When people find out what I do for a living, they mostly want stories - and tend to hold off shaking my hand until they are quite sure I’ve washed them.
I do have stories - by the bucketload: of mystery objects inserted in unusual places, tattoos you wouldn’t expect a pain threshold to manage, discharge that has put me off custard for life, and the occasional bifurcated penis … (Google it. Go on. Unless you’re at work. Then maybe don’t.) But the average day involves very few weird and wacky cases.
I fell into sexual health after working in South Africa and wanting to get experience in HIV nursing. The lure of the bright examination lights caught me, and I’ve been in the specialism for 10 years now. The first few shifts were an eye-opener, but it is surprising how quickly you get used to asking, “Any fisting, rimming or sex toy use?” with a completely straight face.
My waiting room is full of people from all walks of life, from teenagers to septuagenarians, all worrying about the same things: “Am I going to get told off?” “Will she laugh at my bits?” “Have I caught something?” First, it’s not my place to tell you off. You’re asking for help, and I’m here to help. So short of being concerned about window periods (the incubation time when a test may be inaccurate), and what you’ve been putting where, I really don’t mind how many times, with how many people. I’m here to listen, not to judge.
Equally, I will never, ever, laugh at your junk. I’ve seen enough genitals now to know that we are all truly unique. No one has a flawless lady garden, and despite what many like to believe, the perfect penis does not exist. No, not even yours. So go ahead, wax your flaps, bleach your anus, tattoo the entire cast of Fraggle Rock down there if you wish. But don’t do it on my behalf, I’m just here for the diagnostics.
Have you picked up something? Quite possibly. Many people do. And this is where my job gets tricky. Fortunately, many infections are now curable with a quick course of antibiotics and a week of living like a nun. There are some that, though manageable, are still incurable.
Telling a patient they have a lifelong condition is a challenging part of the job. Reassuring someone that, with careful management, they can live a normal life has to be balanced against the knowledge that this person has to go home to tell family, friends, partners. They may face stigma from their community or from their own beliefs about their condition. Finding ways to navigate this with a patient is one of the hardest but also the most rewarding parts of the job.
And these patients aren’t just diagnosed, then off they go. They stay with me. I check up on them, feel proud when they make progress in their treatment, worry when they miss follow-up appointments. The moment of diagnosis can bond you to someone in a profound way.
Many people carry secret shame about their sex life, and everybody wants to know if they’re “normal”. The longer I do this job, the more I realise there is no “normal”. I love hearing people’s stories and am fascinated by the complexity of human sexuality, how it is so entangled with our identities and emotions. The downside of this is when I bump into patients outside of work. More often than not they will be trying to remember where they know me from, and I will be hoping they don’t. The general rule in sexual health is that if we pass a patient in the street we treat them as a total stranger. Confidentiality is essential. Which is tricky if you happen to treat someone famous. But my lips are sealed.
One of the most startling changes of the past decade is how much porn appears to have affected attitudes and practices. Ten years ago, it was rare to see women with no pubic hair, let alone men. Nowadays it is practically the norm. As seems to be the expectation that anal sex is part of everyone’s sexual repertoire. Which is fine, if people are enjoying it. But the relief I often see on patients’ faces when I say, “If you don’t want to, you don’t have to” suggests we have a long way to go with teaching our young people about consent and mutual pleasure. It depresses me that, although most patients don’t come in as a result of a sexual assault, when I ask, “Have you ever been pressured into having sex, or been too drunk to remember agreeing to it?” the overwhelming majority of women, and many men, say yes. If I had control of the national curriculum for sex education in schools, consent and sexual wellbeing would be in every single lesson.
Another big change is how sexual health is seen within the NHS. Now that the terrifying crisis of Aids has died down, it is not a speciality that gets much sympathy or publicity. As a result, perhaps, we have been one of the areas to feel the pinch of austerity, with further cuts looming. Many sexual health clinics are now run by private companies, and it has been an interesting ride, finding out what life may be like with a privatised health system. The pressure to see more patients in a shorter space of time is very real; quantity is prioritised over quality. A few minutes spent reassuring a patient in distress is questioned when the waiting room is full. I miss the days of being able to make a patient a cup of tea and give them the time and care they need.
For the most part, my job is great fun, meeting interesting people and hearing their interesting stories, alongside an incredibly hardworking and dedicated team. Obviously, I would say that nurses should be paid more. But we get just about enough to live on, and our jobs are secure. As long as the gonorrhoea keeps on coming, we’ll always be needed.
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