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					   The Advantages of a Fully
Integrated Family Planning (FP)
  and Genito-urinary Medicine
         (GUM) Service



By Alison Bigrigg
GLASGOW
UK
There have always been
beliefs and Taboos About
Sex……
  Permissible Positions
  Anything other than ‘missionary’ is
   unnatural
  3 yrs penance for women on TOP
  Beastly position blurred boundary
   between men and animal

                     Official Handbook for Priests 1215
There have always been
beliefs and Taboos About
Sex…..
  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
Beliefs and Taboos of Late
20 th Century

  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
Beliefs and Taboos about
Sex in Late 20th Century

                                                                  “you don’t think
      “I’m scared”
                                  “I felt dirty”               it will happen to you”




 “only seedy, seedy people                         “nice girls don’t”
prostitutes and like get STI’s”
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
Characteristics of Women presenting to
GUM and FP Services in Glasgow (1)
   Characteristics       FP Attenders   GUM Attenders

   Use of                86%            74%
   contraception or
   condoms
   Always use            22%            14%
   condoms
   2+ partners in last   24%            50%
   year
   Ever been forced      6%             9%
   to have sex?
   Partners of same      1%             3%
   sex
   Psychosexual          6%             12%
   problem
Women presenting with Vaginal
Discharge (2002)
  Diagnosis          FP & RH   GUM
  No abnormality     39        36
  detected
  Candida albicans   28        32
  Bacterial vaginosis 30       33
  Neisseria          0         1
  gonorrhoea
  Trichomonas        2         0
  Vaginalis
  Chlamydia          7         9
  Trachomatis
  Other Streptococci 7         10
Characteristics of Women presenting To
GUM and FP Services in Glasgow (2)
   Client Concern   FP Attenders   GUM Attenders

   Periods          22%            20%

   Due a cervical   29%            22%
   smear
   Urinary          5%             14%
   Incontinence
   Menopausal       2%             3%
   Symptoms
   Previous         8%             8%
   Miscarriage or
   Termination
What are the Consequences of
Combining GUM and FP Clinics?

  Do men stay away from ‘women’s clinics’
   or ‘abortion clinics’?
  Do women stay away from “those dirty
   men in long grey raincoats?”
  Do users worry about confidentiality?
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
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
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
…… in the 21st
 Century lets blow
 away the taboos
 and provide
 comprehensive
 sexual and
 reproductive health
 services in bright
 modern buildings!
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
Different Professional
Backgrounds
Different Professional Backgrounds
GUM Physicians                   FP Doctors/Community
o Hospital based since             Gynaecologists
  World War I                    o Roots in voluntary
o Physicians                       movements in
                                   community. Only into
o Disease orientated               NHS in 1974.
  approach with multiple
  tests                          o Surgical background
o Concentrate on one to          o Promote client focused
  one care                         approach with minimal
                                   tests
                                 o More whole population
                                   approach


  CLASH OF CULTURES BUT EACH CAN LEARN FROM OTHER
Fixed Ways of Doing Things
Fixed Ways of Doing Things

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
Much Larger Services
Larger Services

  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)
  Greater influence – by speaking with one
   voice
  New friends
Conclusion

 Learning together improves communication
   and knowledge but working together
   changes the way we perform to the
   benefit of clients and staff alike
I would recommend
   working side by side
   with GUM physicians
   and encourage you
   to do so

				
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posted:8/29/2012
language:English
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