Choosing and using services for sexual health: a qualitative study of women's views

Objective: To explore women's accounts of choosing and using specialist ser vices for sexual health. Methods: A qualitative study involving semistructured interviews with 37 wo men screened for Chlamydia trachomatis attending genitourinary medicine and family planning clinics in an East Midlands health authority. Results: In making the decision to seek help, women act on a range of speci fic prompts, including lay ideas about the significance of symptoms; their own behaviour; their partner's symptoms or behaviour; contact tracing; and health promotion. Some women do not seek help specifically in relation to s exual health but are identified as being at risk of sexually transmitted in fections (STIs) during routine consultations. Important influences on women 's choice of services include the lay referral system, "insider" knowledge of health services, referral by health professionals, and need to have alte rnatives to general practice care. Women's willingness to access services i s mediated by psychosocial factors such as embarrassment. They may use smea r tests as a legitimate opportunity to raise questions about sexual health. Women's priorities for services are that their feelings of stigma and emba rrassment are managed appropriately; that staff communicate well and are se nsitive to their emotions and comfort during tests and procedures; that the y are "in control" when obtaining test results; and that confidentiality is preserved. Conclusions: A detailed understanding of both lay people's response to symp toms or behaviour that indicates risk of an STI and their needs when using services should inform interventions aimed at encouraging secondary prevent ion of STIs.