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)

A Comprehensive History of Sexual Health

With a UK focus…

Why sexual health?

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

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

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

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

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

Timeline 

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

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

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

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

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

1930s Latex condoms were produced (FPA, 2010)

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

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

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

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

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

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

1973 Brixton Black Women’s Group was formed. They campaigned against “the discriminatory practice of the contraceptive drug Depo Provera being prescribed to black women on a long-term basis” (British Library, 2020) 

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

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

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

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

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

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

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

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

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

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

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

2005 Non-latex condoms produced (FPA, 2010)

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

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

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

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

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

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

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

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

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

 Retrieved online at Revealed: pill still most popular prescribed contraceptive in England

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

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

 In 1970 the FPA commissioned this famous advert, to highlight dual responsibility concerning sexual health

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

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

Image retrieved online at The Black Women’s Movement – Black Cultural Archives

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

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

Poll conducted on my Instagram (@ffiennes) in April

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

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

Resources

Reading: 

Listening:

Dr. Annabel Sowemimo on Hannah Witton’s podcast

Watching:

References

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Introduction

Hey there: for anyone who doesn’t know me personally, my name is Francesca!

So: why did I decide to write this blog? The title, Sexual Health and the City, describes many things for me. I would say excuse the pun, but since my impossibly cool twin Sicily approves, we’re running with it. 

Firstly, I currently work for a sexual health organisation in London, so I literally teach sexual health in the city, in varying formats. Before I got this job, I had just graduated from studying Social Anthropology and Sociology at the University of Manchester. When I left school in 2014, I did a couple of terms of Midwifery training. Whilst working in a hands-on clinical role didn’t suit me professionally, I remained enthralled in women’s story-telling. This often revolved around reproductive and sexual health, and I would often get told off for chatting to all the new mothers instead of remembering to take their blood pressure.

Fast forward to my final year of uni in 2018, I’m a school’s officer on the Manchester Sexpression: UK committee; a wonderful, national, student-led sexual health charity, which runs a combination of free school and university sex education sessions (this volunteering role helped me get the job I have now!) in the respective local communities.

Secondly, my introduction to sex, female pleasure, sexual health and general female empowerment came from the TV show Sex and the City. My twin and I used to watch this with my open and sex-positive family, oftentimes with some very influential best friends around (Molly(s), I’m talking about you). We must have been around twelve when we saw our first episodes, though obviously we didn’t understand all of the sexual references. Fast forward to the present day and much of the 2010s have opened up conversations that elucidate many an issue with the show: notably, the lack of cultural diversity, the lavishness of lifestyle (despite proclamations of a ‘broke’ woman who can somehow afford Louboutins), and in some ways the sexist and misogynistic undertones that the characters adhere to or more, the writers feed into. Other recent TV shows, such as Issa Rae’s Insecure shroud Sex and the City by being more diverse, current and realistic. However, ‘woke’ Charlotte on the Instagram account @everyoutfitonsatc provides some respite to the show’s downfalls. During this unprecedented global pandemic (if anyone reads this in the future I’m referring to the COVID-19 lockdown of 2020 – wild times), some SATC memes have given me food for thought and genuine belly giggles. See below.

Retrieved from Instagram

Thirdly, I believe that sexual health and wellbeing are a collective concern; it might occupy the domain of the private, but really, we are embedded and move through and between communities, spaces, countrysides and countries etc. Our connectivity and collectivity offers us the chance to incorporate sexual health in a macro manner. Hence, I will be looking at sexual health broadly, as opposed to speaking about my personal sexual health and experiences by taking a wholly objective approach.

In December 2019, I got an article published based on my dissertation on Restless Mag, which focused on how women discussed their experiences of sexual violence on Twitter, and how underreporting influences whether victims are believed or not (read the piece, Believe Her here). Now I find myself in the privileged position of having extra time at home, I was forced to stop listening to the imposter syndrome voices in me and get on with it. Whilst such voices are at times self-protective, they can hold us back. So, I began properly writing and researching again. 

Before we get more stuck into the blog and the journeys it will take us on, it is necessary to highlight that I will be working with the WHO definition of sexual health, which holds that it is: 

“…a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.” (WHO, 2006a) 

Taking a holistic view of health, and significantly of sexual health, means that we can consider how society and culture has and continues to influence our sexuality and sexual lives. The compartmentalisation of medical from social leads to unuseful divides, yet informs much of the way we might access sexual healthcare vs. how we talk about and relate to sex. Why is it that we know that sexual health is important, but we know so little about orgasms, or what having STI treatment feels like?  Why has there been so much controversy/illusion/smoke around sex, reproductive history, empowering sexual health messages, as if gasp knowing more about sex could be some kind of good thing?! 

The sex-positives of us may reach out and saturate our lives with podcasts, books, events, films etc. But what about those who could know more, but don’t actively seek this information out? Those who feel like they should know more, but weren’t offered the tools to be able to build new knowledge? Although I will inevitably focus slightly more on people who are women/have female reproductive systems (whose sex lives have also been most policed throughout time), this content is intended for any young adult to read: for the individual, partners, friends, family, colleagues etc. Many young adults might have had the bulk of their formal sex education, but find themselves at their most sexually active in life thus far. Keeping this in mind, I will keep the blog as inclusive and accessible as possible so that anyone regardless of their experiences, sexuality or gender will be equipped with empowering tools and information. 

Although I want to use this blog to compile some fun resources for young adults, I will also look to academia to describe some of the phenomena we see, as the nerd/perfectionist in me needs to write cohesively. As a rule of thumb, medical anthropology will be an interesting academic field to draw upon. 

In order to continue my own education, delve into some academia and crunch it into genuine and enjoyable content, this blog will aim to: 

  • Analyse wider societal topics that relate to sexual health, sex education, and sex in general 
  • Reflect on some of my professional experiences, and aim to draw out useful themes 
  • Collaborate with and interview people who are knowledgeable and passionate about sexual health and related topics, and need to offer their voices online as well

We’ll see where this leads us… and remember: your sex education never has to end.


So here we are… Sexual Health and the City.