Porn in the NHS: A matter of perspective

Julia Manning's report 'Who said pornography was acceptable in the workplace? An investigation into the use of pornography by NHS fertility clinics' [1] is disturbing. All that is missing from this supposed expose is the human story - an interview with Mrs Smith (not her real name) whose husband willingly committed 'adultery of the mind' while they were supposed to be receiving fertility treatment at an NHS clinic.

The report seems to have an identity crisis - is it pushing a feminist agenda? Or does it represent an honest attempt to simultaneously improve medicine and safeguard society? In my opinion, it achieves neither and simply displays ignorance and a lack of compassion for infertility sufferers and patients.

Published earlier this month by 2020health.org - a self-proclaimed 'independent, grass-roots, think tank for health and technology interested in realistic solutions' - the report describes the results of a survey to determine the level of provision of pornographic materials within fertility clinics based in NHS trusts. But it lacks perspective and credibility, leaving this practitioner and many other colleagues incredulous.

Ms Manning appears to misunderstand the findings of her own misguided report in an attempt to push another agenda. For example, the finding that two-thirds of respondents did not provide pornographic materials does not necessarily 'show there is no genuine need for it'. Fact: Lack of funds, ignorance or autocratic local policy could equally explain this finding. From personal experience, I can say providing a semen sample in a sterile clinical setting (for any purpose) can be a daunting, embarrassing and frequently difficult experience for a man. Within reason, any efforts to ease this process should be welcomed, not vilified.

I take particular issue with the notion of 'implied sanctioning of pornography in the workplace' as if the decision to supply pornography has anything to do with the staff when, as the author well knows, its sole purpose is for patients. This is like saying hard drugs such as opiates (a threat to society) are sanctioned in the workplace (hospitals).

Fact: fertility clinic employees understand the requirements of working at a fertility unit, which may include discussing embarrassing subjects and assisting with equally embarrassing activities. This comes with the territory. I have never heard anyone complain about this aspect of working in a fertility unit. Such 'embarrassing duties' fall clearly within the remit of sensible professionals.

There are several published studies demonstrating the benefits of pornographic material to the production of semen samples in a clinical setting. They demonstrate a facilitative effect (2) and increased sample quality (3). While discussing these studies with a non-medical friend, he quipped: 'Another study from the Department of the Bleeding Obvious. You don't need a study to show that'. But, in an era when the evidence-base has assumed unparalled importance in medicine, it is comforting to know that - yes there is even a study to show that.

Fact: Many men may benefit from using pornographic materials to provide a semen sample under stressful conditions in a clinic. The men don't have to use pornography- it is entirely optional. Indeed, some men choose not to. Failure to produce a sample can result in additional stress, failure to make a diagnosis (routine semen analysis), failure to complete an IVF cycle after eggs have been recovered from the female partner (at great cost to the taxpayer and/or patient), the need for Viagra or, in extremis, surgical sperm retrieval (with additional costs that outweigh the entire NHS annual budget for pornography with one swipe of the scalpel).

Ms Manning's expertise in this area leads her to announce there is 'no reason why a specimen cannot be produced at home' and 'the use of hospital space in the clinic for specimen collection is in itself wasteful'. The apparent solution of 'home production' is an option for some patients, but is not without problems. Samples need to be brought to the clinic within a specific timeframe, under optimal temperature conditions and, preferably, with masturbation as the only means of production. Other methods can invalidate the test results. Incidentally, I can't remember the last time I brought a blood sample in from home - I thought phlebotomy was part of the NHS service.

In these austere times, it is reasonable to consider opportunities to cut unnecessary costs within the NHS. The report details truly unconscionable sums of £21.32 per NHS Trust and a whopping £700 for the entire NHS per year on pornographic magazines, suggesting that such expenditure is an 'abuse of taxpayer's money'. By my reckoning, this equates to only pennies each for the thousands of patients requiring this facility each year - considerably less than the price of a cup of tea.

I mention tea because free tea has no proven health benefits for patients, but still forms part of our taxpayer-funded healthcare system. I see it as humanity- rather than evidence-based medicine. But, we are reminded, 'it is the principle that is important', not the sum.

One wonders whether Ms Manning would be more understanding if the pornographic materials were free. Indeed, a large well-respected public sector IVF clinic in London receives all its pornographic magazines free of charge (as surplus to those sent to the armed forces overseas). There are some parallels between men in active service overseas and patients undergoing IVF in the UK. Both are stressed, under pressure to perform, and committed to a job they may find difficult and which no one really likes to talk about. Perhaps there is an equal risk of servicemen suffering from 'adultery of the mind' if we continue to provide them with pornography. I can't wait for that report.