The sexual health clinic (or GUM clinic) is the model of the ideal healthcare system: a hub for different needs, able to interconnect high and low intensity care services and to express the social healthcare vocation of the public service. What are the main features of the activities taking place in GUM clinics?
Direct access. The main perk is that you can talk about your needs straight away. You don’t need to have an appointment if you need something and you don’t need to wait. You can just phone in, drop in in person and you’ll be listened to. The great goal of professions is actually achieved here: workers are on the frontline to welcome people in. When you drop in the clinic a midwife, a nurse or a social worker, or sometimes a psychologist, will see you immediately. You can speak about your needs straight away, whether they’re related to health, social or mental health conditions, or anything else. It doesn’t matter whether you’re a woman, a girl or even a boy. The sexual health clinic is also open to underage individuals, most of the time with a dedicated space for this, and you can drop in to see a gynaecologist without having to book an appointment.
The needs assessment is the first step to identify your needs. The GUM clinic workers will listen, take action and signpost or refer you to the relevant services based on your identified needs, whether these are a counselling session, a medical visit, social support, a pregnancy test or the morning-after pill. It is a hub with a variety of services. The workers can book you a hospital appointment if you need more specialist support around a pregnancy condition that the GUM clinic can’t help with; they can refer you to a mental health service to receive support around post-partum depression. They can refer you to your local authority if you’re a woman experiencing homelessness; they can also refer you to a local oncology centre to verify suspicious test results, and if you have concerns around sexually transmitted diseases they can help with STI testing.
It’s a chaotic space, where each day the chaos of our lives reaches the GUM clinic and gets untangled patiently by the workers, who accept it in its raw state and work with it to put things back in order, just like artisans transforming the wool through their handwork. Sometimes it’s possible to make an appointment; other times it’s not because it’s just too urgent. Sometimes a nurse, a midwife, a social worker or a psychologist can solve the issue, which might not just be health related, but at times it’s necessary to call a doctor.
It’s the place to discuss birth control – whether it’s family planning or emergency contraception. Fortunately it’s often a space that women, often couples, visit to discuss contraception, how to plan having children and insert them in their life plan. We ask, “What do you use? What would you like to use? How could we help you?” We can prescribe the pill, insert the contraceptive coil and sometimes measure the diaphragm. We can prescribe the morning-after pill to underage girls; some workers can even provide that directly. We can also insert the emergency coil up to five days after unprotected sex if it’s too late for the morning-after pill or if it’s the best thing to do for the time of your cycle. We listen, explain and try to demystify any myths about contraception.
It is a space for voluntary abortion. Women, most of the time, alone and worried, come here to get an abortion. They’re immediately welcomed, listened to and reassured. They’re given information on the most adequate track for them to follow, whether they need an immediate and confidential abortion, or an opportunity to reflect on their options and what they want to do. The sexual health clinic does not push, persuade or guide. We listen to the woman and help her identify her needs by reflecting these back to her to empower her to decide what, when and how she would like to proceed, with the unconditional support and encouragement of the clinic.
It’s the space for non-pathological pregnancies, where a woman can plan her delivery with all the relevant details or another woman can come in, four months pregnant, worried and scared, because she didn’t realise anything about her condition until now, “It really looked like my period, and it’s not regular anyway,” – and so on… The sexual health clinic is the go-to place for both cases. It would provide advice to support the first woman and would take charge to manage the urgent needs of the second one. It can book the appointment to get an ultrasound scan done and can prescribe other relevant exams; it can also plan checks for those who didn’t plan anything yet. It’s the community space to connect mothers with services. The clinic provides antenatal services, where women can get together, see the midwife, the psychologist and the gynaecologist, ask about any issue and get information. It’s also the space for women to access antenatal care when they cannot take a break from work for whatever reason. We support them regardless of their situation, reassure them and communicate with the hospital to put together their delivery plan so that they can feel part of a network rather than abandoned on their own.
It’s a place dedicated to childbirth, that challenging time where every mother faces new extraordinary but often overwhelming changes. It’s a place to be together, where women can weigh their babies and talk about their difficulties with breastfeeding, or ask for support because something is just not right. There is crying, there are fears, anxieties or challenges at home that you might want to discuss.
It’s a space to access support around gender-based violence. When you discuss your needs, often seemingly health-related but actually signs of dramatic home circumstances, someone will be able to walk beside you through an empowering journey to get your life back on track.