With greater access to contraception now open for consultation by the HSE, and the recent news that PrEP is to be made available through community pharmacy in Ireland, pharmacy teams have a crucial role to play in the area of Sexual Health.
Community pharmacy has, for many years, been involved in providing support for sexual health, selling products ranging from condoms, lubricants, emergency hormonal contraception (EHC), sanitary goods, pregnancy and ovulation tests, herbal supplements for the menopause, treatments for cystitis and thrush and Viagra for erectile dysfunction. This range of products and services is not available from any other single provider and so community pharmacy is well placed to position itself as a one-stop shop for sexual health.
Condoms offer the best protection from both an unplanned pregnancy and sexually transmitted infections (STIs).
Encouraging use of condoms is of utmost importance and can be promoted by listing their advantages:
1. Many contain lubricant
2. 92-98% effective
3. Prevention of STI’s
4. Only contraception males have control of
5. Females can be prepared and carry them also
If a customer knows or suspects that a condom has failed, they can access services at their local pharmacy to find out if this has happened and/or what the
consequences may be. These (obviously) include the sale of pregnancy tests and similar products. However, customers can also access STI screening and detection services at some Irish pharmacies.
Some available products provide simple kits that a customer may use themselves to extract and store a sample. The sample is then sent to a reputable laboratory to be tested for a range of STI types that are prominent in Ireland. These include chlamydia, gonorrhoea, HIV, herpes simplex and hepatitis. A customer can request screening for a combination of these in accordance with their preferences. The role of the pharmacy team in terms of STI screening, therefore, is mainly on advising on the availability of these kits, and of the potential benefits of screening. If the customer is diagnosed with an STI, the treatment options available from their pharmacy may depend on a consultation with a GP or other health professional (e.g. staff in a sexual health clinic) and on any prescription they receive as a result.
Having the Conversation
As the most accessible healthcare professional, pharmacists are an important resource for STI prevention and control. The large number of pharmacy outlets, and the trust shared between pharmacists and the public combine to afford a unique opportunity to reach patients and discuss their sexual health.
It can be hard to reduce a whole conversation about sexual health into a 30-second-over-the-counter chat. It is much more beneficial if consultations can take place in an appropriately confidential space if possible. This helps to build up a trusting relationship with the patient as confidentiality is a priority when accessing sexual health services in any setting.
Sensitivity
It is important that you are educated and confident in discussing personal details with patients and giving them advice in a non-judgemental manner. Pharmacy team members need to be confident in discussing topics such as sexual health to develop a level of trust with the patient. Sexual health topics need to be dealt with in a sensitive manner:
• Greet the patient
• Bring the patient into the consultation room
• Maintain eye contact
• Use appropriate body language
• Ask open-ended questions
• Reassure them that all information remains confidential, as always
These factors are fundamental to ensure the patient feels at ease and comfortable in your presence. There are some key opportunities to potentially broach the subject and promote sexual health. One such occasion is when emergency hormonal contraception is required. Advice about long term methods of contraception and information regarding STI’s are standard practice throughout the consultation.
A patient asking about irregular periods, spotting or genital warts is a signal that demonstrates the patient requires more knowledge and is open to any information that can be provided. A patient presenting with their first prescription for a contraceptive is another opportunity to utilise, to counsel on sexual health and how to reduce the risk of contracting STIs.
Pharmacy staff can aid patients in several ways including:
• Signposting and referral when necessary
• Sale of OTC items (pregnancy tests, condoms, self-care products)
• Advice and information on STI’s
• Supply of EHC where necessary and appropriate
• Information on long term contraception options
