On The Couch with Nurse Nettie

[00:00:00] Jennifer Farinella: Hello and welcome to an episode of On the Couch, where we collaborate with experts, practitioners, authors, advocates, and influencers to explore current social themes, sex positive topics, and share stories and insights that matter. This podcast was recorded on Aboriginal country. We acknowledge the traditional custodians of the lands that were never ceded on which we live, work and record upon.

We pay our respects to elders past and present and to those who may be visiting our website or listening to our podcasts today.

While listening, we encourage you to practice good self care. Check the show notes for content details and references.

Wherever you are, whatever you're doing, enjoy this episode of On The Couch.

[00:00:44] Maddy Stratten: Welcome to On the Couch with Nurse Nettie.

I'd like to acknowledge that we each have our own sex ed and sexual health experiences to reflect on, some positive and some not so positive. And so what we can do is really recognize and acknowledge that and celebrate how far we have come in providing accessible and positive sexual and reproductive health information to young people.

When we think about young people, and where they find sex and sexual health information, we know that the internet is a go to place.  We also know that there are a lot of misleading and untrustworthy information sources on the internet, which is a concern if a young person is trying to find information around discharge and the internet tells them that they are dying. So not ideal. And that's not what we're wanting for our young people. So, when the Nurse Nettie platform became live on the NSW Play Safe website back in March 2014, it really became a safe place for young people to ask those questions that they may not have felt comfortable asking anyone else.

Nurse Nettie is a real qualified sexual health nurse based in Sydney answering questions around bodies, sex, sexual health. It is anonymous and confidential through an online messaging system. And this really helps provide some professional guidance, around those conversations around sex, sexual health, reproductive health and bodies. In 2021 Nurse Nettie received 284 email questions.

So as the Caddyshack team, we are really excited to reveal one of the people behind Nurse Nettie.

Frances Turner has joined us today On The Couch. And so I really hope that this is interesting to both hear what the most common questions are that are asked to Nurse Nettie, but also hear how Nurse Nettie responds to those questions in an open and respectful way.

Welcome Fran.

[00:02:42] Frances Turner: Hi, Maddy. Thank you for having me. Very happy to be here.

[00:02:46] Maddy Stratten: I'm not sure actually whether our audience would be aware, Fran, about the team of sexual health clinicians behind Nurse Nettie. Can you tell us a little bit about that team?

[00:02:56] Frances Turner: Yeah, sure. So, um, we've got a team of very experienced nurses and they've all been working in sexual health for some time. From a variety of backgrounds and we all work together to yeah, man the phone lines, answer questions, collaborate with other services and yeah, yeah, we love it. It's fabulous. It's great. It's a really different way of interacting with, um, with members of the public.

[00:03:21] Maddy Stratten: And so can you tell us just to start us off to kind of get an idea of Nurse Nettie.

[00:03:26] Frances Turner: Sure. Yeah. So basically the, the thing with Nurse Nettie is Nurse Nettie as an avatar is a consistent presence.

Um, and so it doesn't matter which nurse is answering Nurse Nettie, Nurse Nettie's persona is pretty much the same. They're very positive, very sex positive, very encouraging, which, you know, we as individuals all are hopefully as well. Nurse Nettie just provides a more consistent presence. And, I think that's particularly important for maybe younger members who, who feel like they're talking to the same person, particularly if they have follow up questions, but sometimes they do, they don't necessarily want to be talking to different people.

[00:04:02] Maddy Stratten: Yeah, it's like one of those things right when you call up and you have to explain your whole story again from scratch and so sometimes online is better.

[00:04:10] Frances Turner: Yeah, absolutely, absolutely. So we try and really maintain that consistent persona with Nurse Nettie. Just down to tone of voice. Um, you know, the, the kind of language that we use, that kind of thing, we're also very careful to be mindful of health literacy.

So we always try to aim the reading age, of the answers that we provide to someone who is around the age of, you know, ten years old.

Um, and that's just because we are conscious of the fact that, you know, people, people have differing cognitive abilities or different reading abilities or different levels of health literacy.

So we try and keep it towards that end. Just to make it more accessible for people.

[00:04:46] Maddy Stratten: Yeah. Yeah. And I guess that the online platform removes that barrier in terms of confidence to be able to ask your question over the phone. I feel as though even when I was younger, I would write down my question okay, so,hi, this is who I am, this is what my question is, you know, regardless of what it's about.

But it's that confidence, isn't it? And being able to have time and type it up.

[00:05:10] Frances Turner: Totally. Yeah. And I mean, I don't know about you, but my personal experience of sex ed in school was we had this thing where, you know, there was a box and you could write your anonymous question and put it in kind of thing. And that's kind of the concept of Nurse Nettie I would say.

[00:05:22] Maddy Stratten: Yeah, it's the good old question box that comes out, the online question box. We know that it's confidential and anonymous, but can you tell us about the level of detail that is required for this type of platform.

[00:05:37] Frances Turner: Yeah. Yeah, so it's really important that we do have a way to reply to you. So we need your email, and ideally, just double check that you've put it in correctly because otherwise we're not going to be able to respond to you, unfortunately.

In terms of your age, we just asked that in terms of, you know, safeguarding reasons, I suppose, and also to ensure that we're providing an appropriate level of information. So for instance, the information that I provide to a 25 year old would maybe be slightly different to the information I supply to a 15 year old.

And it's really good for us to be aware of that and, and, and figure out the most appropriate resources to signpost people to as well. Postcode, everybody seems a little bit anxious about the only reason we do that is because, we do get the some people from, out of New South Wales to other states and even from overseas, we've had questions from America. And in those kinds of scenarios, it's really tricky for us because we kind of go, well, we're actually not as familiar, with your location and what's available to you.

So in those instances, we usually respond to people saying, you know, this is actually your nearest sexual health service. We actually recommend you go and ask them because we're not familiar with your area. So that's the only reason we ask for postcode. Gender is really helpful because we like to know how to refer to you.

We like to know your pronouns. We like to know, a little bit more about, but again, making it personable as an answer for you. If we don't know that, we can give you information, but we like to personalise it as much as you possibly can, rather than just giving a blanket, dry textbook answer so it just helps us a little bit as well.

[00:07:07] Maddy Stratten: And good to see that there's options there.

[00:07:09] Frances Turner: Yeah. Absolutely. Yep. Yep.

[00:07:13] Maddy Stratten: How much detail do you usually get?

[00:07:14] Frances Turner: Oh, it varies. Um, yeah. So there's, there's times where people will ask us questions and we actually have to go back and say like, you know, you need to give me a little bit more detail than that. I'm not really sure what you're asking because again, when we train our nurses to work on Nurse Nettie, one of the core rules of being Nurse Nettie is.

Did you answer their question?

And that's harder than it sounds because sometimes you can get really, if someone's written you a paragraph, it's really easy to get bogged down and actually lose sight of what their original question was. So, sometimes we have to write back to people and say, you know, actually, could you give me a little bit more information?

Sometimes we get a lot of information and, that's not a bad thing. But what we ask people to remember is we can't diagnose you over the internet, unfortunately. So we're very happy to provide information and tell you where you should go and give you answers and all that kind of thing. But often, you know, we may get people saying, you know, I've had these spots, they've been there for this long.

And what do you think they could be? And in that case, our answer will always be, you need to go to a clinic. Would you like me to help you find where to go? Because we can't diagnose you online.

[00:08:18] Maddy Stratten: Yeah. And the good thing, I guess, about Play Safe is it has that, find your nearest sexual health clinic function on here.

[00:08:24] Frances Turner: So. Absolutely. And that's where Play Safe is actually really helpful because often, sometimes when we get asked questions, we go Play Safe has actually written this great article or this great blog post. Here it is, here's the link. And so often we can take what Play Safe has already done and yeah, provide that back to them.

[00:08:41] Maddy Stratten: Yeah. And all of those blog posts to, come through you or through the Nurse Nettie team don't like to be able to. Fact check those and everything that's going on Play Safe is always checked by the sexual health clinicians. So we know it's trustworthy and reliable information, right?

[00:08:59] Frances Turner: Yeah, definitely.

[00:09:01] Maddy Stratten: I'm wanting to provide a bit of a glimpse behind the scenes. So what actually happens when a young person or, you know, a youth worker asks that question and it comes through to you. Is it on a, on a shared inbox?

How do you decide who responds to that question? What is the process when someone submits their question?

[00:09:22] Frances Turner: Yeah, sure. So every day someone is responsible for checking the inbox. So it is a shared inbox that the questions will come to. And we make sure that yep, someone is aware that straight away at nine o'clock, which is when we start someone's checking the inbox throughout the day to make sure there's any questions.

Um, and, uh, that person is responsible for answering the questions as well. However, we check in with each other as nurses sometimes. Cause sometimes we get something a little bit tricky or we kind of go, Oh, is that the best way to phrase it or have I used the best resource and often we'll talk to each other and say, you know, Hey, how would you answer this?

Because this is what I've put, but what do you think? And, they range from being very straightforward to being slightly more complex. So we'll sometimes check in with each other. So. That's the nuts and bolts of it really. We do our best to answer all questions within 24 hours. If there's ever going to be a delay, we will usually reply with an email going just so you know, we're really busy at the moment.

Sorry, we will, we have received your email. We'll get back to you. And you know, because the service does only run Monday to Friday, if there's, if there's weekends or holidays, there's always a bit of a lag as well. But we do aim to get back as quickly as we can.

[00:10:25] Maddy Stratten: Yeah. And I love that too, because I can imagine it would be such a big thing to ask you a question and then not know whether, like, have you got it? Has it gotten lost? Has it gone to junk? I'm not hearing from them. So to be able to hear back and say, yes, we've got your question. You know, Nurse Nettie is going to get back to you. It's reassuring.

[00:10:43] Frances Turner: Absolutely. Sometimes depending on the question that someone's asked us, we actually might ask them to call us, and this is usually when, the question has a lot of layers to it. And we actually say, do you know what, it would actually be better if we had this conversation on the phone, if you're comfortable to.

And so then what we'll, we'll say is, generally we'll reply to the young person and say, look, This is confidential still. You can still call the SHIL line, Sexual Health Info Link. But a nurse would just prefer to talk to you because otherwise I'm going to be writing you an essay pretty much.

And it's probably going to leave you with more questions than answers. So sometimes we will reply to the young person and say, Hey, would you mind giving us a call? You know, we're happy to talk to you.

[00:11:20] Maddy Stratten: Yeah. And can you talk more about, you know, that, that tone of voice that you touched on earlier in that type of language. I'm guessing there's guidelines and kind of a standard response behind that.

[00:11:32] Frances Turner: Yeah, there is. Absolutely. So, you know, we, we try to make Nurse Nettie, as I said, very encouraging, very positive, so we always start an answer with Thank you for your question. And, you know, we do a lot of positive reinforcement in that, you know, say for example, if someone's got questions about their anatomy or how they negotiate condoms or all that kind of stuff, we just say, you know, good on you for wanting to use condoms, that's really great.

You know, it's, it's great that you're thinking about how to best protect yourselves and your partners. And we try to keep that positive tone throughout. We definitely don't want to, put across anything that's going to seem like sex is shameful or dirty, you know, sex is a beautiful, wonderful thing.

And, the main thing is to make sure that you and your partners are safe. And the fact that you're asking me this question means that you want to do those things. So good on you. We'll always try and be encouraging of them to engage in healthcare where possible. So where we do a lot of advocate advocating in terms of, you know, we really try to encourage people to have those conversations with their parents or with their partners and just saying, look, no, these are people who care about you, they want the best for you.

And, you know, have you thought about how you could have that? So we're very much kind of trying to facilitate those conversations with partners, parents, or trusted guardians or whatever. So, yeah.

[00:12:52] Maddy Stratten: Yeah. And I can hear that really inclusive language as well. Even saying things like partners rather than making the assumption that you've just got one partner or, or the sexuality and gender diversity of the young people who are asking those questions.

So I can see how that's important too. Yeah,

[00:13:10] Frances Turner: Very much. So I mean, like I said, we're all experienced sexual health nurses who've worked with the LGBTQ + community for a long time. You know, some of our staff members are LGBTQ + themselves. And it's, that's the beautiful thing I think about sexual health is everyone who works in sexual health is so passionate about those things.

And our vision is very much that You know, the Nurse Nettie forum and the Nurse Nettie emails are somewhere where you can be your authentic true self and not worry about any judgment or any assumptions being made. We try very, very hard to say, you know, anything that is between two consenting, you know, people or more, then good on you crack on.

So, you know, and it's just about how we, how we keep it safe.

[00:13:58] Maddy Stratten: I really love that. Love that. And so around those types of questions, you know, talking about condom use and consent. Also I know just from previous conversations with you before you've talked about, you know, is my body normal type questions, you know, what are those big themes, those big common themes that you usually get asked.

[00:14:20] Frances Turner: Yeah. So a lot of it will, you know, we do get a lot of, am I, am I normal? Is this normal? Is that normal kind of thing. And, and we kind of go throw normal out the window. Because we actually don't normal, we don't like the word normal for one. Um, I guess what we say is, is, more, you know is it causing you any discomfort?

Is it causing you any distress? If so, tell us about that. Why is it, you know. But we, we very much promote some wonderful resources. So I know, particularly for, you know, people with vaginas, I tend to send them a resource called the Labia Library for instance, which shows that there are all different kinds of sizes and shapes of labia.

Some have hair, some don't, and, you know, they're all fully functioning. Perfectly fine labias that are "normal", you know, and I guess we just try and encourage that and are very mindful of saying to people, you know, what you see in magazines and porn and videos. Actually is a product it's being sold to people right and and a lot of the time that's presented in a certain way because it's thought that that's what people want but true reality isn't like that.

And, you know, you would actually be surprised if you had a look at some of the resources like Labia Library and saw you are actually more "normal" than you know you are more within the, the bracket of, of what is considered to be, um, yeah, I can't, I can't, I can't, I said I hate word normal and I can't what I mean.

So, you know, we get questions about penis size and, again it's more about having communication with your partner and, uh, you know, meaningful, enjoyable sex, than the size of your penis, it really genuinely is. And, and what, again, what you see is very much people who have been chosen to present themselves in a certain way because they happen to have a large penis, but actually not everybody does and that's okay.

And so, yeah.

[00:16:21] Maddy Stratten: It's that body positivity and that, you know, building your self esteem and

[00:16:26] Frances Turner: Totally.

[00:16:26] Maddy Stratten: Yeah. Which is so important especially when we're talking about, you know, sexual relationships. Yeah.

[00:16:32] Frances Turner: Totally.

[00:16:33] Maddy Stratten: Yeah. My mind was going so many different places. isn it.

[00:16:36] Frances Turner: I know. I could, I could talk about that all day.

Don't even, yeah. Get me started on, you know, and it's, it's funny because it's, I was on my own Instagram recently. Yeah. And because of some of the pages I follow, it's like, I follow Play Safe and stuff like that sometimes.

[00:16:49] Maddy Stratten: And Caddyshack right?

[00:16:50] Frances Turner: Yeah. Yeah. And Caddyshack of course. . And so I sometimes get some, some, you know, because of algorithms and stuff, certain ads pop up and it's things like, I mean, I kid you not.

I've seen things like, um, glitter pessaries to put inside your vagina to make you discharge prettier and glittery. I've seen things like, and the other thing that horrified me recently marketed at young women were non medical pessaries to lubricate your vagina for sex. And I'm like, unless it's for medical reason, it means you're not aroused, and if you're not aroused, are you enjoying it? And if you're not enjoying it, well, why, why would you do it? You know?

[00:17:28] Maddy Stratten: And do you not have access to lube? Yeah! Because you you know you can actually use lube to help if that is a, if that is a issue for you.

[00:17:39] Frances Turner: Yeah, absolutely. And it's, it's just, it's, it's bonkers. And yes. So don't get me started on FemFresh either. Otherwise we'll be here all day. So

[00:17:46] Maddy Stratten: We'll move right on from FemFresh. And I think too, you know, it's, it's that consistent sexual health messaging. But what I really hear from you is that you're linking in and, and providing those pathways to those other trustworthy sites outside of, I guess, New South Wales Health, you know, what other places do you, you know, direct young people to?

[00:18:09] Frances Turner: So we tend to do a lot of directing, outside of Play Safe and Caddyshack and those kinds of partners that we're familiar with.

We do a lot of directing towards the sexual health clinics themselves and saying, you know, sexual health clinics are designed to be safe, welcoming spaces. We do do a lot of directing to GPs as well and kind of encourage young people. Cause a lot of young people don't know they can get their own Medicare card at 15, right.

And we do a lot of facilitating around, well, did you know you can hop online and there's a whole thing and it'll show you how to do it and all this kind of thing. We do a lot of directing towards counseling services. There's a fabulous New Zealand website that we send a lot of our question askers to regarding herpes and that's herpes.org.nz, which is wonderful. If no one's ever seen it, I strongly recommend you check it out. And yeah, and again, a lot of LGBTQ resources as well. So, we have, a referral manual which we tell, a lot of our healthcare professionals about so on the SHIL website when you go on there's actually a section for a referral manual and it's it's organized by concern, essentially.

And so anyone can go in there and find trusted recommended resources and that might be for you know drug and alcohol use, it might be you know for sexual dysfunction, any range of things. But they're resources that we have said, you know, these are reliable, accurate resources that we're kind of happy to endorse and put in our referral manual.

Have at it, go look at it and see what you think would be good for your patients or for yourself or for your loved ones.

[00:19:42] Maddy Stratten: Kind of nice to have Nurse Nettie and, and your team really be able to say, we've verified these websites and this is where you can, find that trustworthy, reliable, accurate information that's consistent with what we're saying as well, because my gosh, Google, like there would just be so many things that pop up when you type in herpes and, and you wouldn't necessarily think of a New Zealand website to go to.

So great that that's there.

[00:20:11] Frances Turner: Yeah, yeah.

[00:20:12] Maddy Stratten: I want to move on to get to those top 10 questions that, Nurse Nettie have been asked. There is a question that came through from our, audience. So I'm wanting to make sure we get to that one first. The question is, is it common slash possible for women who have sex with women to get a UTI from having sex like heterosexual couples?

[00:20:33] Frances Turner: Yeah, sure. So that's a great question, it's absolutely possible, because all a UTI or a urinary tract infection is, is essentially, bacteria entering the tube where you pee from. So your urethra, much more common in people who have because our urethras are shorter, so the distance between that tube to our bladder is a lot shorter than people with a penis because their tube is significantly longer. And so usually bacteria doesn't have time to reach the bladder. It kind of dies off before it reaches the bladder and can cause any infection or any problems.

So for women who have sex with women bacteria can be introduced through sex, certainly. And so yeah, it is still possible. One of the good ways you can mitigate UTIs that I always say is go for a pee after you've had sex, which sounds very odd and basic, but literally just helps clear the urethra out afterwards.

And it sounds like an old wives tale as well, but it's true. It is true. And the other thing, again, that's, might sound very obvious, but people don't always know is that you should be wiping front to back. And the reason you want to do that is because you want to go away from the urethra.

Because if you wipe back to front, then you're potentially introducing bacteria from your vagina or from your bottom um into urethra, and you're more likely to get a UTI that way. So go for a pee after you have sex, wipe front to back, and usually, that helps prevent a lot of UTIs. But sometimes they will happen.

And if you, so if you notice any stinging sensations, if you get any, you know, kind of discomfort where your bladder is, if you find like you're going a lot more often than you used to, or you want to go, but when you go, nothing's coming out. Means you might have a UTI. So it's a good idea to go and get it checked out.

[00:22:14] Maddy Stratten: Yeah. And I guess one of those things too, that, you know, we've had young people say to us those myths, those sexual health myths and oh, if I do a wee after I have sex, I won't get pregnant. If I do a wee after I have sex, I won't get an STI. So I guess that's part of that answer too, isn't it? Yeah.

[00:22:31] Frances Turner: Yeah. And it's a balancing act, right?

Because, and we have to be very careful about that because, those little myths I think always have some nugget of somewhere it's come from something that may have had some accuracy at some point in time. But yes, so we do have to be very careful to kind of say when we give advice such as that, please be aware, this won't prevent pregnancy or STIs, you need to use a condom or contraception for that so we always kind of have that caveat in place.

And as well, using condoms on sex toys, which again is great advice, absolutely. Using condoms on sex toys, making sure you clean your sex toys thoroughly, as well, is a great way of preventing them also.

[00:23:10] Maddy Stratten: Yeah, and I think that was a really good example around how Nurse Nettie would answer a question like that, and we could see the open and respectful way.

 But yeah, I guess, recognizing that people who are working with young people they can actually call the Sexual Health InfoLink, can't they?

[00:23:27] Frances Turner: Totally. Yeah. So when you call Sexual Health InfoLink, what you'll actually hear, is please press one if you're a healthcare professional, so that's your youth care workers, community workers, all that kind of thing, or, you know, hold on the line if you're a member of the public.

And the reason we do that is because, we want to know with our healthcare professionals, obviously you're calling on behalf of someone else, cause it actually shows up on our screen and, we've had people call us before. So, I'll give you a really good example that I had recently is a youth worker that said to me, well, I've got a 15 year old asking me for condoms.

What do I do? And I said, well, my advice would be, if that young person is coming to you for help, number one, if we don't help them, they're not going to ask us for help again. So it's really important that we help them now because if we don't, they're not going to trust us. They're not going to come to us in future.

And we want them to, we want them to know that they can come to us when they've got a problem or a question or whatever. Number two, if this person's asking for condoms, they're either already having sex or they're thinking about having sex. And what we know is that telling people to be abstinent does not work.

It doesn't. It just doesn't. And so my concern would be is, is that young person going to have sex whether they have the condoms or not? And if the answer is yes, they're going to have sex no matter what, well, give them the damn condoms. Because what would be the worst thing is if they got an STI, got pregnant, if they're capable of childbearing, we don't want that to happen. But sometimes, you know, if you don't come from a sexual health background, that can be a really scary thing. Like, Oh, you know, is this out of my scope? Should I be doing this? And we're kind of like there to go, yes, you absolutely should.

You're doing the right thing, give them the condoms off they go. And if they use them. And they have sex, great. If they don't have sex, well, at least they've got them for when they do,

[00:25:11] Maddy Stratten: It's so great to have that reassurance from your team.

[00:25:15] Frances Turner: Yeah. The youth workers are great. I mean, very often they've already made the right decision. They just wanna talk it through and debrief with someone and just kind of go, yeah, should I have done anything differently?

And a lot of the time I'm going, no, you did great. Well done. Like, that's fabulous.

[00:25:28] Maddy Stratten: Yeah. Yeah. I think that's really important. Especially when we're having these conversations around those most common sexual health questions. I've tried to group them together rather than go one to 10. Interestingly, five of the top 10 questions around STI testing. So the first question around STI testing, number one, how often should I get an STI test? Number two is. Is STI testing expensive? Number three, is an STI test anonymous?

And number seven out of ten is, do I need an STI test even if I have no symptoms? So, really interesting that five out of ten are around STI testing, which is really great to know that young people are actually asking these questions. Yeah. To Nurse Nettie, how do you answer those questions around STI testing?

[00:26:19] Frances Turner: Yeah. Yeah. Yeah. So again, you know, we would always say, you know, thanks for asking a question. That's great. And, one of the things we would always say to anybody, you know, is that, is there anything in particular that you're worried about that's making you want an STI test, first of all, but again, we would go back to, okay, well, how often you have an STI test, it really depends. So we would say at least once every six months is a good idea, depending on how sexually active you are.

Um, if you were MSM, the guidelines actually recommend it once every three months. But again, depending on the kind of sex you're having and with whom and all that kind of thing.

[00:26:55] Maddy Stratten: And MSM meaning men who have sex?

[00:26:57] Frances Turner: Oh sorry, men who have sex. So, and the reason we use that term is because not all men who have sex with men identify as gay or bisexual. So men who have sex with men encompasses everybody, which is why we use that. And then we use women who have sex with women as well. So we would always say, look, every, every six months at least is a good idea, or when you've had a change in sexual partner or if you're showing some symptoms. Do I need an STI test even when I don't have symptoms? Yes, you do. Because chlamydia, we know it can present as asymptomatic a lot of the time, so can other STIs. And, one thing they always want to know is, well, my partner's tested negative, so I should be okay, right?

And we're going, no, no, no, no, no, no. And the way I phrase that to people is going, well, it's kind of like COVID, right? You can be exposed to COVID and not catch it. So your partner could have been exposed to chlamydia and not caught it. And they've been exposed by you who does have chlamydia. So you need to go and get yourself tested just to make sure.

 In terms of STI testing being expensive, we always go, no, you know, great news is STI testing is free, you know, here's where you can go. And this is why we like to have the postcode, because we can say this is your nearest clinic. If they don't give us their postcode, we've got a really great list of all the different clinics in New South Wales they can go to.

So we'll just send them a little link and say, you can find your nearest clinic here. It also lists all the Aboriginal Medical Services on there as well, if they prefer to go to those locations too. What we always say to people is anonymous, is different to confidential. So is it anonymous? No, it's not because you have to give us a name and a contact detail because it's a medical test. We need to be able to notify you.

You can't just drop off a urine sample and not give us any date of birth, name or mobile number.

But what we can say is that it's confidential. Sometimes it's necessary to share your information, say for example, if you're going somewhere else to get treated by a GP, for instance, but we would never share your information without asking you first, we would always check with you first that it's okay. We certainly don't go and disclose your results to anyone else. So anonymous and confidential is slightly different. And we try and clear up that myth a little bit as well.

[00:29:02] Maddy Stratten: Yeah. And good opportunity to be able to do that too. Yeah. Before we move on, I was wanting to know how you manage calls when you were concerned about a young person's safety and what are the processes if the person doesn't follow up with you.

[00:29:16] Frances Turner: That's a great question. And it's, it's, it's a tricky scenario to be honest with you because we have limited information.

As you can see from the Nurse Nettie, we don't have an awful lot to go on. The first thing we try to do is, is not to scare the young person off. Um, we don't want them to think that they're in trouble or that they've done anything wrong or, um, You know, anything like that. So we gently try and coax a little bit more information out of them.

Often that's one of the scenarios where we'll say, look, it'd be really great if you could call us, we'd love to chat to you properly kind of thing. And we try and encourage them, but at the same time, what we want to do is we don't want to not answer their question because if they disengage at that point, they've gone away without that information.

So we still try and supply them with the information. So, um, I had a young person asked me recently, well, how do I talk to my parents about if I'm pregnant? And to that, we kind of said, look, you know, we'd really like to talk to you, but however, you know, these are some resources on how you would maybe do that.

But are you even sure that you're pregnant because you need to do a test first? And this is how you do a test. And this is how long you have to wait and all this kind of stuff. in terms of safeguarding concerns, we're very lucky to have a great relationship with the child protection units. And so what we would usually do is, where possible, if we know the person's postcode, we can contact the, the Child Protection Unit within that Local Health District.

But if we don't, then we contact the one within Southeastern Sydney, because that's where we're based and we would contact them and say, look, this is the story. This is what we've done. We've opened a case file. We've recorded all these details. We've got a plan in place. We're going to try and follow up with them.

Do you have any other suggestions for what we would do and then child protection can kind of say, Yeah, you know what you need to do an MRG you need an MRG is a hard because. Again, we have limited information, uh, Mandatory Reporting Guidelines for anyone who's wondering. So it's a, it's a mandatory report we do when we're concerned about a young person.

So what we'll do often is we'll, we'll create, a file in a shared place that all staff can see. All staff will be made aware that we've had a Nurse Nettie, caller or question asker who we're worried about. And just saying, hey, if this person makes contact again, this is the plan. This is what we're going to do.

We will attempt to re engage them a couple of times if they drop off, but we also don't want to hassle them or harass them. We want them to feel like they can come back to us. So we will kind of send them a follow up email, just going, Hey, I just went to check in, you know, you asked us a question the other day and how are you going, you know, did you manage to get to the doctor?

Did you manage to do your pregnancy test? And sometimes they'll respond and sometimes they won't. That's where it's hard because it's not an awful lot we can do except just be open and be there for that young person and just say, you know, just want to say, I'm still here if you need me, you know, call us anytime happy to chat, you know, and all this kind of stuff.

And yeah, it's a tricky one.

[00:32:10] Maddy Stratten: The great thing about that is that they know where to find you. They know they had a good experience the first time they spoke to you and, you know, you actually answered their question as well as giving them an opportunity to have that phone call to find more information because if you're not answering my question I'm going to go find someone else who will. Right?

[00:32:28] Frances Turner: Exactly, yeah, and I mean, the thing is, I think that frustrates me quite a lot. Sometimes when you see how people interact with young people, young people aren't stupid. They're not dumb. No, don't try and pull the wool over their eyes because they'll, they'll snuff you out straight away.

[00:32:41] Maddy Stratten: Absolutely. Okay. Thanks, Fran. I will jump into our next theme of questions that I've grouped together around STI still in the top 10 questions, we've got number eight is how reliable are condoms as a contraceptive and as a protection against STIs.

And number 10, is can you get an STI from a handjob? Both questions around STIs still. Yeah. And interesting ones too.

[00:33:07] Frances Turner: Yeah. So, and the, the thing about both of those questions are, it depends.

So, and it's not a straightforward black and white, yes or no question. So the thing that we say about condoms is condoms are great. They're fantastic because they're the only thing that will protect you from both pregnancy and STIs at the same time. However, like everything in life, if you use it the way it's meant to be intended it will work if you don't it's not going to work.

So we kind of answer that by going, you know, they're really effective provided are you squeezing the air out of the tip you rolling them down the right way you know is it inside out, you know, make sure that your nails aren't ragged or anything, make sure your jewelry isn't getting snagged on it.

Don't try and rip the wrapper with your teeth. You may think you're looking sexy, but you know, it's actually, you're at risk of tearing the condom. Use lubricant because if you don't, then, you know, may the break. If it slips or comes off, don't just put the old one back on. You need to get a new one and all that kind of stuff. So that question, we center more around. how you're using the condom. And also, you know, you could put a condom on halfway through sex and technically be using a condom, but that's very different to putting on right from the beginning.

And so we kind of have that conversation with people as well. And signpost them to some Play Safe resources on condoms too, and, and again, just reinforcing it with that positive, you know, it's great that you're either using condoms or thinking about using condoms.

Here's where you can get them from, all those kinds of things. And, yeah, just to again, go good on you for taking responsibility and doing this.

In terms of getting an STI from a hand job. What we would say to that is, um, It depends on if you've got someone's semen or vaginal fluid on your hands and you're then touching yourself, possibly.

I mean, it's on the lower risk of the spectrum, but low risk isn't no risk. So if there's any doubt in your mind and you're worried. Just go and get a check. It's fine. No one's going to yell at you. No one's going to say you've wasted their time or anything like that, but you know, so it's not this, this, secret club that you've got to know the password to get in or anything.

If you want an STI test, go and get an STI test. But again, what we say to people is, yeah, you know, if you're going to, you know, engage in any kind of mutual masturbation or play really good to wash your hands before and after, you know, If you've made contact with someone else's fluids, don't necessarily be touching yourselves.

If you're using toys, again, use condoms or wash them. And sharing of toys and all of those things. Sharing of toys, all those kinds of things. Yeah.

[00:35:46] Maddy Stratten: There's a question again before I move on. How regularly do you get questions around PrEP?

[00:35:51] Frances Turner: Yeah, we get questions around PrEP quite a lot, actually.

And again, we are very conscious of not discouraging young people because there is I know a little bit of, concern sometimes about young people accessing PrEP, but also it's at the same vein, right? If this young person is asking about PrEP, that means they think they're at risk.

If they think they're at risk, they probably are. And so we need to have the conversation and it may not be that they're at risk now, but they want to know for future. Do you know what I mean?

[00:36:20] Maddy Stratten: " Or for a friend ".

[00:36:21] Frances Turner: Or a friend. Yeah. What a good friend you are. Fabulous. But yeah, so we, and again, there's no, there's no restriction on information, right?

If they want the information, we'll give it to them. We would rather them get it from us than go to an unreliable source. So now we get, we get questions quite a lot.

[00:36:38] Maddy Stratten: Yeah. And also good on that young person to know what PrEP is and wanting to learn more about it, even if it's not right for them right now, maybe it'll be right for them down the track, or it's for a friend, like, actually for a friend.

[00:36:52] Frances Turner: And I mean, things, things are getting better for LGBTQ + youth, but there's still a significant gap, right? LGBTQ + youth don't get the same access to sex education that their heteronormative peers do. And so they have to work really hard to go and find these answers for themselves, which is, really sucks kind of thing.

So if they do, we're not going to go, oh, you're too young to know that. So it's all about empowering them and saying yep, here you go. This is what you need to know.

[00:37:24] Maddy Stratten: Yeah. Love that. Love that. Uh, okay. So we also have a, questions in here. Number five on the, on the top 10 is when do I need to get a Pap smear?

[00:37:34] Frances Turner: Ah, beautiful question.

[00:37:36] Maddy Stratten: Using the words Pap smear too.

[00:37:39] Frances Turner: So, the technical new term for Pap smear because the testing changed a little while ago is a cervical screen. And, one thing I'm very vocal about is even if you are not female presenting or female identifying, if you have a cervix, you still need to get your pap smear.

And it's great to call us if you're not sure about where to go as a non female identifying person. Because you might go, Oh, I don't want to go and have to explain myself in a non friendly space and we can kind of go, we got you. This is where you go.

So to answer the question most people get that start to get their cervical screens at 25. Purely because the research tells us that this is when cervical cancers start to be potentially detected. It's rare that we see them in people younger than that. Mm-hmm. There are caveats to that though. So sometimes if you, you had early what we call early sexual debut. So if your first, sexual encounter, consensual or otherwise was under the age of 14, which mm-hmm does sometimes happen. You should be getting them earlier. If your mother was on a medication called, I can't say in full, I'm so sorry, cause it's about 50 syllables, but it's called DES. You should get it earlier as well. And if there's a particular prevalence of cervical cancer in your family, then you should consider getting one done earlier as well.

[00:39:03] Maddy Stratten: Yeah. And for it to be number five, I'm actually really, surprised that it's actually so high in the top 10 questions, it's number five yeah. Okay. So the last three questions, I guess are around that. Am I normal and looking more around sex and those concerns.

Number nine is how can I manage premature ejaculation. Number six, I've lost my libido. How can I get it back? And number four, my partner can't climax anymore, is this my fault? And I love that these three questions are included in the top ten because it's looking at sexual health so much more than just STIs and condoms, right?

[00:39:42] Frances Turner: Yeah, yeah, yeah, yeah, which is what we tend to say to young people, right? Don't get an STI and don't get pregnant. And there's so much more than that. This goes way beyond that. So premature ejaculation is an interesting one because I always say to people, what, what do you mean by premature ejaculation?

Because, actually what you consider premature ejaculation actually might not be. So tell me, tell me a little bit more about that. What, what do you mean by premature ejaculation? And often it's a case of reassuring young people and going, actually, that's not premature ejaculation.

You're perfectly normal again, you know, porn.

[00:40:20] Maddy Stratten: Yes.

[00:40:21] Frances Turner: Don't pay any mind to it. And actually I can guarantee you, your sexual partner probably doesn't want to keep going for two hours straight, you know, they're probably looking at the ceiling and that point going missing my Netflix show. So, so it's a lot of time just saying, that actually what you're describing as premature ejaculation isn't, but did you know that sex doesn't just encompass actual penetration and intercourse, it encompasses foreplay and all the things that lead up to it and beyond it as well.

So, so actually don't just think of it in terms of this the moment your penis enters an orifice to ejaculation, because that's not the only thing that plays in there. If they were genuinely having issues with premature ejaculation, then we kind of go, okay, well, look, there are services you can go to.

You know, sometimes it's a psychological thing. Sometimes it's a biological thing. So you need to see, a specialist in that area to help you figure out which is which. And once they do that, they can help you go, okay, right. Well, if it's a psychological thing, like, talk about some techniques you can use some, you know, it might be Cognitive Behavioral Therapy or something like that, that will help if it's a biological cause, then certainly you need to be referred to a specialist, but I would say look, the vast majority of times it's a misconception of what premature ejaculation actually is.

[00:41:37] Maddy Stratten: Yeah. And I love how you can kind of weave in those conversations and what an opportunity to weave in those conversations around that sex isn't penis in vagina, you know, that, you know, heteronormative, but also, sex is more than just penetration and such a, and such a great opportunity to talk about that.

So how would you then answer the lost libido question?

[00:41:59] Frances Turner: Sure. Sure. So again, I guess we would want to know was, well, what was it like before and how long ago was that and how old are you now? And has anything changed? You know, are you really stressed at the moment?

Has anything big happened in your life recently? Have you started any new medications? So for example, a lot of anti anxiety and antidepressants can cause low libido. And I guess what we kind of say is, is that it's dependent on the cause right? And sometimes it's, it's because, the person actually doesn't feel like having sex when their partner wants to have sex and it's kind of going, well, it's not that your libido's lost.

It's just that your libido's different. So you shouldn't feel like you should be having sex just because your partner wants to have sex. It doesn't mean you've got a low libido necessarily. It just means that you're going, no, I'm not in the mood. Yeah, just on this occasion, but the rest of the time I am. And so again, it's weaving and having those conversations about it.

And if it's, if it's determined to be something that is caused by say medication or stress, we then say, right, let's signpost you to the right place to help you with that. Maybe you need to go back to your GP and say, look, this is happening with the, you know, I don't know. The Citalopram I'm taking for my anxiety.

Let me look at how, you know, we can maybe combat that, you know, or if you're having a lot of stress in your life, let's go, well, how do you cope with stress? And what does that look like for you? And, you know, what, what do you enjoy doing that can help lessen your stress? Let's talk about that kind of thing. So.

[00:43:21] Maddy Stratten: Yeah, I guess also bringing in sex therapy, and talking about pleasure and desire, which often gets lost in those questions.

So the last question we've got is number four. Um, my partner can't climax anymore, is it my fault? And I think that is just such an interestingly worded question.

[00:43:37] Frances Turner: There's a lot to unpack there, right? I mean, in that scenario, I would say, look, first of all, you're obviously a very considerate person to be concerned with your partner's pleasure and not just your own. So it's wonderful that you're thinking of them.

When we say is it not, is it not my fault anymore? The short answer is no. No, not necessarily. Have you talked to your partner? Because again, what's going on for them? Is it again that they're particularly stressed if they got a lot going on in their lives at the moment? Because sometimes when we've got a lot of stress going on in our lives, the last thing we feel like doing is having sex.

And so, that's where we really encourage open conversations with your partner. Have you talked to them? What did they say? Because they may be feeling really self conscious about it and it's kind of a bit of a minefield that people try to avoid sometimes. So what we would do is encourage that open conversation with your partner, have a discussion with them.

Where are they at? What are they feeling? And take it from there really, again, depending on the answer.

[00:44:41] Maddy Stratten: Yeah. And I love that the, one of the big themes in that answer is around communication.

Which is super important. And also where you're having that communication, it's not in the bed, you know, just before you're going to be having sex, maybe not the best time to be having it.

[00:44:57] Frances Turner: Why didn't you climax?

[00:44:58] Maddy Stratten: Yeah. Super great to hear those answers and those questions, but also how Nurse Nettie would answer them.

And, and I can hear, you know, that open and respectful responses, those inclusive responses, but also the whole listen to your body and all of those things was just really great.

Thank you so much for, joining us today and sharing your, your knowledge, but also, I guess your energy around, like you can really feel the passion that you have for this project, and the team that you have behind you. And it was really great to hear, a little bit of that behind the scenes glimpse of Nurse Nettie and to know that it is a real person. They are real people behind, behind this online platform, which is just so cool.

[00:45:40] Jennifer Farinella: Thanks for listening to On The Couch. We create this podcast because we are allies in actively challenging discrimination, microaggressions, and exclusionary behaviors. We want to create spaces where people feel safe to share their thoughts, knowing they will be heard and respected. Such an environment fosters collaboration, [00:46:00] innovation, and contributes to a more inclusive society.

Connect with us on Instagram and Facebook where you can share On The Couch with your colleagues, friends, and family. On The Couch is made by Jennifer Farinella, Naomi Viret, Maddy Stratten and Winnie Adamson.

Until next time, peace, love and protection.