My ex-partner just told me she tested positive for an STI (sexually transmitted infection). Can I get treated here?
My period is a few days late. Is it too early to check if I am pregnant? Can I get a pregnancy test here?
I just tested positive for chlamydia and have been with the same partner for three months. Does that mean he cheated on me?
What are my options for non-hormonal birth control?
What is normal physical appearance “down there”?
You can ask questions like that at the Nelson Options for Sexual Health clinic (Opt for short) and have a discussion with a doctor, a nurse, or trained volunteer. It doesn’t feel clinical, it’s strictly confidential, and you don’t feel rushed.
In Nelson, the Opt clinic is open every Wednesday from 5:30 to 8 p.m. at 333 Victoria St.
Holli Kosof is the receptionist, the volunteer co-ordinator, and the one who gives clients an overview of the clinic when they arrive.
Clinic volunteer Kathy Koep says Kosof is “the backbone of the place. She’s an amazing woman, dearly loved at Opt. Sexual health is a touchy subject and it is something that takes finesse, skill, practice, and a very solid presence She has created an an environment of friendliness and approachability.”
Kosof, in turn, feels grateful to the organization.
“When I look back at the kids I knew when I was a teenager, there was no place to go like this. Now I can have a teen sitting across from me and they feel they are being heard, and have options. I am truly grateful we have that in our community.”
Questions about birth control
The most common questions are about birth control and STIs.
“We have people who come in with absolutely no idea where to start with birth control,” Kosof says, “and there are people who have tried a variety of options and just aren’t feeling a fit with any of those. They don’t know what their next choice should be. Other people come in with a solid vision of what they want. We see it all.
“Some people come in with strong beliefs as to what form of birth control would absolutely not be appropriate for them, and an opportunity to have some additional information can be helpful. A lot of anecdotal information floats around, things they have heard from friends.”
Last year the Nelson Opt Clinic saw 325 people. Almost half were in their 20s, only 39 were male, and 16 were under 15.
Kosof says some people come to the clinic for access to a female physician. Others aren’t comfortable confiding in their family doctor about sexuality.
“Many people have grown with us,” says Kosof. “They came as young teenagers, and have developed a comfort level in the clinic. They report it’s very welcoming and they feel they can have open dialogue because we aren’t judgmental.”
Sexually transmitted infections
Judith Fearing has worked as the Nelson clinic’s nurse and now supervises the Opt clinic on the Castlegar campus of Selkirk College. She says she sometimes needs to tell people that most birth control doesn’t prevent STIs.
“We want them to understand that any time you have any sexual intimacy you are vulnerable to an STI, and they should get tested often, and realize how easy it is to get tested,” she says.
“There is this huge stigma about having an STI and it’s perpetuated by how we have taught sexual health. You shouldn’t show terrible pictures of STIs and make people feel like it is really bad to get one. When it is flu season you wash your hands to prevent getting the flu, but some people still get it. So if you are involved in sexual intimacy you should take precautions, but sometimes you still get STIs. So get tested.”
The clinic screens for chlamydia and gonorrhea and gives lab requisitions for HIV, syphilis and hepatitis. For people who come with positive results, the doctor or nurse does treatment at the clinic.
Kosof says a common misperception is what an infection looks like.
“We have people say, ‘No, I looked, everything was clean, they looked fine.’
“I tell them we can have people in with the doctor who is looking with a light, and we can’t tell by looking. Or they connect sexually transmitted infections with cleaner people or dirty people, which is totally not the case. We provide information around that.”
The clinic also does pap screening and pregnancy testing. And they provide a wealth of literature on a variety of sexual health subjects.
Sexuality and consent
Kosof says they had many discussions with their clients concerning consent and healthy sexuality.
“We tell them sexuality should be pleasurable for all parties involved.”
When drugs and alcohol are involved, issues of consent get confusing, she says.
“Their understanding of what may be going on is not obvious until the next morning. They may be concerned that they may have been exposed to an STI but have no recollection of it.
“The goal is to empower people so things aren’t just happening to them, they are choosing what will happen. We want them to understand it is not a given that just because you say yes in the beginning that you have to say yes in the middle. You have an opportunity to say no at any given time, and the absence of the word no does not mean yes. It should be an emphatic ‘Yes this works for me, this feels good for me, I am happy with this, I am comfortable.’ But the ball starts rolling and people don’t know how to stop it.”
Both women agree the proliferation of porn available to anyone with a smartphone sets up some difficult expectations among young people about what sexual activities they are expected to enjoy.
“I like to help people understand that it is very individual what people like,” says Fearing, “and they need to be able to communicate with each other about it. What you watch in porn is often only one recipe, and it is sensationalized, and the people involved are earning money doing this. This is why we need lots of sexual health education.”
School sex ed curriculum
Fearing and Kosof say the quality of sexual health education in the schools varies a lot, and depends on whether the individual teachers have the knowledge or desire to teach it.
“BC has a good curriculum, but the problem is that it is mostly not implemented,” Fearing says.
Opt Nelson has a arrangement with Trafalgar Middle School for classes tour the clinic annually, just so students know it’s there as a confidential service.
Options for Sexual Health is a non-profit that runs 58 clinics across the province, funded by Provincial Health Services Authority. Last year they saw 33,387 people. The “pop-up” clinics don’t duplicate other infrastructure.
The organization offers the only certification program for sexual health educators in Canada, and it runs Sex Sense, a phone line (1-800-739-7367), staffed by sexual health educators. Callers can ask anything. The service got 12,000 calls and emails last year.
There are two Opt clinics in Castlegar, one at the Selkirk campus, open from 11 a.m. to 1 p.m. Thursdays (from September to June), and the other at 1007 2nd St., open Tuesdays from 5 to 7:30 p.m.