervical screen? And I mustn’t forget to check their blood pressure, smoking status and BMI. Phew.
Today’s 16 year old has just one partner, a boy at her school of the same age and they have been using condoms so far. (Correctly? Better check that.) She’s on her period now so I know she’s not pregnant. She is slim, doesn’t smoke and is usually fit and well. So far, so (relatively) straightforward. She has mentioned the pill already. Perhaps she has spent hours researching online, or perhaps it’s all she has heard about. I bring out an A4 leaflet, double sided, with text so small you can barely read it, detailing 14 different choices.
For a few reasons, at this point I may become a little more directive. A - I don’t want to overwhelm her, and B - I only have 10 minutes, and we’re at 13 already. Specialist clinics are better set up for fitting a coil or implant on the same day, but most GP or practice nurses will need to rebook you to have one of these.
She’s a smart cookie and takes it all in her stride. She leaves armed with a prescription for the COCP (combined oral contraceptive pill) and clear instructions for how to start it and what to do if she misses a pill. She’s interested in the implant so I give her a couple of extra leaflets to read through with ‘SH:24’ scrawled in the corner. There is fantastic information available online, but I like to direct people to reliable websites where I know they will get accurate information.
“It may just be contraception, but it’s part of the bigger picture, the whole person. “
It’s a lot to take in so I encourage her to call or come back with any questions. When the system works well, she’ll see the same person a few times and the conversation develops over each appointment. Often women need more direction at first, but over time my role steps back and I am just there to guide and advise, provide a sounding board and facilitate them to make their own choices and decisions.
It’s a privilege getting to know these young women and help them to live healthy, happy lives - to see them go from nervous teenagers to confident adults. It may just be contraception, but it’s part of the bigger picture, the whole person. And people are interesting creatures, none of us the same. It’s why the job never gets boring. And that’s a good thing.