Sexual health for people in long relationships

Sexual health services are used overwhelmingly by people with new or multiple partners, which is rational and which leaves a group whose needs go unaddressed.

Why it still matters

Several reasons that are not accusations.

Infections acquired before the relationship may not have been detected, since a large proportion of chlamydia and gonorrhoea is asymptomatic and since herpes and HPV can be dormant for years.

Testing at the start of a relationship is frequently either not done or done before the window period had passed, producing false reassurance.

Symptoms arising years into a relationship are commonly assumed to indicate infidelity and frequently do not, which causes an enormous amount of avoidable distress.

And relationships change, including in ways that are not disclosed.

The screening that continues regardless

Independent of sexual activity.

Cervical screening continues on the national schedule for anyone with a cervix, irrespective of relationship status, number of partners or vaccination.

Attendance falls in long-term monogamous relationships and in same-sex relationships, in both cases on the basis of an incorrect assumption.

Breast and bowel screening are unrelated to sexual activity and are frequently deferred for the same reason people defer everything: they feel well.

What actually changes over the years

The clinical picture shifts from infection towards function.

Erectile difficulty and its relationship to cardiovascular risk, which is discussed elsewhere on this site and which makes it a screening opportunity rather than only a sexual complaint.

Menopausal genitourinary changes, which progress rather than resolve and which respond well to treatment that most people do not know exists.

Medication effects, which accumulate with the number of prescriptions.

Pain, which develops for reasons that are treatable and which is frequently endured for years.

And desire changes, which have physical, psychological and relational components simultaneously.

Testing after a change

The practical situations.

Following the end of a relationship and before starting another, which is a sensible point regardless of what came before.

After any incident of unprotected sex outside the relationship, where the window periods matter and where post-exposure prophylaxis for HIV is time-critical.

Where symptoms appear, in either partner.

Where an infection is diagnosed in one partner, both need treating, since treating one produces reinfection.

And before trying to conceive, where undiagnosed chlamydia is a preventable cause of tubal damage.

The conversation after a diagnosis

Genuinely difficult and worth approaching carefully.

A positive result does not establish timing for several infections, and clinicians can explain what a specific result does and does not indicate.

Which means the first step is understanding the result properly before drawing conclusions from it.

Where infidelity has occurred, the health decisions and the relationship decisions are separate and should be made separately — testing and treatment first, since delay has medical consequences and the relationship discussion does not have a deadline.

Partner notification services will contact partners anonymously, which is available and which people rarely realise.

Prevention that still applies

Vaccination against HPV and hepatitis B where not already received, which is available at older ages in many places.

Condoms where the relationship is not exclusive, or where exclusivity is uncertain.

Regular screening where either partner has other partners, at a frequency the service will advise.

And honest disclosure to clinicians, who ask the questions in order to order the right tests and who see every possible configuration routinely.

What to raise even if nothing is wrong

Since the appointment is available.

Changes in desire, function or comfort.

Anything about the relationship's sexual side that has been quietly worrying you for a year.

Contraception, which continues to be needed until the accepted point after menopause and which is frequently continued long past necessity or stopped too early.

And medication review, which is the highest-yield single intervention for sexual problems in people over fifty.

General information only, not medical advice. Consult a sexual health service or qualified clinician about testing, and attend screening programmes regardless of relationship status.