Young people often start having relationships in their teenage years and may enter into a sexual relationship. Because people who have had transplants need to take essential medication, there are some important things to consider about your sexual health.
Physical changes
Your body will be changing from a child to an adult. This happens at different times for different people.
You may have had education about this at school or from other places. Very occasionally this can be affected by the transplant.
For example, girls may find their periods are affected by being very ill around the time of their transplant.
Certain drugs can have side effects such as extra body hair growth which can be upsetting for some people.
Some medications can cause issues such as swelling of breast tissue in both boys and girls and although this does not happen often, it can be embarrassing.
Body image is an important consideration particularly for young people. Social media often puts pressure on young people to look unrealistically perfect. Many of the images are edited to give a false impression of how a ‘perfect’ body should look. Remember, everyone is uniquely different and no one is perfect.
If you have any questions, please ask at your next clinic appointment or contact the transplant specialist nurses.
Some young people worry that they are not developing normally and there may be changes we can make to your treatment that will help.
You can also talk to someone in private either on the telephone or in clinic without your parents or carers being present if you prefer.
Safe sex
There are a number of infections that can be passed from person to person during sexual contact. Some of these can be very serious and some infections like chlamydia may not give any obvious symptoms particularly in boys. Because people who are on anti-rejection medication cannot fight infection as well as others, it is important that you know how to protect yourself.
If you have unprotected sex, there is a risk you could catch an infection. The risk increases with the number of times you have unprotected sex and with the numbers of partners you have.
Never feel pressurised to have sex if you do not want to. There is lots of information available about safe sex on the Internet, in leaflets or you may have been taught about this in school.
Condoms are very effective at preventing infection and are readily available often free of charge. The C Card scheme enables young people of either sex to access free condoms from a variety of outlets to improve sexual health.
This confidential service is also available to anyone over the age of 13 in children’s outpatient’s at the Freeman Hospital. A trained C Card worker will register you to the scheme and take you through the information you need to know.
If you are worried about how to protect yourself or that you may have picked up an infection, do not be too embarrassed to tell someone.
Your doctor or nurse on your transplant team, your family doctor or local sexual health clinic will help you. Remember the sooner we know about a problem, the sooner we can help sort it out.
Contraception
When you have had a transplant, it is possible to have, or father a baby. It is important to prevent unplanned pregnancies by using the right contraception for you and thinking carefully before starting a sexual relationship.
The type of contraception that you use will be tailored to you and what suits you best.
Oral contraception is commonly used by transplant patients, usually the Progestogen only pill, commonly known as POP or the mini pill.
Mini pill
The mini pill should be taken at the same time each day. The traditional mini pill only has a 3-hour window for any missed pills to be taken.
POP
There is a POP which has a 12-hour window for missed pills to be taken and would be the first choice of POP to use.
Combined pill
It is also possible to take the combined pill which contains a mix of oestrogen and progestogen but many transplant patients have existing problems such as high blood pressure which makes this type of pill less suitable.
Contraceptive injection or implant
Some people prefer the long acting reversible methods such as the contraceptive injection or implant and again there is no issue for the majority of transplant patients to use these.
Intrauterine devices (IUD)
Intrauterine devices (IUD), commonly known as the coil are other methods that can be used. These include the copper non hormonal coil or the hormonal coil.
Both types are usually suitable for transplant patients even if you have not had a baby before. You may be able to have a local anaesthetic when having the coil fitted to make it less painful.
There may be a slightly increased risk of developing an infection for some women.
Although hormonal contraceptives are unlikely to cause a problem with your immunosuppression, we would generally advise having an immunosuppression drug level taken a week after starting the new contraceptive.
Male condoms
Male condoms are a popular method of contraception and when they are used correctly, they are a very effective method of birth control. They are also the only type of contraception that can prevent pregnancy and protect against most types of sexually transmitted infections (STIs)
Oral emergency contraception
Oral emergency contraception can be used when there has been a pregnancy risk. There are two types of emergency contraception pills.
The first can be taken within 72 hours (3 days) and the other 120 hours (5 days) from the unprotected sex.
There is also a copper emergency coil which can be fitted at a specialist service.
All emergency contraception options would be discussed with you and are readily available free of charge from a variety of sources (depending upon the type of emergency contraception).
Pregnancy
In the future you may want to have or father a baby. If so, you should ideally talk to your transplant doctor or nurse first.
Some medicines can affect an unborn baby so people who have had transplants are encouraged to talk to their transplant team about this before trying for a baby.
This will allow medicines to be changed if they need to be, and for your transplant team to ensure you are well enough to have a baby.
You will also need more frequent check-ups and blood tests whilst pregnant as it is also common for immunosuppression doses to need changing frequently during and after pregnancy.
It is also helpful for us to be in contact with your obstetrician and midwifery team early in the pregnancy to make the best plan for you and your baby.
If you think you may be pregnant, please tell someone as soon as possible so we can help you to stay well.
Who should I contact if I have questions about sexual health?
Questions about sex and sexual health are a normal part of growing up and affect everyone. There are a lot of very reliable online resources some examples of which are listed below.
You may prefer to have a chat with someone from your transplant team if you have any questions or concerns about the information in this leaflet.
If you would like to speak to someone further, please don’t hesitate to talk to a member of staff at your next clinic appointment.
For those living in Newcastle, there is a sexual health service available at Hadrian House provided by Sexual Health Services 2 Newcastle.
Useful resources
Family Planning Association
The Family Planning Association provides confidential information and advice on contraception and sexual health. You can also get details of family planning clinics and sexual health services anywhere in the UK.
Freedom shop
The Freedoms Shop is an NHS sexual health promotion initiative offering a wide range of top-quality condoms and lubricants at low prices. All products conform to British (BSI) and European (CE) standards.
Brook
Brook is a confidential sexual health advice. Find out your rights in relation to sex, find out sexual health facts and the play ‘the defender’ game.
Teenage health freak
A comprehensive website for teenagers, including the facility to email questions to a doctor on a wide range of medical and sexual issues
Avert
Over 100 pages on HIV/AIDS, including sections aimed specifically at young people.
Terrence Higgins Trust
Offers support to people living with HIV, if you know someone who is, or if you think you might be at risk from HIV. Provides information on details of services.
Willy worries
Answers questions about contraception, sexually transmitted infections and generally safer sexual health.
Women’s worries
Answers questions about contraception, sexually transmitted infections and generally safer sexual health.
Childline
Confidential information and advice for children and young people on any issue.
Young and free
Sexual health for young people.
Streetwise
Streetwise Young Peoples Project is a Newcastle upon Tyne based charity offering advice, information and counselling to young people.
