N02 Integrating an in-house counselling service within a sexual health service highlights the association with adverse childhood experiences, domestic violence and poor sexual health

Introduction

Sexual health clinics have experienced an increase in sexually transmitted infection (STI) rates and a greater complexity of patients. There is a clear need to address the underlying issues that keep patients within cycles of behaviour which negatively impacts on their sexual health.

Method

We established a counselling service within our clinic for patients who may: present with repeat STIs; display patterns of sexual risk; sex influenced by alcohol or chems use; difficulties in negotiating the sex they want because of issues such as consent, control or coercion. The service began in April 2022, led by a psychotherapist/Health Adviser. Patients receive up to 12-weeks of therapy, and the service is open to all genders/over 18s. Patients seen in general sexual health clinic are assessed by clinicians and referred if they meet the criteria and are motivated to seek therapy.

Results

So far, 7 patients have completed 12 weeks and 6 are currently in the programme. Patients range from age 24–55 and include men who have sex with men, trans-female, bisexual and heterosexual women. The initial 7 patients disclosed at least one ACE (Adverse Childhood Event). 5/7 experienced sexual assault and violence, 4/7 childhood sexual abuse, 2/7 parental neglect, 2/7 parental physical and mental abuse, 1/7 parental separation. All patients experienced domestic violence from parents, siblings or partners. Common themes include internalised homophobia, internalised misogyny, self-loathing and self-blame for their historic abuse and on-going struggles. The service aims to work through these issues to facilitate positive change within our patients leading to enhanced sexual and emotional well-being.

Discussion

We have identified significant levels of ACEs and domestic violence experienced by patients accessing our sexual health counselling service. More work is needed to understand and develop effective interventions for people experiencing poor sexual health from ACEs and domestic violence.