Ronan McGreevyon why the Well Woman centre is calling for a 'cradle-to-grave' approach as more people in their 40s and 50s seek sexual advice and information
THE CHANGING face of Ireland is reflected in the latest report of the Well Woman clinic.
A rise in the number of divorced, separated and single people in their 40s and 50s has led to an increased demand for its services.
They are a generation who were not taught sex education in school and who now have to struggle with the expected, the menopause, and the unexpected - sexually transmitted diseases.
"There are a lot of people who are 'out there again' so to speak," said Alison Begas, the chief executive of Well Woman.
"The single biggest age group is between 17 and 35, but we are increasingly finding that 40 and 50 somethings are coming to us whose marriages might have ended and they are of a generation where the sex education message did not get to them.
"Sometimes we have to sit down a 40 something year old and tell them they have chlamydia. We recommend that they be tested for other sexually transmitted diseases, because sometimes one sexual encounter can be enough.
"Typically, people have more sexual partners these days than would be the case 20 or 30 years ago. They are starting to be sexually active younger, they are sexually active for longer and their needs for sexual health are more complex."
The need for age-appropriate information is the thinking behind Well Woman's call for a "cradle-to-grave" approach. This would be through a national sexual health strategy which would involve a programme of sexual health screening and testing which is age-appropriate.
"We would like to see the Government joining up the dots and offering a strategic approach to sexual health services in this country," she said.
"When we set up 30 years ago it was purely about contraception. We have broadened out our services. We are trying to meet people's sexual health needs at every life stage.
"There is also the issue of age-appropriate advice. There is a huge lack of information about the menopause. It is easy enough to think we are in the information age and you can just go online and get the answer to all of your questions.
"We are inundated with women who want to know about the menopause. 'Am I normal, should this be happening to me' and there is a huge sense of isolation," she said.
Well Woman is also now carrying out infertility investigations for couples who want to have children and cannot have them. They do blood tests and sperm counts and refer couples on to a fertility clinic, although the waiting lists can be five or six months.
"In the last five or six years, the number of couples coming to us for infertility investigations has more than doubled," she said.
Well Woman believes this too is a sign of changing times. Women are better educated, they have better career paths and they are marrying and having families later than ever.
However, many find they have fertility problems in their mid and late 30s because they have left it too late to have children.
"With all the changes that have happened in Ireland, women are building careers, they are involved in post-graduate education, they are struggling to put together the wherewithal to buy a house, they are struggling with two mortgages, they are delaying starting families and yes it does get exponentially harder," she warned.
"The facts that the number of couples coming to us for fertility treatment has risen suggests that they are not taking it into account. John Lennon once said that life is what happens to you when you are thinking of other things and somewhere along the line they have forgotten to have children and there is a lot of heartache in it."
Well Woman's medical director, Dr Shirley McQuade, said the increasing number of infertile couples was an issue of "national concern" which was putting huge strain on services.
"Due to the number of couples now requesting this service arising from referrals from general practice or Well Woman, the waiting time for a hospital appointment is several months," she said.
A significant and growing problem also identified by Well Woman has been the rise in chlamydia to the point where the testing capacity at Well Woman's three clinics in Dublin has almost been reached with 4,670 clients availing of a test last year. Of those about one in 20 tested positive, but among those under 20, the figure was 19 per cent.
Ms Begas believes there should be a national programme of screening for chlamydia as part of a national sexual health strategy.
"They use the expression 'the silent epidemic' to describe chlamydia. We don't know what the prevalence is. There are a lot of information gaps," she said.
"People need to be aware of who they are being sexually intimate with. You can be exposed to chlamydia without exhibiting any symptoms. It can be asymptomatic among both men and women.
"It can be diagnosed using a simple urine test so people need not fear a very intimate examination. If it is diagnosed it can be cured with a simple course of antibiotics.
"It is better to be tested and know and have an infection and not deal with it."
Chlamydia: the silent epidemic
Chlamydia is a sexually transmitted bacterial infection which can be transmitted mostly through sexual intercourse, but also through oral or anal sex.
It is most prevalent in teenage girls and those in their early 20s.
It is known as a 'silent' disease because three- quarters of infected women and about half of infected men have no symptoms.
For women, symptoms, if they exhibit any, can include abnormal vaginal discharges or pain when urinating.
Other symptoms include back pain, pain during intercourse or bleeding between menstrual periods. It can also lead to fertility problems.
Men with signs or symptoms might have a discharge from their penis or a burning sensation when urinating.
Chlamydia can spread to the rectum area in both men and women.
It can be diagnosed using a simple urine test.
Chlamydia can be easily treated and cured with antibiotics.