Content Note / Trigger Warning: This blog will discuss sexual health, interacting with medical professionals, relationships (good and bad), teenage pregnancy, abortion, sex work and stigma. (this is also quite a long blog)
Today I went for a sexual health check-up, as I do pretty much every month (as long as I can get an appointment). It was a perfect example of how well these appointments can go but also how much they can bring up that you might not think about. So I wanted to write this blog to talk you through my experience and what it’s brought up for me.
Let’s start at the beginning, to get my appointment I had to phone my local council’s sexual health appointment line and inform them that I am a Sex Worker and need a sexual health check-up. Why do I need to tell them that I’m a Sex Worker? Because right now the NHS is running at reduced capacity due to a combination of COVID19 and lack of funding. So walk-in clinics are not currently running and to try and get a “regular” appointment you have to call at 8 am to maybe get through to a receptionist in time to book an appointment that day – the same system that GP’s use here in the UK which cause’s thousands of people stress and upset every morning. So rather than stress me out and potentially not get an appointment I out myself to the NHS so I can be sure that I’m being safe and aware of my sexual health status.
So even before I’ve gotten to the clinic to get my check up I’ve had to deal with what it means to tell someone that I am a Sex Worker and to acknowledge that being a Sex Worker puts me in the high-risk category which means that I will be given an appointment as quickly as they are able. I have to deal with the fact that it is now recorded on my medical records that I am a Sex Worker. Luckily for me, I’m already out and have come to terms with the idea of being known as a Sex Worker but not every Sex Worker will be prepared to deal with that. It can be a lot to work through. There is so much stigma around being a Sex Worker, I mean let’s be honest, there’s so much stigma around going for a sexual health test, to begin with so being categorised as high risk doesn’t feel great on top of that. But it’s ok, I’ve done it before and I’m ok.
Skip ahead to today, walking to my appointment and trying to drink enough water to make getting blood taken easy but not so much that I’ll be bursting for a pee before I arrive. Get to the clinic, get called in and sit in the waiting room, then on to see the nurse. All very quick, friendly and totally normal. It turns out there’s a second nurse shadowing today so I get double the chat whilst we go through the usual questions, swabs and blood test options. The lead nurse is a lovely woman that I had seen many times before (pre-covid) at the regular walk-in clinics and she is delightful to chat to and catch up with. She’s also checked my file before I’ve arrived and has noticed that I’m due my booster for my Hepatitis B vaccine, which is great because I have no way of checking that, so she gets that organised. We even get to have a funny moment where the first injection malfunctions and spills the contents down my arm – surprising everyone in the room. Then after the booster is successfully injected she informs me that my Mirena coil (my birth control) will expire in February 2022 and asks if she should add me to the waiting list for an appointment to get a replacement – I say yes and that’s all taken care of. She let me know that I’ll likely not get an appointment by February but that I can go onto the pill (a different type of birth control) from February until I get the replacement. We then move on to the usual questions: how many sexual partners, when did I last have sex, any unprotected sex, have I been forced to have sex or experienced any sexual abuse – all the routine questions I get asked at every check-up. That’s all fine, I get given my swabs and sent to the bathroom to take them myself – no problems there. Hand the tubes back and present my arms to see if any of my veins will be suitable for taking blood – I have tiny thin veins so it’s quite common that I end up having blood taken from the veins on the back of my hands. No luck with arms so it’s a hand vein for my blood today. As the second nurse is taking my blood (with help from the lead nurse since it’s my hand and that’s fiddly) we’re making small talk – she’s asking after my partner and asking how we’ve been through COVID19, the usual sort of COVID19 chat and then she asks a little about my sex work and my charity work – all perfectly happy and polite whilst they’re both taking my blood. It’s quite a funny image now that I’m describing it haha. She asks if I’m safe and is clearly concerned and empathetic but I reassure her I’m as safe as I can be and manage to stop myself from diving into my usual rant about how decriminalisation of sex work would make me safer but it’s so nice to see her caring and not judging or trying to tell me that I need to stop. I ask if there have been any updates on the possibility of getting PrEP (pre-exposure prophylaxis is a daily pill that can help prevent a person from contracting HIV) and she informs me that there have been no changes and that I still wouldn’t be eligible to be prescribed it but she says that it can be purchased online. Then they finish up taking my blood, all the vials are labelled and packaged up, I get some free condoms and my patient card that has my patient number and the results line phone number on it and sent on my way.
Easy peasy. In and out in around 20 minutes. So why did I feel the need to write a blog about this?
Well, there are a few reasons. First of all, to highlight how straightforward going for a sexual health checkup can be. It doesn’t have to be some terrifying thing that you endure. Especially if you get to see well-trained staff that know how to be friendly and professional.
Secondly, I wanted to highlight that getting an appointment (in parts of Scotland at least) right now is needlessly complicated and has meant having to out myself to be seen in a reasonable amount of time. The UK Government has pledged to end new transmissions of HIV by 2030* and likely has made similar pledges to reduce numbers of people testing positive for other sexually transmitted infections and blood born viruses but if people are struggling to access testing then how are we ever going to meet those goals? Some people might be able to pay to get an STI test privately but that can cost up to £99.95** depending on what test you buy. Realistically more needs to be done to provide free sexual health testing and that starts by funding the NHS.
Thirdly, I wanted to highlight that there are nurses and medical professionals that do excellent work and really make me feel safe interacting with the NHS as a Sex Worker. Both of the nurses that I interacted with were lovely, neither of them was judgemental and I left feeling positive about the entire experience. Especially since she had been proactive in mentioning my Hep B booster and my Mirena coil expiring.
However, the last thing I wanted to talk about is the unexpected consequence of my check-up today. This is the point where I discuss things that are not so cheerful so feel free to stop reading now.
This was primarily brought on by the mention that my Mirena coil*** is due to be replaced. Which means having to go in and get the old one removed and a new one put in. For those that don’t know, the Mirena coil is inserted into the womb and then left for 5 years/until removal to prevent pregnancy (amongst other things). It’s a very simple procedure and done whilst your awake, usually you won’t be given any numbing or painkillers – it’s very similar to a smear test in many ways. The procedure itself isn’t absolutely awful, it’s uncomfortable and so far I’ve had horrible cramps after it’s been done but it’s bearable. What makes this a talking point is the memory of why I first got the Mirena coil. When I was seventeen I had a boyfriend, the relationship was very toxic and I faced a lot of mental abuse but then I got pregnant. So I was faced with the dilemma that all teenage pregnancies face, do I keep the child or do I get an abortion? My boyfriend very much wanted to keep the child, he definitely saw this as his golden ticket to keeping me forever. I had a bit of mental breakdown over what this would mean for me either way and eventually decided that I would get an abortion. My Mum, school nurse, head teacher (probably most of the teachers, let’s be honest) and my boyfriend were the only people that knew. When I went to get the termination (as they called it) I was alone, my Mum dropped me off but then had to go to work. I was left in a room by myself after the nurses inserted the medication to wait for everything to pass. It was painful and lonely. I paced the room trying to take my mind off of everything. I’d be doubled over in pain from cramps and then hear footsteps so I’d stand up straight and smile as a nurse appeared at the door’s window to check in on me. I told myself that I deserved any pain that I got because I’d been stupid enough to get myself into this situation. I was bleeding and passing clumps of blood/lining all day but by the end of the day I hadn’t passed enough so I was kept overnight. After I was released the next day I went back to school. Still bleeding and feeling as if parts of my womb were falling out of me every few hours. After that I went for a check up to make sure everything had gone smoothly and it turned out there was still a lot of lining stuck so I would have to be put under local anaesthetic to have everything cleaned out properly. So that was another day off school, alone, in pain and spiralling into some pretty horrible thoughts. But the one thing that always gets me is that when the nurse gave me my gown she didn’t help me with it or offer any kind small talk. I’d never had an operation or worn a hospital gown before so I had no idea how to tie it – when my Mum saw it she immediately said it was done wrong and I explained I’d done it myself, she seemed quite surprised. I don’t know why that always sticks out so much but I guess it’s just one of those things. But the procedure went smoothly, everything was fine and they’d inserted the Mirena coil for me as well whilst I was asleep. So life went back to normal. Back at school, the headteacher asked to chat with me to check-in, so I put on a brave face and tried to make light of the situation not wanting to admit how awful I felt. He then got upset with me for the way I chose to speak about what I had just gone through, saying his wife had had to have a similar procedure and that I should be more considerate…Me, the seventeen-year-old that’s just faced a termination on her own and was having a horrible time mental health-wise, should be more considerate of his feelings about his wife’s procedure. But I didn’t say anything, just apologised and went back to class. You’ll be horrified to know that I stayed with that boyfriend for nearly a year after that. But eventually, I moved on, met the person that became my current partner – granted I dated a few more idiots in between. However, over all that time I told only a small handful of people that I had been pregnant and had gotten an abortion. It was still so upsetting to talk about. It is still so upsetting to talk about, I’ve cried whilst I’ve written the majority of this section. And all of this has been brought up by the simple mentioning of needing to schedule an appointment to get the Mirena coil changed. And that’s me leaving out the horrible relationship stuff. It’s a lot.
It’s also something I had no idea that I would be thinking about today or having to deal with all of the complicated emotions attached to it. So it’s completely thrown me off from whatever I had planned for the rest of my day.
Isn’t it funny that you can have a very pleasant experience but still be in tears because of something that was brought up during it?
So you might be wondering why I’m sharing this publicly when I’d been so private about it before, in all honesty, I think it’s just another thing that I have to let myself be open about to be able to really heal. Sometimes to move on from something properly you have to actually face it head-on again years later. Plus it’s good to let people know that they aren’t the only ones to have faced things like this. And to highlight where we need to try harder to make people feel cared for. Because of the fact that I was allowed to go through all of that entirely on my own, with no counselling being offered after, with a horribly manipulative boyfriend making me feel even worse and no empathy/understanding from the one teacher that did check in on me has been the most difficult part of the entire experience.
So let’s take this story as a reminder that no matter how brave a face someone is putting on, let’s not leave people alone to deal with their problems and let’s actually check in on them and ask them how they are.
Thank you for taking the time to read this. If you have any questions about sexual health please contact your local sexual health practice or consult official medical resources.
Until next time,
Stay Safe & Be Happy x
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*https://www.gov.uk/government/news/health-secretary-announces-goal-to-end-hiv-transmissions-by-2030
**https://onlinedoctor.lloydspharmacy.com/uk/sti-tests?gclid=Cj0KCQiA5OuNBhCRARIsACgaiqUYiTbnndL3CSa7FwEn2mVvlT009w62SXUtb5DItKyBa7T12iz1KDkaAl8PEALw_wcB
***https://www.uhcw.nhs.uk/download/clientfiles/files/Patient%20Information%20Leaflets/Women%20and%20Children_s/Gynaecology/Mirena%20Coil%20(IUS)%20(1078).pdf
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