Talk:Sexual health clinic

Who do we write for in sexual health articles on en.wikipedia?
I would like to write for any reader of English. But I cannot characterize sexual health clinics in Bangalore. The question arises throughout the article. The first sentence of paragraph three and all of paragraph four raise the question for me.

--davidz (talk) 04:08, 30 August 2008 (UTC)


 * The article is a bit strange in that it characterizes sexual health clinics without giving any basis for the generalizations (i.e. source for information, country/culture involved/etc.). I guess I would read it as generalizations/examples of some of the issues involved (privacy, gender interaction between client and clinician, etc.)  Might be improved by giving the issues, and examples of ways they are commonly handled?  (e.g.: Sex is a human universal - but cultures vary in how comfortable people of one sex are with being examined by a professional of the same/another sex.  e.g., many women in US might prefer having a chaperon when being examined by a male clinician, but it is rare for men in the US to prefer chaperonage when being examined by a female clinician. ...)
 * At least examples should indicate what cultural basis/background they are based on. (If everybody does this, define which everybody we are talking about.)
 * Don't know if that musing helps any? Zodon (talk) 06:23, 30 August 2008 (UTC)


 * --davidz (talk) 22:22, 30 August 2008 (UTC)
 * --davidz (talk) 22:22, 30 August 2008 (UTC)

Std clinic
Std clinic redirects to Sexual health clinic.

That suggests content.

--davidz (talk) 00:28, 31 August 2008 (UTC)

Male or female clinicians
Male clinicians seem rare. I think it more informative to write "patients can choose to see a male or female clinician, if available".

--davidz (talk) 00:34, 31 August 2008 (UTC)


 * I liked the phrasing "At many clinics patients can choose to see a male or female clinician" better - saying they can choose male or female "if available" is sort of strange (obviously if they aren't available, they can't make that choice). Whereas "at many clinics" gave the indication that this isn't universal, but it is a common option.


 * Agreed. I too prefer the phrasing "At many clinics patients can choose to see a male or female clinician". I have changed the article to use that phrasing with male and female reversed. -- davidz (talk) 10:30, 31 August 2008 (UTC)


 * As to commonness of male clinicians - surely that is a cultural matter? Or has that become the norm  worldwide?  (I have not seen statistics on this.)  In the USA male clinicians were rare until recently.  Zodon (talk) 07:01, 31 August 2008 (UTC)


 * I have not looked everywhere. But sexual health clinics usual get staffed by nurses, and the world over nurses still mostly come in female. -- davidz (talk) 10:30, 31 August 2008 (UTC)

"due to the sensitive and personal nature of sexual problems and issues"
Some cultures and individuals find sexual problems neither sensitive nor personal. So that description introduces bias; thus not neutral. -- davidz (talk) 01:15, 31 August 2008 (UTC)


 * Just out of curiosity, any examples of major current cultures for which that is true? (Only examples I can think of where sexuality isn't particularly private are historical.)


 * I'm not sure major cultures should be the standard, especially for articles on sexual health. -- davidz (talk) 10:49, 31 August 2008 (UTC)


 * Norwegian high school seniors divide into two teams and have a competition at the end of the school year. They complete challenges to earn knots on their cords (how they keep score). A few years ago one of the challenges was to have sex with 17 people in the two weeks of the competition. The king and queen awarded the wining team at the palace in Oslo. This was published in the leading newspaper.


 * Margaret Mead got a lot wrong but Samoan girls did have very different ideas about sex than where Margaret grew up.


 * Some of the cultures of Papua New Guinea have marvelously wild ideas about sex.


 * In some African cultures it is common to have a spouse and a lover, making for larger and denser networks of sexual contacts increasing the spread of STIs.


 * In a Dutch cafe you can overhear or participate in a conversation about sex and sexual problems. Also possible in some parts of Germany.
 * -- davidz (talk) 11:19, 31 August 2008 (UTC)


 * On the other hand lots of cultures do have additional privacy /etc. perceptions relating to sexuality, and additional protections for information relating to it. Zodon (talk) 06:50, 31 August 2008 (UTC)


 * Agreed. I added a ref and cite to Title X as many readers may not recognize it. -- davidz (talk) 10:45, 31 August 2008 (UTC)


 * Was going to add a citation, but you beat me to it. Thanks. Zodon (talk) 03:02, 1 September 2008 (UTC)

Privacy, confidentiality, anonymity, and "don't-ask-don't-tell"
Medical service, including sexual health clinics, has standards of privacy and confidentiality.  

In some jurisdictions anonymity only comes from the patient providing a false name, at the possible suggestion of the clinic.

Clinics should not tell, but mostly they do need to ask.

-- davidz (talk) 02:10, 31 August 2008 (UTC)

"Few sexual health clinics offer abortion services."
STD clinic redirects to this article, but this article covers sexual health clinics in general. Few STD clinics offer abortion services. (None to my knowledge.) But in the US, the most prevalent sexual health clinic, Planned Parenthood, does offer abortions. -- davidz (talk) 11:52, 31 August 2008 (UTC)


 * I guess I interpreted the article as being about STD clinics (certainly all the "also known as" items amount to more or less that). Does "sexual health clinic" frequently refer to something more than that?
 * As I understand it, many Planned Parenthood clinics are broader than just STD clinics - covering Family Planning and general Reproductive health as well. (I don't know administratively how they are organized - whether all in one "clinic" or separate areas for primarily STD, primarily family planning, etc.)
 * Certainly there is variety in exactly what services are covered under what name. But do need some definition/references to distinguish what the article is/isn't going to be about.  (Whether it is to be a broad coverage of all of Family planning/Reproductive health/STD clinics, or more narrowly focused on just the STD portion of that.) Zodon (talk) 02:58, 1 September 2008 (UTC)


 * Limiting the article to sexual health and excluding reproductive health does help focus the article. -- davidz (talk) 05:04, 2 September 2008 (UTC)


 * Most Sexual Health Clinics (GUM Centers/Departments) in the United Kingdom offer emergency contriception (in the form of the Morning After Pill) with appointments or walk in options generally available.

Consent
This article could use a section on consent. Consent fails to serve in this context. -- davidz (talk) 23:09, 31 August 2008 (UTC)

Terminology
The Terminology section serves to indicate other names for sexual health clinics. The initialisms STD, VD, and GUM are the current parlance. Few say "sexually transmitted disease clinic", instead they say "STD clinic". The wiki links on STD and GUM serve to explain the initialisms. As not a disambiguation link, the terms need neither capitalization nor italics. -- davidz (talk) 00:19, 27 September 2008 (UTC)


 * For a general audience the initialisms need explanation, e.g. not being from the U.K. I had no idea what GUM meant (and presumably they may not be as familiar with STD). Though some use just the initialism, some clinics do use the full names (e.g. http://www.calgaryhealthregion.ca/programs/std/ ).
 * Providing the full terms, in addition to the initialisms
 * helps clarify the initialism,
 * it makes the section more inclusive (since it then includes those clinics that do use the full names, as well as the abbreviated terms)
 * and having the full terms does not remove the abbreviated ones.
 * Why object to screening and diagnosis as "jargon," and then reject explanation of this jargon? What is the advantage in making it more obscure?
 * The italics is not required, but is often used when designating a term for definition. Would have to check WP:MEDMOS to see if they specify a preferred style.  I think it helps, so one know where the term begins/ends, but don't mind the other style. Zodon (talk) 05:41, 27 September 2008 (UTC)


 * The initialisms do need expansion and italics should the article get printed. -- davidz (talk) 01:30, 28 September 2008 (UTC)

Lead
Sexual health clinics spend considerable thought, time, and effort on informing their patients. Though "prevention" subsumes and implies "inform", the lead should explicitly mention "inform" as a major activity of sexual health clinics. -- davidz (talk) 01:01, 27 September 2008 (UTC)


 * I would favor educate or counsel, rather than inform. Get more of the sense of interaction/working with the client; to me inform connotes telling, without necessarily interacting/getting feedback/responding to client concerns.  Zodon (talk) 05:47, 27 September 2008 (UTC)


 * Many clinics lack the time, resources, or funding to educate or counsel. They do inform, in the sense of telling and providing brochures. Clinics use the term inform. -- davidz (talk) 10:24, 1 October 2008 (UTC)


 * Clinics also use the terms educate and counsel. Many clinics do education and counseling.  Telling and providing brochures can just as easily be subsumed under education as informing.  Zodon (talk) 02:14, 2 October 2008 (UTC)


 * The lead needs a lot of work and expansion. As the article grows it will suggest content for the lead. Inform, educate, and counsel, as distinct, may each need mention in the lead. -- davidz (talk) 08:12, 2 October 2008 (UTC)

Services
Sublists
 * though possibly logical
 * considerably reduce the legibility of web pages
 * and could provide further difficulties for users of screen readers.

The terms "screening" and "diagnosis" seem medical jargon inappropriate for a general or the likely audience.

-- davidz (talk) 01:48, 27 September 2008 (UTC)


 * How do they reduce legibility? (References, etc.)
 * What difficulties do they provide for screen readers? (Sources?  Where is this covered?  Is it mentioned in the wikipedia MOS, or in the accessibility project, etc?)  Seems dubious - if it merely flattens the hierarchy, you get the same result as if the hierarchy wasn't there.

Specifically:


 * sexually transmitted infection screening, diagnosis, treatment and counseling
 * Tests to detect some sexually transmitted infections
 * Treatment for sexually transmitted infections
 * Testing and disease counseling and education
 * Assistance informing sexual contacts, possibly anonymously

vs.


 * Examinations
 * Tests to detect some sexually transmitted infections
 * Medication and treatments for treatable sexually transmitted infections
 * Counseling and education for patients undergoing testing or with sexually transmitted infections
 * Assistance informing sexual contacts of possible exposure to sexually transmitted infections


 * Making the items sub-bullets
 * makes logical structure (grouping, commonality) more apparent
 * making lists more manageable by breaking them into groups of thoughts
 * eliminates redundant qualifiers (all the "...sexually transmitted infections")

Zodon (talk) 06:21, 27 September 2008 (UTC)

Screening and diagnosis
While screening and diagnostic testing warrant explanation, they are important for every user of medical services to understand. (What they mean, and the distinction between them.) Certainly anyone receiving a Pap smear or STD test should know what they mean and what the difference is. (Not should know as in be expected to know at the outset, but should know as in it should be explained.) Zodon (talk) 06:21, 27 September 2008 (UTC)


 * Most clinics use the same tests whether diagnosing symptoms or doing general screening, with the exceptions of herpes and followup tests for HIV. The distinction, if need in an article describing sexual health clinics, will not fit in a list item and would need to go in a carefully written brief paragraph somewhere after the list of services. The distinction already exists in the article on STD testing. -- davidz (talk) 09:32, 1 October 2008 (UTC)

Other changes
Just to clarify couple of other changes which were removed without explanation:
 * Treatment may be other than just medication (e.g. heat or cold, soaks, exercise (Kegels, aerobic exercise, etc.), comb for lice, ...)
 * Counseling is also commonly done for those undergoing STD testing, (e.g. as part of informed consent), not just for those with positive results (e.g. counseling for HIV test). Zodon (talk) 06:51, 27 September 2008 (UTC)


 * Treatments suggest two or more list items.
 * Sexual health clinics provide antibiotics for curable STIs.
 * Some sexual health clinics provide medications for treatable STIs.
 * Pubic lice get treated chemically.
 * Do sexual health clinics often prescribe Kegel exercises or aerobic exercise? Sexual health clinics focus on the prevention and treatment of infections, not on reproductive health.


 * Counseling seem less common for testing and most common after detection of an STI. The services list item easily simplifies to "Counseling and education".
 * -- davidz (talk) 00:22, 28 September 2008 (UTC)


 * In a summary, is it important to distinguish the type of treatment (medication vs other)? The term treatment covers medications as well as physical, etc. interventions.  I was pointing out examples of common non-medication treatments just to clarify/point out that medications aren't the only treatments used.


 * Sexual health clinics provide or prescribe antibiotics and sometimes a few other medications. So the article should use those terms to describe what sexual health clinics provide. Many readers will recognize and understand the terms, or easily look them up. -- davidz (talk) 10:39, 1 October 2008 (UTC)


 * More specific to STD treatments: heat (Bartholin gland infection)/cold (epididymitis), diet/liquids (e.g. beverage intake to prevent UTI, water intake for PID), washing/laundering/cleaning procedures (lice), comb (lice, including pubic, - especially in pregnancy), cryotherapy (warts), opening with a needle or freezing (Molluscum Contagiosum), general healthy diet and exercise (HIV), smoking avoidance, diet, and condom use (cervical dysplasia/cervical cancer prevention). etc.
 * Pubic lice can be treated chemically and/or physically (comb, cutting hair), in either case, laundery/washing is also involved. Zodon (talk) 06:56, 29 September 2008 (UTC)


 * Sexual health clinics do not provide laundry services. This article covers sexual health clinics and the services they provide rather than a comprehensive list of all sexual health treatments. Sexual health clinics recommend liquids and quitting smoking. On occasion they may recommend diet and exercise. They do not provide these things. Clinics provide or prescribe antibiotics for Bartholin gland infections; they recommend warm baths but do not provide them. Infection most commonly causes epididymitis and clinics will provide or prescribe antibiotics and recommend, but not provide, rest, elevation of the scrotum, and cold compresses. Write treatments that sexual health clinics provide into the article as needed to describe the clinics. Put further details into the articles on those conditions. -- davidz (talk) 09:17, 1 October 2008 (UTC)


 * Sorry if the laundry list confused. I wasn't suggesting adding all those treatments, but pointing out that medications are not the only type of treatment provided by clinics for STIs.  Some therapies may be prescribed/recommended by the clinic, some of them may be provided, which ones are and aren't probably depends on local conditions.  There are places where sanitary laundry facilities are a rarity.  There used to be places where ice was a rarity (e.g. for cold compresses; I don't know if that is still true).  In any case, most homes are not equipped for cryotherapy.  Zodon (talk) 01:54, 2 October 2008 (UTC)


 * Indeed. The article needs content on the treatments that clinics provide for warts and molluscum. Write it in. -- davidz (talk) 08:24, 2 October 2008 (UTC)


 * Don't see much point in the treatable/curable distinction with regards to treatment types (yes, some STIs are considered curable and some not, but non-medication therapy is used in instances of both types.)  And not all cures for curable diseases use antibiotics.
 * As I recall, counseling for HIV testing was routine in the US; I believe it may be less common now. Zodon (talk) 06:56, 29 September 2008 (UTC)


 * Good public clinics in the US provide perfunctory pretest counseling on first intake to the clinic, not on subsequent testing. Someone other than the clinician often provides the counseling. Small clinics serving specific groups, such as LGBT, often skip pretest counseling as they lack the time and funding. This article attempts to describe sexual health clinics for its readers in English speaking regions, not just the US, and attempts to provide some use to readers of en.wikipedia in other regions. (see Nigeria above) -- davidz (talk) 09:54, 1 October 2008 (UTC)

Curable v treatable STIs
A useful distinction exists between curable STIs (such as gonorrhea, chlamydia, and syphilis) and treatable STIs (such as HIV and herpes). Some public health efforts currently attempt to stress that distinction hoping it will encourage more people to get tested. This and all Wikipedia articles related to STIs should use the distinction. -- davidz (talk) 23:19, 27 September 2008 (UTC)


 * Curable v. treatable distinction may be useful, but, as noted above, the type of treatments do not break down as antibiotics for one, medications for the other. There are physical treatments used for some examples of both types (preventive, palliative and in some cases for the former type, curative).
 * I still think that in the services provided saying "Treatments for sexually transmitted diseases" would be clearer, more concise, and cover all cases.
 * Then the distinction of treatable vs. curable diseases could be made when characterizing the diseases (e.g. on the STD page, or in summary of such here), rather than in characterizing the treatments.
 * While I suggest the above wording, I have made the smallest change I could see to make the text cover all cases. Zodon (talk) 07:57, 29 September 2008 (UTC)


 * On reflection, it isn't obvious that much should be made of the curable vs. treatable distinction. (Or at least it should be handled with care.)  In some cases it might tend to obscure, rather than aid understanding.  Specifically for HPV.
 * Almost everyone gets HPV, but in most cases it causes no disease.
 * There is no treatment for HPV itself, but there are highly effective treatments for cervical intraepithelial neoplasia (potentially precancerous condition that a few people develop as a result of HPV infection). So, while HPV is not a disease and isn't "curable," CIN is treatable and curable.
 * But there is all the confusion about "H" infections (HIV, HSV, HPV), and all the advertising hoopla from those pushing HPV vaccines, HPV tests, etc. So people who don't understand may get upset about having an incurable STI, when this one is in most cases no big deal. Zodon (talk) 06:01, 1 October 2008 (UTC)


 * The distinction between curable and treatable comes from documented current best practices in sexual health clinics and public health. This article describes sexual health clinics, a subfield of public health. So the distinction belongs in this article. The distinction serves to both caution and to encourage.
 * The concern with HPV comes from its connection with cervical cancer. Women would also like to avoid cervical intraepithelial neoplasia and treatments for it: repeated excision from the cervix.
 * Any confusion about HIV, HSV, and HPV should get addressed in the article on sexually transmitted infections. -- davidz (talk) 10:17, 1 October 2008 (UTC)

Discrete atomic edits
Changing one sentence or one list item per edit greatly facilitates following and modifying edits. -- davidz (talk) 00:53, 28 September 2008 (UTC)


 * For this talk page too please. One topic per entry makes following and responding easier. -- davidz (talk) 20:45, 2 October 2008 (UTC)