Thursday, November 26, 2009

Another day, another presentation

Yes, another day, or rather another week, and I was off to do another presentation. This time I was attending the annual meeting of the European Society of Sexual Medicine in Lyon.

The task at hand was to present - at a formal dinner - to 100 international opinion formers about the difficulty of addressing sexual issues in medical consultations. As always I was delighted to oblige because - as those of you who read my previous blogs will know - bridging the gap between patients and health professionals is one of my passions. It was all very exciting!

In the event, what excited me most about my four-day presence at the conference was how enthusiastically the other delegates shared my vision. Remember, we are talking here not about a gathering of therapists or counsellors, but of physicians - and frankly, even up to even a few years ago, the issue of empathic communication would have fallen on deaf ears. But this time, not only was my own speech well-received, but the main body of the conference contained a wonderful flurry of other relevant presentations

One of the best was a session led by my colleague John Dean, where two young actors and a willing therapist role-played a worst- and then a best-practice consultation for a couple with sexual difficulties. The actors were convincing, the therapist skilled, and John himself drew some very nice lessons from the demonstration.

In short, the energy for open, sensitive and cooperative patient-professional communication was higher than I have ever seen it; I do believe that there is a real sea change on the way, where both sides can start to understand (and help) the other.

The result, surely, will be better health care and more job satisfaction. The next decade ahead is going to be very exciting!

Yes, there is sex after conception...

It all began in early November when I was invited by the British Association of Sex Educators to take part in a seminar on sex in pregnancy and beyond.

I was delighted to have been asked. Because the thing that annoys me is that once conception's actually happened, both lay people and health professionals often assume that sex has done its duty and has become irrelevant.

Pregnancy itself - and the few months after birth - may be a period where stress, strain and raging hormones mean that lovemaking is the last thing on anyone's mind. Plus, he as well as she may be terrified that any form of vigorous exercise - particularly one that involves a penis in a vagina - is going to threaten the pregnancy. End result is all too often that sex goes on hold for at least a year and often more.

Of course, if that's truly a couple's choice, no pressure. But it needn't be that way. Human beings need touch - to reassure, to relax and to bond with each other. Hence I would argue that in that huge challenge that is parenthood, we need such touch more rather than less. So it's essential to help couples to realise that making love after conception is not only Permitted but also a Good Idea.

Hence I put together a 45-minute presentation which offered health professionals a simple guide to helping couples overcome the blocks to having sex, and summarised the best practical advice as to what's possible, what's inadvisable and how to get the most pleasure throughout pregnancy, labour and post partum.

I'm not commenting on my contribution - modesty forbids - but otherwise it was arguably one of the best seminars I've ever attended. The other speakers covered the the myths and the challenges of sexuality and suggested some ways of tackling those. The audience - including not only experienced midwives but also students, was attentive, eager and extremely enthusiastic. The feedback was highly positive. We're going to do it again - hopefully soon, hopefully throughout the country, and hopefully with an attached workshop for skills practice. Watch this space...

Only one thing saddened me. No names, no postmortems, but apparently the NHS hospital first approached as a venue for the training had refused, saying that they didn't feel it appropriate to be covering the practicalities of sexual pleasure during pregnancy. Which brings us, of course, full circle back to the preconceptions I originally railed against...

Well, all I can say is that that wasn't the attitude of the health professionals who attended the course, all of whom were vociferously in favour. So.. please lead me to the nearest wall and let me bang my head against it...

Monday, October 5, 2009

Talking of passion...

... my past weeks have been full of it. No, not the sexual sort I'm usually writing about - though there are links, as you'll see if you read on.

I'm talking about the passion that people have for a cause - the sort of passion that makes them go the extra mile, give the extra pound, or be willing to spread the word so that others get involved and the passion pool gets bigger and stronger.

The first passion pool I've been involved with of late concerns just that last-mentioned skill: spreading the word - in short, advocacy. The World Association of Sexual Health, having set their millennium aims, are keen to help those in the field to brush up on their advocacy skills to achieve those aims: health for all, an end to sexual abuse, sex education worldwide. I attended a workshop on the subject (brilliantly led by Esther Corona of WAS) earlier this year, and then with Esther's support, led a shorter workshop at the recent International Sex and Relationships Education Conference in Birmingham.

How inspirational was that! Sex educators, sexual health specialists, relationships education teachers, from a variety of countries... all passionate about spreading the word in their own societies. When we came to the exercise where I asked delegates to report on a time they had advocated successfully, we were all moved to tears by the stories that emerged - particularly from two amazing women from Eygpt, Mahaweb and Samira, who had campaigned for decades against female genital mutilation and finally, finally, got it made illegal. The group broke into a spontaneous round of applause and, as the workshop came to an end, we all went forth even more motivated to make a difference.

Three days later, different city (London) and different group (cervical cancer survivors), but just as inspirational a group. I ran two workshops for the charity Jo's Trust which supports women who have had a positive smear or worse. Two groups of women, again with their own stories, this time of unimaginable bravey, both physical and emotional - but once again, despite what they themselves had gone through, with a passion to do their utmost for the cause. Tears flowed even more than they did at Birmingham - but alongside those tears came energy and commitment, that women should be helped in every possible way to cope with the cervical cancer challenge.

In these days of credit crunch and tightened belts, financial wobble and knock-on emotional insecurity, we can lose sight of causes. We can lose sight of the fact that people are still suffering and still need our support.

These two workshops reminded me not only of that fact, but also of the fact that there are still those who feel passionately enough to remember the sufferers, and to give that support. Which - on this cold October morning - gives me, and I hope you, reasons to be cheerful.

Friday, August 28, 2009

Long, hot - slightly depressed - summer...

So how was your long hot summer? Long and hot, I hope, and full of rest and recuperation - as mine has been.

Back now, I'm downhearted to see that there seems to be very little good news. The economic crisis is still hitting. Politicians are still squabbling. Celebs are still breaking up.

In particular, it hasn't been a particularly good summer for feeling down. According to the newscasts, anxiety and depression rates are soaring. But GPs, apparently, only spot clinical depression in half the patients who have it. And even when the condition is spotted, funding for some forms of treatment - such as exercise - is limited . and there are as yet not enough therapists to go round. No surprises there - but no optimism, either.

But wait! There is a news piece this morning that offers a little light in the darkness. Apparently a study in the Lancet suggests that online therapy increases the chances of recovery from depression twofold when compared to medication only. And as online therapy is likely to be more accessible (handier for client and counsellor, theoretically cheaper when it comes to funding), we can hopefully expect it to be rolled out across the NHS.

I hope it is. For let's not forget - as the long hot summer comes to an end and the darker winter days take hold - that during our lifetime one in four of us will suffer some form of mental illness. This means you - or several of your friends, family and loved ones. So the more that can be done to support the cause (as well as reduce the stigma) the better.

Thursday, June 25, 2009

I do understand, truly I do, exactly why the government has decided not to hand out free smear tests to women in England under the age of 25.

It's absolutely logical. Studies suggest that below that age more women have false positives - which scares them. Subsequent unnecessary treatment may be harmful - and even necessary treatment can occasionally cause damage to the woman and premature birth to her future children. And - though of course this couldn't possibly be a factor in the government's decision - increased smear tests cost money that could be spent on other more urgent causes. You know it makes absolute sense.

And yet, and yet.... If it makes such sense, how come countries like Denmark and Sweden set the test age at 23? How come the advice in many countries is to have the test at 21? And how come the rest of the UK offers smear tests at 20 (why do the words 'postcode' and 'lottery' come inexorably to mind?)

But actually, my main worry here isn't to do with the figures, the statistics or even the logic of the argument (nor am I, as so many press sources are today, citing the Jade argument). No, my main worry is for individual younger women, women who because of their youth are probably less aware of the risks of cervical cancer whilst at the same time being more at risk simply because they are in that life stage of having many partners. The hard fact is that if we lowered the smear test age - lowered it way down to the average age of sexual intercourse at 16, we would save lives. Not many, but a few. And the fact that we aren't doing so horrifies me.

I'm not arguing that cervical smears are a better use of money than other heart-rending health causes - who am I to deny the importance of treatment for leukaemia, infertility, heart disease. and who is anyone to make comparisons and judge who should get the cash?What I'm arguing is that tests would be a better use of money than so many other things that the Government spends on - warfare, thousand-pound-an-hour consultancy, and of course, second homes and dirty videos.

My suggestion? Just cut a fraction back on the expenses and put that money into bringing England into line with the rest of the UK when it comes to the life-saving smear test...

PS: When one writes an academic paper, one need to cite 'vested interests'. This isn't an academic blog, but here is mine. At age 31 I had my own positive smear test, which led to treatment for developing cervical cancer. Yes, even with the age bar held at 25 I would have been spotted and saved. But I still feel a shiver at the thought that any woman, absent the possibility of that test, will have to go through the treatment and the trauma that I suffered.

Friday, June 19, 2009

Let's hear it for the mourners

I get a lot of letters - I mean a lot - from readers and listeners who have just endured the ending of a relationship.

But here's something that may surprise you. The ones that worry me are not those who outline in heart-rending detail their tears and rages, not those who report a deep loss of self esteem and trust in the world.

Yes, such responses are painful and not to be trivialised - but they are totally normal and healthy. Let emotion flow, get support for the agony, and in the end you will likely recover. Of course there are exceptions, those who are crippled by break-up grief for the rest of their lives; but as with a bereavement, typically nature takes its course and you come through. You may suffer, but you will surive.

No, the readers who terrify me are those that think that they won't - shouldn't - suffer. Those who try to carry on regardless and then wonder why they are finding life difficult. Cf poor, sad Katie Price, downing drinks and hitting the Ibiza dancefloor while shouting defiantly at reporters "I'm over Peter!"

I'm not criticising these readers - their hurt is just as strong as the griefstricken or depressed correspondents, and they need just as much support and pity. But who said that suffering isn't an inevitable part of having loved? Who said that one shouldn't mourn when that love dies?

What sort of world do we live in that persuades people that they should 'bounce back' from the ending of - in Katie's case - a five-year relationship that produced two children? What sort of world do we live in where the default option for coping with such an ending is not to lick our wounds and receive the support and comiseration of friends, but to think we have to carry on regardless drowning our sorrows in drink and yet another relationship. Only last week, in my postbag, I received a long letter from a woman worried there was something wrong because she didn't 'feel better' after her long-term partner had walked out on her... barely a fortnight before.

So let's hear it for the relationship mourners, those who have the courage to feel the pain and grieve the loss, to take their time to come back onto the dating scene, and to learn the lessons of the breakup before they emerge into the world again.

Short term they may seem emotionally weaker than those who don't even break step. Longer-term, however, they will be healthier, happier and far more able to love.

Tuesday, June 16, 2009

Dying of embarrassment

Some worrying research results yesterday highlighted the differences in the way men and women react to the suspicion of cancer - that is, whether they hie themselves off to the GP within hours of spotting the lump/bump/lesion, or whether they instead burrow their heads even more firmly into the sand.

No criticism here. Fear, which must surely be the key motivator, is a powerful paralyser. And if men - for yes they are the ones doing the sand-burrowing - are terrified, then that's utterly understandable.

It is, however, also tragic. The abovementioned research, brought out to coincide with Men's Health Week, suggests that there is no biological reason why men are 60% more likely to develop cancer and 70% more likely to die from it - particularly from the gender-specific, sexually-linked types of cancer such as prostate and testicular. Yes, there are major lifestyle causes. but the high mortality rate is also down to an unwillingness to acknowledge symptoms, take them seriously and then report them.

It comes as no surprise that this unwillingness is higher when it comes to the gender-specific cancers - because the emotional discomfort factor is so much higher there. I know this myself - for every 20 letters I receive from women asking me to advise on sexual problems I get perhaps one from a man. A mixture of anxiety, machismo and shame is holding the guys back.
Men are, literally, dying of embarrassment.

The answer? Professor Alan White of the Men's Health Forum puts his finger on it when he appeals for health services to be more male-appropriate. And that doesn't just mean more available outside working hours - but more encouraging, more motivating, and more aware of y chromosome reluctance.

I am inexorably reminded of that classic self-development question: which do you choose to be, the rabbit or the headlights? Let's hope that by next year's Men's Health Week, men are beginning to choose the latter option...