Sexual Health Week 2025 ran from 15 to 21 September, with this year’s theme, chosen by Brook, being: 'Chronically Online: Love, Sex and Relationships'. The campaign explored how digital technology has rapidly become a familiar part of how we negotiate life, sex and relationships.
Like many technological innovations, the digital revolution has brought with it significant benefits but also new and unforeseen challenges. Nowhere is this more true than in the world of sexual and reproductive health. For many commissioners and providers of sexual health services, 2020 marked a sharp acceleration in the amount of services provided online necessitated by a global pandemic. Though the world has largely returned to face-to-face life as before, the genie is definitely out of the bottle and many people now prefer to access their information, contraception and STI testing online, rather than having to attend a clinic in person.
The new NHS 10-year plan outlines the need for a shift from 'analogue to digital' in our health system, but simply digitising is not enough; we should be aiming for digital health equity. It is worthwhile thinking in a little more detail about what actually comes under the umbrella of 'digital health'. Yes, it refers to the interface between services and patients and how we enable patients to access health care resources and information online, but more than that, it encompasses the dimensions of healthcare data usage. What data we hold, about whom and how we use it are all important. From an equity standpoint, it also entails having an understanding of algorithmic bias, asymmetrical data collection and poor quality coding of demographic characteristics. For this reason, some advocate for a new 'layer' to our Dahlgren and Whitehead rainbow; that of the digital determinants of health (DDOH). Chidambaram and Colleagues suggest a framework for conceptualising these DDOH including digital accessibility, affordability, and technology personalisation:
Understanding these DDOH helps to see why caution must be exercised when considering moving sexual health services exclusively online. Whilst this will be a very appealing and convenient option for some, there will be others for whom this does not meet their access needs. For example, many lack access to devices, wifi or data. Relying exclusively on a digital service will disadvantage some, and likely those already at risk of worse outcomes. In recognition of this, and other challenges, the CoSRH and BASHH jointly produced standards for online and remote sexual health providers which provide guidance on how to provide a safe equitable service at distance. Many local authority commissioners are also looking at their own online SH service data to monitor equity of access in a time of rapid change.
The impacts of a digital revolution go way beyond how we access health services and manage our wellbeing, however. Digital technologies are now an inescapable part of the way in which we navigate our lives and relationships and find information. Children and young people are coming of age in a world where not only are their views on everything from contraception to dating to gender norms being constantly influenced by social media algorithms, but also where they are expected to safely navigate the world of sexual relationships whilst being alert to threats and misinformation. The UNFPA defines good sexual health as 'a state of complete physical, mental and social well-being in all matters relating to the reproductive system. It implies that people are able to have a satisfying and safe sex life, the capability to reproduce and the freedom to decide if, when, and how often to do so'. Whilst this definition has not changed, the circumstances in which we are trying to achieve it have done significantly, and therefore sexual and reproductive health services must adapt too. Digital technology has helped many to access care in a way that works better for them, but it also presents a risk and therefore the way in which we provide relationships and sex education to our children and young people must also adapt to this new environment.
Of course, the health system must evolve and embrace digital technology; a failure to do so would be to eschew the many benefits offered by innovation, but it must be done in a way which seeks to diminish rather than widen inequalities and with an eye on the horizon of change.
