Posted in Good Question?!

What is Sex?!

Both as a Doctor and as a Sex Ed Facilitator, I get asked questions about sex a lot. Sometimes this is in spaces that are designed for that, such as a in classroom sessions. Sometimes it’s a furtive WhatsApp query from a friend or someone ‘@ing’ me. Today I’m starting a collection of some responses to some of the interesting ones.

This one ‘comes up’ in that it’s one we tend to pose to explore assumptions children and sometimes adults have…

*Heteronormativity. It happens.

Posted in Genitals: A User's Guide

Bloody Periods

Much of my primary school experience rolls in to one, but learning about periods is one of the more vivid memories I have.  All of the girls in year 6  were segregated from the boys, marched off into an assembly room and shown a video.  We were each given a bag of period products at the end.  I don’t know what the boys learnt about.   They might have been shown the same video.   They were definitely not given the goody bags, as this later became a point of contention!

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This was in the 90s, so we were limited to being told about disposable tampons and sanitary pads.  Overall, we weren’t given any guidance on why we might want to use a certain type of product over another.  We were only told how they worked in very basic terms.  Talking to other friends about managing periods, very specific individual needs and preferences need to be taken in to account.  For example, I hate using anything disposable because of the environmental impact.  I also can’t get over the similarity in principle between nappies and sanitary pads and find this really off-putting.  One of my friends however, just doesn’t feel she would every be comfortable inserting a tampon.  Another feels the same way as I do about disposable period items but can’t bring herself to wash and use a menstral cup.  Here’s a rundown of some of the things people do with their period blood.  I’ve based this information on mine and friends’ experience of using various methods and medical experience, as well as questions that come up a lot in sex ed workshops…

TAMPONS

A bundle of soft, absorbent material which is inserted in to the vagina to soak up blood.   They sometimes come with ‘applicators’ – card or plastic tubes that help to insert the tampon further in to the vagina.  There is a string that sits outside the vagina, which can be pulled to remove the tampon.  The tampon (but not the packaging or any applicator) is designed to be flushed down the toilet, like toilet paper.   They are a disposable method, so obviously have an environmental impact.   Manufacturers often suggest leaving them in for between 4-8 hours.  They come in various sizes – smaller tampons absorb less blood and so are for lighter periods, larger ones for heavier periods.   Tampons seem to be the period product that people frequently concerns about:

  1. Toxic Shock Syndrome.  This is an infection that can be caused by a foreign object left in the body for a long time, including a tampon.  It is quite rare though, especially if tampons are changed regularly.
  2. Penetration.  Many people have worries about it being painful to insert a tampon.  Tampons are typically only a couple of inches long though, which is much smaller than some of the other things that people easily fit in and out of vaginas (baby’s heads, dildos and penises for a start!).   It might take a bit of practice to do it easily, but many people find that this is something they can learn to do.  Others worry that it ‘counts’ as losing your virginity if you’ve used a tampon before you’ve had penetrative penis-in-vagina sex.  ‘Losing your virginity’ is a social construct which relates to what you find arousing so this is just not true for most people!
  3. Getting stuck.  As someone who’s been the oncall doctor for an out of hours Gynaecology service, this is something this does sometimes happen.  People do insert tampons which they later feel they can’t remove.  However, there are manoeuvres you can try that really do work… and if it doesn’t I’ve never seen a ‘stuck’ tampon that couldn’t be removed easily in a clinic setting.

MENSTRUAL CUPS

These are my personal period product of choice!  The can take some getting used to and you may well splash a small amount of blood about getting to grips with them.  But once you have you may grow to love these reusable, washable devices that sit in the vagina and collect blood.  This is then emptied in to the toilet bowl.  The cup can be washed with water in between uses and sterilised in between cycles, so is completely reusable and produces minimum waste.  Cups don’t seem to be very widespread at the moment – I found out about them from a sticker on the back of a loo door!  There are several different brands.  I use Mooncup – basically because this was the only one that was available at the Chemists when I bought mine.  I’ve been told by a friend that their sizing is not the best however.  All manufacturers make cups of different sizes, again according to how heavy a person’s period is.

SANITARY TOWELS

Pads or towels are absorbent material made in to a pad that lines your underwear.  Unlike tampons, there is usually a large plastic component, which is not possible to flush down the toilet.   Reusable pads – ones that can be washed and reused – are becoming more widely available. They can be bought or made.  Free patterns for making your own are available online, such as here from Luna Wolf.  More recently pads seem to have been extended to ‘period pants‘ – where the bit that soaks up the blood is built in to underwear and the whole thing is washed.  

FREE BLEEDING

There is of course the ‘do nothing’ option.  Some people choose to sidestep all of the above and opt for free bleeding.  This is when nothing is used to collect period blood and someone simply allows their clothing to soak it up.  This often seems to be done as a point of political protest, such as against the ‘tampon tax’.  This might partly be because free bleeding in and of itself is seen as a political act, such as when runner Kirin Gandhi free bled during the London Marathon.  There are probably many more people who unintentionally or unwillingly free bleed, due to lack of period product resources.   ‘Period poverty’ seems to be an issue worldwide, with campaigns against it evident in both developed and developing countries.

Posted in Anatomy, SRE

Lark in A Park

As well as facilitating Sex Ed workshops in schools for the last month, I’ve been involved in a few events aimed exclusively at adults.  Although the style of presentation has been different, these have all involved using an arts & crafts or D.I.Y approach.  These events reaffirmed my belief in this as a particularly good medium for exploring personal issues in a fun, engaging and accessible way.

The first was a ‘genital making’ workshop, hosted by the Candid Collective.  Adapted from an activity used to teach children about anatomy, puberty and health, this saw us showing adults how to make vulvas and penises with air drying clay to then be turned in to fridge magnets!  Held in a cosy upstairs room of a pub in South London, it had a very different feel to the classroom and was lots of fun.

The second was a talk for the antiuniversity lecture series – in which a group of us took to a local park to talk about arts and craft as a medium for discussing bodies and our own experiences of sex ed.  This culminated in making a ‘zine page about some of the issues that had been brought up.

There are a couple of future crafting themed sex and relationship events (in London) for adults that you may be interested in:

Thanks to Lisa, Leah, Adam and Bel for the images!

 

 

 

Posted in Genitals: A User's Guide

Blue Waffle with a Side of Misogyny…

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Sometimes being a facilitator for Sexplain involves attempting to hold the attention of young people through wit, honesty and sheer confidence as you explain a specific curriculum point as your unembarrassable self.  At other times it involves asking questions your audience may not have considered before and standing back whilst a tide of answers hits you.

“Can anyone name any sexually transmitted infections?”  My colleague asked of a group of year 10 students just outside of London.  Three off us were delivering a workshop on sexual health.  This was definitely going to be one of the latter type of encounters.  Luckily, this group wasn’t a shy one and answers came flooding forward.

“Chlamydia”, “syphillis”,  and “gonorrhea” were proffered.  All good answers and affirmed as such.

“Mono” was suggested, the infection also going by the name of ‘mononucleosis’ or ‘glandular fever’ – the ‘kissing disease’.  By our extremely wide definition of ‘sex’ (any behaviour that someone finds arousing) completely valid and a good opportunity to bring this in.

“HIV” was another suggestion, to me offered surprisingly late.  Once seen as the sexually transmitted infection in the UK, hopefully this reflects a reduction in stigma and fear around this disease as treatment and prevention becomes so incredibly effective.

“Crabs” one pupil proffered- a nice segue in to talking about parasites.  Another good talking point.

And then it came. The complete surprise.

“Blue waffle” one student called out.

This caught me by surprise a little.  I had heard of this before, but only come across it in training and never actually in the classroom before.

If you haven’t come across it before, blue waffle is a fictional STI.  It was something that Amelia and Hazel, Sexplain’s Founders had come across when talking to children in their research original work.  The story doing the rounds at the time was that blue waffle was a disease contracted by women who had had a large number of sexual partners.  At the time a google image search would return pictures of vulvas covered in lesions- very nasty looking lumps and bumps.  To my clinical eye, some of the images looked to be lesions caused by genital warts.  Others looked like erosion and growths caused by vulval cancers.  Interestingly (and perhaps not surprisingly) the rumour ran that it was transmitted to people with vulvas and did not trouble penises at all.  Even though this is how the disease was said to be spread.  Turns out misogyny can be a powerful vehicle for keeping a lie alive – who’d have thought it!

This turned out to be the case for the young person who had introduced it in to the classroom in this instance.  He was quite resistant to my telling him that it was a made-up thing.

“But Miss, if you look on Google, there are pictures!”

I tried to gently unpack this, explaining what I thought these images were actually of.  It was a nice opportunity for a discussion about being critical of sources, particularly those on the internet.  However, I left with the distinct impression that I had only created an aura of doubt in this person’s mind.  I had not completely convinced him it was a total urban myth and an element of belief in blue waffle remained.

Posted in Genitals: A User's Guide

Trouble Down Below

**TW:  mentions of rape**

There are a wealth of products designed specifically for genitals.   Some for aesthetics, some for convenience, some for hygiene, some for pleasure.  It’s certainly true that there needs to be less stigma around products to help with basic bodily functions and/or sexual pleasure.  Take the stigma surrounding period products for example – literally decades of advertising aimed at showing us how unacceptable and dirty periods are.   However, not all products are equal.  Some things that are sold to help your genitals are unnecessary or problematic.   Here are four of (what I think are) the worst!

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Femfresh (other brands exist). 

Femfresh is a range of products for ‘feminine hygiene’ – e.g. washes and scented wipes.   The vagina is self cleaning and the only thing you need to use to keep a vulva clean is warm water and unscented soap.  However Femfresh and its ilk push an agenda that they are vital, with their vagina friendly pH balance giving them the edge over soap (which is the same for water, which is free and comes out of the tap).  The Femfresh website promotes the products using a smiling face of a gynaecologist, ‘Dr Sara’, with a list of advice on how to ‘care for down there’.  Much like the period adverts, euphemisms abound – the implication being that your vulva is smelly and dirty and only buying this type of product can fix that.  The branding is phenomenally successful.  As a facilitator for Sex Ed classes to young people, I am often asked about this product, by name.  It can be quite difficult to assert that it is unnecessary and a person’s genitals are completely normal and healthy in the face of such advertising and branding.

 

Vaginal Douches

Like Femfresh, but super-charged!  Vaginal douches are devices and products that ‘flush out’ the vagina – unfortunately taking all of the natural bugs and secretions that keep the vagina health with them.  Just say no!

 

The Consent Condom

This is definitely one from the ‘road to hell is paved with good intentions’ department.  Sold with the tagline ‘consent is the most important thing in sex’, this is a condom that requires two people (or at least four hands working together) to open the packet.   It received quite a backlash when it came out.  People were quick to point out that flaws – such as rapists not necessarily caring about using condoms, or having the ability to work in pairs.  The consent condom also implicitly buys in to the idea of consent as a single moment of ‘yes’/ ‘no’.  Consent should be reversible and always up for discussion.  Even if you’re in a long term relationship and sex is something you do regularly.  Even if you said ‘yes’ at first and then changed your mind.  Even if you helped someone open a condom packet holding two of the four pressure points.

 

Anti-Rape Wear

This is underwear marketed as only being able to be removed by the wearer.  It is reinforced to prevent cutting and tearing off by an attacker.  Originally designed and crowdfunded by a victim of sexual assault, this is probably again something made and marketed with noble intentions in mind as well as profit margins.  Given the state of the world, fear of sexual assault is very understandable.  However, I just don’t want to live in a society we focus our efforts on designing things to make people less rapeable.  We need social and structural change, not ‘rape-proof’ clothing.  Additionally, anti-rape wear reinforces the idea that sexual attacks are committed by strangers when a person is out and about in the world.  In fact, most victims of sexual assault know their attacker – be it a family member, friend or partner.   It is hard to see how anti-rape wear will be of much use  unless it is worn at all times and in all places – except for those brief moments when you need to either pee or have penetrative sex with someone and definitely won’t change your mind at any point (which we’ve already established you have a complete right to do).

These are my four.  Tweet me if you think of any more or disagree – @squisquasque…

Posted in #gayrightsarehumanrights

5 Star Luxury Brand Funds Homophobic Murder.

Earlier this week Brunei’s Sultan brought in laws that makes sex between men and adultery punishable by stoning.  Sex between women is punishable by caning and imprisonment.

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‘Anal sex and adultery is what luxury hotels were made for’

Homosexuality was already illegal in the Kingdom, but with imprisonment and not with the death penalty.

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‘Protect Queer Muslims’

Today (Saturday 6th April) there was a protest outside of the Dorchester hotel.

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On the steps of the Dorchester Hotel
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Cream tea and death by stoning at the Dorchester Hotel.
LGBT+ lives matter.

The Dorchester hotel is one of the luxury brands that the Sultan of Brunei owns.

Storming the steps. 

In addition to this, the Sultan (Hassanal Bolkiah) holds an honorary law degree from the University of Oxford, another honorary degree from King’s College London and an official honorary title of ‘Companion’ with the Royal College of General Practitioners–  none of which had been revoked at the time of writing.

Love isn’t a choice, but being a cunt is/ We want to be ‘stoned’ not get stoned. 

A boycott of the Sultan’s businesses may not have a significant impact on his wealth.  However,  it is clear from such links with auspicious Western institutions that prestige  mean something to him.

Five star service funding homophobic murder.
Rainbow eye shadow! 
Posted in Genitals: A User's Guide

The Egg and Sperm Race…

A message we all seem to consistently pick up in Sex Ed and elsewhere is “you have unprotected sex, you get pregnant”.  However, if we think about this, we know that it isn’t quite the whole truth.   An often quoted statistic is that around 84% of couples trying to get conceive and having sex twice or more a week will get pregnant in a year (e.g. NHS, 2019).  If you do the sums, you can see that that’s an awful lot of sex not resulting in a pregnancy!

So, why not?  Well, pregnancy relies on four conditions that need to be met (Impey and Child, 2012):

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Firstly, an egg must be produced.  An egg is produced by the ovaries once every cycle and is only viable (capable of being fertilised) for a few days.   Sex outside of this time is less likely to result in pregnancy – remember though that sperm can live inside the vagina for up to seven days.  This means that penis-in-vagina sex that happens up to seven days before this ‘fertile window’ can still result in pregnancy!

Secondly, adequate sperm must be released.  ‘Adequate’ means that the number and quality of the sperm in ejaculate must be sufficient to fertilise an egg.

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Thirdly, sperm must reach the egg.  Lots of contraceptive methods work on this part of the process – for example from preventing sperm from entering the vagina and the womb (condoms) or by preventing the egg from travelling from where it is produced in the ovaries to the womb, via the fallopian tubes (tubal ligation, sometimes called ‘female sterilisation’).

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And lastly, the embryo (i.e. an egg fertilised by a sperm) must implant in to the lining of the womb.  This allows the embryo to survive and develop.  Again, some contraceptive methods work partly by altering this process (e.g. the copper coil or the ‘morning after’ pill).

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So, all of these four factors need to align to result in pregnancy!

 

 

References

Impey., and T. Child., (2012) Obstetrics and Gynaecology. Fourth Edition. Wiley-Blackwell: Electronic Copy.

NHS online, Overview Infertility, (Accessed online 2nd April 2019).

 

 

Posted in Genitals: A User's Guide

Hidden Depths

The clitoris used to be  represented and thought of as a small ‘pea’ like structure, sitting above the urethra (Enright, 2019).  It wasn’t until relatively recently when Professor Helen O’Connell fully investigated and modelled the full extent of the clitoris in 1998 (Fyfe, 2018).  O’Connell is a Urologist (a type of doctor, who specialises in surgery in areas of the body including the bladder and urethra).  She used cadavers to map fully map out the clitoris, demonstrating that it was a much bigger structure.  Like this:

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The structure of the clitoris, showing its relation to the urethra and vaginal opening (After Drake  et al., 2010).

It includes structures that are hidden deep to other tissue, such as the corpus cavernosum and the bulbs of the clitoris.  As you can see from the diagram the bulbs of the clitoris are very close to the vagina – even more so when a person is aroused, as they become swollen and more erect by blood being diverted to them, just as the penis does (Drake et al. 2010).

There is an excellent and short French cartoon about the structure, function and history of ‘Le Clitoris’- the only organ that is just for pleasure – here.

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3D printed, scale-sized model of the clitoris

 

References:

Drake, R. L., Vogl, A. W. & Mitchell, A. W. M. (2010) Gray’s Anatomy for Students. Second Edition. Canada: Churchill Livingstone Elsevier.

Enright, L. (2019) Vagina a Re-Education. Croydon: Allen & Unwin.

Fyfe, M. (October 2018) Get Clitorate: how a Melbourne doctor is redefining sexuality. The Sunday Morning Herald.  Accessed online on 21.03.2019 at [https://www.smh.com.au/lifestyle/health-and-wellness/get-cliterate-how-a-melbourne-doctor-is-redefining-female-sexuality-20181203-p50jvv.html}