Janelle McAlpine MMRes BA (Human Bioscience) BMid
Registered Midwife
Sometimes women find themselves in a situation as a result of not using condoms. This may have been a situation of their choosing but sometimes it is not, and sometimes there are consequences.
STI testing
STI’s (Sexually Transmissible Infections) are passed from one person to another during sex or sexual contact. Your doctor, family planning clinic or sexual health clinic can offer STI testing. This is confidential, simple and usually painless.
Why get tested?
Many people who have an STI may not know they have one. They may pass it on to a partner without knowing. Left untreated these infections can lead to unpleasant symptoms, infertility, serious health problems or worse.
When should I get tested?
You should begin getting check-ups when you start having regular sex. You should also have a checkup when you change partners or start a new relationship. If you engage in any high risk sexual activity (eg multiple partners) you should get checked more often. Both you and your partner should get tested before stopping barrier methods including condoms and dams. Please see your doctor if you have unsafe sex, or have unusual symptoms down below,including itching, burning or unusual discharge.
The rate of diagnosis of gonorrhoea increased by 67% from 2008 to 2012 (1).
STI test results are completely confidential. Sexual health clinics usually keep their records separate from the files kept by your doctor or local hospital. However, all notifiable diseases (including chlamydia, gonorrhoea, syphilis and HIV) are recorded by relevant health departments. The notifiable STI’s will require contact tracing to ensure that anybody who may have been exposed to it gets treated promptly.
These tests are low cost or free and may involve a urine test, a swab, a blood test or a simple physical examination.
Chlamydia was the most frequently reported STI in Australia in 2012, with 82,707 new cases. This amounts to 355 cases per every 100,000 people. Even higher rates were recorded in remote areas. 81% of reported cases are 15-24 year olds (1).
Contact tracing
If you have been told you have a notifiable STI, by law your sexual partner/s (past and present) must be contcted. While you can choose to remain anonymous they must be told they have been exposed and referred for testing and treatment if necessary. The aim of this is to prevent you getting the STI again, and to get them treated and to stop the infection passing onto someone else. You can contact them in person, by phone or SMS, email, or by using a contact tracing website. Your health care provider can also discreetly contact them without identifying you in any way.
How far back should you go?
- Chlamydia—up to 6 months
- Gonorrhoea—up to 2 months
- Syphilis—up to 12 months
- HIV—3 months before your last negative test
Depending on your circumstances, you may need to go further back, however your health care provider will discuss this with you. Treatment is available from doctors or sexual health clinics. You will need to have a follow up STI test in 3 months.
A considerable proportion (39%) of sexually active students reported they only used condoms ‘sometimes’ when they had sex, and a small (13%) but nonetheless notable proportion ‘never’ used condoms (1).
Morning after pill
The morning after pill is a hormone tablet taken after having unprotected sex to prevent pregnancy. It is effective for up to three days (72 hours), however the sooner it is taken the more effective it is. Only barrier contraception offers protection against STI’s so you may need to visit your GP or sexual health clinic for testing.
The morning after pill is an option when;
- You didn’t use any birth control,
- Your birth control was not effective
- You were the victim of a sexual assault
The hormones in the pill help to stop an egg being released or prevent a fertilised egg from implanting in the womb. The hormones may result in short term nausea, but have few other unwanted side effects. There is still a 1 – 3% risk of becoming pregnant after taking the morning after pill. You will need to see your doctor or sexual health clinic three weeks after taking the pill to make sure that it has worked properly.
It is most likely to not be effective if;
- You are already pregnant.
- You vomit within two hours of taking the pills.
- You have unprotected sex after taking the pills.
Unplanned pregnancy
A woman’s right to choose when faced with an unplanned pregnancy is a topic of debate around the world. This is influenced by a number of factors, including cultural norms and religious beliefs. Each woman will know what is right for her as an individual because only she can foresee how the pregnancy will affect her. Some women may be angry or disappointed that they have found themselves in this situation. However unplanned pregnancies are very common, with an estimated 200,000 unplanned pregnancies occurring in Australia every year.
Unplanned pregnancies may happen for a number of reasons, and while many women have support in this situation, many feel like they are alone. Fear of being judged often stops women talking freely about their situation (2). Discussing options with an objective and non-judgemental care provider can help women access the support and services they may not have realised they had.
Terminating your pregnancy
In Australia, it depends on which state you live in whether you can legally terminate your pregnancy. Click here to find out what the requirements and options are in your state. Internationally speaking, each country (and sometimes states) have laws governing the termination of pregnancy. Please refer to your country’s support services to find out which laws apply to you.
Abortion is one of the biggest killers of women worldwide. Just under 8% of mothers that die around the world every year do so as a direct result of abortion. Surprisingly, the statistics between developed (7.5%) and developing countries (7.9%) are very similar (3). In places where abortion is legal, it is performed with consent and in consultation with a doctor. Under these circumstances a pregnancy termination is reasonably safe.
Despite this women may report feeling judged by those closest to them or by complete strangers. They may feel judged for considering single parenthood or for terminating their pregnancy (4).
Types of termination
There are two types of termination – a medication and surgical abortion (5).
To have a medication abortion you usually need to be less than 9 weeks pregnant. The process may take a few days and doses of medication but when it does happen you will probably feel some crampy pains and have some bleeding. While medication is very effective, approximately 5% of women will need surgery to complete the process.
A surgical abortion is carried out between 7–12 weeks of pregnancy. This is calculated from the first day of your last period or is measured by ultrasound. This procedure is usually done under general anaesthetic. Your doctor will dilate your cervix enough to insert the instrument and remove the contents of your uterus via suction. You may hear this called a D&C.
After 12 weeks the procedure is more difficult, both physically and emotionally. This is one of the reasons why there are restrictions on termination after 12 weeks in some areas.
The risk of a D&C are low, but include:
- Only partial removal of the pregnancy causing heavy bleeding and need for repeat surgery (2%)
- Uterine infection
- Damage to the uterus or cervix (0.1%)
- Haemorrhage (0.1%)
- Risk of general anaesthetic
Continuing your pregnancy
If you decide to continue your pregnancy please discuss your situation with the pregnancy care provider of your choice. They will be able to tell you what support services are available to you. It is their role to do this regardless of whether you intend to keep your baby or consider alternative options such adoption.
Adoption
Adoption is when parents give up the right to parent their child to the child’s adoptive parents. Adoptions may be open (meaning to birth parents may have limited access and information about the child) or closed (where the birth parents have no rights or access to information). Research shows closed adoptions can have a negative effect for children. They can be equally as damaging for birth parents. It is for this reason that open adoptions are encouraged in Australia.
The number of babies put up for adoption has decreased in recent years. This may be due to improved choice and access to contraception, the morning after pill, availability of termination and community acceptance and support for single parents.
It is difficult to provide further information on adoption due to the differences in laws and support services between states. Please see your health care provider or state government website for further information. If you are Australian and considering adopting a child from overseas please click here for further information.
For further information, please go to;
Let them know (Victorian site)
Playsafe (NSW site)
Victorian State Government, Abortion Law Reform Act 2008
Victorian State Government, Better Health Victoria, ‘Abortion procedures’, ‘Pregnancy – your options’
Information courtesy of The Royal Women’s Hospital, Victoria Australia.
References:
- The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance. Report 2013.
- Gibson R et al, ‘The Australian Survey of Social Attitudes’, Canberra, Australian Social Science Data Archive, The Australian National University, www.assda.edu.au, viewed January 2010.
- Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global health. 2014;2(6):e323-e33.
- Rosenthal, D et al. ‘Understanding Women’s Experiences of Unplanned Pregnancy and Abortion’, Key Centre for Women’s Health in Society, University of Melbourne, 2009, p.6.
- Royal Australian & New Zealand College of Obstetricians & Gynaecologists (RANZCOG), ‘Termination of pregnancy: a resource for health professionals’, November 2005, Victoria, p.2