Many sexual health services aren’t open during lockdown. What do you do if you need to get a refill of the pill, an IUD removal, and STI check or a pregnancy scan?
Like many organisations, Family Planning have decided to close during lockdown, for the safety of their staff and clients. They’re an essential part of many people’s sexual and reproductive health needs, so it’s obviously a major disruption.
They are doing over-the-phone consultations for a limited set of services, which you can book online. These are:
- Prescription of emergency contraceptive pills
- Prescription of oral contraceptives
- Consultations (with prioritisation for unwanted pregnancies)
But there’s a whole range of other services unavailable during lockdown, including IUD insertion and removal, Depo Provera injections, STI checks, and pregnancy scans.
I need a new IUD or injection during lockdown - what do I do?
Family Planning national medical advisor Dr Beth Messenger says the lockdown is particularly disruptive for people who rely on a time-sensitive procedure such as Depo Provera injections, or the removal of IUDs that have come to the end of their use period.
Beth says the best solution is to schedule an over-the-phone appointment with Family Planning in order to switch to a prescription for oral contraceptives for the next four weeks.
“Some will find that challenging,” Beth acknowledges. “Usually women have chosen to go onto Depo because they're not that great at remembering to take a pill every day. Having said that, we don't usually consider Depo Provera to be a long-acting method because it only works for three months - but it doesn't involve taking a pill every day.”
The other downside is that switching birth control can affect your body. Beth warns some people may experience discomfort in this transition, and side effects such as unexpected vaginal bleeding.
“We're hoping to be able to offer more services as we get things set up,” Beth says. “So it may be that we'll be able to offer some advice about change in bleeding and so on.”
It is also difficult for people who want to get pregnant, but still have IUD implants. “For them it's disappointing that we won't be able to offer [IUD removal],” Beth says.
I need an abortion
Abortions are still an essential service, so people will still be able to receive them from other medical health facilities that remain open during lockdown.
To find out where you can get an abortion near you, you can book a phone appointment with Family Planning and they will tell you where the nearest open facility is.
Family Planning’s priority is making sure people know what providers they have access to in their area, and any other information they may need, Beth says.
This lockdown happened shortly after the recent de-legalisation of abortion in Aotearoa.
“We were terribly excited about this,” says Beth. “But it has happened at a time when everything's up in the air. So we're very limited in what we can do. Normally we would facilitate - in the past, you had to have a referral and now you don't, but ideally women would be having things like an STI check, routine blood tests, and maybe a scan. We would look to continue to support those things, but we are not able to access most of those things.”
Family Planning will be prioritising over-the-phone consultations for people with unwanted pregnancies, Beth says, especially because many resources on this topic still refer them to Family Planning.
“We don't want to not offer them any service, but won't be able to see them to confirm their pregnancy - so, they still need to do a pregnancy test at home. Then we will be doing our best to help them find the appropriate provider, and organise what test, if any, we're able to do remotely.”
I want my pregnancy - how do I get care?
There will also be people who find themselves with wanted pregnancies this month, who would usually go to Family Planning for the advice and support they need. For these women, Beth says the most important thing is to begin taking folic acid and iodine - which can be purchased over the counter at any supermarket or pharmacy. Early scans are not necessary unless there are concerns over the date or any pain or bleeding - but maternity services are still available for people in these situations.
What about STIs?
Sex itself is impacted by this lockdown. Covid-19 itself isn’t transmitted sexually, but the closeness involved in sex means that sexual partners would have a risk of transmitting the virus if they were infected.
There are also interesting implications for STIs during lockdown - as presumably, if people are adhering to lockdown restrictions, the transmission of these infections will be lowered as people are cut off from potential sexual partners.
“Which should help us,” Beth says. “But, I don't know that any of us feel wildly confident that that's actually going to be the way that it plays out. And there is real concern about not being able to routinely screen and how people are going to access services.”
“We can't do STI checks because the laboratories aren't processing routine ones right now - especially because the kits, while not the same, are very similar to the Covid-19 test kits and the reagents in a lot of laboratories are the same.”
Laboratories are very stretched right now, and many of the chemicals used to process STI tests are also needed for Covid-19 tests. So routine precautionary STI tests aren’t being submitted by GPs and other medical staff.
However, Beth says tests will still be submitted for people presenting symptoms. This is a good reason for people to be really sensible with their sexual health and use contraceptives right now - so as not to add to the burden Covid-19 is putting on lab time and resources.
It is also another very strong reason to limit yourself to your own bubble, and not sleep with anyone outside of it. However, there will be people who have contracted STIs before entering lockdown, or those who have had a test prior and are still awaiting results. To those people, Beth says they should consult their GP - some of whom will prescribe medication based on symptoms alone.
For people who have sexual partners within their bubble, the advice remains the same as always - keep sex safe and consensual.
“It’s important to be able to say no to sex you don't want to have. I think people are aware than when everyone shut in the house, we can predict there may be some increase in family violence incidents and coercive sex will, no doubt, be a component of that as well.”
Like everything during these unprecedented time, sex and sexual health has become much more complicated - so make sure that you are taking every precaution and opportunity to keep yourself and your partners safe, healthy, and happy.