With World Sexual Health Day 2025 coming up this September 4th, Dr Annette Fenner and I discussed her journey to becoming Chief Editor at Nature Reviews Urology, her research and studies prior to her position, and how conversations surrounding Sexual Medicine have been changing for the past 15 years.
Dr Fenner also talks about the challenges that surround Sexual Medicine and her hopes on how to overcome them in order to achieve good sexual health and wellbeing, for all.
Please tell us about yourself.
I’ve been at Nature Reviews Urology for 15 years, 14 of them as Chief Editor. My journey to get there was a little convoluted – my original background was clinical medicine; I started my medical degree at Imperial College in 2001, but realised after the course switched from lecture- based to hospital-based that I enjoyed the theory of medicine more than the application! I was lucky enough to be able to intercalate a BSc as part of my medical degree, which led on to a PhD in reproductive biology, before I then went back to finish my medical degree. By the time I’d finished that (the final 2 years are entirely clinical, hospital-based), I realised that a standard medical career wasn’t for me. However, my final placement before my finals was in urology, and I really enjoyed the subject – it’s a great mix of medicine and surgery, benign and malignant conditions, and sexual medicine, which was where my real interest lay. I saw the advert for the NRU job just after telling the medical school that I wouldn’t be taking up my junior doctor position; it felt like serendipity! Here I could work in urology and sexual medicine, without the night shifts or the touching people aspects, and indulge my hobby of correcting people’s grammar! I’ve been here ever since, during which time I have become more interested in the subspecialties of sexual medicine and sexual health.
How has knowledge of Sexual Health developed over the course of your time as Chief Editor of Nature Reviews Urology?
I first started working on the journal in 2010 and in the past 15 years we have seen massive shifts in the way we understand and approach sexual health. One of the main changes relates to our understanding of HIV and AIDS, which can, of course, be sexually transmitted. 15 years ago, AIDS was largely considered an incurable disease and was associated with significant stigma, particularly in the LGBTQ+ community. Now, we have effective treatments that can manage viral load, and far more accurate means of measuring this parameter. We also have the capability to prevent transmission entirely before it occurs through the use of pre-exposure prophylaxis (PreP), which is offered to high-risk groups. We also better understand that, even in individuals who are HIV+, an undetectable viral load means the disorder cannot be sexually transmitted to a partner (undetectable = untransmissible/U=U). These improvements in scientific understanding, medical management, and social stigma have completely altered the way in which HIV affects people today.
Outside of HIV, we’ve also seen the application of vaccination programme against human papilloma virus (HPV), which is associated with cervical and penile cancer, as well as improvements in telemedicine, enabling access to care for people who previously struggled to see a clinician, and improvements in access to testing, for example by post.
We’ve also begun to (finally) see a more focussed approach to women’s sexual health and sexual function; in the past, much of the research surrounded male disorders, especially erectile dysfunction (impotence).
Why did you decide to go into reproductive endocrinology in your studies?
I somewhat fell into it! I was working on an intercalated BSc in endocrinology in the middle of my medical degree and was offered a lab project on kisspeptins in a metabolic medicine lab as part of that. The head of the lab (the wonderful Professor Sir Steve Bloom) knew that I hadn’t been enjoying my clinical medical studies and that I liked lab work, so he offered me the opportunity to stay on and intercalate a PhD on the topic. I really loved the multi-layered aspects of the field: the multiple inputs and complexity of the sexual response and behaviour aspects, coupled with the logic and predictability of the endocrine aspects. I was fascinated by it and remain so to this day.
What challenges surrounding Sexual Health do vulnerable people face in particular?
The biggest challenges to sexual health across the board relate to stigma. Sex remains a taboo and people find it difficult to discuss their sexual health, even with their doctor (who has already seen it all, trust me!). Couple this with vulnerability – for example, homelessness, which can impact access to care and availability of contraceptives, or if someone identifies as a sexual minority, which can add further barriers to discussion and understanding, and you have a perpetual cycle of a problem arising, it not being managed, and it getting worse. Sadly this is a problem across all fields of medicine, but I do feel that the added discomfort that many people feel around discussing their sexual health, practises, and roles, makes this a particularly difficult challenge.
What are your hopes for progress in the future of Sexual Medicine?
I think the only way we can improve things is education. Sex and relationships need to be taught in schools, with an inclusive approach that does not demonise particular groups of make them feel ‘abnormal’. Sexual health is just one facet of overall health, but an important one, with implications not just for physical health, but also for a person’s mental health and relationships. I hope that future generations will be able to have a more open discourse around sexual function and sexual health, which can only be a good thing!
What would you like to remind people on World Sexual Health Day?
Get tested! See your doctor if you have any concerns or symptoms – they won’t judge you and can sort out most things pretty quickly. If you don’t have symptoms, but you’re sexually active, you should still be having regular check-ups, as many STIs are symptomless. You don’t even need to see a doctor for this – you can order a test online, do it yourself, and post it back for results within a few days. Everyone has a responsibility to take care of each other by being aware of their disease status and by using appropriate protection.