In 2008 Alice Dogruyol representing The Spa PR Company wrote to me requesting I plug a new genital cosmetic procedure – the g-shot. It involved injecting collagen into the vaginal wall. And was being spearheaded in the UK by a Professor Phanuel Dartey of Harley Street.

I immediately noticed there seemed to be no robust peer reviewed clinical evidence for the safety and effectiveness of the g-shot procedure. I felt the press release I was sent was so poor and the ‘treatment’ described seemed so bizarre that it was best ignored. I assumed no media outlet would pick up on it.

I was wrong.

Several newspapers including the Sun, Mirror, Telegraph and Mail clearly had been sent the same press release as me. The only difference was they joyfully publicized the g-shot and promoted Prof Dartey’s Harley Street practice. And in the case of the Sun and the Mirror the pieces were written by their Health and Science correspondents. Who really should have known better. Since then many women’s magazines and websites have also described the procedure as a sex life enhancer, promoting both the g-shot and Laser Vaginal Surgery (which Dartey also offered).

I was so concerned I wrote a blog post about the problems I foresaw with the g-shot procedure and subsequent media coverage. I also outlined core questions journalists and the public ought to be asking about it.

A journalist colleague then tried to pitch a story critiquing the g-shot , but they were unsuccessful. Over the past three years I sent my blog post questioning the g-shot to any media outlet I spotted giving it publicity. In most cases I heard nothing back. Occasionally a journalist would politely thank me and tell me they’d consider my opinions if they wrote similar pieces in the future.

In other words they ignored my concerns and questions. Probably because they weren’t as exciting as the sexy ‘science’ of collagen injections, and probably because anyone critiquing their breathy discussions of amazing orgasms through genital enhancement could be dismissed as an anti capitalist/feminist/academic killjoy.

I did not systematically continue to campaign against the g-shot because I reasoned even if the media were occasionally (albeit enthusiastically) covering it, I doubted many women would opt for either the g-shot or Laser Vaginal Surgery.

I was wrong here as well.

Last week Phanuel Dartey was struck off by the General Medical Council (GMC).

This followed complaints from five women. The British Medical Journal (16 November) reports Dartey ‘botched laser operations on four women and left another seriously ill after a termination’ . It goes on to report from the GMC hearing:
“Patient A was said to have suffered visible scarring and asymmetry of her genitals, although she had been told that the incisions would be nearly invisible. Part of her vagina had been “effectively amputated,” and she required revision surgery
Patients B and C were given laser surgery for urinary incontinence, which the GMC’s experts say would have been of “limited value”.
Patient E was in major pain after a labioplasty to reduce the size of her labia minora, which Dr Dartey is said to have “significantly over-reduced.” When she complained of the pain, the GMC alleges that he suggested an injection of absolute alcohol into the area of the labial scar to kill the nerve endings, an intervention that was “inappropriate.”
Patient D travelled from Ireland to the Marie Stopes centre for a termination at 18 weeks’ gestation. Dr Dartey is alleged to have perforated her uterus during the procedure but failed to recognise this.
The GMC alleges that he failed to check that all the products of conception had gone and failed to notice that the fetal thorax had not been removed. When D returned home, she became “extremely ill,” … “She was on the critical list and was in hospital for two months.”
Dr Dartey, who was suspended from practice pending the hearing, is also charged with having no valid medical indemnity insurance when he carried out the termination in February 2006”.

A further report of the hearing, again from the BMJ (6 December), explains why Dartey was struck off:
“Robin Knill-Jones, who chaired the GMC’s fitness to practise panel, said, “In the panel’s judgment there is a continuing risk to patients from the way Dr Dartey conducts his practice. His dishonest actions in relation to professional indemnity were a serious abuse of the trust that his patients and those with whom he worked were entitled to place in him.
“The panel considers that the extent and seriousness of Dr Dartey’s clinical misconduct, the gravity of his dishonesty, and his subsequent lack of insight evidence a harmful attitudinal problem.”
When Dr Dartey carried out the termination in 2006 on a woman who had travelled from Ireland, he perforated her uterus and failed to remove the fetal thorax. When she returned home she became extremely ill and was in hospital for two months, the panel heard.
Dr Dartey’s membership of the Medical Protection Society had lapsed in 2002, and he had no indemnity cover when he performed the abortion. The panel found that a membership certificate he sent to Marie Stopes International purporting to cover 2005-6 was a forgery.
Dr Knill-Jones said, “Each of the five patients with which this inquiry has been concerned has suffered from the events in question. In his written communications to the GMC Dr Dartey has shown little remorse or acknowledgment of, or insight into, his failures.
“He has rather adopted a derogatory attitude towards his patients, accusing one of racism, another of blackmail, a third of causing her own problems by failing to follow his advice, and another of reporting him to the GMC because she wanted free corrective surgery for an unrelated problem. The panel has found no substance in any of these complaints and regards Dr Dartey’s lack of insight as a matter of serious concern.””
The lack of insight comment seems particularly relevant given that during the time the GMC were investigating his case, and while it was being covered in the media, someone claiming to be Professor Dartey appeared to comment at Ghanaweb where he belittled those complaining against him. This comment has not been verified as from Prof Dartey but it seems uncannily similar to the report from the GMC hearing.

This is truly shocking case that raises questions about the conduct and supervision of medics in private practitice. Marie Stopes also undoubtedly need to review procedures for the selection and supervision of staff working at their clinics.

The media also has a role to play here, but this was not (as far as I know) picked up on at the GMC investigation.

The PR company who promoted Dartey and the journalists who covered his g-shot and Laser Vaginal Surgery interventions in uncritical and often glowing terms are, in my opinion, culpable.

We know from research on women seeking cosmetic genital surgery one of the main things that persuades them they need cosmetic procedures is advertising from clinics/consultants. And how better to advertise than via an enthusiastic media endorsement? Even though it is well documented there’s no evidence of effectiveness of cosmetic genital surgery but plenty of evidence of active efforts by medics to promote such practices.

Perhaps unsurprisingly the papers that fawned over the g-shot have been remarkably silent about the GMC hearing. And none have admitted they gave publicity to an untested and dangerous cosmetic intervention.

The only paper who reported in favour of Dartey and also on his striking off was The Daily Mail. They managed an incredible about face with their initial piece ‘I’ve had the G Shot and YES, YES, YES my sex life has never been better!’ promoting the g shot procedure. While Dartey’s GMC investigation was ongoing they were still publishing testimonies in his favour. Finally describing his fall from grace in less than glowing terms. The latter piece, of course, made no reference to the former. (Thanks to @MrNorthice for helping with these links).

This media distancing could be coincidence, or it may be more deliberate. In the Mail’s case it can be seen as deliberate in the way Dartey is talked about. When his g-shot procedures are being lauded he’s a Professor from Harley Street. When his striking off is detailed his qualifications from the Soviet Union and Ghanaian heritage are at the fore. As @PeteDeveson astutely commented on twitter: “on the way up it’s “Hollywood” and “Harley Street”. On the way down it’s “Ghana” and “Soviet””. This xenophobic coverage neatly airbrushes any involvement of the newspaper in promoting Dartey’s practice – and subsequent harm done to his patients.

When I first read the press release about the g-shot it raised not so much a red flag as a string of red bunting. I tried to challenge it where possible with journalists but felt powerless to really get anyone to listen.

I still feel powerless about this situation and the countless others like it. Journalists cover stories on sex and health topics that advocate untested treatments, products and procedures. Therapists and practitioners are showcased with no check on their skills, qualifications or professional ethics. Cosmetic genital surgery is increasingly presented as ‘the norm’ and if any criticism is allowed it is always a small voice of dissent in a wider promotion of surgical intervention. While this case concerns surgery performed on women, men’s media is just as problematic when it comes to promoting dodgy sex pills, potions and procedures.

Of course claims that science, medicine and surgery can transform your sex life, give you amazing orgasms, make you more desirable or a better lover are beguiling to both editors and the public.

Sadly these claims are rarely put to the test.

Which allows dangerous practices like those offered by Professor Dartey to go unchecked.

Editors and journalists lack basic skills to evaluate press releases or stories they are sent about sex-related products and procedures. Either because they are busy, seduced by science speak, or unable to critically evaluate medical claims. More importantly editors and journalists do not make enough use of willing qualified individuals and organisations who could help them assess whether claims they’re about to write about are accurate or not (for example using guides like this one created by Dr Jennifer Gunter). Where practitioners try and tell them they could be advocating something that is ineffective at best, life threatening at worst, the media (for the most part) ignores them.

We should be rightly angry with the media and with practitioners who promote untested and unnecessary cosmetic genital surgery.

This will be of little comfort to the five women involved in this case, who will be scarred psychologically and physically for the rest of their lives.

Professor Dartey should be ashamed of his actions, but GMC reports imply this is unlikely.

The journalists who didn’t bother checking a simple press release and promoted his products and services should also be ashamed of their actions. Again, I think this is unlikely.

The Spa PR Company who originally promoted the g-shot and Dartey’s clinic should also take responsibility for their role in this tragedy. I have written to them offering a right to reply which I will post here if they wish me to.

Other media outlets could now write about this case critically, and make a commitment to reporting on sex/science stories ethically and carefully. They could campaign against cosmetic genital surgery or refuse to showcase it in their features or advertising. Here too I expect this is unlikely.

It is easy to forget in stories like this how real lives can be destroyed. My sympathies are with the women affected by Dartey’s professional misconduct. While I find it easy to compile a case against media and medical incompetence, I find I lack the words to adequately express how badly I feel for them.

It’s nearly Christmas and you may have already got gifts for friends and family. But if you’re still wondering what last minute goodies to buy, or can stretch to one more present, then here’s a few suggestions for charities and organisations who could do with your support.

These are all programmes I feel are often not given much publicity and may not fit in the usual ‘good gift’ type Christmas promotions, but nevertheless do amazing work all year round and deserve our support.

I’ve picked 6 charities/groups who represent various different activities around sex, relationships and health. Some are faith based, some secular. Some are specifically focused to one region or country, others are international. You may want to support the one you feel most impressed by – or perhaps give a small amount to several of these very good causes.

As well as financial support there are also other ways to help these organisations so do read up on any that interest you and see if you can help them as a volunteer in the new year.

Hesperian Foundation
Hesperian is a non-profit publisher of books and newsletters for community-based health care. It produces free resources in various different languages on topics such as Where There Is No Doctor, Disabled Village Children and Helping Health Workers Learn.

Here are ways you can get involved, which don’t just involve financial donations – you can also volunteer, translate and review books, and let other people know about the work Hesperian are doing.

Jabulani Rural Health Foundation
Jabulani is a non-profit organisation that supports Zithulele Hospital and its surrounding community. Zithulele Village is situated in a remote part of the Wild Coast (Eastern Cape Province, SA). Founded in 2007 by four Christian doctors, our focus is on healthcare, education, poverty relief, environmental issues and care for those affected by HIV/AIDS.

Practitioners at Zithulele have introduced a number of innovative programmes for rural health which have been reported in The Lancet and SAMJ and include nutrition, maternal health, occupational therapy and education projects.

A short film about the hospital can be found here:

Donation information can be found here
Become a friend of Zithulele here

Scarleteen
Scarleteen is an independent, grassroots sexuality education and support organization and website. Founded in 1998, Scarleteen.com is visited by around three-quarters of a million diverse people each month worldwide, most between the ages of 15 and 25. It is the highest-ranked website for sex education and sexuality advice online and has held that rank through most of its tenure.

More info here

Donate here

Outsiders
Outsiders is a community for people with physical and social disabilities that enables people to meet, make friends, overcome isolation and form relationships. It coordinates local meet ups, provides advice and hosts numerous events to raise funds for greater advocacy for people with disabilities. It also operates a peer support network, lobbies for greater rights for disabled people, and informs health and social care practice around sex, relationships and disability.

As well as providing financial assistance there are other ways you can help Outsiders including lobbying on issues around disability rights, and assisting the organisation with research, advocacy and resources. More information on how to give here

Education for Choice
Education For Choice is the only UK-based educational charity dedicated to enabling young people to make informed choices about pregnancy and abortion.

When young people have opportunities to explore the decisions that can lead to and result from pregnancy they are better able to:
Protect themselves from sexually transmitted infections and unintended pregnancy
Make informed choices
Access appropriate services to support their choices.
Education For Choice’s work is focused on the word choice. Whilst we concentrate on the issue of abortion, as it is the issue that receives least attention, we believe that work with young people should value all pregnancy choices equally.
Our ethos is that the best outcomes of unintended pregnancy occur when the woman involved has been able to make her own informed choice.

Donate here

The New View Campaign
The New View Campaign was formed in 2000 as a grassroots network to challenge the distorted and oversimplified messages about sexuality that the pharmaceutical industry relies on to sell its new drugs.
The pharmaceutical industry wants people to think that sexual problems are simple medical matters, and it offers drugs as expensive magic fixes. But sexual problems are complicated, sexuality is diverse, and no drug is without side effects.

The goal of the New View Campaign is to expose biased research and promotional methods that serve corporate profit rather than people’s pleasure and satisfaction. The Campaign challenges all views that reduce sexual experience to genital biology and thereby ignore the many dimensions of real life.

The New View Campaign is devoted to education, activism, and empowerment. We invite you to benefit from the information on this website, and we invite your support and participation.

More information on donating and volunteering for the New View, as well as implementing its ideas into policy and practice can be found here

I hope you are able to support one or more of these charities/organisations financially or in some other way.

Thanks for your continued support for this blog. Your feedback, suggestions and ideas for content (and how to improve the blog) is always very welcome.

Wishing you a very Merry Christmas and all the best for a happy and healthy New Year.

To get people in the Christmas spirit – and the mood for giving, I’ll be sharing carols, seasonal songs and a few sketches on twitter between 1-4pm on 22nd December (GMT) on the hashtag #PsXmasCharityConcert.

If you missed it, here’s the concert in full – please consider giving to one or more of the charities/organisations listed above while you tune in!

We opened with Mariah Carey’s All I Want For Christmas Is You

Followed by Meryn Cadell’s The Cat Carol which you can listen to here. [Not really suitable for young children, anyone who feels a bit hormonal, or people who like cats]

Then it was time for a bit of reading, with the fabulous Joyce Grenfell’s Nursery School Nativity Play And George, Wise Men never do that…

I bet you’ve never heard a better (or madder) version of The Little Drummer Boy than this one by The Klezmonauts.

It’s a Christmas tradition in our house that my dad reads King John’s Christmas as part of our family concert (he does it beautifully). So it felt apt to include it in my virtual Christmas Concert.

Next it was time for some Christmas kitsch – and it doesn’t get much kitscher than Eddie Dunstedter and his organ. I feel like I need a pair of heels, a cocktail and a Christmas pinny to really get into this one…

And if that wasn’t camp enough, it was time for some innuendo with Larry Grayson asking ‘Who’s stuffing your turkey this Christmas?’ (Go on, you can tell me!)

Do you believe in reindeer and the magic of Christmas? Of course you do! It’s only those pesky physicists who try and spoil things with all their logical explanations. Bah humbug!

Another song due after that, and it was over to Si Cranstoun and a very jolly Miss Santa Claus (he’s part of the Dualers – who are fab!)

What could be more seasonal than a song about an Angel Gabriel by LAMB?
I can fly
But I want his wings
I can shine even in the darkness
But I crave the light that he brings

Hoping you have someone in your life who make you feel this way.

On a lighter note I asked if people were familiar with the term Camp As Christmas? You will be after watching Bearforce 1 and ‘Christmas is here’ (which frankly ought to be the Christmas number one IMHO)

Next it was time for an activity for all the family – and kids of all ages. The Santa Application form (which I use in teaching questionnaire design – only at Christmas obviously). Still time to get your application written!

Obviously it wouldn’t be Christmas without a bit of Judy Garland, and the tearjerker anthem Have yourself a merry little Christmas

Last up in the virtual concert was my favourite carol In The Bleak Mid Winter which has the most beautiful words written by Christina Rossetti. I have a bad habit of ruining carol services by blubbing my way through the final verse of this.

Thanks for joining in my charity concert – either here or on twitter, and remember this was all for the good causes listed above, so please give them your money or your time if you are able.

Merry Christmas!

Tonight the UK will see the first television advert for abortion services. Shown at 10.10pm on Channel 4 the advert for Marie Stopes will highlight for viewers where to get help and advice about pregnancy. The advert has already been opposed by charity Life and will not be shown in Northern Ireland (where termination of pregnancy is illegal).

Despite following a public consultation about advertising condoms and termination services on television, some quarters of the media have responded to this advert as though it was automatically going to entice all young women to have abortions – even if they weren’t pregnant! Before the advert had even been made available some journalists were expressing outrage that such messaging could be shared, and were referring to the campaign as ‘the abortion advert’ (rather than an advert for an advice service). Although there was also balanced coverage elsewhere.

One key question that the advert has raised is why do we need to promote services offering termination on television? A common theme in discussing this case has been that those who want a termination would know how to get one so why should there be a television advert talking about this issue?

Unfortunately we know there are many myths about termination of pregnancy which include what terminations actually involve, how you go about getting one, when you can seek a termination, do you have to pay, and what happens afterwards (you can find answers to these questions here courtesy of Living Well/NHS and Patient UK).

We have to remember not everyone has access to the internet and signposting to reproductive health services is generally poor. So it is not always obvious what services are out there or how you might access them.

Some people agreed the advert should be shown, but felt it ought to be screened earlier in the evening so as to reach a younger audience. While I agree with this there is the stereotype we need to challenge that the only people who have/need terminations are teenagers and young adults. Terminations are sought by women of all childbearing ages and for a variety of reasons and with a variety of outcomes. This is why we need clear signposting as it may be older women, young women, unmarried or single women assume such services are not open to them.

We know through research women often make up their mind about having a termination before seeing a doctor but do benefit from prompt referral to termination or maternity care services (depending on the choice they make). But we do also know that women worry about making the move to discuss their options (having or not having a baby) for fear of being judged or concerns over confidentiality. Making it clear there is a service out there who can offer advice and support can be a step towards reassuring women and their partners.

Another issue raised was that having an advert on television ‘trivialised’ the topic of termination or made it into entertainment. This is obviously reliant on how the advert was presented, but generally having information about reproductive health made available on prime time television is beneficial because it is targeting an audience who may otherwise miss the information. Our problem remains if we decide some issues cannot be mentioned in public information adverts on television or in the cinema, where are we able to share them? And if we decide to only have information accessible online or in pamphlets at the GP surgery how many people will we be excluding?

In discussing the proposed advert the media rehearsed several of the stereotypes we’ve grown used to in relation to termination. That it’s only young girls who have unplanned pregnancies, that terminations are only for unplanned/unexpected pregnancies, that everyone who experiences a termination suffers regret (or should feel shame), and that most terminations are carried out at a very late stage. Having such views expressed but not challenged remains a problem – and causes distress for many people with either experience of termination or general problems with fertility. It is unfortunate in the run up to screening the advert there were not more opportunities taken to challenge such myths or provide accurate information.

Having advertising that helps people find advice services for termination of pregnancy is important – particularly since all evidence suggests an early intervention (if one is going to take place) is preferable. While I welcome the advert for Marie Stopes International I would prefer to see a far greater effort made to improve the general signposting to our reproductive health services, the funding for such services and more information about what is available. In particular highlighting contraception choices and getting access to family planning services is vital to women and men and equally as important as having adverts showing where to get advice in the case of considering whether or not to continue with a pregnancy.

Hopefully having this advert screened will pave the way for more opportunities to highlight reproductive and sexual health services and for us to lobby for better sex education and family planning care within our communities.

Here is the advert, see what you think…

Further help can be found at

Family Planning Association has advice and information about what to do if you are pregnant
I’m not sorry is for women who have had positive abortion experiences to share their stories
Health Talk Online (DIPEX) focuses on the feelings and reactions people have when ending a pregnancy over a fetal abnormality

What’s the difference between sexual, reproductive, psychosexual and relationship health?

Sexual health refers to dealing with either sexually transmitted infections, or physical or psychological sexual problems (also called sexual dysfunctions).

Reproductive health refers to your fertility – either advice on getting pregnant, information on contraception, supplying contraception (to prevent pregnancy), or helping you deal with an unplanned pregnancy.

Some clinics specialise in sexual health, sexual problems or reproductive health, other services will offer treatment or advice for any of these issues.

Psychosexual health services tackle deep-seated sexual problems that could be caused by psychological and/or physical factors.

Relationship counselling services help with problems ranging from sexual communication difficulties, to jealousy and coping with arguments or life after infidelity or divorce.

These services are dependent on your location – there may be more services available in certain countries/states. The politics or religion of different countries/states may affect service delivery or approach. Many clinics offer free support and advice, some private clinics do charge a fee, as do some doctors in certain countries – if you live outside the UK check your health care policies for more information.

Many sexual health services particularly those for sexually transmitted infections are often overwhelmed by patient demand. Part of the reason for this is that people pick the wrong service for their needs – so consult the list below to ensure you get the right help at the right time. And tell your friends so they get it right too!

Your Doctor (GP/Family Practitioner)
What can they offer?
• Advice about contraception and prescribe (and sometimes provide) contraceptives for you
• Advice on sexual problems (dysfunctions)
• Health checks relating to sexual problems (e.g. pain during/after sex, loss of erections)
• Information about menstruation, menopause, fertility (getting pregnant), pregnancy and abortion (termination), pregnancy testing
• Physical examinations of your genitals (including smear tests for women or testicular exams for men)
• Referrals to counsellors or other specialists in the case of sexually transmitted infections, sexual dysfunctions, previous or current sexual abuse, genital cancers
• Assessment and testing/treatment for STIs
• Advice about pregnancy/fertility, antenatal and postnatal support
• Advice and referrals for termination of pregnancy (in countries where abortion is legal)

Your doctor or practice nurse can perform external and internal genital checks, swabs and blood tests. They can test and treat you for STIs, or related infections. Depending on your location they may be able to provide you with condoms or refer you to a condom clinic. In many countries, GPs are the main providers of contraceptive services, so they’re not shy about talking about sex. Some people do feel embarrassed discussing sexual health with their doctor, particularly if they’ve known their doctor for a long while – or in cases where they may have an STI through an extra-marital affair or unprotected sex. If you would prefer to see someone you don’t know as well, you can either speak to a different doctor at the practice or go to a Genito Urinary Clinic for STIs or Family Planning/Reproductive Health Clinic for contraception/fertility advice (see below).

Useful links
NHS Choices has a dedicated section on sexual health
Patient.co.uk (links, resources and helpsheets on a variety of health issues)

Genito Urinary Clinic/Sexually Transmitted Infections Clinic
What can they offer?
• Tests and treatment for sexually transmitted infections.
• Advice about contraception (some clinics also prescribe contraceptives and provide condoms – at some clinics these are free).
• Information about safer sex.
• Advice on how to tell a partner you have an STI – some clinics will notify your partner(s) for you.

These clinics (also sometimes known as ‘sexual health clinics or centres’) will test and treat you for STIs, and provide safer sex advice and information. Some clinics work on an appointment basis, others on a ‘drop-in’ system, or a ‘first come, first served’ basis. Some have set times for teenagers, women or men to attend. You may want to telephone first to check appointment times and whether there’s a waiting list for treatment. You shouldn’t have to wait long to get an appointment, but in many countries where there is high demand for services the wait could be longer. You can get condoms from Genito Urinary Clinics.

Useful links
NHS Choices: Sex, worth talking about includes guides to sexually transmitted infections, including locate your nearest clinic and symptoms and signs of STIs
Planned parenthood’s guide to STIs (also available in Spanish)
Go ask alice! (your sexual health questions answered)
STIQ answers common questions about STIs, testing and treatment

Family Planning/Reproductive Health Clinic
What can they offer?
• They can advise you about contraception and give you contraceptives
• Information about how to get pregnant, or options if you have an unplanned pregnancy
• Pregnancy testing and referrals for termination of pregnancy (abortion) if you require it
• Smear tests for women

These clinics can perform smear tests (internal exams for women), and offer contraception and pregnancy advice. They can provide contraception such as birth control pills or injections, or condoms. If you want contraception only, then make an appointment at one of these clinics. If you think you have an STI, it’s better to see your GP or Genito Urinary Clinic.

Useful links
Family Planning Association guide to contraception, pregnancy and STIs
Brook sex advice for under 25s
Planned Parenthood advice on contraception, STIs and sexual and reproductive health – in English and Spanish
Marie Stopes global reproductive health advice source

Your Pharmacist
What can they offer?
• Home pregnancy testing kits (some pharmacies will do the tests for you)
• Over the counter treatments for cystitis, thrush, period pains (menstrual pains), folic acid (for those planning to get pregnant or during pregnancy and breastfeeding)
• Condoms and lubricant
• Give you contraceptives as prescribed by your doctor

In some countries, community pharmacists are taking a more active role in health care. For problems such as thrush or cystitis you can get confidential advice from your pharmacist. You can also get condoms, the morning after pill (emergency oral contraception), and lubricant from many pharmacies. In parts of the UK, US and Europe, you may also be able to be tested and treated for certain STIs by your pharmacist. If you think you have Chlamydia or Gonorrhoea, the pharmacist can provide you with a urine kit, which you return to them or post to a local laboratory. Results are returned in a few days and you’ll be given the all clear, provided with antibiotics by the pharmacist, or referred on to a Genito Urinary Clinic or your doctor if further tests or treatment are required. Not every pharmacy can offer this service, those that do will usually advertise testing with posters or leaflets. All pharmacies should be able to signpost you to your local Genito Urinary Clinic who will be able to help.

Psychosexual Therapy (Also known as sex therapy)
What can they offer?
• Identification and treatment of psychosexual problems (e.g. erectile dysfunction, loss of desire)
• Overcoming sexual problems due to past or present sexual abuse
• Dealing with sexual problems due to worries about sexuality
• Sexually compulsive behaviour
• Referrals to other healthcare services (e.g. urology, gyneacology) if needed

Many countries offer psychosexual advice and services. In some cases, they are free to patients with severe sexual problems, although have to be referred through a medical doctor, and can have a long waiting list. In countries where psychosexual services are free, patients can also book to see therapists privately. This cuts down the waiting time, and will cost money, but allows the client choices who they get therapy from (e.g. a religious person may prefer to have sex therapy from someone who understand and respects their religion; a lesbian or gay client may prefer a ‘pink shrink’). In other countries, psychosexual services are entirely private, and have to be paid for. These services may not be covered by medical insurance, check your policy. Some countries do not offer any services, or a limited number of therapists.

Useful resources
Overcoming sexual problems by Vicki Ford (Constable and Robinson)
Women who love sex: an inquiry into the expanding spirit of women’s erotic experiences by Gina Ogden (Womanspirit Press)
Our bodies ourselves: a new edition for a new era by Boston Women’s Health Book Collective (Touchstone Books)
Sexual health for men by Phillip Kell and Vanessa Griffiths (Class Publishing)
The new male sexuality by Bernie Zilbergeld (Bantam Doubleday)

Basrt (British Association for Sex and Relationship Therapy)
Sexual Dysfunction Association includes advice and support on male and female sexual problems
Women’s Health gynaecological and other women’s health advice
Male health information from the men’s health forum

The above organisations cater to gay or straight couples – however if you’d prefer to see a gay or lesbian-friendly counsellor you can contact:
Pink Therapy
Pace

Relationship Therapy/Counselling (also known as couples counselling)
What can they offer?
Counselling for individuals and couples for issues like…
• Communication skills
• Increasing sexual confidence
• Overcoming common sexual problems
• Dealing with jealousy
• Coping with infidelity
• Reducing arguments
• Planning for parenthood

Relationship therapy is offered in different forms in different countries. In most cases the service is paid for by the client – but is often means-tested, meaning those on a low income may pay less. Medical and psychosexual services can refer clients to relationship therapists, and clients can refer themselves. Many religious groups or other support networks offer relationship therapy – again this may be free or paid for and evidence underpinning advice may be patchy. Medical insurance may not cover costs for relationship therapy – check your policy. Some therapists will tackle domestic violence and reputable therapists will not see a couple together while one party is being violent. If domestic violence is a problem within your relationship you need to alert your therapist to this as soon as you can.

Useful resources
Overcoming relationship problems: a self-help guide using cognitive behavioural techniques by Michael Crowe (Constable and Robinson)
Loving yourself, loving another: the importance of self esteem for successful relationships by Julia Cole (Relate Guides)
Gay relationships: how to find them, how to improve them, how to make them last by Tina Tessina (Jeremy P Tarcher)
Relate
British Association of Counselling and Psychotherapy
Couple counselling Scotland
Relationships Australia
American association of sexuality educators, counsellors and therapists (AASECT)
BBC Relationships has a collection of resources and referrals addressing domestic violence

The above organisations cater to gay or straight couples – however if you’d prefer to see a gay or lesbian-friendly counsellor you can contact:
Pink Therapy
Pace

Hopefully you can work out from the list above what service suits your needs best. If in doubt call the service/clinic and ask if they can help you. If they can’t they should be able to explain a source of support.

Where to get advice about your sexual, reproductive or relationship health by Dr Petra Boynton is licensed under a Creative Commons Attribution-Noncommercial 3.0 Unported License