A Comprehensive History of Sexual Health

With a UK focus…

Why sexual health?

Sexual health is something that we are all encouraged to engage in and might have been taught to most of us in some skeletal form of sex education. Which at worst would have been scaremongering and misleading (n.b 2010 circulations of a ‘blue waffle disease’ which was actually a photoshopped image of other STIs), and at best involved a discussion of the bare minimum such as STIs, reproductive biology and pregnancy. Although some of you might have been taught a curriculum discussing consent, LGBT identities or female pleasure (which is least discussed even in wider society), I can assure you; you were the lucky few. 

Many of us might have self-educated, learned with experience, or dabbled with pornography (a blog topic coming later). Whilst none of these are necessarily bad options (provided they are done safely and legally), there is overwhelming evidence that the less sex education we receive, the less likely we are to enjoy sex, more likely to have earlier pregnancies, be at risk of abuse, and display higher rates of STI infections. This is a large issue in the UK at the moment – STIs increased by 5% between 2017-18 across all population groups, with 16-24-year-olds being the most affected age group (displaying a 24% increase in gonorrhoea infections alone). 

Sexual health is imperative to address, especially if you are engaging with a large number of new partners. It must also be seen as an empowering and radical form of self-care. This is particularly important in a neoliberal and austerity policy-oriented climate such as the UK, where sexual health funding continues to be cut (by as much as 14%). It is likely that the current coronavirus pandemic will also influence allocation for sexual health services, as funds are being diverted elsewhere. Taking care of sexual health also reduces anxieties around actually having sex; alleviating the fear of contracting an STI or having children at an ill-timed moment in life doesn’t have to be a consistent source of stress.

So; given we know what sexual health is, that it is necessary, and empowering to take care of:

What is its history? Who were the prominent figures that brought it to the stage it is at now in the UK? What can we consider for the future?

Timeline 

3000 BC Condoms created in Egypt, thought to be made of animal hide (DeNoon, 2003) 

1855 Reusable rubber condoms were designed by an American man, Charles Goodyear (Moss, 2018) 

1909  The first IUD (intrauterine device, often referred to as the coil) was designed, using “a ring of silk-worm gut” (FPA, 2010) 

1914 – 1918 During World War 1 there was a massive increase of STIs in the UK, where approximately 5% of men in the army were infected (Carlin, 2017)

1921 First UK contraception clinic was founded in London by Marie Stopes (FPA, 2011)

1930s Latex condoms were produced (FPA, 2010)

1951 “Carl Djerassi, a chemist in Mexico City, creates a pill by synthesizing hormones from Mexican yams. On a chemical level, the pill has been invented, but Djerassi isn’t equipped to test, produce or distribute it”. (Nikolchev, 2010). Djerassi was Austrian born Bulgarian-American chemist 

1957 Men and women were tested on for a combined hormonal contraceptive pill by Gregory Pincus in the first stages of developing ‘the pill’ (Extance, 2016) (part of the Catholic scientist team) 

1961 First contraceptive pill licensed in the UK (Moss, 2018) but only to married women. “Each pill used in the 1960s was roughly equivalent to seven of today’s pills” (FPA, 2010)

1964 Helen Brook founded the first Brook Advisory Centre exclusively for young unmarried women who were not able to access contraceptive advice elsewhere (FPA, 2011)

1967 Homosexuality is decriminalised (LGBT Foundation, 2017) and an Abortion (with restrictions) Act is passed, coming into effect the next year (Parliament, 2020) 

1969 Formal training of doctors and nurses in contraceptive techniques started (FPA, 2011); the copper coil (IUD) also gets introduced (FPA, 2010)

1974 Unmarried women get access to the pill (Moss, 2018) on the NHS, as opposed to getting it from clinics such as FPA and Brook. Under 16s can access confidential advice (People’s History of the NHS, 2020); Depo-Provera (the injection) was licensed in the UK for short-term contraceptive use (FPA, 2010)

1975 What is now the LGBT Foundation (a health and community charity) is formed in Manchester (LGBT Foundation, 2017)

The late 1970s/early 80s cases of HIV/AIDS emerged in MSM (men who have sex with men) communities in San Francisco (AVERT, 2019), going on to become a global sexual health pandemic (which is still prevalent today across all population groups, maintaining hold in places such as countries in Southern Africa) 

1983 The Terrance Higgins Trust (THT, 2020) was formally set up, the UK’s leading HIV and sexual health charity, in memory of one of the first people in the UK to die from an AIDS-related illness

1984 Emergency contraception (often known as ‘the morning after pill’) gets licensed in the UK (Moss, 2018)

1990 Saheli, a non-hormonal weekly contraceptive pill makes it onto the Indian market (Balasubramanian, 2017)

1992 Femidom becomes available in the UK (FPA, 2010)

1993 The contraceptive arm implant is introduced (FPA, 2010)

1996 Intrauterine Systems (releasing hormones, also known as IUS) introduced (FPA, 2010)

2001 Women can purchase emergency contraception without needing a prescription (Laurance, 2008) 

2003 The contraceptive patch is made available (FPA, 2010)

2005 Non-latex condoms produced (FPA, 2010)

2013 Online STI testing becomes available in London boroughs (SH:24, 2020); sexual health services become decommissioned to local authorities

2017 A Swedish ‘rhythm method’ app, Natural Cycles, gets approved as an EU official method of contraception (despite usability issues reported by UK women) (Sudijic, 2018)

Jan 2019 The Faculty of Sexual and Reproductive Health announces that there is no need for a break in the pill; the original scientists did so to cater for the acceptance from the Catholic Church (Forrest, 2019) 

March 2019 Reports of male contraceptive pills and body gels having been tested with good results. It could be at least a decade until this becomes available on the market (Roberts, 2019). 

September 2019 New RSE is recommended this year in primary and secondary schools (level-dependent), and will become mandatory in September 2020 (GOV.UK, 2020) 

October 2019 Abortion is decriminalised in Northern Ireland (Connolly, 2019)

Early March 2020 PrEP to be made available on the NHS for those at high risk of contracting HIV (Taylor, 2020)

Late March 2020 During the 2020 coronavirus pandemic, women can take abortion pills at home to maintain lockdown measures (RCOG, 2020)

I have included here some of the key events that contributed to the historical transformation of sexual health; such as introducing the combined contraceptive pill (used by 151 million women globally), and the other long-acting methods of contraception. Take a look below at the most popular contraceptives in the UK:

Speaking to my grandmother (in her 80s, radical leftist and very committed to the feminist movement), she describes the social landscape of the 60s where many women were overly ostracised for merely asking about contraception. Further, she stipulates that if anything ‘happened’ (pregnancy, STI transmission) it fell on the shoulders of female partners. These are unfortunately unsurprising sentiments to hear, even today.

Despite this, activists such as Marie Stopes (there are now 60 abortion clinic services under her name in the UK) and Helen Brook (Brook is now a nation-wide, leading sexual health charity providing both clinical and education services for young people), fought for clinics to be made available for women. Margaret Pyke, another significant founding member of the FPA, originally helped offer contraceptive advice to women. 

Unfortunately, upon further research, it appears Marie Stopes was also considered a eugenicist, who believed that certain ‘classes or races’ of people should use birth control in order to not have more children. Her organisation also previously advocated for ‘state forced sterilisation’. In many ways, despite the liberating availability of contraception for women in terms of creating reproductive choices, this has come at a significant cost for many communities.

The Brixton Black Women’s group campaigned against the use of the contraceptive injection, as it was found to be over-prescribed and unknowingly tested on women of colour from certain communities. Further, side effects such as rapid weight gain and increasing risk of osteoporosis, especially for under 25s raised even more concern. Their work was crucial in highlighting inequalities in reproductive health; and such issues are still the case globally, where underprivileged women are in ways targeted to use this type of contraception despite other safer methods being available. Now, groups such as Decolonising Contraception work to highlight the racism that has and unfortunately continues to exist in sexual and reproductive health. Such work is vital given that it can take some digging to unpick these injustices; they argue that in ways contraception exists as a ‘tool of oppression’ for some women rather than others (see further reading and resources below on this). 

In the last couple of years, we can also see developments that again, signify an even further trajectory of sexual health in the UK; such as the availability of PrEP. This medication has been campaigned for by the LGBT community for a long time (PrEP stands for pre-exposure prophylaxis treatment; this medication prevents someone from contracting HIV). Despite advancements, many LGBT people still find that sexual health services don’t cater to them, and with the withdrawal of dental dams (barrier protection for oral sex on vulvas) from global markets, it can seem that barrier methods and contraceptives available are heteronormative, and do not cater to the plethora of sexual and gender identities in existence. It is important in these considerations to note that with sexual health services continuing to be cut, young people and gay men will be the most affected.

Many people also feel that male (reproductive system) contraceptives should be made more available. They have also been tested for decades, in various global locations, although there is speculation that a big enough market wouldn’t exist. For some food for thought, see my Instagram poll below on whether people with a male reproductive system would be willing to take it (I also highlighted the side effects first, which were thought to be a contributing factor to why the drug hasn’t gone to market): 

Ultimately, the history of sexual health and the key figures are important to learn about; I for one definitely wasn’t taught this at school. Sexual health is the responsibility of all sexually active people and their partners, and deserves to be spoken about in more open and caring ways. Nevertheless inequalities exist in access, funding and education across a variety of intersections.

I look forward to see how we can address this in the post-COVID-19 future!  

Resources

Reading: 

• In Natalie Fiennes book, Behind Closed Doors, she also unpicks many of the historical aspects of sexual health and education. See an interview of her and the book here: ‘More than just condoms on bananas’ – Natalie Fiennes is reshaping the debate on sex education | gal-dem 
• The Wonder Down Under: a user’s guide to the vagina by Dr. Nina Brochmann and Ellen Støkken Dahl
•  Petition · Make the only non-hormonal birth control pill Centchroman (Saheli) available in the UK 
• Naz Sexual Health | Southwark Wellbeing Hub | Together: A leading UK mental health charity – their website is down, hence I couldn’t retrieve much information about it, but NAZ is a BAME-specific sexual health charity
•  The weird history of contraception
• How the inventor of the pill changed the world for women
• How Puerto Rican Women Made Birth Control Possible—at the Expense of Their Health – whilst contraception has been seen a liberating choice for many women globally, Puerto Rican were essentially tested on with high doses of the contraceptive pill without their knowing consent about their use as ‘guinea pigs’. This issue is a far larger topic, outside the scope of the UK focus I chose, but I can and will look into this more. 
• #DecolonisingContraception: how reproductive medicine has been used to oppress people of colour | gal-dem – gal-dem 
• Contraceptive Use by Method 2019 – global contraception use by method. A very interesting read, and you might be surprised at the most common global contraception… 

Listening:

Dr. Annabel Sowemimo on Hannah Witton’s podcast

Watching:

• Sex, Explained: Birth Control on Netflix
• Decolonise Contraception Black Bodies & Sexual Health talk on Youtube

References

AVERT. (2017). History of HIV and AIDS overview. History Webpage. (Accessed online: https://www.avert.org/professionals/history-hiv-aids/overview 06/04/20)

Balasubramanian, D. (2017). On conception and contraception: The story of Saheli. Science Webpage. (Accessed online: https://www.thehindu.com/sci-tech/science/on-conception-and-contraception-the-story-of-saheli/article19140909.ece 09/04/2020)

British Library. (2020). Timeline of the Women’s Liberation Movement. Sisterhood Webpage. (Accessed online: https://www.bl.uk/sisterhood/timeline 07/04/2020)

Carlin, E. (2017). Sexual health – what happened 100 years ago was remarkable. Blogging 4 Bashh Webpage. (Accessed online: https://www.bashh.org/news/blogging-4-bashh/sexual-health-what-happened-100-years-ago-was-remarkable/ 06/04/2020) 

Connolly, M-L. (2019). Northern Ireland abortion law changes: What do they mean? (Accessed online: https://www.bbc.co.uk/news/uk-northern-ireland-50125124 09/04/2020)

DeNoon, D. (2003). Birth Control Timeline. Women’s Health Center Webpage. (Access online: https://www.medicinenet.com/script/main/art.asp?articlekey=52188 06/04/2020) 

Extance, A. (2016). What happened to the male contraceptive pill? Contraception and Family Planning Webpage. (Accessed online: https://www.theguardian.com/society/2016/jul/23/what-happened-to-the-male-contraceptive-pill 07/04/2020) 

Forrest, A. (2019). Contraceptive pill can be taken every day, NHS says in new guidance. Health Webpage. (Accessed online: tindependent.co.uk/news/health/contraceptive-pill-every-day-nhs-guidance-break-catholic-church-pope-a8737456.html 08/04/2020) 

FPA. (2010). Contraception: Past, Present and Future factsheet. Factsheets Webpage. (Accessed online: https://www.fpa.org.uk/factsheets/contraception-past-present-future 06/04/2020)

FPA. (2011). A history of family planning services factsheet. Factsheets Webpage. (Accessed online: https://www.fpa.org.uk/factsheets/history-family-planning-services 06/04/2020)

GOV.UK. (2020). Relationships education, relationships and sex education (RSE) and health education. Publications Webpage. (Accessed online: https://www.gov.uk/government/publications/relationships-education-relationships-and-sex-education-rse-and-health-education 08/04/2020) 

Laurance, J. (2008). How Britain Learnt to Love the Pill. Indy/Life Webpage. (Accessed online: https://www.independent.co.uk/life-style/health-and-families/features/how-britain-learnt-to-love-the-pill-1099148.html 06/04/2020)

LGBT Foundation. (2017). Our History. About Us Webpage. (Accessed online: https://lgbt.foundation/about-us/our-history 24/04/2020)

Moss, S. (2018). The Brief History of Contraception. My Morning After Blog Webpage. (Accessed online: https://www.mymorningafter.co.uk/blog1/2018/11/13/the-brief-history-of-contraception 06/04/2020)

Nikolchev, A. (2010). A brief history of the birth control pill. Health Webpage. (Accessed online: https://www.pbs.org/wnet/need-to-know/health/a-brief-history-of-the-birth-control-pill/480/ 06/04/2020)

Parliament. (2020). National Health Service (Family Planning) Act 1967. Parliament and the 1960s Webpage. (Accessed online: https://www.parliament.uk/about/living-heritage/transformingsociety/private-lives/relationships/collections1/parliament-and-the-1960s/national-health-service-family-planning-act/ 06/04/2020)

RCOG. (2020). Coronavirus (COVID-19) – Information for women requiring abortion. Guidelines Webpage. (Accessed online: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-abortion/information-for-women/ 09/04/2020)

Roberts, M. (2019). Male pill – why are we still waiting? Health Webpage. (Accessed online: https://www.bbc.co.uk/news/health-47691567 08/04/2020)

SH:24. (2020). SH:24 – Online Sexual Health Service. Health Innovation Fund Webpage. (Accessed online: https://www.gsttcharity.org.uk/what-we-do/featured-projects/health-innovation-fund/sh24-%E2%80%93-online-sexual-health-service 07/04/2020)

Sudjic, O. (2018). ‘I felt colossally naive’: the backlash against the birth control app. Contraception and family planning webpage. (Accessed online: https://www.theguardian.com/society/2018/jul/21/colossally-naive-backlash-birth-control-app 09/04/2020)

Taylor, P. (2020). NHS England will make PrEP for HIV available in April. Pharma News Webpage. (Accessed online: https://www.pmlive.com/pharma_news/nhs_england_will_make_prep_for_hiv_available_in_april_1329238 08/04/2020)

THT. (2020). How It All Began. Our History Webpage. (Accessed online: https://www.tht.org.uk/our-work/about-our-charity/our-history/how-it-all-began 24/04/2020)

Article cover photo by Benjamin Moss on Unsplash. The image here is of the EllaOne emergency contraception pill. You can access it at pharmacies, sexual health clinics and in emergencies from emergency hospital departments.