As a new President has been elected in the US, you might hear campaigners in sexual health talk about ‘The Global Gag Rule’. But what is it and why does it matter to people working in sex and relationship education?
The Global Gag Rule is US policy which forbids NGOs (Non Governmental Organisations – for example, health charities) from taking part in certain activities if they receive US funding.
These activities include providing abortion care directly. But it also includes referring pregnant people to abortion services, simply providing them with information about abortion, or campaigning around legal reform in this area.
So NGOs (Non-Governmental Organisations) that want to receive US funding are effectively ‘gagged’ from working in abortion care – hence the name.
This policy was originally called The Mexico City Policy and was first introduced by the then President Reagan in 1984. Under the Mexico City Policy, the ‘gag’ applies to all of the work that an NGO does. For example, an organisation cannot use funds from another source to fund work in abortion care.
How big a deal is this? Well the US provides a huge amount funding to overseas NGOs. The US can be a major source of funding for NGOs. The Global Gag forces them to balance the importance of abortion care with the need for financial stability.
In addition to this, US culture and political ideology is hugely influential around the world. This is true, even if you are living in a high income country which doesn’t rely on overseas funding from foreign powers, like the UK.
The US position on abortion care is really important right now, at a time when some countries are rolling back on abortion laws – for example in Poland.
So why are we talking about the Global Gag Rule at this particular time? Well, since it was first introduced this policy has been removed and reintroduced several times. There has been a pattern of Presidents from the Democratic Party to overturn the Global Gag Rule, and for it to be reinstated the next time a Republican President gets in to power.
The outgoing US (Republican) President – Donald Trump – is noted to have reinstated the Global Gag Rule. In fact, some people say that his version of the Mexico City Policy made it even more restrictive – for example by making it apply to all of the global health assistance funding, not just that set aside for family planning.
Many people hope that new US President will, as the pattern has been, remove the Global Gag Rule and allow NGOs to be supported in providing essential health care. At the time of writing this, there is an international petition to call on him to do just this.
Rounding off the year, let’s have a look at penises! We (the societal ‘we’) tend to be a bit more familiar with the constituent parts than we are with vulvas…
Glans: This is the tip or ‘head’ of the penis.
Foreskin: This is a fold of skin that covers the glans of the penis. It can be removed, either at birth or later in life, for either medical or cultural reasons in a process called circumcision. Rates of this practice vary across the world and it isn’t as common in the UK as in other parts of the world.
Urethra: The opening of the penis. Semen, urine and discharge can leave the body here. As with discharge from the vagina, this can be normal. Changes in the discharge (e.g. smell or colour), especially when accompanied by other symptoms (pain, itchiness) can however indicate something’s not quite right and might need checking out.
Shaft: This is the main bit of the penis. Internally are found the tubes that carry urine and semen out of the body, as well as blood vessels supplying the penis – this is part of the mechanism that causes the penis to become hard and bigger during an erection.
The average penis size is 9 cm when not erect, although there is a fairly large and health variation in this.
The information here is adapted from an exercise from Sexplain UK, used as part of their SRE lessons. In short, it involves using play dough to build genitals. This exercise can be used to teach people about external genitalia (both penises and vulvas). As an arts and crafts activity, it can be fun and engaging and help to give something concrete to talk around in terms of things like physiology, variation and health. I have also included the recipe I use for homemade play dough.
To make your dough.
2 cups plain flour
1 cup of salt
2 teaspoons cream of tartar
1 tablespoon of vegetable oil
2 cups of boiling water
Something to colour the dough with (optional) such as food dye, paint powder, or a crushed soft pastel
Put all of the ingredients except for the water and colouring in to a large mixing bowl. Boil water and add this to the mix whilst still very hot. Mix immediately using a wooden spoon. Once the mixture is cool enough to handle, put some flour on a surface and lightly knead the mixture for a short time. If you are adding colouring, now knead this in until the dough is roughly all the same shade throughout.
Make sure the dough is left uncovered until it is cool, then cover in an airtight container. It should last for about a week. This recipe makes enough for about twelve people if doing the exercise below.
So, all foetuses have the same general genital structures, regardless of what sex they will become. They then typically (but not always) differentiate in to either a penis or vulva. These are the external genitalia (i.e. the bits you can see).
We’ll look at vulva first, as this is the one people tend to find a bit trickier.
Take your ball of play dough and divide it in to four pieces. With one of these quarters, make a left or diamond shape:
This is the vestibule of the vulva.
Next, take another quarter and roll it in to a sausage shape, about the length of one side of the vestibule and attach it to one side:
This is the labia majora, the fatty tissue that covers the whole vulva and tends to be covered in hair after puberty. Complete it by making another sausage to attach to the other side:
Next, divide the last quarter in to two. With one piece, make a smaller sausage to attach inside one side of the labia majora. This can be flattened if you like:
This is the labia minora. In about half of people with vulvas, the ‘inner lips’ of the labia minora sit outside of the bigger ‘outer lips’ of the labia majora. Let’s complete these. As with the labia majora, it’s not a problem if they aren’t exactly symmetrical:
Next, let’s make a very important structure: the clitoris. Either take a little ball of extra dough, or pinch a piece off from your existing structure:
The bit we can see here only represents the external part – it extends to be a much bigger structure internally. The clitoris is made of very sensitive tissue, with lots of nerve fibres. Some people find it arousing or stimulating when touched gently.
To complete, let’s make the ‘holes’ in the vulva. Get people to guess how many ‘holes’ the vulva contains (guesses I’ve heard range from one to twenty!). For this model, we’ll be looking at two (you can explain that some people talk about a third, the anus, which is actually outside/below the vulva). The first is about a third of the way down and can be marked with a finger or a pencil:
Get students to guess its name – the urethra, and it’s function – carries urine away from the body. It is separate from the next hole we’re going to make. This hole is nearer the bottom of the vestibule and can be marked by making a hole all the way through:
Again, you can get people to guess the name (vagina) and point out that this is the name people often use (incorrectly) to refer to the vulva. You can talk about things that come out of the vagina – i.e. blood (periods), babies and discharge (either healthy or a sign of otherwise, such as thrush or bacteria).
Next, we’ll make a model of a penis.
This time, divide the dough in to two pieces. With the first piece, make a sausage shape:
This represents the shaft of the penis. We can then make a little distinct area by marking out the end:
This is the glands of the penis, which tends to be more sensitive than the shaft. Next we can make a hole in the end (with a pencil or finger). This is the urethra or the penis. Three things can come out of this – urine, ejaculation or discharge.
Give people the option of making a foreskin – pinch off a little bit of dough and fashion in to a thin rectangle to cover the glans. This is a good point to talk about hygiene – e.g. washing with water and changes during puberty, as well as circumcision.
Next, we’ll finish off with making the testicles (scrotum). There is a good chance that students will already have made them with the other half of the dough by making two balls and attaching these to the base of the penis:
This is fine and validate this. Also explain that you can make them from a ‘teardrop’ shape and attach that. You can talk about the misconception that ‘balls drop’ (i.e. they get bigger and hang lower after puberty, but don’t actually ‘drop’ further out of the body).
It can be a nice idea to get the students to look at and reflect on how different all of the bits are. Lots of them seem to ask what ‘normal’ is – this can be a good place to point out that this is something that is highly individual.
We often talk (briefly) about the concept of it being possible to be biologically ‘intersex’ – i.e. it is possible to have someone who doesn’t have external genitalia that fall neatly in to either of these categories.
It can also lead on nicely to talking about internal genitalia and reproductive functions.
I joined the lovely voluntary organisation Sexplain (‘Bringing sexual and relationship education into the 21st Century’) as a volunteer facilitator based on two things. The first was an array of terrible personal experiences of Sex Ed over two decades ago during my time at school. The second was professional surprise at how little people (particularly those with vulvas!) appeared to know about the intimate parts of their own bodies when I started working on a Gynaecology ward.
One of the things that I found a little unrelenting about my own school SRE learning experiences was how much the emphasis around sex was ‘not getting pregnant’. It’s all very well to encourage and teach healthy sexual practices. However, I feel the message went beyond this. In my classroom, romantic intimacy amounted to sex and sex meant penetrative, penis-in-vagina sex only. Pleasure, consent and masturbation were not on the curriculum. Sex was problematic, dangerous, risky – never ‘fun’ or ‘fulfilling’. The ultimate hazard was pregnancy and STIs. Nothing good could come out of sex but if for some reason you found yourself having it, the ultimate consideration was to NOT GET PREGNANT.
It turns out that this world view prepared us badly for adult reality. We learnt how effective a condom was versus a diaphragm, but not how to procure or negotiate the use of either. We learnt that STIs cause discharge from orifices that we had only a crude understanding of.
Another classroom illusion that was challenged, by both my personal life and professional experience, was that there is a ‘perfect’ choice of contraception for each person. For many, contraception can be a compromise, a ‘best match’, or a pragmatic move. It can take in to account what you feel able to negotiate with a sexual partner. Or what you can afford or have the time and resources to obtain. Or choosing something you feel is a bit shoddy, but doesn’t leave you with the terrible side-effects of some methods.
I created ‘contraception top trumps’ because I wanted to look at contraception not as a set of absolutely rational, clear-cut decisions (you fulfil criteria x so you should use y) but as a work in progress. You can learn about and develop an approach to contraception, depending on what is important to you… and unfortunately there’s an element of luck to the whole thing.
I’ve published a printable pdf of contraception top trumps – I would advise printing four pages to an A4 sheet for large print cards and eight for more portable ones!
The link above is for a smartened up and downloadable version of the top trumps game I published earlier this year here on this blog. One of the lovely things about doing this was the interesting and open conversations this prompted with friends. For example -the one person who confessed she’d had a blazing row with her GP about removing the hormonal implant because she couldn’t cope with the emotional changes that came once it was fitted and had been told simply to ‘persevere’. Or the friend informed that they couldn’t have the copper coil fitted because ‘she hadn’t had children’. Or the disbelieving faces that meet you when you look at failure rates of condoms, many peoples’ go-to! Please download, play, share and learn these with whoever you can and start your own conversations.
My estimate of 20% effectiveness from ‘a wing and a prayer’ was based on a statistic I saw that said 80% of couples having sex regularly would conceive within one year. So it’s probably a bit low for one single instance of sex. However, I can’t for the life of me find that and the current online NHS advice on infertility suggests that 84% of such couples would conceive within a year, suggesting a figure of 16%. Either way, it’s not a great method and is incredibly less reliable than actively doing something. I just wanted to show that it was not guaranteed that you would get pregnant every time you had sex, even once, which is definitely the impression that I got from Miss Hargreaves in Year 9…