The Sex Education I Missed Out On

To round off #PrideMonth, and this weekends celebrations, a lovely LGBT colleague of mine, Lota from @Kliteraturapod wrote a guest blog!

I have a confession to make. I’m 25 years old, a sex educator, and I have never put a condom on a banana. Shocking, I know. I wanted to get that out of the way first, because whenever I talk to anyone also raised in the UK they always say: ‘oh yeah, not much sex ed apart from the condom on a banana’. My own schooling, however, was banana free. The closest I got to a condom was a picture on the smartboard. 

Unfortunately, during my schooling, it was considered acceptable practice in the field of RSE to show young people grotesque images of STIs. We know now that this is, in fact, a Terrible Idea for a number of reasons. I mention this because I want to paint a picture of the (gross yet ultimately lacking) sex education that I received. The most I received was in science where we ‘learned the right names for things’, and it was ultimately very much about PiV (Penis in Vagina) sex, and babies. 

Condoms were for stopping babies and those gross diseases (STIs aren’t ‘gross’, of course, and are actually normal and most of the time, easily treatable). Gay men had a higher risk of HIV/AIDs, but we didn’t actually know what it was or how you caught it. In fact, they were so vague about how men could possibly have sex with each other that my two best friends asked me when we were in year 11, in whispers, at the queue to buy popcorn at our local cinema. I wish I’d been able to answer maturely, rather than reductively and crudely, but hey, I wasn’t a trained sex educator yet and as a summer baby was the youngest of the trio. We didn’t touch on the concept of healthy/unhealthy relationships other than physical domestic violence.

So, to recap mine: Sex is putting a penis inside a vagina. Use contraception to not get pregnant. STIs are nasty, use a condom. Don’t hit your girlfriend. 

It didn’t help that I attended secondary school from 2006- 2011, otherwise known as the height of the ‘That’s so gay’ era. Your phone? Gay. The teacher setting homework? Gay. Your friend having to go straight home after school? Sooo gay. Did someone steal your pen? They’re being gay! The two boys grabbing each others bums? It’s all good if you say ‘no homo’. This was all before you got into the explicit homophobia going round. Once a boy in my form derailed a PSHE lesson to protest against our form tutor, proclaiming that he ‘just thinks (being gay) it’s disgusting and unnatural’, amongst other choice quotations. I could rattle off some more incidents, but I think you get the point. 

So where did curious, in denial, 13-year-old me turn to? The Internet, of course. I tried googling to see if I could find any information on lesbian or bi women: what did their relationships look like? Could they have families? How did they have sex and was it ‘real’ sex? The search was cut short when I made the mistake of simply typing ‘lesbian’ into the search bar. I’m sure you’re already way ahead of me: it was pages upon pages of porn. I quickly closed all tabs and deleted the search history, absolutely mortified. Curious, but mostly mortified. 

The first LGBTQ+ Sex Education, the first decent sex education of any kind I received, was at an LGBT youth group in Islington when I was 16 (RIP Pace, a victim of Austerity Measures). It was predominantly male-oriented, but I still felt SEEN for the first time. Shyly, I asked ‘Can a woman get an STI from sleeping with another woman?’. I tried to hide my genuine shock that the answer to that was yes, she could. 

I wish someone had told closeted me about the different ways that I could have satisfying and fulfilling relationships. I wish someone had spelt out for me that LGBT people could have families, and indeed did have families. I’m lucky, because my own family are very accepting, and because a family friend I regard as a sister has an Aunt who is a lesbian, and she had a civil partnership and a child to boot – so I got to see a positive example of an LGBT person just living their life in the flesh.

I had plenty of LGBTQ+ friends by then, and I can easily say that none of the group was exploring sexuality and relationships in a healthy way. Friends were meeting up with much older men on Grindr, often for ChemSex. Everyone was playing fast and loose with condoms/ other contraception. None of the lesbian and bi girls my age were going to the sexual health clinic for screenings. Trans friends weren’t given concrete information on important health issues, such as ‘can I get pregnant when I start taking testosterone?’ I recently discovered that the mental health nurse I was seeing at CAMHS didn’t truly believe I was bisexual, putting in her notes that I was confused for various reasons. 

At the time, those were just our lived experiences. You don’t think about how young you actually are, how much you are owed a duty of care. You’re 16 and you’ve reached the age of consent, and therefore it’s normal and fine for your friends to be sleeping with people over half their age. Now I remember the hundreds of children (Yes, 16-year-olds are still children) that I have worked with, think about how much safeguarding they need, and my heart hurts for us. It’s not just sex education we missed out on, it was relationships education, education about consent, pleasure, intimacy. Education about power dynamics, grooming, emotional abuse. Education about love. 

I’m an educator and a trainee teacher and I understand the challenges teachers are up against when it comes to teaching RSE, doubly so when it’s LGBT inclusive. I do. No one is trained in it. Parents are up in arms. You signed up and trained to teach teenagers about mathematics, and suddenly you’re being asked to talk to them about sex. Your own sex education wasn’t that great. There are some long-standing myths that were so widely accepted in your generation that you never learnt they weren’t true (a common one is ‘you always bleed when your hymen ‘breaks’). Reading things online, even today, people are frothing from the mouth that you’d dare talk to teens about some people finding anal sex pleasurable.  

The bottom line is, though, that young people come first. Comprehensive sex education may make you uncomfortable at times, but you’re the adult. You owe it to the kids in your schools, not just the LGBTQ+ ones, to make sure they get unbiased, facts-based sex education. Lobby your schools, your PSHE leads for better training. If you’re noticing your own homophobia, you owe it to the young people to unpack it. Whatever you’re using to hide it behind, it’s not good enough. I’d also argue that safeguarding around LGBTQ+ issues needs to be more robust and explored: outing a child to their parents for simply telling you they are gay is taking away their autonomy and not effective safeguarding (of course, unless there is more to a story, such as abuse signs such as older partner etc). 

Teaching our young people ‘how babies are made’ is not enough. ( I touch on why in this post I wrote for Brook’s blog about Talking to Teenagers about consent and pleasure here: https://brookblog.health.blog/2019/12/12/talking-to-teenagers-about-consent-and-pleasure/). All our young people deserve better than the current RSE they get, and LGBTQ+ young people in particular are owed more. In order to make this happen, educators need to start acknowledging the existence of LGBTQ+ youth throughout the curriculum, and not just taking us on. We need to be included at all levels of the RSE curriculum. 

 With the introduction of the Mandatory RSE guidelines in schools, I’m hopeful that things will be better for all youth, and LGBTQ+ youth in particular.

By Lota Bantic

Photo by Alex Jackman on Unsplash

Sex education: talking to my sisters, mother and grandmother

I couldn’t help but wonder: why has sex education been so contested throughout time?

“An American school board member wrote in 1986, ‘There’s an old saying that “there are only two things for certain in this world; death and taxes,” a third certainly might be added: disagreement about sex education” (Fiennes, 2019, p. 2).

From the Kama Sutra from 400BC – offering erotic advice for newlyweds, to the Christian church having defined when sex is appropriate, the conditions around it and our sexuality (ibid), it is safe to say that sex education, in its various forms is not a new phenomena. However, speaking about sex, particularly in schools, has not always been top of the priority list. If we are looking at the British, who are more culturally renowned for being prim and proper, rather than openly liberal like the Scandis for example (in 1959 Sweden was the first country in the world to have compulsory sex education), this is even more the case.

In the UK, sex ed in the First World War focussed on preventing STI transmission (Freetest.me, 2020), a period during which over 400,000 British men were admitted to hospital for STIs (Carlin, 2017). Unfortunately, the spread of STIs at the time was mainly placed on the shoulders of women, who were ‘unruly’ or sex workers (Fiennes, 2019). Much of these ideas contribute to the shaming of sexuality or sex positivity, and also create myths and stigma toward those who might transmit an STI (which definitely it is time to debunk, considering than a young person is diagnosed with an STI every 4 mins in the UK (PHE, 2018)). This was however, pre-COVID-19 – I expect these will be much lower at the moment. 

Following changes to reproductive health services beginning in the 60s (see A Comprehensive History of Sexual Health), where contraception for unmarried women, legalised abortions and decriminalised homosexuality were being successfully campaigned for, sex education began to catch up. 

Forwarding to the 80s with moral panic about a Danish sex education book that discussed gay couples, to making homosexuality illegal for local councils in the UK to promote (which only changed in 2003) (Sex Education Forum, 2020), it seemed the leaps and bounds made by those who were campaigning for better sexual health and education were cut short. However, following the HIV epidemic of the 80s (which in some places is still considered an epidemic), biological parts of sex education were properly introduced to curriculums  (Freetest.me, 2020). 

Backwards again, the Lib Dem – Conservative coalition in 2010 abolished statutory Sex and Relationships education, only for the Conservatives to do a U-Turn – this September (2020) will see the introduction of compulsory Sex and Relationships education for the first time, in both primary and secondary schools. 

Considering the zig-zag of policy, policing identity, alongside real time shrinkage of sexual health services which often disproportionately affect marginalised communities, particularly black communities in the UK, it is evident that many have been and are left out of receiving adequate sex education. 

Concerning recent events and supposed social awakening (many have expressed their dismay at it taking a global lockdown for the world to wake up to the realities of racism and police brutality), reproductive health is something that has been significantly highlighted. From experimentation on black women without their consent, to inequalities in contraception, STIs and even maternal mortality (black women in the UK are 5X more likely to die during childbirth), it imperative that sex-education going forwards incorporates anti-racist education aswell.

Image retrieved from @every1deservessexed Instagram

There are many benefits of a clear sex education, with sufficient evidence that the more you have had, the less likely you are to get pregnant, an STI, and will have first-time sex later on in life (rather than underage) etc.; all the things some are worried about in relation to sex education. To have the tools to be able to articulate yourself emotionally, physically and mentally is crucial. Determining healthy/unhealthy behaviours, having sex safely, with great communication, consent at the heart and learning how to and/or regularly orgasm are not demands that should be cast as unreasonable. 

Next, I speak to women in my family: Mother (57), Big sister (33), Twin (23), Grandmother (81), to ask them about their sex education. 

  1. What do you remember about your sex education?
  • Mother: I remember getting a sort of basic biology class at school, it was just functions of reproduction really rather than anything comprehensive. My main sex education came from a book called ‘Our bodies ourselves’, which was written by an American feminist collective. It went through sex, ‘venereal’ diseases, childbirth, masturbation, sexuality, contraception, abortion, in a very pragmatic, open and liberal way. No judgement on being straight or monogamous. 
  • Big sister: I think I remember a banana on a condom. That’s about it, I remember lying about having sexual relations to a friend in a sex-ed class, must have been around 11; exaggerating the truth. Don’t remember having lots of them; there was a term rather than a whole year of it. Got taught about contraception and not getting STIs.
  • Twin: I don’t remember it being very extensive. I don’t remember it a lot which I think shows the inefficacy of it. Did we even have any at secondary school – I have a good memory and have no recollection of it? I remember primary school, maybe the later years, learning about the minimum age you can have sex. I remember anatomy and biology. We didn’t speak about pleasure, consent, orgasms, the duration of sex, penis length, average sexual partners. The big takeaway message I guess from secondary school was about breaking your hymen, which was painful and using a condom every time.
  • Grandmother: I remember three things. I had no clue when my mother was pregnant when I was 6 and half, and they didn’t tell us because my mother was slightly older. Then my big sister knew, but she knew it wasn’t to be talked about. My mother showed me a dictionary how babies develop in women. I remember starting my period when I was 12 or something, and my mother told me that was early. In sixth form when I was 16 or 17 we had a biology textbook that explained penises get erect. 
  1. Was it any good?
  • Mother: Yes and no. it didn’t cover any emotions; stuff, which I think is almost the most important part. But it covered the practical stuff. It didn’t cover consent, although I think having a feminist background I have always felt a sense of rights and autonomy toward my body through that structure.
  • Big sister: No. I remember it was our tutors who would give us the classes, I remember not feeling at all connected to the teacher. I think we all felt we would have benefited from someone younger, maybe someone we felt was ‘cooler’, who we connected with more.
  • Twin: no I think it was completely insufficient. 
  • Grandmother: no. I mean your sex education comes from friends, the wider world, its difficult to say. We knew there were things going on, although contraceptives weren’t really on the agenda. I remember a doctor not prescribing caps (a diaphragm form of contraception). I wouldn’t say it was good or bad, at some stage we learnt what we wanted to do.
  1. What could have made it better?
  • Mother: I suppose having had someone to discuss stuff with openly, and to ask questions and address the things I was concerned about. Your age, how do you know you want to etc.? I do feel I had influence from the Danish values that meant I didn’t feel ashamed about sex. 
  • Big sister: Sex ed shouldn’t be too formal. Maybe talking about actual sex more, rather than prevention or the bad sides, and naturalising it more. I was also open and quite ready to have sex, so it didn’t bother me too much. It might have been interesting to see what the other girls who weren’t so open felt about it.
  • Twin: I didn’t really understand what consent was to the point when I was raped in my adult life, I didn’t understand it as rape when it happened. I didn’t know that women have longer orgasms than men or can climax more times. I felt I was programmed, I was tailored to pander to the man’s experience of sex, so I might have had sex when I didn’t really want to; you have sex until the guy comes and that’s it. It’s very heteronormative, my sex ed did nothing to propagate freedom of sexual opinions or choice, or even speak about the difference between attraction and being stimulated, which don’t go hand in hand. I had no idea about the anatomy of the female body to the point where only until recently, I felt comfortable to speak about my vagina with the correct terminology, and I didn’t even know what the clitoris was until my late teens. I was afraid of masturbation because I felt like it was self-indulgent. Criminal – even something at school people got bullied for. 
  • Grandmother: sex was a taboo in my generation. I don’t think anybody had sex education. Schools didn’t provide it, although I did grow up in a provincial backwater. Girls got pregnant and it was always their fault. So it was common to assume that you keep your legs together. But there was a firm myth that if boys got away with it then girls might have been the ‘promiscuous’ ones. It would have been nice if it wasn’t a taboo. 
  1. Where did you mainly learn about sex then?
  • Mother: through this feminist book. Then I didn’t really learn about it until my adult years. I suppose it was something I just did, learning on the job. I don’t think I knew very much, and if I had known in my twenties about a whole pile of things, I would have had a different attitude toward sex and my body. My own pleasure didn’t come into it. As I’ve got older, there are more resources to find out things, I use Youtube, Google, as there are people out there to listen to who aren’t just talking about functions and biology, like Betty Dodson.
  • Big sister: don’t know, I think you learn doing it really (laughing!). I think there might be something instinctual. I used to go to the Brook centre when I was 14. I went 2 weeks after my first time to Brook, I told mum that I’d had sex and I was on the pill, and I went there until I was too old to go (its a service for under 25s). They supported me so much throughout the years. I also went somewhere on Tottenham Court Road. 
  • Twin: I would actually say maybe through TV shows like Sex and the City, the rougher side of sex came to my attention from watching Girls, although I didn’t think it was that consensual. Most movies don’t show a realistic view of sex.
Image retrieved from @nakedgrapefruitt Instagram
  • I think sex education is lifelong, recent shows like Sex Education and Normal People normalise sex and make it more relatable – it’s safe, sometimes awkard, mutual and FUN. And obviously more recently my twin sister has been great, and a good friend who encouraged me to buy a vibrator.
  • Grandmother: from experience. When I was in my early twenties I remember coming across books that explained relationships and sex, but that was on the other side of knowing it personally. I had never come across those books before, although I’m not sure if they would have interested me terribly. 
  1. Is there anything you have changed your mind on concerning sex and relationships throughout time?
  • Mother: there is tonnes I have changed my mind on. I have changed my mind on what kind of people I want to sleep with, why I want to sleep with them. I changed my mind on realising it is something I need to discuss, it is not just something natural that happens. Sharing and support is important. I have changed my mind on the possibility of what counts as sex. I’m a lot more open-minded and prepared to explore stuff. Attaching love and sex, I often tried to find love through sex rather than what I wanted, which was intimacy. I wish I had talked about it more. Also, being post-menopausal, I just think that women are so conditioned to think their sexuality is only valid when they are fertile. And the impact of the period cycle on your libido. I think if more women could see post-menopause at a time when their bodies come back into their own, having sex for the sheer ability of it. I was driven by something else steering, to be post-menopausal and to come through with flying colours, not resisting menopause and seeing it as a beginning rather than an end, to actually reclaim sex that is something about pleasure and sharing and closeness. 
  • Big sister: I think primarily my own pleasure is more important than it was. I’m aware of what I need to get to my own pleasure nowadays, more than I was when I was a teenager. I think I had squirting orgasms when I was a teenager but I didn’t know what they were. For me, because I’ve had a few long term relationships but in between those have had promiscuous moments, it doesn’t change definitively. If I ever became single again, I think I would feel more guarded about who I share my body with. I couldn’t imagine having one night stands now. 
  • Twin: I think now I view sex as more something to really, really enjoy rather than a rite of passage or centred around the other person emotions more than mine. I think the most crucial thing that’s changed for me is not to be afraid before and during sex and feel like you have to be this perfect version of yourself who doesn’t jiggle and wears sexy underwear or has time to shave their armpits. This should be whether you’re having sex casually or in a relationship and you are in a space to feel comfortable, sharing something that is so fun and social with another person. The bigger lesson for me over the past few years has been consent, and when or where to set your boundaries. Who cares about being ‘prudish’, ‘boring’, ‘not that sexual’ in a particular moment? It’s about your comfort.
  • Grandmother: remember I grew up in a provincial place. We didn’t know homosexuality existed. A whole aspect of sexuality then we had no knowledge or experience. I certainly feel, I remember when your mum was not 4 yet, her nursery in Sweden introduced some form of sex education. I remember an Italian family withdrawing their child. I was quite, ‘ah’, things have changed. Sex has become much more out there, it was sort of hush hush for such a long time. Of course, I don’t want this to be the case. I remember children being shown to put a condom on a banana when I was working in Sheffield. I would find it quite difficult to talk about in front of a big group, maybe you need someone more detached. I’m not sure the taboo angle stops. You can uncondition yourself, but you can’t ignore its presence in your life. The roots of thinking might always be with you. 
  1. What are your top recommendations for future young people to learn (particularly at school)?
  • Mother: I would want them to learn about the emotional stuff. Connection between oxytocin and feeling in love with someone, how to not be a sex addict if you are hooked on your emotions. How to be respectful to your body. Choosing someone who really cares about you. Someone nice and cool, over someone hot and dangerous. Also to have somewhere people can speak about this whether its a friend, teacher, sexual health workers. Not just the clinic, somewhere in between. I wish I had had the verbal language, how to talk about it, ask each other what you want, a dialogue between sex, not the more ‘animal’ instinct I have experienced.
  • Big sister: Sex is really fun, and it’s something you should really enjoy and know to hold respect around. Using contraception all the time should be taught as a golden rule. Sex shouldn’t be taboo, it should be something we can feel open about, it’s not a sin, not something to be hidden. If people are more open, people would have more access to information. Imagine how many girls might not have been coerced into situations to make someone ‘like’ them because they might not have had the education or confidence to understand things a bit more. The ramifications are huge. Sex is one simple act but it has so many implications on individuals and society. It is integral we keep it open. Why the fuck are we learning about animals in science but not sex education?!
  • Twin:  I think extracurricular TV shows should be given as compulsory homework, like Sex Education. If you’re ever getting with someone, make sure you have a friend who can offer advice and help you if there is anything you might need or want to talk about!  It’s heartbreaking to find out just how many of your friends and family have been assaulted or raped, we also need to talk to each other more; don’t keep this to yourself. As awful as it is to have to drill into young people, it’s crucial for women, non-binary people and to a lesser extent, men, to know the laws regarding sexual violence, and what your rights are if you have been abused. Simply, just to understand please only have sex when you really really want to and you can’t stop yourself, because you’re so excited. That has to be mutual on both sides. I guess for men, I think there should be a greater education on focussing on female pleasure – this isn’t really in the news or represented in porn, and to think really carefully about contraception and protecting your own and your partners health, and knowing where your nearest clinic or pharmacy is where you can get condoms, pills and emergency contraception (especially if you’re travelling and having sex). YOU’RE never ever alone, always tell someone what you’re feeling and share the good, the bad and the ugly of sex. It should be celebrated, it’s not shameful. Don’t let other people silence your needs, fantasies or voice
  • Grandmother: I mean the thing that struck me as a teacher was, I’ve just been watching Normal People, and I feel to some extent it has to include feelings, emotions, respect and concerns; this is something special. I remember when I was at uni in Brighton (I did a degree as a mature student) I overheard younger students discussing entitlements to having sex, rather than something more emotional. I would like to think there is something magic to it. I’m not sure how to teach respect all that well, but I think Normal People discussed it well – there is lust and respect, they weren’t that monogamous but it was there. For a long while, there was something section 28, where we weren’t meant to teach about homosexuality, and most people are on a spectrum of 100% of being heterosexual or homosexual. I think this is crucial to tackle today, where identity is more scrutinised. 
Image retrieved from @lusterypov Instagram

And remember… Sex education doesn’t end at school. Stay curious, reading this blog and quizzing 🙂

Photo by Dainis Graveris on Unsplash

Resources 

Reading:

Listening:

Watching: 

References

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)  

Fiennes, N. (2019). Behind Closed Doors : Sex Education Transformed. London: Pluto Press.

Freetest.me. (2020). Sex Education in the UK. Blog Webpage. (Accessed online: https://www.freetest.me/blog/history-of-sex-ed 11/06/2020)

PHE. (2018). An STI is diagnosed in a young person every 4 minutes in England. News Webpage. (Accessed online: https://www.gov.uk/government/news/an-sti-is-diagnosed-in-a-young-person-every-4-minutes-in-england 27/04/2020)

Sex Education Forum. (2020). Our history – 30 years of campaigning. About Webpage. (Accessed online: https://www.sexeducationforum.org.uk/about/our-history-30-years-campaigning 11/06/2020)

Wildlife trade and the pursuit of sexual performance

We couldn’t help but wonder: could there be a crossover between our main fields of interest: illegal wildlife trade and sexual health? 

We thought it was time for a twin collab, but we didn’t realise how timely this could get. In case you didn’t know, Sicily, my twin, is a wildlife trade researcher (see her blog here). Given that the current coronavirus, COVID-19 is thought to have come from illegal wildlife trade (allegedly from wild meat sold in a market in Wuhan, China), it forms a pretty hot topic atm. You wouldn’t think these worlds would collide, but hey, you can’t make this stuff up

A brief note: when discussing illegal wildlife product consumers (especially relating to Asia), culturally nuanced approaches are essential to avoid furthering racist stereotypes, which conjure up images of the ‘Asian Super Consumer’. As aptly written by Marguiles, Wong and Duffy (2019)- there is no catch-all caricature of an illegal wildlife product consumer.

Illegal wildlife trade and traditional medicine

Illegal wildlife trade is estimated to be a multibillion-dollar industry- between USD $7 and 23 billion a year (GEF, 2020). The illegal wildlife trade, including illegal, unreported and unregulated (IUU) fishing and timber trade is comparable to the international trade in narcotics and weapons.

A large portion of the legal and illegal wildlife trade industries concern the use of wild plants and animals, known as phytotherapy and zootherapy, which are also intertwined with traditional medicine systems. The World Health Organisation (WHO) estimates that 80% of the world’s population primarily rely on animal and plant-based medicines (Alves and Rosa, 2005).

Many cultures employ traditional medicine which has been in use for thousands of years, such as wildlife-derived remedies. Arguably, Traditional Chinese Medicine (TCM) is the most famous of these systems, though other well known medicines include Ayurvedic medicine (developed in India) or ‘muthi’ (traditional medicine in Southern Africa).

TCM is recognised officially by the WHO, and accepted as a system by a quarter of the world’s population (Alves and Rosa, 2005). However, the WHO have since said that the inclusion of traditional medicine was “not an endorsement of the scientific validity of any Traditional Medicine practice or the efficacy of any Traditional Medicine intervention”. There is often debate, particularly from the West, as the efficacy of some products has not been scientifically proven (Shaw, 2017).

This article will focus largely on the use of TCM in the pursuit of sexual performance. TCM encompasses many areas – acupuncture, breathing and physical exercise (think Tai Chi), eating relative to the needs of certain organs and pursuing balance in the body. It just so happens that TCM products used to enhance sexual performance have been demonstrated to have some important medicinal effects…

Why do we want to enhance sexual performance? 

What supposedly differentiates humans from other animal species is our imagination and cognitive powers. It is thus no surprise that for thousands of years, humans have looked for new ways to innovate their sexual experiences. The use of aphrodisiacs, or substances to enhance sexual performance/experience is no new feat, the first known of which was thought to be body odour?! (Williamson, 2015). Original and cheap. 

Aphrodisiacs can be considered “any food or drugs that arouse sexual desire or pleasure” (Fogle & Picard, 2018). Whether they actually work or not, is a different story. These have ranged from oysters to chocolate to piranhas (Malmed, 2017), to parts of tigers (we’ll get to this later). It is thought that when food diversity was scarcer, anything that was tantalising, or sensual were seen as aphrodisiacs (Gomez-Rejón, 2014).

Further, it is thought that visual symbolism influences what is consumed as an aphrodisiac (ginseng, sea cucumbers (phallic shaped)) (Malmed, 2017), or walnuts to represent testes and thus virility (Williamson, 2015) although exactly what is consumed seems to be far more complex than these symbolisms alone.

Whilst the effectiveness of aphrodisiacs has commonly been seen as myth, sexual dysfunction is a recognised physiological issue. 1 in 5 men in the UK experience erectile dysfunction, and by 2025 it is thought that 322 million men will be affected by it (King’s College, 2020). However, other research suggests that this figure is more around 1 in 10 men, also highlighting issues of premature ejaculation.

Although often missed out, it seems that female (reproductive system-wise) sexual problems are more prominent, with around 1 in 3 young women and 1 in 2 older women will experience these (albeit they are not all physiological, such as depression affecting desire etc.) (NHS, 2019). Yet, most aphrodisiacs are advertised to the male consumer.

People do turn to (Western) medical options in order to combat sexual dysfunction, such as Viagra, which was one of the fastest-selling drugs in history – this has by no means slowed down, with it’s annual revenue a cool $1.8bn (Cox, 2019). Viagra, working to increase blood flow to the penis to enable easier and more erections (NHS, 2019), is the most popular for people with penises (apparently it is now available over the counter in the UK (Millar, 2018)). It can be taken 4 hours before intercourse, and can be prescribed (NHS, 2019b).

Although women can take Viagra (our favourite Samantha famously tries in a SATC episode) it is not proven to be licensed, safe or physiologically useful (Dutt, 2020). The drug is not used to increase desire (ibid) (which is a complex, personal, context-specific matter (Nagoski, 2018)). Female sexual dysfunction is not categorised the same as male – it is not a blood-flow to sustain an erection kind of situ, but more physiological and potentially psychological. 

There are Viagra-esque daily options for women but these are used to treat Hypoactive Sexual Desire Disorder (HSDD). These pills work to boost chemical messages in the brain that aid arousal – so they’re actually very different to Viagra (WebMD, 2020). On the plus-side, cannasexuals – people who use cannabis to enhance sex – can use weed lube, oils, spray, cream for vulvas that are specifically designed to increase pleasure (Al-Juzi, 2018), although there are cautions for combining drug use with sex. 

What is interesting is that there seems to be a considerable placebo effect of taking aphrodisiacs – the illusion and increased confidence from the promise for increased sexual performance could actually be what is more beneficial (Shaw, 2017). Knock yourself out (although ofc if you do start taking medications such as viagra, N.B. it doesn’t mix well with other medications). What must be known however, is that “the Mediterranean diet may have aphrodisiac qualities”… (Brown, 2019). Pass the wine. 

The mechanisms behind of action behind aphrodisiacs in the male body

This figure, from Lim (2017), shows the various action sites of phytotherapies, for male sexual performance enhancing substances. Different products can enhance different aspects of sexual performance, showing a complexity to consumer product choices. Testosterone facilitators increase the level of testosterone in the blood. Dihydrotestosterone blockers such as pumpkin seeds have antidepressant properties and promote healthy hormone function (Lim, 2017)

So what do people take and where in the world are they taking it?

Plants

It is important to appreciate that a lot of aphrodisiacs are plant-based (yay for the vegans). Wildlife trade often surpasses plant trade, and ‘plant blindness’ is an important phenomena (Marguiles et al., 2019), which also affects how we perceive the use of animal vs. plant tonics for sexual performance. In a post-COVID 19 era, where we can expect to see the relative phasing out of endangered animals offered in traditional medicines, dependence may shift to plants (which comprise 80% of wild species in TCM). 

This could lead to a greater societal dependence on plant-based aphrodisiacs. For wild-sourced products, this could lead to new pathways of unsustainable harvest. For example, Panax ginseng, the famed aphrodisiac Asian or Korean Ginseng, is a Class 2 protected species in China, which requires that their harvesting and trade take place only with a permit from provincial authorities and under their oversight. 

As TimeOut Hong Kong (2020) advised this Valentines day: “Be advised that with ginseng you’re playing the long game – it’s a better idea to start with a low dose every day, and increase the amount over time to improve your condition, rather than popping a capsule right before getting down ’n’ dirty”. Ginseng is particularly popular as it does have pharmacologically active components – having been linked to higher sperm counts, and increased libido (Leung and Wong, 2013).

Alongside ginseng, which could also help menopausal women as an aphrodisiac, Peruvian maca is also used to supposedly boost fertility and stamina (Sengupta, 2017). However, there is not concrete scientific data to support this trend (Shaw, 2017). 

Some people use aphrodisiac tonics, which can be used by both men and women, which may enhance sex drive, stamina and performance. Female reproductive tonics are traditionally used to tone and preserve the Yin (such as Rehmannia, Chinese Licorice and Ginger) and promote the flow of Qi (energy) and Blood to the ovaries, uterus and pelvis (such as Cyperus and Ligusticum) (Fusion Health, 2020). 

Not all phytotherapies are available over the counter; some require prescription, such as Horny goat weed (no joke lol) (Time Out, 2020). This translates from the Chinese as ‘licentious goat plant’. Some studies have shown that extract of the plant may restore low levels of testosterone (Lim, 2017). 

Beyond Chinese traditional medicine systems, herbal remedies, such as Tribulus terrestris, are used as folk medicine in Eastern Europe and Bulgaria for sexual deficiency (Lim, 2017).

Animal parts 

Typically, for men, sexual performance carries an identity and the sense of self-esteem in society (we know, patriarchal society and ideals don’t really help). Although it is often sensationalised in Western media, it is likely only a small portion of consumers who actually engage with taking TCM products for erectile dysfunction (ED). Lim (2017) cited that only 9% of men in China and 30% of men voluntarily admit to having ED.

Seafood section – given that Aphrodite herself, was Goddess of the sea, it’s no surprise people turn to a salty seafood treat

  • One of the earliest reports of a salty aphrodisiac we could find was in 8th Century B.C. The sucking fish or remora, was mixed into potions sold in Roman markets and was said to induce passion (Williamson, 2015)
  • Oyster extract is allegedly excellent for men’s reproductive health and endurance. It is rich in the amino acid taurine, which is vital for cardiac health and nerve transmission and additionally boosts dopamine for all lovers (Lim, 2017)
  • Other popular marine products such as  abalone and seahorses are consumed as an aphrodisiac (Costa-Neto, 2005; Lim, 2017)

Kim Reiley of ‘Eat Something Sexy.com’ highlights the allure of abalone (a group of sea snails) as a lucky aphrodisiac – used in soup as a sexy ‘boost’. The illegal harvesting and export of abalone in one of its hotspots, South Africa, is largely controlled by Chinese triads (organised crime ‘secret societies’, originating in China and Hong Kong) collaborating with South African fishing communities. Its scientific quality (which could explain its use as an aphrodisiac) is its’ high source of selenium (a mood enhancer and component of sperm) and magnesium (good for the production of sex hormones) (Reiley, 2020). From South Africa alone, this market may be worth as much as 500 tonnes ($32.5 million) (Gastrow, 2001).

Weirder – although more sustainable oi oi – the sea cucumber

Another phallically-shaped food which is in high demand in Asian markets is the sea cucumber, in the echinoderm family (the same family as starfishes!). This is a particularly net-positive product as it is promoted as an alternative livelihood in many former fishing communities (although debatably unsustainable- see the Sustainable Asia podcast episode at the bottom). At $100 per kilo, sea cucumbers are a versatile and low-maintenance aquaculture crop, even implemented in FAO programs to female seaweed farmers in Zanzibar, whose seaweed crop is diminishing due to climate change (FAO, 2020). 

Sexy and saving the planet? We love to see it. It contains niacin, magnesium and zinc, which help reduce muscle tension, increase blood flow, build sex hormones and maintain a healthy sperm count (Reiley, 2020).

A sea cucumber (Think Stock)

It physically resembles a phallus and uses a defense mechanism akin to ‘ejaculation’ when it squirts its insides at its oppressor. Quite an impressive parallel.

High profile examples of animal products

Meat consumption of the literal (phallic) body parts of other animals

  • Tiger-penis soup/wine – “Particularly sought after are the penises and bones, which are soaked in an awful-tasting rice wine and served, usually to men. They’re supposed to imbue men with the prowess and sexual energy of the tiger” (Nuwer, 2018) 
  • Cobra meat- known as ‘Surabaya’ – cobra meat and blood has had claims of improving erectogenic prowess (Lim, 2017)

Male-focussed aphrodisiacs are often consumed in powder form:

  • Ostrich/cow penis powder (Lim, 2017)
  • Rhino horn powder (dissolved in water, taken as a shot). Detoxification properties. Using rhino horn was a myth, but now Vietnamese men actually use it (myths often turn into ritual, for all my anthropology people, you know what we mean). Asian economies are growing, so more there is an increasing demand (Smith, 2012)

As well as the literal consumption of animal body parts and their derivatives, some male animal parts are used to represent virility and thus indirectly act as an aphrodisiac, such as the use of hippopotamus tusks as a sex symbol in rural Nigeria (Costa-Neto, 2005) or deer antlers from young bucks used in sexual tonics in TCM (Lim, 2017). 

Unfortunately, we can’t do an analysis of ALL the various products used to enhance sexual performance; believe it or not, this list is by no means exhaustive.

Concluding points

An interesting point to conclude with is whether society’s, and largely the West’s fascination and proliferation of sex as a cultural symbol may have impacted the search for increasing penis size and longer performance using TCM. 

Although aphrodisiacs have been dominant through time and across space, the proliferation of these pursuits within the illegal spheres perhaps show that such controls over the body are increasing (I’m sure somewhere Foucault has a point about body power and sexuality here). Regardless, humans are still in hot pursuit of enhancing their sex lives. 

It is also important to appreciate the gendered consumption of wildlife products, as the most endangered products are often linked to male consumers. In addition, women are seemingly omitted in both Western and TCM – there aren’t the same options for female sexual performance. It seems there are none marketed for non-binary people either, which demonstrates that pursuits of wildlife trade and increased sexual performance are informed by heteronormativity. 

Ultimately, COVID-19 has caused society to question the sustainability of zootherapy. Most zootherapies were never illegal, until populations of animals started to decrease in the wild. In particular, we do not condone the use of endangered animal parts in the pharmaceutical pursuit of sexual performance – especially when there are effective domestic animal or plant substitutes. However, it is important to embrace diverse cultural practices and not be rooted in the dogma that only Western medical science is valid.

Regarding the use of endangered animals in TCM, the tide is turning. The endangered pangolin, the most highly trafficked mammal in the world, has now been officially removed from the Chinese Pharmacopoeia. On this compendium of recipes, pangolin scales were listed as useful for nursing mothers and promoting blood circulation.  Now, those caught trading or hunting pangolins could face up to 10 years in prison (Pinghui, 2020).

It’s expected that the face of sexual performance enhancer consumption will drastically change, as these products may also be removed from TCM compendiums. Will we see increased volumes of phytotherapies consumed in the pursuit of sexual performance? Only time (and evidence-based research) will tell.

We hope you enjoyed reading this mini twin research project. Our favourite discovery: a close competition, but it has to be the sea cucumber. 

Resources 

Reading: 

Listening:

Watching: 

Photo by Ben Stern on Unsplash

References 

Alves, R.R. and Rosa, I.L., (2005). Why study the use of animal products in traditional medicines?. Journal of ethnobiology and ethnomedicine, 1(1), p.5.

Brown, J. (2019). Do aphrodisiacs really work? Articles Webpage. (Accessed onlineL https://www.bbc.com/future/article/20190211-do-aphrodisiacs-really-work 10/06/2020)

Costa-Neto, E.M. (2005). Animal-based medicines: biological prospection and the sustainable use of zootherapeutic resources. Anais da Academia Brasileira de ciências, 77(1), pp.33-43.

Cox, D. (2019). The Race to Replace Viagra. Science Webpage. (Accessed online: https://www.theguardian.com/science/2019/jun/09/race-to-replace-viagra-patents-erectile-dysfunction-drug-medical-research-cialis-eroxon 04/06/2020)

Dutt, M. (2020). Can women take viagra? Erectile Dysfunction Webpage. (Accessed online: https://onlinedoctor.lloydspharmacy.com/uk/erectile-dysfunction/can-women-take-viagra 10/06/2020)

FAO, 2020. How sea cucumbers are boosting the bioeconomy in Zanzibar. Accessed online (http://www.fao.org/fao-stories/article/en/c/1247576/ 12/06/20) 

Fogle, A & Picard, C. (2018). Some Scientists Say These Aphrodisiacs for Women Could Actually Boost Your Libido. Health Webpage. (Accessed online: https://www.goodhousekeeping.com/health/a33791/aphrodisiacs-that-work-study/ 01/06/2020)

Fusion Health. (2020). Libido & Sexual Performance. Healthy Ageing Webpage. (Accessed online:  https://www.fusionhealth.com.au/health-categories/healthy-ageing/libido-sexual-performance 11/06/2020)

Gastrow, P., 2001. Triad societies and Chinese organised crime in South Africa. Institute for Security Studies Papers, 2001(48), pp.1-1.

GEF. (2020). Illegal Wildlife Trade. Topics Webpage. (Accessed online: https://www.thegef.org/topics/illegal-wildlife-trade 12/06/2020)

Gomez-Rejón, M. (2014). The Ancient Wisdom of Aphrodisiacs. The Iris Webpage. (Accessed online: https://blogs.getty.edu/iris/the-ancient-wisdom-of-aphrodisiacs/#:~:text=Food%20and%20sex%20are%20the,for%20love%20or%20sexual%20desire.) 10/06/2020)

King’s College. (2020). The global prevalence of erectile dysfunction. News Webpage. (Accessed online: https://www.kcl.ac.uk/news/the-global-prevalence-of-erectile-dysfunction 04/06/2020)

Leung, K.W. and Wong, A.S. (2013). Ginseng and male reproductive function. Spermatogenesis, 3(3), p.e26391.

Lim, P.H. (2017). Asian herbals and aphrodisiacs used for managing ED. Translational andrology and urology, 6(2), p.167.

Malmed, A. (2017). Love Potions: A Brief History of Aphrodisiacs. Article Webpage. (Accessed online: https://www.vogue.com/article/what-foods-are-aphrodisiacs-history 01/06/2020)

Margulies, J.D., Bullough, L.A., Hinsley, A., Ingram, D.J., Cowell, C., Goettsch, B., Klitgård, B.B., Lavorgna, A., Sinovas, P. and Phelps, J., (2019). Illegal wildlife trade and the persistence of “plant blindness”. Plants, People, Planet, 1(3), pp.173-182.

Margulies, J.D., Wong, R.W. and Duffy, R., (2019). The imaginary ‘Asian Super Consumer’: A critique of demand reduction campaigns for the illegal wildlife trade. Geoforum.

Millar, A. (2018). Can Women Take Viagra. News and Features Webpage. (Accessed online: https://patient.info/news-and-features/can-women-take-viagra 10/06/2020)

Nagoski, E. (2015). Come As You Are: the surprising new science that will transform your sex life. Croydon: CPI group.

NHS. (2019). Female Sexual Problems. Sexual Health Webpage. ( Accessed online: https://www.nhs.uk/live-well/sexual-health/female-sexual-problems/ 04/06/2020)

NHS. (2019b). Sildenafil (including Viagra). Medicines Webpage. (Accessed online: https://www.nhs.uk/medicines/sildenafil-viagra/ 10/06/2020)

Nuwer, R. L. in Worrall, S. (2018). Inside the disturbing world of illegal wildlife trade. Animals Webpage. (Accessed online: https://www.nationalgeographic.co.uk/animals/2018/11/inside-disturbing-world-illegal-wildlife-trade 11/06/2020)

Pinghui, Z. (2020). Pangolins removed from Chinese directory of medicines. South China Morning Post Online. (Accessed online: https://www.scmp.com/news/china/society/article/3088470/pangolins-removed-chinese-directory-medicines 11/06/2020)

Reiley, A. (2020a). What is Abalone and is it an Aphrodisiac? Eat Something Sexy. (Accessed online: https://www.eatsomethingsexy.com/aphrodisiac-foods/aphrodisiac-history-of-abalone/#:~:text=Abalone%E2%80%93the%20endangered%20aphrodisiac%20of%20the%20sea&text=The%20Chinese%20view%20abalone%20as,to%20calamari%2C%20is%20the%20draw. 12/06/20).

Reiley, A. (2020b). What is Abalone and is it an Aphrodisiac? Eat Something Sexy. (Accessed online:  https://www.eatsomethingsexy.com/aphrodisiac-foods/sea-cucumber/ 12/06/2020).

Sengupta, S. (2017). Maca Benefits for Men: 7 Amazing Benefits Of The Peruvian Superfood. Health Webpage. (Accessed online: https://food.ndtv.com/health/maca-benefits-for-men-7-amazing-benefits-of-the-peruvian-superfood-1677240#:~:text=Traditionally%20used%20as%20an%20aphrodisiac,reduces%20stress%20and%20increases%20stamina. 12/06/2020)

Shaw, G. (2017). Aphrodisiac Foods: For Real or a Placebo Effect? Articles Webpage. (Accessed online: https://www.berkeleywellness.com/self-care/sexual-health/article/aphrodisiac-foods-real-or-placebo-effect 10/06/2020)

Smith, D. (2012). Rhino horn: Vietnam’s new status symbol heralds conservation nightmare. Environment Webpage. (Accessed online: https://www.theguardian.com/environment/2012/sep/04/rhino-horn-wildlife-trade-vietnam# 11/06/2020)

TimeOut Hong Kong. (2020). The best 6 traditional chinese medicine aphrodisaics to try. Health and Beauty Webpage. (Accessed online: https://www.timeout.com/hong-kong/health-and-beauty/the-best-6-traditional-chinese-medicine-aphrodisiacs-to-try 11/06/2020)

WebMD. (2020). Your Guide to ‘Female Viagra’. Features Webpage. (Accessed online: https://www.webmd.com/women/features/guide-to-female-viagra#2 10/06/2020)

Williamson, N. (2015). 16 Bizarre Aphrodisiacs Throughout History. Sex Tips  Webpage. (Accessed online: https://www.womansday.com/relationships/sex-tips/g1775/bizarre-aphrodisiacs-throughout-history/?slide=8 04/06/2020)

Anti-racism and sexual health: anthropological reflections

I couldn’t help but wonder: how can we go beyond performative social media alliances, and bring about a deeper educational and structural change in society, sexual health and beyond in regards to anti-racist work?

In order, to be anti-racist, silence cannot be assumed. This is a passive way to respond to the urgencies of the current world situation, and as a white woman working in sexual health, I acknowledge it is necessary to do the work, reading, knowledge unpicking, protesting, donating, uncomfortable discussions etc., in order to contribute to these conversations and challenge/change systems of oppression. 

Sexual health, sexual violence and sex education are not free from racism. I have been spending time curating these so that they are organised to be integral in my sex education and health praxis. If you have already experienced too much collective trauma over the past week, do not feel obliged to read ahead; see free mental health resources for black people in the UK here

I will first include critical readings of anthropology itself’s relationship with colonialism; a compilation of wider reading, with some honing in on sexual health. These resources also span time and space, and so do not explicitly focus on Black Lives Matter-related content. 

Here is a great master google doc of all the current Black Lives Matter petitions, updates on protests, further injustices, and resources/reading/websites. Highly recommend spending time working through it, donating etc. Prioritise this first.

This list (teeny literature review) will roughly focus on the anthropological/sociological course reading I did at university, and is inspired by a friend from my university cohort who has been integral in speaking and protesting at this week’s Black Lives Matter protests in London. I can see these conversations need to be made much more public in order to take academia from the ‘ivory towers’ to public knowledge. Share this with anyone you know who didn’t do social sciences; I promise there is a lot to understand here: many connections to be made between various systems of oppression such as colonialism/imperialism, white supremacy, capitalism, patriarchy etc.

Anti-racist resources need to be taken into consideration concerning public health, and access to healthcare, amongst all other forms of public care/goods, such as social care, education, governance, policing (if it is even recommended as the most useful form of community care/protection), the justice system etc. 

I have a lot of these saved as PDFs/physical copies. Please DM or email sexualhealthandthecity@gmail.com about them, although I highly suggest buying texts from independent bookshops, directly supporting the author’s work if you can’t access PDFS in the links below. A great collection of black revolutionary pdf texts can be found here (via @newreadernet Instagram), New Beacon Books specialises in African and Caribbean literature, Pluto Books are currently having a BAME author’s sale until the 21st June, Verso have a free eBook on the end of policing, and JSTOR have lots of articles for free.

This is an edit-able post PLEASE send me anything to add – it is intended to be an open resource.

Racism in the UK

History and colonialism/imperialism; American racism

Anthropological work on racism

Re-theorising feminism

Post-colonial theory

Sexual health specific resources

Podcasts

Black Sex Educators on Instagram

Sexual violence 

Sexuality 

Discussing medical racism

Reports 

Get learning. Remember to support, donate, reach out, and listen to those telling their traumas at this time. If you are white, it is time to play an active role.

Main image retrieved from https://www.philanthropy.com/article/Dismantling-Racism-Might/248899.

Talking periods

I couldn’t help but wonder: what was the deal with periods? Why is there so much taboo around them? 

Prerequisite: although this article will refer to ‘women’ based on surveys and research done, it is imperative to understand

Image retrieved from @emmycoletti on Instagram

The average menstruator, having their period for roughly 5 days every 28, from the average ages of 12 to 52 (NHS, 2019) will menstruate for a total of 6.5 years across their lifetime. This is a considerable amount of time. Certain factors affect this stat, such as pregnancy, hormonal contraception, reproductive issues such as PCOS or endometriosis, stress, testosterone (taken during gender transition) etc.

The word ‘period’ was used for the first time in a television commercial in 1985 (Hampton, 2017)  (a tad late considering electronic TV has been around since 1927), and it wasn’t until 1972 that pads could be stuck to pants, as opposed to using an elastic belt that held pads in place (Moss, 2014); I CANNOT imagine using this now. Considering that the humans have been around some 200,000 years these developments are revolutionary to say the least.

Everyone experiences periods differently, ranging from preferences for hot water bottles, chocolate, yoga, pain killers, emergency care, none at all etc. Some people refer to it as a disaster zone while others find their periods as a time to nest/reflect/hibernate – referred to as Winter by Maise Hill (2019).

I wanted to ask how you all experienced yours, because collective voices are louder, richer, and relatable:

 ‘Lighter since going on the pill. Periods were awful and irregular when I had the implant’

‘PMS KILLS ME EVERY MONTH but my actual period is light and short’

‘The week before is worse than the week on. Much bigger boobies, back pain, emotional haha. Since I cut down my sugar & meat consumption they are much more manageable’

‘Confession: I have a weird fascination with the contents of my menstrual cup during my period’

‘After losing my period for 8+ months due to stress, I now appreciate them more than before!’

‘Super irregular because of PCOS so its super hormonal dependent and variable’

‘I used to hate mine. Very heavy and painful. But I love them now. I love how cyclical they are. Embracing them has made me more in tune with the natural ebb and flow of my body’

Most menstruators will recall cases where they haven’t had products on them, and awkwardly mouthed or mimed ‘I need a pad’ to a friend/fellow menstruator, and then skurried off with one tucked up sleeves/in bras/crunched in ones palms – it is time to say it with our chests.

Periods in history

If we cast ourselves back to ancient Western civilizations, who claimed that women’s bodies were the source of their madness, it is fair to argue that women’s bodies have often been a site of debate. 

Many amusing anecdotes have been produced on the ‘danger’ of menstruating women: Pliny, a famous Roman thinker thought that “bees will forsake their hives if touched by a menstruous woman”; others thought that men whose penises touched menstrual blood would be burned, or that menstruating women turned meat and flowers ‘bad’ (Hampton, 2017) (now that seems like madness). 

Such beliefs have been understood by anthropologists like Mary Douglas, who examined the ideas of pollution of the body, of which menstrual blood was seen to transgress the boundary of in/out of the body (Tunstall, 2015). It is no surprise then, that 45% of men refuse to have period sex, with 44% of women saying that they ‘don’t feel sexy on their period’  (Bodyform, 2020). However, periods have also been seen as protecting people from danger, purifying, or even a “love charm” (Hampton, 2017) – their social positioning is significant. 

Beyond the minimal knowledge school biology offered us, we often aren’t taught the practicalities of periods, and how they actually feel. This is evidenced in that as many as 44% of young women were unsure of what was happening when they first had their periods. As in, young women have genuinely thought they were dying when they first began to menstruate. This isn’t comical, or a case of ignorance; it is a serious lack of education. 

Period education is only recently becoming more common, and I was lucky enough to get my first post-uni job working on one. 

Let’s Talk Period

The Let’s Talk. Period project was a partnership of two charities in the UK (Brook and Plan International), that aimed to develop period education, distribute period products, and raise awareness about the realities of period poverty to young people who menstruate. Such work builds on campaigning, such as ending the tampon tax, moving it from its previous tax status as a luxury product – private jets weren’t exempt from this, but tampons we paid tax on. Bloody cheeky if you ask me. Pun intended.

Activists such as Amika George spearheaded the #FreePeriods movement, campaigning for free period products to be made available in schools for those who are struggling to access them. From January this year, schools in the UK can order a certain amount of products through an online portal.

(Life) Lessons I learned on this project:

  1. Convincing a group of young people to speak about something they find ‘gross’ is intimidating at first
  2. Lots of young people aren’t comfortable speaking about their bodies – when I asked if they were comfortable speaking about vulvas – they said “Miss I swear vulva is a car company?!” 
  3. Many menstruators will fall through the gaps of the government school scheme; more needs to be done, following the example of Scotland, where menstrual products were just voted to be free everywhere
  4. Ultimately, speaking about periods offers menstruators the opportunity to discuss the changes in their body, and encourages them to reflect on sex, contraception and their cycle fluctuation, which in turn becomes empowering over time

Lack of knowledge, coupled with taboos also affects access to period products (in order to see periods in a better light in society, issues like period poverty equally need to be tackled!).

It seems that many of us could have had more education at school, particularly to break the deeply entrenched taboos, make everyone more comfortable with the practicalities and sights of period blood, and to destigmatise period sex. 

Poll conducted on Instagram on 26/05/20, approx 73 participants

Lest we forget: periods and sex

People, there are benefits of vaginal period sex: oestrogen levels increase leading up to your ovulation: so many people have an increased interest in having sex during their periods, some evidence of reduced cramps (from the increased contraction of the uterus during orgasm) (Brochmman & Dahl, 2017) and more ‘natural’ lubrication (although you can still use lube, as menstrual blood is not exclusively designed for vaginal lubrication). 

Get creative: shower sex (if you’re using condoms be very careful, they could slip off), sex on towels, or red sheets (gamechanger). Some menstruators may ask their partners to focus more on oral sex, particularly if they are wearing a Mooncup or tampon (McWeeney, 2018). 

Many a creative and tender epithet were imparted with me on Instagram, which I will plop here for you all to take notes on:

As long as everyone is OK with it then go for it! Nothing to be ashamed of’

Be prepared! Always found it made by flow heavy so have a pad / tissue /whatever near’

‘It’s not for everyone but it’s a pain reliever and feels empowering and very intimate’

‘In my experience, it’s more pleasurable for both people if you get creative with ways of having orgasms that aren’t as messy so both people are comfortable and satisfied’ (on period sex in a lesbian relationship)

‘Just bleed all over your lover. They should love your blood, hair and body’.

Image retrieved from @whoregasmic on Instagram (INTENDED AS TONGUE IN CHEEK OFC)

It must be noted that you can still get pregnant on your period if you are having unprotected sex/aren’t on hormonal contraception: sperm can live in the body for up to 7 days. So, if you ovulate earlier in your cycle than the typical day 14, you’d still be at risk – which is dependent on how irregular your cycle might be.

STIs, unfortunately, don’t stop during periods (rude I know): the cervix is more open leaving space for bacteria/viruses to move on up, the pH of the vagina becomes more alkaline (its slightly acidic pH normally helps protect the vagina more), and the increased blood from the vagina can mean an increased risk of bloodborne infections such as HIV or Hepatitis (Franklin, 2018). So period sex is more ‘risky’ in terms of STI transmission with no external/internal condom/dam usage, but doesn’t HAVE to be a sex-free time.

Apparently 70% of women don’t have period sex, although that is not case for you lot… perhaps more research needs to be done on this!

Poll conducted on Instagram on 26/05/20, approx 73 participants

Concerning the future of periods, we have:

  • Concerns about lack of access to sanitary products during coronavirus lockdowns globally 
  •  Increased market shifts towards more sustainable products, such as the Mooncup, period pants, reusable tampon applicators, sanitary pads etc.
  • To include all genders in the conversation (check out Kenny Ethan Jones article below)
  • To integrate periods into wider sex education programmes 
  • To normalise menstrual leave policy – for people who have debilitating period pain such as dysmenorrhea. Since 1947, a policy like this has existed in Japan, Italy since 2017, Nike has had it in their employee code of conduct since 2007 and Coexist, a firm in Bristol has recently included it (to much debate) (Denteh, 2019). Time’s up.

Have sex on your period, or don’t. Shout from the hills about them, be as un-discrete about your pads/Mooncup chat as you want. Or don’t discuss them at all. But if you want to, that’s great! You should be able to discuss the monthly goings-on in your body without people being ‘squeamish’.

While you’re at it, discuss with your workplace HR what they think about menstrual leave policy (at your own risk, because it causes a little stir).

Resources 

Reading: 

Listening: 

Watching: 

Cover image by Erol Ahmed on Unsplash

References

Bodyform. (2020). Period Sex Survey: Why The Taboo? Our World Webpage. (Accessed online: https://www.bodyform.co.uk/our-world/period-sex-survey/ 24/05/2020)

Brochmann, N & Dahl, E. S. (2017). The Wonder Down Under: A user’s guide to the vagina. Great Britain: Yellow Kite

Denteh, B. (2019). Should The UK Implement a Paid Period Leave Into Work Policies? TCS NEtwork Webpage. (Accessed online: https://www.tcsnetwork.co.uk/should-the-uk-implement-a-paid-period-leave-into-work-policies/ 25/05/2020)

Franklin, A. (2018). You’re More Likely to Get an STI During Your Period—Here’s Why. Sexual Health Webpage. (Accessed online: https://www.health.com/condition/sexual-health/std-risk-during-your-period 25/05/2020)

Hampton, J. (2017). The taboo of menstruation. Essays Webpage. (Accessed online: https://aeon.co/essays/throughout-history-and-still-today-women-are-shamed-for-menstruating 30/04/2020)

Hill, M. (2019). Period Power. Green Tree: London.

McWeeney, C. (2018). Period sex 101. Articles Webpage. (Accessed online:  https://helloclue.com/articles/sex/period-sex-101 25/05/2020)

Moss, G. (2014). I Wore An Old-Fashioned Sanitary Belt For My Entire Period, and Here Are The Gory Details. Articles Webpage. (Accessed online: https://www.bustle.com/articles/46404-i-wore-an-old-fashioned-sanitary-belt-for-my-entire-period-and-here-are-the-gory-details 24/05/2020)

NHS. (2019). Periods and Fertility in the Menstrual Cycle. Period Webpage. (Accessed online: https://www.nhs.uk/conditions/periods/fertility-in-the-menstrual-cycle/ 24/05/2020)

Tunstall, E. (2015). Re-doing the cycle: menstrual power protests and design. The Conversation. (Accessed online: https://theconversation.com/re-doing-the-cycle-menstrual-power-protests-and-design-40526 30/04/2020)

Locking down sex

I couldn’t help but wonder: will quarantine change how we think about sex forever?

It’s May 2020. In the UK, we have been locked down/quarantining/self-isolating for 2 months. Some of us may have crawled inside before then, and with a lift of restrictions last week (go to work, don’t go to work, be safe, go out? Stay alert!?) some may have emerged into the outside again, only to feel slightly downhearted by the ‘new normal’. 

This immense social change, with most people inside, either making contact with their households, neighbour/key work niceties, or no one at all, will and has changed the UK’s (and slightly wider spread a.k.a the globe’s) sex lives. 

Sexual health

Firstly, a necessary sexual health plug. In most people’s lifetime, including during the initial HIV epidemic, there has never been such a significant break in people being able to engage with new partners (Petter, 2020).

With 26% of 16-24 year olds never having been tested (FPA, 2016), this is the perfect opportunity to diagnose new infections, or just simply definitively know what your sexual health status is. You can do this by ordering STI testing kits online, straight to your home (see the resources section of the Demystifying STIs post).

That way, post quarantine fun, aka when Boris lets us join the Dutch who have been recommended to seek a coronavirus sex buddy, you’ll know your status. 

Sexual health isn’t just for the singles – given that you can be asymptomatic for an STI such as chlamydia, it is worth being tested regardless of whether you have a partner or not. 

It can also be seen as a great time to renew your sexual wellbeing, given that sexual health is: “a state of physical, emotional, mental and social well-being in relation to sexuality” (WHO, 2006). This could be for couples together, who might respond differently to the stresses of lockdown, or people who do not currently have access to their/a sexual partner(s); anyone can use this time for reflection, exploration etc. Think of it as a self sexual healing. When I asked on Instagram how lockdown will change sex/dating, an insightful user said ‘I hope people think more about chains of transmission’ (to which I say YASSSS).

New sexual partners during a coronavirus pandemic

As unfair as it might seem, if everyone goes out to meet new people, that means more people out and about, public transport being used unnecessarily (sob). In terms of physical movements, everyone should be staying at home as much as possible or being outdoors 2m away from other people. If you are meeting new people, a distanced park stroll would be your best bet. 

COVID-19 (the current form of coronavirus circulating causing a disease) is spread via air droplets, so exchanging saliva, touching infected surfaces means that intimate interpersonal sexual activity can lead to transmission/spread of the virus (Ritschel, 2020). There has been some conflicting research about whether coronavirus tends to be found in semen – one small study found that 16% of participants who had coronavirus had it in their semen, another study not; clearly more research is needed (Reuters, 2020). 

Have we been prioritising certain kinds of sex > others?

Many criticise the idea of Penis In Vagina (PIV) sex as being what most people refer to when they are talking about sex. This links to a long history of establishing binaries and sexual norms: people being heterosexual, having sex after marriage, normal (as opposed to ‘perverse’) sexual desires etc. (Barker, 2018). Of course, sexual activity often involves two people engaging in an activity together, but lockdown could serve to revolutionise these age-old ideas. 

If solo sex (masturbating woop #MasturbationMay, using sex toys), watching pornography or sexting are our only options, and these are considered sexual activity – we can’t truly say we aren’t having sex (unless of course, you aren’t doing any of these); so what we aren’t doing is having partnered activity, but sexual dimensions still exist outside of these. 

Image retrieved from @bellesaco Instagram

Some of us are thinking about partnered activity; others not. Some resentful of those coupled up, high on the dopamine of an unlimited lockdown love fest, others crippled by anxiety maybe less so. Remember the divorce rate in Wuhan went up – lockdown isn’t necessarily ‘amazing’ for your sex or romantic life.

Here’s what you say:

Research done on Instagram on 18/05/2020, approx 61 participants

Sex toy popularity

Hurrah, hurrah! Sex toy companies must be absolutely gassed; sales went up by 25% in the first two weeks of lockdown alone in the UK, tripled in New Zealand (just a fun fact) with companies such as Lelo reporting a 40% sales increase. Considering that pre-lockdown, roughly 50% of people used sex toys, I hope this number goes up. There are many out there, and it is definitely time for some me-search. Retailers like Sh!, Unbound, Lelo, Cult Beauty, Naked Grapefruit, Love Honey, etc. are a great place to start. Following some sex educators will also help you do some market research – such as Ruby Rare who often does talks/reviews on sex toys. 

Sex toys have been around since supposedly back in the day when Cleopatra allegedly used a vase with bees in to stimulate herself. Ain’t no time like the present to experiment – although people are definitely on this – searches for ‘bullet’ and ‘fleshlight’ have gone up 60% and 50% respectively since the beginning of lockdown (Google Trends, 2020).

Sex and online spaces 

As some of you may have seen in the quizzes on the @sexualhealthandthecity Instagram, Pornhub usage has skyrocketed during lockdown, particularly when they made some of their content free; 7,300 quarantine themed videos have also now been uploaded. 

Let’s not consider some more innovative options – She might start an OnlyFans (who have 5X the amount of content creators sign up during lockdowns). Given that mainstream pornographic production has been temporarily shut down, DIY creators are shifting the power from producer to performer by making pornographic content for a subscribers fee (Lee, 2020). 

With increased ‘intimate-image’ sharing, it is also important to stay uber safe online. 

‘Revenge porn’ (I’ve said this already but intimate image abuse is more accurate) has increased across the whole world – a form of sexual assault – where someone is unconcensually sharing an image that was consented to for private viewing. See the resources for the best ways to stay safe online: my personal recommendations would be (for > 18s, it is illegal for < 18s to possess pictures of even themselves that are considered intimate or pornographic) don’t include your face, identifying features like a tattoo, birthmark and no family pictures, notable paintings in the background etc. 

It is also important to make sure you have consent to whom you want to send them to. If someone demands nudes from you and you feel uncomfortable, feel free to ditch them. You don’t owe any partner/potential interest any  intimate images of yourself.

Sexting (discussing sexual activity via text) can be a nice alternative to ‘normal’ sexual activity – discussing what you might like to try can be really healthy and instil a deeper sense of partner communication. 

Dating online 

People are having longer and more interactions with dating apps like Tinder (Mellor, 2020). Given that in the UK, it’s ambiguous to say the very least when dating might be considered allowed/socially acceptable again, many are turning to online dating apps: Tinder, Bumble, Hinge etc. Online Zoom dates, quizzes, sharing meals etc, are a sweet and potentially Black Mirror-esque alternative. But we love to see it. In fact – many of you are doing it!

Research same as before


People already in relationships must be struggling, particularly quarantining separately. However, I’m hearing many tales of ‘virtual dates (and sexy time) to stay involved’. People might also be using social media more in order to meet new people, or shoot their shot…

Image retrieved from @newagegents Instagram

Unfortunately, spending so much time inside could be affecting the success or outcomes of online dating. Some of you shared some negative experiences via Instagram:  ‘I was on Tinder, and it disgusted me of most guys I’ve talked to. I ended up deleting my account’ and my personal favourite: ‘bun these men. Wedding day is the next time I’m having sex’ (slightly tongue in cheek). 

Another follower said ‘more people will have social anxieties triggered making it potentially harder to connect’. I was always wondering about ‘ghosting’ – where people cut off communication with someone they may have been dating/having sexual activity with. Based on the below, lockdown ghosting appears to be higher than normal.

Research same as before

Continuing

Luckily, some of you had cute/spicy quarantine stories. The two most commendable:

 ‘Started sleeping with a guy 2 weeks before lockdown – he’s still here and we also got a pup’

‘Have been sent £350 pounds worth of sex toys by a hot lecturer I’ve never met’

Equal sentiments of ‘people will rush into it post lockdown as they may have been lonely’ and ‘people may wait more, not jumping in the sack so quickly’ were expressed to me; we can only wait and see. 

Some of us are manifesting post-lockdown dreams: ‘everyone will be fucking everyone (hopefully)’. All in all, I can’t WAIT to review sex AFTER lockdowns. 

Resources

Reading:

Listening:

Watching:

Cover image photo by Ahmed Nishaath on Unsplash

References

Barker, M-J. (2018). The Psychology Of Sex. Oxon: Routledge. 

Google Trends. (2020). Sex Toy Search. (Accessed online: https://trends.google.com/trends/explore?geo=GB-ENG&q=%2Fm%2F012pld 21/05/20)  

FPA. (2016). Sexually Transmitted Infections Factsheet. Factsheets Webpage. (Accessed online: https://www.fpa.org.uk/factsheets/sexually-transmitted-infections 21/05/2020)

Lee, A. (2020). Coronavirus is bad news for Big Porn but great news for OnlyFans. Article Webpage. (Accessed online: https://www.wired.co.uk/article/coronavirus-porn-industry-onlyfans 20/05/2020)

Mellor, M. (2020). Coronavirus has created a sex toy boom. A baby boom may not follow. Article Webpage. (Accessed online: 

https://www.wired.co.uk/article/coronavirus-pandemic-sex-toys 20/05/2020)

Petter, O. (2020). Lockdown could be ‘gamechanger’ for STIs as people unable to have sex with new partners. Lifestyle Webpage. (Accessed online: https://www.independent.co.uk/life-style/love-sex/lockdown-sti-sexual-health-sex-benefits-a9501246.html 18/05/2020)

Reuters. (2020). Covid-19 found in semen of infected men, say Chinese doctors. World Webpage. (Accessed online: https://www.theguardian.com/world/2020/may/07/covid-19-found-in-semen-of-infected-men-say-chinese-doctors 18/05/2020)

Ritschel, C. Five Things You Should Know About Coronavirus And Sex. Lifestyle Webpage. (Accessed online: https://www.independent.co.uk/life-style/coronavirus-sex-spread-kissing-safe-std-masturbation-a9489111.html 21/05/2020)
WHO. (2006). Sexual and Reproductive Health. Topics Webpage. (Accessed online: https://www.who.int/reproductivehealth/topics/sexual_health/sh_definitions/en/ 21/05/2020)

Contraception: pick and mix?

I couldn’t help but wonder: Are women simply ‘indecisive’ about their contraception, or has there been some miscommunication?

Research shows that 70% of British women have tried the contraceptive pill, with around 3.5 million women currently using it (Fiennes, 2019). This accounts for nearly 90% of contraception use.

In recent years, other forms of contraception known as Long-Acting Reversible Contraception (LARCS) have become increasingly popular, such as the copper and hormonal coil. Alongside the popularity of natural planning apps like Natural Cycles, these shifts demonstrate that women are increasingly dissatisfied with their contraceptive options. 

I’ll refer to it as ‘pick and mix’; people often use contraception recommended to them by others, or what is represented in popular culture. Considering that 62% (of approx. 66 people who answered the blog’s Instagram quiz) said they were not given adequate contraception information when they were younger, there has been a clear education gap.

Here we’ll consider the benefits of contraception, address some of the myths, and look at the types and their effectiveness. I also wanted to include some of your personal experiences to socialise medical information, yet also highlight that everybody reacts differently to contraception. 

Whilst these words are subjective experiences, it is important to consider how some people have had some very negative experiences using contraception. Having this information can help with decision-making. Keep in mind that contraception is continually reviewed by healthcare professionals, and advice does change throughout time – for example, the original pill had 7 times the amount of hormones it does today. 

Condoms (external, internal) can also be considered contraception as they prevent pregnancy, although as they are single-use, and have no internal reproductive functions, so  we’ll skip these. Of course, barrier methods should always be used for sex with a new partner to reduce the risk of STI transmissions – see the demystifying STIs post for more convincing ;). They also have no hormones, so can be used for short-term contraception.

If you don’t have a regular partner, are committed to your sexual health and use condoms to best practice standards, there is no reason you need to go on longer/hormonal forms of contraception. It’s totally up to you! Knock yourself out with all the tropical, warming, ribbed, dotted, thin condoms you can find. Note that some of these, such as tropical condoms are only intended for oral sex.  You can also use dental dams for oral sex on vulvas, and make sure to check yourself for other STIs that condoms don’t protect against such as herpes, syphilis and genital warts, which can be passed through skin-to skin contact

What are the benefits of contraception?

  1. The first and clearest benefit is that it protects against pregnancy – although it isn’t possible for any form of contraception to be 100% effective. In a year 80-90% of women will get pregnant with no contraception… (FPA, 2019)
  2. Some can regulate your menstrual cycle (NHS, 2019) – a huge relief for some women
  3. Can help with reproductive conditions such as PCOS, endometriosis (NHS, 2019) as well as in some cases of PMDD (premenstrual dysphoric disorder)
  4. Being able to plan when you have sex more and an element of personal control (leading to more sexual freedom!)
  5. Useful if you’re with longer-term sexual partners (less anxiety/stress!)

Myths around contraception

  1. Affects fertility in the long-term
  2. You don’t need to use condoms because you’re protected from pregnancy
  3. It can or will give you cancer

Types 

If you want to see the timeline of when these all emerged, refer back to the history of sexual health post. I’ll start with the most common!

Ultimately, it is best to do your own research, consider your lifestyle or medical history, and then consult a healthcare professional. There are side effects to taking contraception, which are important to consider alongside the clear benefits of using it. 

Image retrieved from @sh24_nhs on Instagram

The pill – taken daily 

  • Can be combined: estrogen and progestin, which are synthetic hormones similar to what is naturally produced by the ovaries. The effect of them is similar to what the bodies hormones do during pregnancy – they prevent an egg from being released, thicken the mucus in the cervix (which connects the vagina to the uterus, opens during childbirth), and thin the uterus lining that usually thickens during the menstrual cycle (FPA, 2019) 
  • Can also be progestin-only (also known as POP). This is mostly taken by people who can’t take estrogens: such as people who are smokers, at higher risk of blood clots/high blood pressure, family history of migraines, past or present breast cancer (NICE, 2019)
  • Taken daily for 21 days with/without a 7-day break (new guidelines show this break is not needed)
  • 99% effective, 91% with typical use (FPA, (2019) (so 9 in 100/year pregnant). Ideally take at the same time every day. If you begin taking it during your period, you’ll be immediately protected up to 5 days (ibid). Can make periods lighter, can improve acne (FPA, 2007)
  • Have to be careful concerning diarrhoea/sickness – affects reliability 
  • Not everyone can use it: see here for the list of conditions it is not compatible with. Usage declines with age (FPA, 2007). There can also be drug interactions if you’re on important medications that can stop you needing to take it
  • It is also one of the most politically contested forms of contraception, especially given its insidious testing history on Puerto Rican women (Fiennes, 2019). Most people will try it, although the research is increasingly suggesting that there might be easier contraceptive options out there
  • It can increase your risk of breast cancer, and longer-term, cervical cancer. However, it can decrease the risk of ovarian and womb cancer, amongst others. The risk goes away 10 years after usage (Cancer Research, 2020)
  • Instagram users say: Cerazette (POP) ‘ruined my life’ and have had the coil for about 7 years and love it’
  • POP: ‘made me feel zero emotions % gain weight but the combined pill has been good!
  • ‘Fairly positive with the pill (Gedarel)
  • Changed from ‘Marvelon instead of Microgynon!!!’
  • ‘The pill worsened my mental health when I was younger!! Did start it young, however’ (research suggests for younger patients there is a significantly increased risk of clinical depression (Fiennes, 2019))
  • ‘Quick weight gain and stretch marks, unrecognisable mental health’

The patch – Changed once a week for 3 weeks, then break/no break

  • Looks like a nicotine patch
  • Delivers the same hormones as the combined pill through the skin. Same effectiveness, similar effect on periods as the pill may be easier if you forget to take your pills every day
  • Might not be as effective for people who weigh > 90 kg (FPA, 2019)
  • Can’t be placed near the breasts, many people choose upper leg, arm, bum etc. (anywhere where it won’t get rustled about too much, needs to be moved to prevent skin irritation (ibid)) 
  • Can be temporary side effects when beginning usage, spotting bleeds, and longer-term side-effects similar to the pill 
  • You have to be really on it, like the pill, with putting them on at the same time every day

The vaginal ring – one provides contraception for a whole month

  • Less popular than the combined pill
  • Folded and inserted into the vagina, and pushed upwards towards the cervix (NuvaRing, 2020)
  • Releases the same hormones as the combined pill, same effectiveness
  • Avoids the diarrhoea/sickness issue of the pill as it stays in 
  • More popular in the wider European continent (I’ve heard in places such as Italy, Spain)

Injection – Lasts for 13 weeks

  • Progestin injection,  and works similarly in the body to the combined pill, POP and patch. There are combined injections but these are generally not offered in the UK
  • 99% effective, 94% with typical use (6 in 100 pregnant/per year)
  • Can thin bones, not greater longer-term; if you use it, you will be risk-assessed for osteoporosis every two years (FPA, 2019). Not recommended for < 25-year-olds whose bones are still growing
  • Can take a year for fertility to return (ibid)
  • Some people may put weight on, your periods are likely to change (most often stopping completely)
  • It’s overprescribed use on certain communities such as black women in the UK and globally,  this has been protested throughout history 

Implant – lasts for 3 years!  

  • Most effective – less than 1% failure rate (<1 in 1000 pregnant over 3 years)
  • A small rod inserted under the skin in the upper arm (FPA, 2019), which releases progestin into the bloodstream
  • Periods should be lighter
  • Not compatible with enzyme-inducing medication such as for HIV, epilepsy, TB (ibid)
  • You may get acne or, acne could get worse
  • Earlier this decade, there was some controversy around incorrect insertion of the implant, which has been reported in a small but significant amount of users 
  • Instagram users say: ‘My sister in law had the implant and it relocated in her body so she had a procedure to remove it’
  • ‘I had a period that lasted over 8 weeks on the implant and it got stuck in my arm’
  • ‘Extremely awful mood swings and low mood with the implant – when removed, back to normal’
  • Another user told me her implant caused really irregular bleeding, and the inconsistency ‘caused pregnancy scares’
  • ‘I have had the implant twice now, and I would recommend highly’

IUS (intrauterine system) – effective for 3 -5 years

  • Hormones are localised, 99% effective (<1 user pregnant/year)
  • Has a similar effect to the pill thickening cervical mucus and thinning the uterus lining, given that it releases progestin
  • Periods meant to be lighter, although some spotting in the first few months, can be used whilst breastfeeding
  • Speculum used when inserting, where it is opened ‘like an umbrella’ into the uterus  
  • Strings – not ideal for Mooncup usage – ask your healthcare provider when you get this fitted 
  • May not be suitable if you have any cervical or womb problems, pelvic inflamation, certain cancers, liver disease, or history of of unexplained bleeding after or during sex
  • It can also in some cases be rejected or displaced by the womb, and there’s a small risk of ectopic pregnancy if it fails (NHS, 2018) 
  • Possible to get an infection when it is first fitted (FPA, 2019)
  • Instagram users say: ‘very negative experience of the Mirena coil’
  • ‘Had excruciating periods before I got the Mirena! Would literally pass out or throw up’
  • ‘It can be really good and REALLY REALLY BAD. Almost put me in A & E and I had to argue with Drs./Nurses to have it removed. The pain isn’t taken seriously enough’

IUD (intrauterine device) – lasts for 5 – 10 years

  • The copper (and plastic) coil, non-hormonal
  • The copper in it kills sperm and also changes cervical mucus to make sure sperm don’t reach an egg; it can also stop a fertilised egg from being implanted in the uterus (FPA,  2019)
  • 99% effective (fewer than 2 pregnant in 100 over 5 years)
  • Can be fitted as emergency contraception
  • Some people cannot use it if they have uterus/cervix problems, unexplained bleeding between periods or a history of pelvic infections
  • Periods can be longer, heavier/more painful at the beginning (FPA, 2019)
  • Similar to the IUS, your body can reject it 
  • Instagram users say: ‘No one tells you how incredibly painful it is to get a coil put in!!’
  • ‘Increased rate of yeast infections’
  • ‘The GP couldn’t get it in’

Caps/diaphragms 

  • Are circular domes ‘made of thin, soft silicone that’s inserted into the vagina before sex. It covers the cervix so sperm can’t get into the womb (uterus) to fertilise an egg’ (NHS, 2017)
  • When used properly with spermicide (a foam/cream/paste/gel containing chemicals that kills sperm), they have 92-96% effectiveness (ibid)
  • You have to put them in before sex, and they can take time to learn how to use – because of this, their effectiveness goes down, and thus they have become less popular
  • You also have to leave them in the vagina 6 hours after having sex
  • Cystitis can be common, as well as spermicide irritation. They are still an option however, and better than the pull-out method… with its 22% human failure, is a lot less reliable than condoms
  • Used to be very popular back in the day; not popularly discussed, although Carrie in SATC did use it! And Monica in friends

Situating women’s voices 

‘No one warned me about contraceptive periods’

‘I have always made positive experiences with condoms’

‘The morning after pill – when those emergencies come, it’s awful’

People who responded to the Instagram poll I did expressed their justified concerns that there is a lot of haziness concerning contraception, and they often felt unprepared concerning the effects of it.

Women have made a lot of ‘noise’ concerning their experiences: through #MyPillStory (mainly in the USA), and the Mad About The Pill investigation. These voices should be listened to in order to shape the future of contraception and the needs of users.

Depression and changed mood/personality, is often the most reported side effect, at least verbally and between women. Some studies were considered to be inconclusive or with a too-small data set: until 2016 when a Danish study found a slightly higher causal relationship between pill users and antidepressant usage, particularly with higher dosage progestin pills. This study was conducted on over 1 million women, over 13 years. 

Other side effects people may discuss from hormonal contraception are decreased sexual desire, although research suggests that whilst they may affect it, other factors such as age, and partner attraction could affect it more. Concerning research, it seems that it is hard to a) get a large enough sample size of women to inform scientific trends and b) to extrapolate effects directly caused by contraception as opposed to other lifestyle factors such as mental health, poor working/living conditions etc.

For some people, it might be worth tracking your natural menstrual cycle (which you can do here) to see where your natural fluctuations of weight gain, mood, feelings of lower desire etc., lie. If you get to know this, it might be that you can prepare more for the side effects of contraception, and highlight what was normal for you before taking a specific contraception. 

The future

Worryingly, many women might gaslight themselves concerning their symptoms, or may not have their pain taken seriously. Ultimately, there seems to be frustration around inadequate contraception education, and a yearning for more non-hormonal options.

From what I can ascertain, there are two main non-hormonal contraceptive futures. India’s Saheli non-hormonal pill (not licensed out of India or by the WHO) and labs in America are exploring ‘the use of polidocanol foam, currently used as a treatment for varicose veins, as a non-hormonal, non-surgical permanent contraceptive that, once inserted transcervically, blocks sperm from reaching an egg’ (Brooke, 2019). The Natural Cycles App, which is receiving better testing throughout its uses, could be an option for those who want to track their fertility whilst testing their temperatures. It isn’t as reliable as other methods of contraception, but provides some hope. 

Male contraception could be an option, which could have more non-hormonal options than for female reproductive systems – given that ovulation doesn’t need to be prevented.

With 93% of the Instagram poll said they would feel more satisfied to try non-hormonal options in the future, we can only hope for more scientific innovation.

Feel free to let me know – what contraception do you like?

What might you consider in the future?

Blog illustration by the ever phenomenal Mayra Salazar, @mayra.tee on Instagram

Resources

Reading: 

Listening: 

Watching:

  • Sex, Explained: birth control on Netflix

References 

Brooke, E. (2019).  The bitter pill: why isn’t birth control better? (Accessed online: https://www.vox.com/the-goods/2019/6/25/18715504/birth-control-side-effects-pill-iud 14/05/2020)

Brochmann, N & Dahl, E. S. (2017). The Wonder Down Under: A user’s guide to the vagina. Great Britain: Yellow Kite

Cancer Research. (2020). Does the contraceptive pill increase cancer risk? (Accessed online: https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the-contraceptive-pill-increase-cancer-risk#XXX1 13/05/2020)

Fiennes, N. (2019). Behind Closed Doors : Sex Education Transformed. London: Pluto Press.

FPA. (2007). Contraception Patterns of Use Factsheet. Files Webpage. (Accessed online: https://www.fpa.org.uk/sites/default/files/contraception-patterns-of-use-factsheet-november-2007.pdf 10/05/2020)

FPA. (2019). Which method of contraception is right for me? Contraception Webpage. (Accessed online: https://www.sexwise.fpa.org.uk/contraception/which-method-contraception-right-me 13/05/2020)

NHS. (2017). Contraceptive diaphragm or cap. Contraception Webpage. (Accessed online: https://www.nhs.uk/conditions/contraception/contraceptive-diaphragm-or-cap/ 14/05/2020)

NHS. (2018). Intrauterine system (IUS). Contraception Webpage. (Accessed online: https://www.nhs.uk/conditions/contraception/ius-intrauterine-system/ 14/05/2020)

NHS. (2019). What is contraception? Contraception Webpage. (Accessed online: https://www.nhs.uk/conditions/contraception/what-is-contraception/ 10/05/2020)

NICE. (2019). Contraceptives, hormonal. (Accessed online:  https://bnf.nice.org.uk/treatment-summary/contraceptives-hormonal.html 13/05/2020)

Nuva Ring. (2020). Inserting NuvaRing. NuvaRing website. (Accessed online: https://www.nuvaring.com/inserting-nuvaring/ 14/05/2020)

Starting with consent

My heart sinks. I’m teaching consent to a classroom of year 9s, and a large cluster of them move to the true side of the classroom: the myth goes something like ‘if two people have had sexual activity together before, they don’t need to ask for consent again’. It’s false.

Luckily, after lots of mythbusting, we move on to the law, how to navigate/discuss consent etc. I’d like to mirror something like that here. Mayra (blog illustrator and often editor) suggested an illustrative aid – so we’ve chosen the idea of a phone password. In a digital age, asking for someone’s password is seen as commonplace and respectful; picking up their phone and sifting through it without their consent would be a violation of their privacy. 

You may give your password freely/enthusiastically to someone you trust; you might be hesitant to give it to someone you don’t know very well; you might change the password entirely even if you’ve given it to someone once before. We’ll return to this analogy in ‘talking about consent’. 

‘Not really present’ consent education

Many of us may have been taught about consent during school, although I know I’m not alone in thinking it certainly wasn’t drilled in. In the UK, it will be introduced at primary school level through healthy relationships education from September this year (PHE, 2019). This is promising news for younger generations. 

If you find yourself as an adult post-mandatory sex education, you may be a bit stumped. There’s a lot to (un)learn. When I say this is one of, if not the most important message to take from sex education, burn these words into your brain. 

You do not have to engage in any sexual activity that you are not 100% up for. 

You can also change your mind and withdraw your consent at any time. Your consent is not frozen. 

As many say: “consent is sexy!”. 

Don’t let anyone tell you otherwise.

Consent and the law

The legal age of consent in the UK is 16 (Brook, 2020). The Sexual Offences Act from 2003 defines a personing consenting if said person “agrees by choice and has the freedom and capacity to make that choice” (Brook, 2020). Choice represents being given the option to choose, and freedom would be to feel free from pressure/coercion/abuse influencing your decision-making. Power/trust also comes in here: if someone is between 16-18, having a relationship with a boss/doctor/teacher would also be illegal.

Things that affect your capacity are drinking alcohol, taking drugs, being asleep/unconscious and your age. Although the law indicates someone would have to be very drunk or high for their capacity to be compromised, it is important to note that any drinking/drug taking etc. can still affect decision-making and reflexes etc.

During sexual activity, individuals ideally “affirmatively communicate their willingness to participate in the activity on offer” (Gilbert, 2018, pp. 268). If consent is not present – it is non-consensual = rape/sexual assault.

Image retrieved from @smash.thepatriarchy on Instagram

Additionally, with the increase of ‘revenge porn’ (not an apt title to use given that intimate image sharing is different to acting and being paid to be in porn), it is clear that online safety is becoming an increasing issue; proliferating in coronavirus lockdowns globally. It is important to include consent in online activities such as sexting.

Unfortunately, it has taken #MeToo, or #WhyIDidn’tReport to get society talking about sexual violence (Fiennes, F, 2019) and the importance of consent. Most of this happens in online spaces; this fact is not insignificant. In many ways, discussions have ‘resurfaced’, although the appropriate age to be able to consent has often been debated through time.

Consent in society 

Certain ideas are ‘written’ in social scripts, which we often unconsciously absorb. Given that sexual consent is often not clearly portrayed in culture, it is understandable there is not much clarity.

Although “consent can be messy” (N, Fiennes, 2019, p. 64), it should be seen as something that becomes commonplace. In a 2018 YouGov poll, “around one in 10 are unsure or think it’s usually not rape to have sex with a woman who is asleep or too drunk to consent” (EVAW, 2018). 

Young men, in particular, might find it harder to discuss consent. Nathaniel Cole (2019) discusses the ‘man box’: a specific way that men are socialised, which reifies heteronormative ideals, and also misogynistic/sexist tropes that women are property/conquests. He argues that whilst ‘men need to do better’, we also need to engrain in people that consent is something we should all strive for in sexual relationships and activity.

Meg-John Barker (2019) discusses how we live in a ‘non-consensual society’. They argue that in wider social relationships there is a large pressure to say yes to activities, join in, be social, rather than simply say: “no, I don’t want to come to the pub today”. Such norms make it harder for people to articulate and expect mutuality and ongoing communication that is needed during sex. 

Meg-John (2017) (and several others) discuss that we have marginalised communities, such as the BDSM (Bondage, Discipline, Sadism, Masochism) community to thank for ‘consent culture’. Consent needs to be negotiated before BDSM activities, during including the use of ‘safewords’, and aftercare tends to be practiced. Such culture needn’t be limited to marginalised communities. Windows always need to be created for people to opt-out, and be given several options. Consent, Barker argues, is the goal, rather than successful sexual activity/conquest.

Navigating consent

To start with, each individual has the capacity to enjoy some form of sexual activity: “everyone’s genitals are made of the same parts, organized in different ways” (Nagoski, 2015, p. 40). But what you like/at what times needs to be negotiated and discussed. If this makes you feel awkward/uncomfortable/confused, check-in with yourself

Why wouldn’t you want to receive consent? There is nothing unsexy about people communicating during sexual activity and having no expectations of the other beforehand, even if they are already partners. Actually, people can use this to their advantage to articulate their desires. Ever sat there and thought someone doesn’t know what you like? Tell them. They won’t know automatically! You can easily weave consent into these everyday conversations.

Image retrieved from @mattmcgorry on Instragram

There are some arguments that people might actually like something they wouldn’t initially consent to – does consent shroud sexual experimentation (Gilbert, 2018)? 

The difference here lies in not assuming someone is always experimental vs. two people consensually trying something new, one person doesn’t like it, partners check-in and they discuss changing something/stopping. It can be a delicate dance.

It is important that ‘through this having and giving and sharing and receiving, we too can share and love and have… and receive” (Joey, from Friends). You get the message.

In 2018, there were talks of apps that would serve to legally bind consent for sexual activities and preferences. Thankfully, such discussions of technologising something that needs to be on-going, in real-time and checked in, was not met well (see the Twitter outrage on anti-blockchain consent).

Conversing consent

The ‘yes means yes, no means no’ phrasing doesn’t always manifest IRL: there are situations where people might feel pressured to say yes/have an inability to say no. Thus, it is important to consider non-verbal communication around consent.

Retrieved from @clementinemorrigan on Instagram

It is also important to steer away from the construction of responsibility to say ‘NO’. In ways, this can be victim-blaming. The responsibility lies with the initiator to seek consent. Re: a phone password: if someone looks uncomfortable, or shrugs if you ask, they probably don’t want to give their password away.

Dr. Zhana, a sex researcher, offers tips such as discussing blanket consent. This could be for more experienced people/partners who know they are willing to consent to something, but offer a sort of tap-in/tap-out setup (Vrangalova, 2016). Some people feel that their sexual experiences are most enjoyable when based on spontaneity and ‘flow’ – they speak with their bodies. Back to the password example: some people are happy to let people they know have their passwords: and they’ll express so otherwise. Some people might also really enthusiastically respond with: “yes of course!!!”, or “YESSSSS!”.

Given that our sexual preferences and desire are not fixed, and are context-dependent (Nagoski, 2015), we can’t expect consent to be this way either. So keep the dialogue open – even if you think someone will let you have their password, check anway.

A quick note by Emily Nagoski concerning arousal non-concordance (which is very common, moreso in women), which is a bodily state where people can be sexually aroused when they don’t want to be/or don’t think they are: thererefore: “my genitals do not tell you what I want or like. I do” (Nagoski, 2018).

To wrap up: I hope I’ve made the case for consent, and clearly defined it, but also shown that actually, it can be simple to understand, and makes for lots of sexy time to be had ;). 

Communication is always beneficial – recognising how consent and discussing pleasure can sit together is crucial for lifelong societal wellbeing. 

Resources

Reading: 

Listening: 

Watching: 

Blog illustration by the ever phenomenal Mayra Salazar, @mayra.tee on Instagram

References 

Barker, M-J. (2015). Make Consent Your Aim. Podcasts Webpage. (Accessed online: https://podcasts.apple.com/gb/podcast/the-meg-john-justin-podcast/id1196374474?i=1000395192916 04/05/2020)

Brook. (2020). Sex and Consent. Your Life Webpage. (Accessed online: https://www.brook.org.uk/your-life/sex-and-consent/ 04/05/2020)

Cole, N. (2019). Why we need to change the way young men think about consent. TED talk. (Accessed online: https://www.ted.com/talks/nathaniel_cole_why_we_need_to_change_the_way_young_men_think_about_consent 05/05/2020)

EVAW. (2018). Attitudes to sexual consent researching findings. Uploads Webpage. (Accessed online: https://www.endviolenceagainstwomen.org.uk/wp-content/uploads/1-Attitudes-to-sexual-consent-Research-findings-FINAL.pdf 05/05/2020)

Fiennes, F. (2019). Believe Her. Restless Magazine. (Accessed online: https://restlessmagazine.net/believe-her/ 05/05/2020)

Fiennes, N. (2019). Behind Closed Doors : Sex Education Transformed. London: Pluto Press.

Gilbert, J. (2018). Contesting Consent in Sex Education. Sex Education: Sexuality, Society and Learning, 18(3), pp. 268–279.

Nagoski, E. (2015). Come As You Are: the surprising new science that will transform your sex life. Croydon: CPI group.

Nagoski, E. (2018). The truth about unwanted arousal. TED Talk. (Accessed online: https://podcasts.apple.com/gb/podcast/the-meg-john-justin-podcast/id1196374474?i=1000395192916 04/02/2020)

PHE. (2019). RSE and Health Education. Publications Webpage. (Accessed online: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/805781/Relationships_Education__Relationships_and_Sex_Education__RSE__and_Health_Education.pdf 05/05/2020)

Vrangalova, Z. (2016). Everything You Need to Know About Consent That You Never Learned in Sex Ed. Story Webpage. (Accessed online: https://www.teenvogue.com/story/consent-how-to 05/05/2020)
Witton, H & Barker, M-J. (2019). Consent Culture and Intentional Relationships with Dr Meg-John Barker. Podcast. (Accessed at: https://podcasts.apple.com/gb/podcast/doing-it-with-hannah-witton/id1464870183?i=1000444652351 04/05/2020)

Demystifying Sexually Transmitted Infections

This week I will attempt to demystify STIs! Wooow, I’ll tell you; what a task. I work in sexual health in education and wellbeing, but not in the clinic. This took a lot of trawling through ins and outs of symptoms, treatments etc. (I knew a big proportion of it but definitely scrubbed up on some new facts).

For context, in 2018 (the most recent data), there were 447,694 STIs diagnosed in the UK, of which 16-24 year olds were the most at risk age-group (PHE, 2019). Research in 2017 found that 47% of young people often don’t use condoms, and 10% have never used one before either (same study). Treating sexual health infections costs the NHS £620m pounds a year; this is no small issue.

Because there is so much information on this topic, I have dealt with some social/cultural stipulations on the main post, but please refer to the STI type, symptoms and testing post. If you are concerned you might have an STI, refer to the resources at the bottom of the blog and seek help from a medical professional. 

What are ‘Sexually Transmitted Infections’?: 

“Any kind of bacterial or viral infection that can be passed on through unprotected sexual contact. It doesn’t matter how many times you’ve had sex or how many partners you’ve had; anyone can get an STI” (Brook, 2020). These “can pass to another person through unprotected vaginal, anal or oral sex, by genital contact and through sharing sex toys” (FPA, 2019). 

Situating STIs

The idea of diseases creates more stigma than necessary, so let’s stick with calling them infections. Longer term, sex education can hope to eliminate shame, and notions of ‘dirtiness’ that are associated with STIs. I won’t lie. Having an STI when you are unsure whom you got it from, and how to treat it can be a terrifying experience. It doesn’t, however, mean there is something wrong with you, or that you are dirty. These ideas have been culturally constructed. It is, predominantly, one of the least discussed parts of sex, from casual conversation to films and media. 

Even in music! You wouldn’t hear a rap or love song about a couple queuing at the STI clinic, or doing a home testing kit together. It’s hard to market sexual health as sexy or romantic, when we have heard such negative discourses concerning STIs. Big up the recent Normal People series: in episode 2, they discuss and use a condom. Yay! – although this should be much more commonplace in media…

Image retrieved here

Given that infections are rising in the UK (most recent data shows a 5% increase), and sexual health funding continues to be cut, the prevalence of STIs and the need to treat them remains increasingly urgent. The experience of waiting for a clinic or not being able to get an appointment is unfortunately becoming too familiar.

STIs IRL

It is beneficial for everyone, not just for public health professionals, to talk about and promote sexual health. Especially as many STIs such as chlamydia and gonorrhoea (incidentally the two most common in the UK), can be asymptomatic

Far from ‘ruining’ the fun by pulling a condom/dental dam out (whoever you are, let’s get rid of the ‘boys have condoms girls are on the pill’ assumptions), you can rest assured (provided the condoms are in date, don’t break etc.) that you will have the headspace to fully immerse yourself in the safe sexual situation you’ll find yourself in

Just a top tip: external condoms (and internal condoms, otherwise known as femidoms, are inserted into the vagina or used for anal sex although not as popular) are barrier methods of contraception that protect against STIs and pregnancy. So you might as well use them given their dual benefits. With perfect usage, they are 98% effective. That means that 2 out of 100 people with vaginas using them will get pregnant across one year. Dental dams are used for oral sex on vulvas, as not only people with penises enjoy safer oral sex (pun intended, lots of people enjoy oral sex), although these were unfortunately discontinued in the EU. See here how people make their dental dams from external condoms.

Talking about STIs

If you’re finding yourself in the situation where you are about to engage in sexual activity and someone offers excuses such as: 

  • They don’t feel nice for me”
  • “They’re too tight”
  • “They kill the mood”
  • “I don’t need one, you are/I am clean”
  • Etc…

You can do a few things:

  1. Initially, don’t shut them down. They might not have much experience using condoms, or have absorbed cultural assumptions that they make sex less enjoyable. Pleasure is personal; although condoms may affect pleasure, there are a plethora of brands to try out. Skyn condoms are very popular (a thinner feel, latex-free), and if you are under-25 and live in London, you can sign up for a ComeCorrect card scheme which runs in most boroughs: entitling you to 6 free condoms a week. If people don’t feel comfortable going to get them for free, they can always bulk buy them online.
  2. Express your feelings around sexual health, and that you are unwilling to consent to sexual activity without a condom. If someone removes a condom during sex, this is called stealthing, is illegal and a form of sexual assault. If they vehemently protest, or are rude to you, and it’s possible, try and remove yourself from the situation. You only want to be having sex with people that respect your sexual health. I’ll cover consent properly at a later point, as before safety and contraception, consent is needed for all and every form of sexual activity. It’s also important to disclose your sexual health status so that people can give their informed consent. 
  3. If you are on contraception and both get tested regularly, you can discuss this at the time (or before), and then you’ll know your sexual health status before sexual activity (the goal!)
  4. You choose not to have sex, get tested individually, and maybe go condom shopping together (dams are no longer on the market 😦 ). Get a selection to try, and have some fun!

It is important to avoid naming/shaming/judging others sexual health. The ‘human error’ element of sexual health means that drinking, improper use, forgetfulness, spontaneity, awkwardness etc. can affect the praxis of it. However, even if young people are notoriously ‘worse’ at their sexual health, this doesn’t have to be the fixed tale. The truth is that many people will get STIs in their lifetime. We all might forget about our sexual health from time to time. Even if your partner has a negative result, you could still carry an infection (FPA, 2019). So if you get an STI, notify your partners ASAP; some clinics can even do anonymous partner notification on your behalf. 

Inevitably, sexual health should be a shared responsibility. If you are using longer acting contraception, but have multiple new partners: always use condoms until there is some guarantee of exclusivity. Otherwise, you could still transmit an infection. If exclusivity isn’t your thing, then do some me-search and stock up on your favourites to have on hand. 

From @sexpressionmanchester on Instagram

Ultimately, the more open we are with our sexual health status, the more it becomes normalised! 

Main lessons: 

  1. Diagnoses alone, a young person in the UK is diagnosed with an STI every 4 mins (PHE, 2018). Considering that most people think they are less at risk of STIs, it is imperative to get sexual health testing, use condoms/dams, know your body and check for anything away from its ‘norm’. 
  2. Most people at some point at their lives will have put themselves at risk, or will get an STI infection. Respond to people who disclose their STI status to you with care.
  1. If you feel internal judgement/shame/fear towards STIs, read more or listen to podcasts. Hearing people speak about them free of shame can be music to the ears. 

Resources

Reading:

Listening:

Watching:

NHS Highland – Condom demo: in case you didn’t see at school/forgot 

References

Brook. (2020). Sexually Transmitted Infections. Topics Webpage. (Accessed online: https://www.brook.org.uk/topics/stis/ 27/04/2020) 

FPA. (2019). STIs Overview. STIs Webpage. (Accessed online: https://www.sexwise.fpa.org.uk/stis/stis-overview 27/04/2020)

PHE. (2018). An STI is diagnosed in a young person every 4 minutes in England. News Webpage. (Accessed online: https://www.gov.uk/government/news/an-sti-is-diagnosed-in-a-young-person-every-4-minutes-in-england 27/04/2020)

PHE. (2019). Sexually transmitted infections and screening for chlamydia in England, 2018. (Accessed online: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/806118/hpr1919_stis-ncsp_ann18.pdf 27/04/2020)

STIs: types, testing and treatments

This blog post describes the various main types of STI’s, symptoms, testing and treatment. They are generally categorised as bacterial, viral or parasitic.

Lets start with the most common…

  1. Chlamydia: bacterial. Represents 49% of all new STI diagnoses in the UK in 2018, and is most prevalent in the under 25s age group. Testing at least 2 weeks after unprotected sex.
  • The reason why it is so important to test for chlamydia is that many people are asymptomatic – 70% of women are, and they also account for a higher amount of chlamydia infections (PHE, 2019)
  • Chlamydia testing has gone down by 22%, although infections increase
  • This is an infection you can get in the throat, and eyes, where it can be irritable, swell, cause pain, have discharge (FPA, 2019). It is less frequently passed on through oral sex (NHS, 2018)
  • Symptoms for people with vulvas: bleeding between periods and/or heavier periods (including if you’re on hormonal contraception), after sex; pain and/or bleeding when you have sex; lower tummy pain (from the pelvis); pain from vaginal discharge when weeing
  • Test: a swab (like a massive cotton bud) inserted into the vagina, circling 5-10 times inside (FPA, 2019)
  • Symptoms for people with penises: a white/cloudy/ watery discharge from the penis; pain when weeing; rarer: pain in the testicles (FPA, 2019)
  • Test: urine sample. Throat/anus swab for people with penises having sex with each other
  • Treatment: antibiotics for anywhere between 3-12 days. Repeat test 3 months after
  • Long term: can affect fertility (Brook, 2020)
  1. Gonorrhoea: bacterial. Second most common in the UK, a 26% increase (PHE, 2019) owing to drug-resistant strains (known as XDR-NG). Testing at least 2 weeks after unprotected sex.
  • Commonly transmitted through oral sex (NHS, 2018)
  • Similar to chlamydia, infections can be in other parts of the body. Same tests
  •  Symptoms for people with vulvas: any abnormal vaginal discharge could be thin/watery/yellow/green; painful when peeing; lower tummy pain/feels tender; occasional bleeding between periods or heavier periods (including if you’re on hormonal contraception) (FPA, 2019)
  • Symptoms for people with penises: An unusual discharge from the tip of the penis – the discharge may be white, yellow or green; painful peeing; rarely, pain or tenderness in the testicles
  • Treatment: antibiotic injection, and then a tablet (ibid). It is becoming increasingly treatment-resistant
  • Long term: can affect fertility (Brook, 2020)
  1. Genital warts: viral. Caused by the HPV (human papilloma virus). 
  • Two types of virus (6 and 11) that cause warts, but not cancer (FPA, 2019). HPV (other forms) can cause cervical cancer. 56% decrease due to the introduction of the HPV vaccine as young women were vaccinated before this data was collected
  • Can be spread skin-skin. More likely to be passed on if someone has visible warts. It is less frequently passed on through oral sex (NHS, 2018)
  • Symptoms: see here for the list of where they develop on the body. Can be itchy, inflamed. Some people might bleed from the anus and urethra
  • Most people don’t develop visible warts. Clears from the body over time, but can grow and are infectious
  • If they do, at least 3 weeks to show, but you can get tested immediately. Main test is visual
  • Treatment: cream (specific for genital warts), freezing, heat, surgery, laser (local anaesthetic) (ibid)
  1. Genital herpes: viral. Caused by herpes simplex. Two types: HSV 1 and 2. Accounts for 8% of 2018 STIs (Brook, 2020).
  • Commonly transmitted through oral sex (NHS, 2018); see here for more information on transmission (it’s quite complex)
  • Outbreaks can last 2-4 weeks
  • Virus becomes inactive over time
  • Symptoms: people tend to get a stinging/itching in the genital/anal area, owing to small blisters which burst and leave sores (FPA, 2019)
  • Test: visual, swab, occasionally blood test for antibodies
  • Treatment: antiviral tablets within 5 days of the first outbreak. Can take them again if more outbreaks for 1-3 days. >5 outbreaks/year = longer course of treatment. Tips for soothing treatment and ways to prevent outbreaks found here (useful for everyone to know!)
  • Long term: there is no cure, so you can get more outbreaks. They tend to be less severe, and your body will produce antibodies against it (Brook, 2020; FPA, 2019)
  1. Syphilis:  Bacterial. 7,541 diagnoses of syphilis reported in 2018, a 5% increase since 2017 (PHE, 2019).
  • Commonly transmitted through oral sex (NHS, 2018)
  • Stages: early (primary and secondary syphilis), latent, late (FPA, 2019). The latent has no symptoms. It can appear 2 weeks – 3 months after contact
  • Having syphilis means you can be at a greater risk of contracting HIV
  • Primary symptoms: ulcers anywhere on the body, but tend to be around/on the genitals.they are very infectious, can take 2-6 weeks to heal (ibid)
  • Untreated syphilis develops to a second stage after 4-10 weeks of any ulcers showing (ibid)
  • Secondary: more symptoms. Painless rash, wart-like growths, flu-like illness, patchy hair loss, white patches on tongue/cheeks/roof of mouth (ibid)
  • Latent: no symptoms but a positive blood test. Can pass on
  • Later syphilis has more serious health implications, but is much rarer in the UK (ibid)
  • Testing: if you think you might have it, get tested as soon as possible. Blood test and physical examination to look for bodily symptoms such as ulcers/growths. Swabbing ulcers 
  • Treatment: antibiotics. Often with penicillin. Let your healthcare professional know if you have a penicillin allergy. Primary, secondary, latent syphilis can be cured. Late phase can cause longer-term damage
  1. Trichomoniasis: Parasitic; the parasite is called Trichomonas vaginalis. 

 (When I started my job, I had never heard of this one. And I’d already been teaching sex ed at uni. So no worries if you’re confused. Again, around half of people don’t get symptoms for this one. It’s rarer in men (FPA, 2019).

  • Mainly spread through unprotected vaginal sex, affecting the vagina or urethra
  • Symptoms: burning during urination, discharge (can be frothy, yellow, thick, thin, strong smell), itches, pain from soreness/inflammation. They can show up a month after contracting
  • Testing: can be asap if you’ve been in contact with someone you think might have trichomoniasis. Swab in the vagina, or tip of the penis. They can be looked at under a microscope in real-time or sent off for testing. Takes 10 days
  • Treatment: antibiotics. Can be one dose or over a week

7. Scabies: Parasitic (tiny mites) Can take 6 weeks for symptoms to show (FPA, 2019).

  • Passed on with close body/sexual contact with someone who already has scabies. They live for up to 72 hours away from the body, so can exist on clothing/bedding
  • Symptoms: itching (often noticed at night), itchy red rash, tiny spots, inflammation, broken skin
  • Again, if you think you might have it, get a checkup ASAP. Can be tested visually/microscopically. Likely to receive treatment immediately even if it’s only suspected
  • Treatment: neck-down whole body overnight lotion treatment for 12 hours. Hot wash affected clothing/materials

8. Public lice: Parasitic. Sometimes called crabs. Tiny lice that live in pubic hair (Brook, 2020).

  • Can take weeks to show symptoms. It is less frequently passed on through oral sex (NHS, 2018)
  • Symptoms: itching in affected areas. Brown eggs, sky-blue spots after a few days, tiny specks of blood (ibid)
  • These can be found in the hair on the body such as on the armpits, legs, chest, but they are different to head lice (FPA, 2019)
  • ASAP testing again like with scabies
  • Treatment: lotions/shampoos/cream for pubic lice. They vary for how long they’re left on, usually need to be repeated within the week – depends on brand etc. (ibid), also need to hot wash things in your house that have made contact with your body

9. Bacterial vaginosis. This can develop after having sex, but isn’t only sex-related. If you have unusual discharge from your vagina, this is thought to be the main cause. Only affects people with vaginas, of which 1 in 3 will get this across their lifetime (FPA, 2019).

  • Symptoms: discharge becomes thin, watery, changes to a different greyer colour and can smell ‘fishy’, which can be amplified after having sex (ibid). See ‘typical’ female discharge info here
  • It can be that people get BV often, and sometimes have to do extensive research to find out the causes
  • Essentially, someone has less of the usual vaginal bacteria – called lactobilli – and the vagina becomes more alkaline (FPA, 2019). When people say people with vaginas shouldn’t use ‘Femfresh’ hygiene products, this is because the vagina cleans itself and usually regulates its own environment (Brochmann & Dahl, 2017)
  • It can, unfortunately, be more common if: you use medicated/perfume soap when cleaning yourself which introduces unfamiliar bacteria, ‘douche’, clean your underwear with a particularly potent laundry cleaner, or you are a smoker (FPA, 2019). It is also thought that: “hormonal changes during the menstrual cycle, receiving oral sex, semen in the vagina after sex without a condom, an intrauterine contraceptive device (IUD) and genetic factors may also play a part” (FPA, 2019)
  • Test: an examination, a swab and/or a pH test of discharge from the vagina
  • Treatment: antibiotics in pill form or creams or gels. Different treatments

10. Thrush. From a “yeast fungus” (FPA, 2019). The fungus inflames mucous membrane (Brochmann & Dahl, 2017), which cause the symptoms. Similar to BV that it doesn’t always come from having sex but can be brought on by increased sexual activity. 75% of people with vaginas will get this over their lifetime. People with penises don’t often get it (FPA, 2019).

  • More likely to get thrush if: wearing tight clothing, synthetic underwear, on antibiotics, pregnancy, chemo, illnesses that affect your immune system. Similar irritants affect BV like feminine hygiene products (ibid)
  • Symptoms: itchiness, feeling sore, red area, fissures (similar to the feeling of paper cuts (ibid)), thick white, “cottage-cheese like discharge” (ibid), the same can happen on the penis, with painful foreskin
  • Test: examination and swab. As some of these symptoms might be similar to other STI’s, it’s good to get tested at the same time
  • Treatment: antifungal cream for your genitals, pessaries (pills inserted into the vagina), pills – or a big ol combination

11. UTIs. these are caused by bacteria from the anus making their way into the urinary tract (includes infection of the bladder, kidneys, urethra (NHS, 2017). 

  • The risk is at least 60% higher than normal in the two days following intercourse for women < 30 (Brochmman & Dahl, 2017)
  • See more: non-gonococcal urethritis, cystitis, urethritis
  • Symptoms: needing to wee a lot, burning when weeing, bloody/smelly/cloudy wee, tummy pain, feeling ill (NHS, 2017)
  • Go and see a GP, they might need a urine sample from you to test; treatment is usually prescribed antibiotics and it should clear up in a few days

12. Hepatitis B. viral. It has flu-like symptoms. It can be long term and is treated with antiviral medication. Blood tests. Longer-term it can affect the liver (Brook, 2020). There are also other forms of Hepatitis (C is most common in the UK but mainly transmitted by the sharing of needles (ibid)). No ‘cure’ if you get a longer-term infection, but it tends to ‘go away’ for most people (NHS, 2019).

13. HIV (human immunodeficiency virus) viral. 108,800 people have HIV in the UK, 7,500 of those are reckoned to be undiagnosed (THT, 2020).

  • The virus stays in the body for your lifetime. There is a difference between HIV (virus) and AIDS – it “stands for acquired immune deficiency syndrome” (FPA, 2019)
  • Testing: blood test checking for antibodies. Window period: 1 – 3 months for the infection to show (Brook, 2020)
  • People get symptoms soon after (two weeks) an infection, called the ‘seroconversion illness’ (Brook, 2020). They can be flu-like, or much more severe like meningitis and other hospitalisable conditions (Brook, 2020; FPA, 2019). Sometimes after this people do not have symptoms for a long time: this causes long term damage where people experience weight loss, more serious “life-threatening illness” (Brook, 2020)
  • As I’m not an HIV expert, see the below: “HIV lives in the blood and some bodily fluids, so to get HIV, one of these fluids from someone with HIV, has to get into your blood. The virus exists in blood, semen (including pre-come) and vaginal fluids. The commonest way for HIV to be transmitted from one person to another is through having unprotected vaginal or anal sex” (Brook, 2020)
  • Rarely transmitted orally but if it was, this could be with an infected person and someone who had a mouth ulcer
  • Now treatable, but there is no long term cure. People can have an “undetectable load” (FPA, 2019) meaning that they can’t pass the virus on if they are on anti-retroviral medication and their infection has been treated and ‘caught’ early. This medication stops the HIV growing and working, which gives the immune system a chance to repair (Brook, 2020)
  • Certain communities more at risk in the UK: MSM (men who have sex with men) and heterosexual Black African people (ibid)
  • PrEP: ”a medication taken by someone who’s HIV negative to prevent them from acquiring HIV. PrEP has proven to be effective for people who are at especially high risk of acquiring HIV” (ibid)
  • PeP: post-exposure, 28 days of strong medication (Brook, 2020)

Where to now?

I hope everyone learned something new, and feels a little more reassured about the various STIs that can be transmitted. Apologies if this information has overwhelmed anyone; it’s kind of a mini dissertation. Shows how much we all need to know, and the more you know, the more powerful you are!

Believe it or not, this isn’t even the FULL list, just the most heard of/tested for. It is thought there are at least over twenty. Check how STI treatment affects having sex/condom use when you go and get treatment; it differs for all of them and depends on the severity of the infection. 

Further, one of my colleagues will do an LGBT sexual health special, so keep your eyes peeled. I hope that in the future, young people persist with their sexual health, even if they are obstacles in their way.

References

Brochmann, N & Dahl, E. S. (2017). The Wonder Down Under: A user’s guide to the vagina. Great Britain: Yellow Kite

Brook. (2020). Sexually Transmitted Infections. Topics Webpage. (Accessed online: https://www.brook.org.uk/topics/stis/ 27/04/2020) 

FPA. (2019). STIs Overview. STIs Webpage. (Accessed online: https://www.sexwise.fpa.org.uk/stis/stis-overview 27/04/2020)

NHS. (2017). Urinary Tract Infections. Conditions Webpage. (Accessed online: https://www.nhs.uk/conditions/urinary-tract-infections-utis/ 27/04/2020)

NHS. (2018). What infections can I catch through oral sex? Sexual Health Webpage. (Accessed online: https://www.nhs.uk/common-health-questions/sexual-health/what-infections-can-i-catch-through-oral-sex/ 01/05/2020)

NHS. (2019). Hepatitis B Treatment. Conditions Webpage. (Accessed online: https://www.nhs.uk/conditions/hepatitis-b/treatment/ 27/04/2020)

PHE. (2019). Sexually transmitted infections and screening for chlamydia in England, 2018. (Accessed online: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/806118/hpr1919_stis-ncsp_ann18.pdf 27/04/2020)

THT. (2020). HIV statistics. About HIV webpage. (Accessed online: https://www.tht.org.uk/hiv-and-sexual-health/about-hiv/hiv-statistics 27/04/2020)