Health Outcomes

The Wider Influences on Sexual Health

Economic, social and cultural influences all impact on sexual well being and often give rise to inequalities. In particular, there is a strong link between social disadvantage and early initiation into sexual activity. Those with lower aspirations are more likely to become sexually active at a young age, less likely to use contraception, and therefore more likely to contract sexually transmitted infections and go on to become young parents. The overall rates of teenage pregnancy for the most deprived areas are more than treble than for the least deprived areas. Conversely, those with good educational and employment prospects are more likely to use contraception and more likely to terminate unwanted pregnancies. Planning to avoid unintended teenage pregnancies is closely linked with having a stake in the future, a sense of hope and an expectation of inclusion in society. There are also links to the cultural and social expectations of the lives and experiences of girls and boys.

Drug misuse and the disinhibiting effects of alcohol, the media, and peer and social pressures can all influence sexual behaviour, as can the experience of sexual abuse in childhood. The 2002 Scottish Schools' Adolescent Lifestyle and Substance Use Survey (SALSUS) National Report, commissioned by the Executive, found that 17% of 15-year-old girls and 12% of 15-year-old boys surveyed, reported having had unprotected sex during the last year as a result of drinking alcohol. The same survey found that drug users were more likely to have had underage sex and at an earlier age.

The Media and Mass Communications

Sexual imagery pervades many aspects of modern society and is often used to sell products. Its portrayal of sex and relationships tends to reinforce stereotypes about differing expectations in activities and behaviours, often in a sensational fashion and in a way which ignores the risks associated with sexual behaviour. It can also reinforce the social stigma around sexual relationships and sexual health services and sensationalise the issue. Media messages can lead to pressure and confusion over the realities of relationships and sexuality, particularly for young people, and can imply that casual attitudes to sexual issues are risk free and acceptable.

Yet the media can be a powerful communication tool, with the capacity to provide positive information about sexual health. Thus work with the media will seek to support action to improve sexual health through accurate and balanced reporting, promoting the core values of this strategy, and including the message that abstinence and delayed sexual activity in young people are socially acceptable choices and that sexual relations should be based on self-respect and respect for others.

Sexually Transmitted Infections and Unintended Pregnancies

Sexually transmitted infections, including HIV, affect people of all ages in Scotland, although incidence is greatest among those under 25. High chlamydia prevalence amongst young men and women is of particular concern, albeit the increasing numbers may be, in part, due to more people being tested. These infections can give rise to health complications and affect fertility, placing increasing demands on clinical services that can be prevented through the encouragement of safer sex practices.

Many women and teenage girls experience unintended or unwanted pregnancies. While pregnancy and parenthood are positive choices for some young people, for others unintended pregnancies and parenthood are associated with negative social and psychological consequences such as incomplete education, poverty, social isolation and low self-esteem.

Sexually transmitted infections can result in distressing and costly long-term morbidity in women in relation to ectopic pregnancy, infertility and chronic abdominal pain. Appropriate services for contact tracing are essential for the effective management of these infections.

The Role of Schools

Sexually transmitted diseases, such as HIV infection, chlamydia, gonorrhoea and hepatitis, are damaging but preventable. Public attitudes to sex education need to be addressed. Schools have a crucial part to play in fostering healthy attitudes towards sexual health and relationships education. High-quality sex and relationships education should be delivered in an objective, balanced and sensitive manner by professionals who are trained for this role and who are able to support and complement the role of parents and carers as educators of children and young people.

Health Services

Individuals need accurate, unbiased information, guidance and services if they are to take responsibility for their own sexual well being. Confusion or lack of knowledge about sexual health, or about the range of available services, may discourage or delay attendance and result in poor management of sexual ill-health problems.

Opening times, geographical location, suitability of premises, and perception of the services by users may limit accessibility to sexual health services. Access to services in rural areas raises particular issues such as confidentiality, anonymity and the limited choice of services provided.

National Trends In Sexual Activity, Sexually Transmitted Infections and Teenage Pregnancy

Since the 1960s there has been an increase in sexual activity amongst teenagers in Scotland. In particular, until 1960 sexual activity amongst under 16s was not very common (Bury 1984); however, since the 1960s increasing numbers of under 16s have been partaking in sexual relations. Between 1960 and 1990 the median age of first heterosexual intercourse has dropped from 21 to 17 amongst females and from 20 to 17 amongst males.  Over the same time period the proportion of teenagers reporting an experience of heterosexual intercourse before turning 16 has increased from 1% to 20% (McIlwaine 1994).

Trends in specific diagnoses made at genitourinary medicine (GUM) clinics in Scotland over the six year period 2000-2005 are shown below. Overall there were a total of 24,436 sexually transmitted infections diagnosed in 2005 (14,072 males and 10,364 females).