Leaving judgement at the door

To the Editor: Swannell's article offers a refreshing reminder of the conflicted and contested scope of sexual health medicine.1 Recent public sector changes are forcing sexual health services to revert to the “disease” paradigm that dominated for most of the 20th century. Moves towards a more holistic vision of sexual health with a focus on wellbeing, as promoted by the World Association for Sexual Health,2 are now being pursued only in the private and non-government organisation sectors.

In Swannell's article, the dimensions of the broader approach (beyond sexually transmitted infections [STIs]) were given only token lip service — a brief mention of “sexual assault, contraception, sexual dysfunction, reproductive health and gender identity issues”. Most of the article reverted to a narrow biomedical emphasis on STIs and their management, and neglected the management of other crucial sexual health issues. This is disappointing, and a lost opportunity to advocate for a better response from the medical sector.

While the medical profession is central to STI service delivery, the broader realm of sexual health services requires a multisectoral response that involves sex therapists, counsellors, nurses and educators. Groups such as the Society of Australian Sexologists are working towards a more comprehensive approach through the professionalisation of sex therapists and others, with strict accreditation requirements. Sadly, it appears that a more comprehensive vision in the public sector is decreasingly likely, despite its importance in promoting sexual health.