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

A Cock and Bull Story…

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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.

Posted in Genitals: A User's Guide

Playing Around

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.

Ingredients:

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

Instructions:

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.

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Vulva models made from play dough recipe

 

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:

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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:

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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:

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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:

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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:

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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:

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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:

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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:

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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.

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This time, divide the dough in to two pieces.  With the first piece, make a sausage shape:

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This represents the shaft of the penis.  We can then make a little distinct area by marking out the end:

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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.

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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.

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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:

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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).

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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.

 

Posted in body positivity

Naked Ambition

I’m on holiday abroad at the moment. It’s got me thinking about cultural norms and attitudes to various things, including nudity and attitudes towards sex.

The more I meet and talk to people from outside of my own country, the more I reflect on our own general national attitudes. It’s inherently difficult to get an unbiased and honestly reflective impression of yourself. With that caveat, it seems to me to be evident that in the UK we are a little more uncomfortable talking about sex. Whenever I travel I seem to see a wealth of examples of people being generally more at ease with their bodies. From the presence of wrinkly, black bikini-clad Nonnas on Italian beaches, to the communal changing rooms in Japanese Onsen.

I’ll be taking a few souvenirs back with me to London. Above are some I’d like to share with you: various types of nudes from the Montreal Musée des Beux-Arts. Enjoy!

Posted in Genitals: A User's Guide

A Hymn to the Hymen

The inspiration for this one came from a pub conversation.  It’s time for…

Firstly…

The hymen is a often described as a ‘membrane’.  It is membranous tissue, but this can lead to some confusion-

This is called an ‘imperforate hymen’.  The main reason it needs treatment (i.e. surgical removal) is that it means that menstral blood cannot drain during a period.

So, as with many aspects of genitals, individuals can be VERY different and this is completely normal.

 

References (a note): 

When I have an idea for something, I usually start by looking at some standard Gynae textbooks and then try to find reliable looking online sources (e.g. NHS, clinical guidelines).  They failed me somewhat on this topic.  I’ve found a teeny tiny amount of information from my textbooks (mainly on imperforate hymen).  This is basically a way of explaining why my main source is a wiki page (here)!

Posted in sexual health

Alienation and lip gloss free with every issue.

My friend M and I were reminiscing about the ‘Just-17’ magazine era of our lives recently.   I say ‘reminiscing’, but ‘looking back with discomfort and some introspection’ might be more apt.  We had just attended a volunteer training day with the lovely people at Sexplain – an organisation that provides inclusive sex education.  As part of this, we had been asked to reflect on messages we had picked up about sex when we were younger.   M and I went to school together in the 90s.  This was when the likes of Bliss, Sugar and Cosmo-Girl were the height of sophistication for an adolescent girl.   Contained within their pages were a mixture of fashion, make-up tips, celebrity gossip and relationship advice – with the edgier ones including advice on ACTUAL SEX.  They often came with free lip gloss.

Ostensibly, sounds great – a place to get informal and confidential information on sex.  However sometimes the tone and implicit assumptions of these magazines were what I would now describe as ‘problematic’.   There was very much a dominant, heteronormative view of relationships.  There was an implicit assumption – within advice pieces on how to give a good blow-job, for example – that being anything other than straight just wasn’t an option.  Advice on how to deal with your boyfriend came in many guises, but never what to do if you might want a girlfriend, or something else.  Sex was defined very narrowly as penis-in-vagina penetrative sex.  In addition, the endless parade of smiling, white, stick-thin celebrities and models did nothing good for my self-esteem.  All of that said, before the unfettered internet access of today, this was one of the few places that talked about sex.  Every week.  With an opportunity to write in and ask anonymous questions.

I used to buy the magazine during my trips accompanying my Mum to the supermarket on a Saturday.  I  was interested in them from the ages of about 11 – 14 years (i.e. a fair while before I was going to have sex).  There was a real gap of sources of information for curious teenagers wanting to know more about sex and relationships.   Even if they didn’t do it as deftly as you might hope, they did fill a niche in a way other sources didn’t.  Sex Ed classes at school were too staid and delivered by a deeply out of reach authority figure.   My parents were well meaning, but I think honestly relieved to just get over ‘the talk’.   My friends generally knew as little as I did.

As I’ve said, I was reading the likes of Just-17, Bliss, Sugar, and Cosmo-girl well before I was actually having sex.  By thta time the internet had come along and I could rely on a dubious combination of the world wide web and rumours spread amongst my (now slightly more experienced) peers.  The magazines I remember are now defunct, having died along with much of print media.   Teen Vogue, established in 2003, seems to be the contemporary thing anything like the mags of my youth.  Thankfully, it is somewhat different in content as well as form (online only since 2017).  It contains a ‘news and politics’ section.  It is queer friendly and controversial with it – it first came to my attention during the furore over their publication of an anal sex guide.   I thought a guide to bra fittings was pretty revolutionary in my adolescence – this puts it in to a whole different perspective.  And in an age of sexting, online grooming and internet pornography ‘desensitising’, I see this as a hugely welcome step.   Technology it seems has opened the flood gates on some pretty scary things, but also allowed in a new perspective on sex and relationships.  And I never really liked the lip balm anyway…

Posted in contraception, reproductive rights

Contraception Top Trumps!

Here’s a round-up of contraception methods, envisaged as the childhood game ‘top trumps’. If you feel I’ve left important pros/ cons or pieces of information out, please tweet me @SquiSquaSque !

I’ll try to update daily with a new card everyday for the next fortnight or so.

Hoping and praying: *for various reasons (lack of knowledge or planning, inability to negotiate) sometimes people do! ** This is an estimate based on the statistic that 80%trying to get pregnant do so within a year.

Fallopian Tube Sterilisation: either clips can be put on to block the Fallopian tubes, or they can be surgically dissectedclosed off. I’ve seen this performed a few times at elective Caesarian section, on request. It isn’t very common in the UK where contraception is widely available. I’ve been told by an Obstetrician that in his home country (a developing nation) it is much more popular for financial and cultural reasons.

Progesterone Pill: a.k.a the mini pill. Take it continuously, so no need to remember when to stop and rest as with the combined pill. As with all progesterone based hormonal methods, this stops your ovaries from ovulating (releasing eggs) and also helps to create a mucus plug in the cervix.

Contraceptive Patch: Works in a similar way to nicotine patches- sticks on to the skin and delivers a substance to your blood stream. I’m not convinced that they are very readily available as I’ve only ever seen them on Sex Ed leaflets.

Mirena: Progesterone based, fitted in to the womb.

Progesterone Depo: A twist on a classic- this injection delivers the hormone progesterone subcutaneously, where it slowly releases in to your body. This suppresses ovulation and thickens cervical mucus. Usually given every 8 weeks. A new preparation is available that is given every 13 weeks and can be self-administered at home. A terrible idea for anyone afraid of needles.

The Combined Pill: Tablet containing the hormones oestrogen and progesterone. This helps to stop ovulation (release of an egg for fertilisation). It is taken for 21 days, with a gap of a week, during which a ‘withdrawal bleed’ takes place. In the UK GP services seem fairly well placed to deliver fairly easy access to the pill, at least compared to other forms of contraception (I’m a bit bitter- I’m currently in the midst of a six week wait to get my contraceptive implant sorted). The main difficulty seems to be remembering to take it. Some people have lifestyles and personalities that are more amenable to this than others.

The Diaphragm:  Fits over the cervix, acting as a barrier to sperm.  Unlike true ‘barrier’ methods like the condom and femidom however, sperm is allowed to enter the vagina, so this method does not offer protection against STIs.   There seems to be some belief that only people who have already given birth can have them.  This isn’t true, but anecdotally I’ve heard from friends that some health care professionals can be reluctant to giving nulliparous people some methods (such as this and the copper coil).  So there may be some truth in this!

Natural Fertility Awareness: I’ve never seriously considered this as an option. It relies on a lot of organisation and not having sex some of the time. However, the real reason is that I didn’t think it was actually any good. My gut reaction is not to believe this ludicrously high effectiveness rate* but that may just be a hangover from sex Ed indoctrination. This figure is quoted from NHS choices who probably have less of an axe to grind than my old PRSE teacher.

Femidoms: work in a similar way to condoms, in that they are made of latex and work as a barrier. They sit in the vagina however, rather than over a penis. For some reason, they never seem to have become as commonplace as condoms, therefore seem much less widely available.

The implant: roughly the size of a match. This sits in your upper arm for up to three years, slowly releasing progesterone to suppress ovulation and thicken mucus at the cervix (entrance to the womb in The vagina). Needs to be fitted by someone with training, e.g. nurse or doctor at a GP or sexual health clinic. Waiting for this can make it a bit trickier to get one inserted, but once it’s in place you’re good to go for three years. Has a very low failure rate and fertility returns very quickly once removed.

The Copper Coil: inserted in to the uterus through the vagina, using a special device. The copper helps thicken the mucus at the cervix (entrance to the womb) to stop sperm from entering. It can also help stop a fertilised egg from implanting into the womb. Because of this theoretically it can be fitted a number of days after sex and act as emergency contraception. However, it needs to be fitted by a professional and this often takes time to arrange. For this reason it doesn’t often seem to be used in this manner, at least not in the UK.

Condoms: Widely available in good (and bad) shops everywhere, as well as some loo vending machines. Generally very cheap (I’ve seen packets for sale in Pound shops). Therefore financial limit to access is fairly small, if still present. However there are some schemes in the UK to get free condoms to particular groups. Red-faced teens in chemists up and down the country show that there’s also a social barrier to obtaining them too. Non-contraceptive uses: good for preventing diseases in penile penetrative sex (e.g. penis to anus).

*Lower efficacy rates been reported (e.g 82%). Lower effectiveness is generally linked to inexperience in using them.

References:

BPAS, accessed Friday 23rd February 2018 at {https://www.bpas.org/more-services-information/contraception/for-men/}

NHS choices, accessed Friday 23rd February 2018 at {https://www.nhs.uk/conditions/contraception/}

Posted in Uncategorized

Nature is ‘unnatural’.

This is my version of an Amazon Molly (Poecilia formosa). This is a fish that reproduces by a process called gynogenesis- it mates with males of another species, but produces only female offspring with its own genetic material.

We often have a pretty clear (heteronormative) idea of what is ‘natural’. A boy duck meets a girl duck and has a little duck family. Often nature has other ideas…