This posts tackles the topic of stillbirth and neonatal death and may be triggering to those affected. Information about support services are listed within this post.

On January 4 2012 Mehdi Hasan wrote 10 things you didn’t know about Rick Santorum for the New Statesman. It included information on Santorum’s political views and actions as well as some personal anecdotes about him.

Point 8 stated ‘When his baby Gabriel died at childbirth, Santorum and his wife spent the night in a hospital bed with the body and then took it home, where, joined by their other children, they prayed over it, cuddled with it and welcomed the baby into the family’.

At the time of publication there were discussions on twitter from people that indicated while they had no time for Santorum (and in many cases disliked him intensely) the focus on the loss of his baby seemed inappropriate in the wider context of the piece.

Whether it was the deliberate aim of the piece to suggest Santorum and his family had reacted in an unusual way to the death of their child, or whether it was interpreted in this way by readers, a discussion grew about whether this was a ‘normal’ grief response.

Those who had no experience of losing a baby to stillbirth or neonatal death responded, understandably, with horror at the idea you might want to cuddle your infant or keep them with the rest of your family. People who had been through such an experience asserted it was not unusual (although it may not have been the way they opted to deal with the loss of their baby).

Today, in response to criticisms of the piece, the New Statesman posted Rick Santorum’s Baby – A follow up also by Mehdi Hasan. In the piece Mehdi outlines why he feels criticism of his previous post was unfair. While he suggested on twitter those who had complained were displaying ‘faux outrage’.

Unsurprisingly, more outrage followed.

What interests me is the discussion that followed between Mehdi, myself and others on twitter. This is not intended as an attack on Mehdi, but more a case study in how journalists (like the rest of us) often work within a narrow frame of reference and find it difficult to cope when asked to see the world differently. Which, of course, has major implications for how we understand and talk about our lives.

Mehdi’s main defence of his writing on this topic included that:
- people had misinterpreted what he was saying about how the death of the baby was managed, and he wasn’t poking fun at this
- he was being unfairly criticized for talking about this issue when other writers who had covered it were not targeted in the same way (not quite true as Sarah Ditum shows)
- the story was in the public domain and the Santorum family had even written a book about it, therefore it was perfectly reasonable to include it in the original piece
- he felt dealing with the baby’s death was highly unusual – specifically taking the baby home and introducing Gabriel to the rest of the family
- people he had spoken to agreed they didn’t think the way the Santorum family had behaved with their baby was ‘normal’ or ‘ordinary’

In the heated discussions that followed GP @PeteDeveson calmly tried to explain why people were criticizing Mehdi. He stated:

‘I don’t blame you or your subeditor for not being aware that it’s not an unusual behaviour after stillbirth

The classy response to this would be to apologise, not characterise it as “faux-outrage”’.

Mehdi’s response was:
@ns_mehdihasan @PeteDeveson On a side note: not unusual? Still waiting for some stats/surveys/evidence for this claim. Am genuinely interested. Educate me.

After Pete provided information from a stillbirth charity, Mehdi said it was interesting but ‘still want stats’. Specifically (it seemed) about how common it was to grieve for a baby in the way the Santorums had, and to take a baby home to be with the wider family.

This is not an unusual reaction from journalists when criticized (or for that matter most academics, medics, skeptics and so on). However there are a number of problems with this approach.

The first is asking to be educated without really wanting to be informed. I may be wrong about Mehdi (and I hope I am) but in my experience journalists who ask to be educated want you to go away and stop bothering them and hope getting you to find evidence will shut you up. If you provide said evidence you usually find they’ll give a lukewarm thanks or simply ignore you. But you will see no sign that anything you have shared with them makes any difference to their practice.

Myself and others did share information with Mehdi so I am hoping this does educate him as he has asked. I’m also sharing this information here as it may be relevant to anyone who is unfamiliar with grieving processes after the loss of a baby (and may be of help to those who have lost a baby or are working in the healthcare/therapy professions).

The second problem is how ‘evidence’ is conceptualized – as ‘stats/surveys/evidence’. While it’s not unreasonable to ask for this, in many cases such data is not always available, nor appropriate. Not just in relation to research on how people deal with bereavement and infant loss, but on research generally. You may find data on how many parents select to take a baby home with them from a survey (or more likely an audit), but it won’t tell you how parents felt, how they coped, what they found helpful or not. You would need qualitative research for that.

And the request for ‘statistics’ is often meaningless if people cannot interpret said data or if said data doesn’t exist for very good reason. I have not found evidence on the prevalence of parents taking their baby home versus staying in hospital following neonatal death. That is not to say such data exists (and if you know if such data let me know and I will add it to this post). But it may not be something routinely collected within healthcare trusts. Even if it is routinely collected it may not be recorded universally across regions making it difficult to obtain reliable information.

Even with ‘statistics’ available, does it really make a difference? If some parents decide to do something to help their grieving process which is not what most parents do, does that indicate something is abnormal about them – or simply that they have decided to grieve in a particular way? Who gets to make this judgement?

As @DrRanj astutely pointed out during this discussion “What is the correct way to grieve? Whatever/whenever/however you need to deal with your pain”.

In fact there is evidence on coping with stillbirth and neonatal death.

Some of this comes through support organisations such as

SANDS
FSID
Winston’s Wish
Child Bereavement Charity
Miscarriage Association

Other evidence can be found in academic research (of which there is a lot in this area, much of it qualitative, focusing on how people grieve and what helps them).

From this we know it is standard practice that following the death of a baby parents, supported by healthcare staff and therapists, may want to:
- Name their baby (if they haven’t already done so)
- Bathe, oil, massage and dress baby
- Kiss,cuddle,sing,talk to and sleep near baby
- Take photos of baby
- Make other mementos such as a hand or footprint
- Have friends and family (including siblings and other young relatives) visit the baby
- Wrapping baby in a blanket the family will later keep

Not all of these things appeal to all parents and families and it is vital to stress the importance of choice and decision making which must be parent led. Well intentioned healthcare professionals may impose some of these activities which do not directly appeal to parents because they have been told they are ‘good practice’. A Cochrane Review on Support for mothers, fathers and families after perinatal death states:
“However, recently there has been an alert sounded that such practices have become prescriptive and ‘routine’ in check lists and ‘do’s and don’ts’ and, in fact, may be failing to offer meaningful care to bereaved families (Lang 2005). A recent review showed that parents perceive many healthcare provider behaviours to be thoughtless or insensitive (Gold 2007)”.

This can be particularly an issue where parents may not want to see the baby or may prefer other services to deal with funeral arrangements. And it is worth noting, depending on circumstances, some parents may find interacting with their baby distressing and might require long term support and counseling as a result. Particularly in cases where parents have PTSD as a result of coping with their experience.

While we may not have exact figures on how many of these activities are undertaken by how many families, we do know they are widely recognized and supported ways that people might choose to interact with their baby, even if they do not appeal to all parents and may not be suitable for everyone.

What about the concept of taking baby home, which the Santorum family did with Gabriel, and which Mehdi and some others apparently find difficult to believe?

Well again it is not unusual. Which is why hospitals have cold cots. A ‘cold cot’ enables a baby to remain in a hospital or be taken home (or remain in the home if baby died there) until their funeral. A baby may be in a cold cot for a few hours to several days, depending on religious requirements, family preference or other funeral arrangements. (If you want more information about using cold cots within healthcare training is available here).

For those who don’t have children, or who have children and find it difficult to contemplate how they would deal with the loss of their child, thinking about ways of being with a baby after it has died might seem mawkish, horrific, or distressing.

However, for parents and families such rituals or opportunities may be exactly what they want or need at the time, and in the long term help them come to terms with the loss of their baby.

It is understandable that, when faced with something we do not comprehend or hope we never have to face, that we react with incredulity. It is also understandable that if we are challenged for holding such a viewpoint that we react defensively and demand others prove us wrong, while not really listening to their feedback.

However, it is important journalists do listen. Miscarriage, stillbirth and neonatal death remain taboo topics within our culture. Not necessarily because those who have experienced loss want not to discuss it (although this can be the case) but because others around us react with embarrassment or discomfort. The media could do so much to challenge stigma in this area or campaign to improve care and support, yet rarely does so. (An exception is Mumsnet’s Campaign for better miscarriage care and treatment).

Instead we are faced with soap operas, dramas and movies that represent bereaved parents as mentally unbalanced (and a risk to other babies), and news coverage or features that either airbrush lost babies out of conversations, or only allow parents and practitioners to discuss stillbirth and neonatal death in particular predictable and sanitized ways. Our anxieties about neonatal death can mean we dismiss valid experiences, or not fully research an area. Relying instead on stereotypes or simply not investigating an area in any depth.

Journalists and others who have perhaps not experienced the loss of a baby may well find how others grieve for or remember their infants as abnormal. But if we allowed ourselves to listen more to their experiences we discover their actions are not unusual and are perfectly understandable. That’s why hearing from bereaved parents is becoming a recognized part of paediatric training. Giving parents and families the opportunity to talk allows them to recognise, celebrate and remember their babies. Not rendering them invisible just to keep the rest of us in our comfort zones.

In 2008 Alice Dogruyol representing The Spa PR Company wrote to me requesting I plug a new genital cosmetic procedure – the g-shot. It involved injecting collagen into the vaginal wall. And was being spearheaded in the UK by a Professor Phanuel Dartey of Harley Street.

I immediately noticed there seemed to be no robust peer reviewed clinical evidence for the safety and effectiveness of the g-shot procedure. I felt the press release I was sent was so poor and the ‘treatment’ described seemed so bizarre that it was best ignored. I assumed no media outlet would pick up on it.

I was wrong.

Several newspapers including the Sun, Mirror, Telegraph and Mail clearly had been sent the same press release as me. The only difference was they joyfully publicized the g-shot and promoted Prof Dartey’s Harley Street practice. And in the case of the Sun and the Mirror the pieces were written by their Health and Science correspondents. Who really should have known better. Since then many women’s magazines and websites have also described the procedure as a sex life enhancer, promoting both the g-shot and Laser Vaginal Surgery (which Dartey also offered).

I was so concerned I wrote a blog post about the problems I foresaw with the g-shot procedure and subsequent media coverage. I also outlined core questions journalists and the public ought to be asking about it.

A journalist colleague then tried to pitch a story critiquing the g-shot , but they were unsuccessful. Over the past three years I sent my blog post questioning the g-shot to any media outlet I spotted giving it publicity. In most cases I heard nothing back. Occasionally a journalist would politely thank me and tell me they’d consider my opinions if they wrote similar pieces in the future.

In other words they ignored my concerns and questions. Probably because they weren’t as exciting as the sexy ‘science’ of collagen injections, and probably because anyone critiquing their breathy discussions of amazing orgasms through genital enhancement could be dismissed as an anti capitalist/feminist/academic killjoy.

I did not systematically continue to campaign against the g-shot because I reasoned even if the media were occasionally (albeit enthusiastically) covering it, I doubted many women would opt for either the g-shot or Laser Vaginal Surgery.

I was wrong here as well.

Last week Phanuel Dartey was struck off by the General Medical Council (GMC).

This followed complaints from five women. The British Medical Journal (16 November) reports Dartey ‘botched laser operations on four women and left another seriously ill after a termination’ . It goes on to report from the GMC hearing:
“Patient A was said to have suffered visible scarring and asymmetry of her genitals, although she had been told that the incisions would be nearly invisible. Part of her vagina had been “effectively amputated,” and she required revision surgery
Patients B and C were given laser surgery for urinary incontinence, which the GMC’s experts say would have been of “limited value”.
Patient E was in major pain after a labioplasty to reduce the size of her labia minora, which Dr Dartey is said to have “significantly over-reduced.” When she complained of the pain, the GMC alleges that he suggested an injection of absolute alcohol into the area of the labial scar to kill the nerve endings, an intervention that was “inappropriate.”
Patient D travelled from Ireland to the Marie Stopes centre for a termination at 18 weeks’ gestation. Dr Dartey is alleged to have perforated her uterus during the procedure but failed to recognise this.
The GMC alleges that he failed to check that all the products of conception had gone and failed to notice that the fetal thorax had not been removed. When D returned home, she became “extremely ill,” … “She was on the critical list and was in hospital for two months.”
Dr Dartey, who was suspended from practice pending the hearing, is also charged with having no valid medical indemnity insurance when he carried out the termination in February 2006”.

A further report of the hearing, again from the BMJ (6 December), explains why Dartey was struck off:
“Robin Knill-Jones, who chaired the GMC’s fitness to practise panel, said, “In the panel’s judgment there is a continuing risk to patients from the way Dr Dartey conducts his practice. His dishonest actions in relation to professional indemnity were a serious abuse of the trust that his patients and those with whom he worked were entitled to place in him.
“The panel considers that the extent and seriousness of Dr Dartey’s clinical misconduct, the gravity of his dishonesty, and his subsequent lack of insight evidence a harmful attitudinal problem.”
When Dr Dartey carried out the termination in 2006 on a woman who had travelled from Ireland, he perforated her uterus and failed to remove the fetal thorax. When she returned home she became extremely ill and was in hospital for two months, the panel heard.
Dr Dartey’s membership of the Medical Protection Society had lapsed in 2002, and he had no indemnity cover when he performed the abortion. The panel found that a membership certificate he sent to Marie Stopes International purporting to cover 2005-6 was a forgery.
Dr Knill-Jones said, “Each of the five patients with which this inquiry has been concerned has suffered from the events in question. In his written communications to the GMC Dr Dartey has shown little remorse or acknowledgment of, or insight into, his failures.
“He has rather adopted a derogatory attitude towards his patients, accusing one of racism, another of blackmail, a third of causing her own problems by failing to follow his advice, and another of reporting him to the GMC because she wanted free corrective surgery for an unrelated problem. The panel has found no substance in any of these complaints and regards Dr Dartey’s lack of insight as a matter of serious concern.””
The lack of insight comment seems particularly relevant given that during the time the GMC were investigating his case, and while it was being covered in the media, someone claiming to be Professor Dartey appeared to comment at Ghanaweb where he belittled those complaining against him. This comment has not been verified as from Prof Dartey but it seems uncannily similar to the report from the GMC hearing.

This is truly shocking case that raises questions about the conduct and supervision of medics in private practitice. Marie Stopes also undoubtedly need to review procedures for the selection and supervision of staff working at their clinics.

The media also has a role to play here, but this was not (as far as I know) picked up on at the GMC investigation.

The PR company who promoted Dartey and the journalists who covered his g-shot and Laser Vaginal Surgery interventions in uncritical and often glowing terms are, in my opinion, culpable.

We know from research on women seeking cosmetic genital surgery one of the main things that persuades them they need cosmetic procedures is advertising from clinics/consultants. And how better to advertise than via an enthusiastic media endorsement? Even though it is well documented there’s no evidence of effectiveness of cosmetic genital surgery but plenty of evidence of active efforts by medics to promote such practices.

Perhaps unsurprisingly the papers that fawned over the g-shot have been remarkably silent about the GMC hearing. And none have admitted they gave publicity to an untested and dangerous cosmetic intervention.

The only paper who reported in favour of Dartey and also on his striking off was The Daily Mail. They managed an incredible about face with their initial piece ‘I’ve had the G Shot and YES, YES, YES my sex life has never been better!’ promoting the g shot procedure. While Dartey’s GMC investigation was ongoing they were still publishing testimonies in his favour. Finally describing his fall from grace in less than glowing terms. The latter piece, of course, made no reference to the former. (Thanks to @MrNorthice for helping with these links).

This media distancing could be coincidence, or it may be more deliberate. In the Mail’s case it can be seen as deliberate in the way Dartey is talked about. When his g-shot procedures are being lauded he’s a Professor from Harley Street. When his striking off is detailed his qualifications from the Soviet Union and Ghanaian heritage are at the fore. As @PeteDeveson astutely commented on twitter: “on the way up it’s “Hollywood” and “Harley Street”. On the way down it’s “Ghana” and “Soviet””. This xenophobic coverage neatly airbrushes any involvement of the newspaper in promoting Dartey’s practice – and subsequent harm done to his patients.

When I first read the press release about the g-shot it raised not so much a red flag as a string of red bunting. I tried to challenge it where possible with journalists but felt powerless to really get anyone to listen.

I still feel powerless about this situation and the countless others like it. Journalists cover stories on sex and health topics that advocate untested treatments, products and procedures. Therapists and practitioners are showcased with no check on their skills, qualifications or professional ethics. Cosmetic genital surgery is increasingly presented as ‘the norm’ and if any criticism is allowed it is always a small voice of dissent in a wider promotion of surgical intervention. While this case concerns surgery performed on women, men’s media is just as problematic when it comes to promoting dodgy sex pills, potions and procedures.

Of course claims that science, medicine and surgery can transform your sex life, give you amazing orgasms, make you more desirable or a better lover are beguiling to both editors and the public.

Sadly these claims are rarely put to the test.

Which allows dangerous practices like those offered by Professor Dartey to go unchecked.

Editors and journalists lack basic skills to evaluate press releases or stories they are sent about sex-related products and procedures. Either because they are busy, seduced by science speak, or unable to critically evaluate medical claims. More importantly editors and journalists do not make enough use of willing qualified individuals and organisations who could help them assess whether claims they’re about to write about are accurate or not (for example using guides like this one created by Dr Jennifer Gunter). Where practitioners try and tell them they could be advocating something that is ineffective at best, life threatening at worst, the media (for the most part) ignores them.

We should be rightly angry with the media and with practitioners who promote untested and unnecessary cosmetic genital surgery.

This will be of little comfort to the five women involved in this case, who will be scarred psychologically and physically for the rest of their lives.

Professor Dartey should be ashamed of his actions, but GMC reports imply this is unlikely.

The journalists who didn’t bother checking a simple press release and promoted his products and services should also be ashamed of their actions. Again, I think this is unlikely.

The Spa PR Company who originally promoted the g-shot and Dartey’s clinic should also take responsibility for their role in this tragedy. I have written to them offering a right to reply which I will post here if they wish me to.

Other media outlets could now write about this case critically, and make a commitment to reporting on sex/science stories ethically and carefully. They could campaign against cosmetic genital surgery or refuse to showcase it in their features or advertising. Here too I expect this is unlikely.

It is easy to forget in stories like this how real lives can be destroyed. My sympathies are with the women affected by Dartey’s professional misconduct. While I find it easy to compile a case against media and medical incompetence, I find I lack the words to adequately express how badly I feel for them.

It’s been a while since I’ve written about medicalisation. Which seems as good an excuse as any to revisit this issue and reflect on some of the developments in this area in healthcare, therapy and media.

A few months ago I took part in the 41st Maudsley Debate entitled ‘Love is a Drug’. Ben Goldacre and I spoke for the motion, Sandy Goldbeck-Wood and John Dean against it.

In fairness the title of the debate ‘This house believes that female sexual arousal disorder is a fabrication’ was somewhat misleading since it could be construed as saying there was no such thing as women having problems with desire and arousal. Obviously that’s a ridiculous idea for anyone to support, so Ben and I kept our focus more on the way female sexual problems have been medicalised, and what implications this can have (particularly in healthcare).

You can hear the debate and subsequent discussion here. Ben and I won the debate, although the discussion certainly indicated this is a complex area and one that is not always fully understood in terms of gender, politics and ‘bad science’. I think Ben’s points about teaching medical students (and healthcare staff more widely) to read and think critically about pharmaceutical research is important – particularly in relation to the area of sexual functioning which is heavily medicalised but often not taken seriously. Because it’s about sex.

Additional reviews of this debate can be found here, here and here.

This event follows a debate last year hosted by the British Medical Association which was also attended by John and Sandy, who discussed issues around female sexual dysfunction with Ray Moynihan (author of Sex, Lies and Pharmaceuticals) and Iona Heath.

Both of these discussions were focused towards a medical audience (with the Maudsley debate particularly aimed at medical students and trainee psychiatrists, and the BMA event at practising clinicians and therapists). While the Maudsley debate was open to the public the BMA event was invitation only, so there is a remaining problem of making discussions around medicalisation open to a wider audience.

One way this is being achieved is through screenings of Liz Canner’s amazing documentary ‘Orgasm Inc’ which have been taking place across the US, Canada and UK. Media coverage of this movie has also helped raise the profile of female sexual problems (examples here, here, here and here). Although unfortunately not all journalists covering this area ‘get’ all the issues surrounding this topic, particularly around medicalisation, evidence based practice, and endorsing largely untrialled/untested interventions).

This leaves us with some stubborn problems which still need tackling. These include:

Critiquing FSD = women don’t have problems
One of the most frustrating aspects of challenging the medicalisation of female sexual problems is the inevitable response from some journalists, medics, researchers and members of the public who interpret what you are actually saying as – ‘women don’t have sexual problems’. Clearly women who are experiencing sexual difficulties don’t want to be told they’re inventing their problems, and do want a solution. Those who are challenging medicalisation of sexual function are not saying women don’t have problems. They’re not saying sex isn’t important. What they are saying is that there are many reasons women experience problems, and an equal number of possible solutions to them (see here for more on this). And that it are the many causes and solutions that require exploring rather than assuming a woman who isn’t desiring sex is ill and requires a clinical solution (we unpack this to some degree in the Maudsley debate podcast linked above).

Discussing women’s problems = denying men have problems
Another real problem around talking about this topic is the focus on women. The media ignored the medicalisation of sex for a long while. Then did a lot to write and broadcast in ways that promoted pharmaceutical company agendas. Some media outlets have more recently decided to focus on the medicalisation problem, but generally in terms of focusing on women. This can partly be attributed to activism in this area, and partly due to rehearsing comfortable stereotypes – that women are not particularly sexual or are more likely to have problems with sex. This has led to criticisms that men’s sexual functioning has been ignored, or is not an issue. In terms of research that’s not really true. The challenging of medicalisation of male sexuality came before campaigns against the medicalisation of female sexual functioning. You can read some examples of that work here, here and here (It’s an area I’ve also researched and published on, as well as given advice to men about e.g. here and here).

What may be a more accurate statement is there is concern over men’s sexual functioning and the medicalisation of men’s sexual lives, but a lack of interest in the mainstream media in really taking this up. Other activist and sceptic groups you’d expect to challenge this problem seem reluctant. Witness the general apathy to helping men affected by the actions of the Advanced Medical Institute as a prime example. It is difficult to get journalists to focus on this in terms of medicalisation of sexual functioning per se, rather than simply seeing it as a ‘woman’s issue’.

Media lack of awareness of/complicity in this area
One of the main issues in this area is the media often doesn’t ‘get’ medicalisation. Indeed promises of wonder drugs that will boost our sex lives attract editors like moths to flames. The result has been uncritical pickup of pharmaceutical research on psychosexual problems, either promoting products that aren’t all that effective, or showcasing drugs that aren’t even available for public use. Even where drugs for desire problems have been identified as ineffective media coverage continues to write about them as if they are – for example with media’s ongoing obsession with testosterone therapy as a sex drive booster for women. This parallels problems within medicine where practitioners simply don’t understand the influence of Big Pharma in this area, can’t access (or understand) the diverse literature about medicalisation and critical sexology, and remain unable to identify and appraise literature on this topic.

Where to next?
The problem of medicalisation and poor media coverage of sexual problems is not going away. So encouraging and recognising good quality reporting in this area is vital. Supporting screenings and discussions of documentaries like Orgasm Inc can help, as can more public events tackling this topic. Moving away from a debate style format (i.e. do problems exist or not) would also allow for perhaps a more nuanced discussion on medicalisation, how it happens, and how to recognise and respond to it. Focusing on this as an issue affecting cis and trans women and men, as well as different sexualities is important. As is reflecting on how we view psychosexual issues for different age groups (and what age groups, genders, sexualities do we seem most keen to pathologize). Helping medics, therapists, journalists and the public to understand core issues around medicalisation as well as critiquing research on treatments in this area would also be useful. As would challenging any suggestion that critiquing medicalisation equals denying people have psychosexual problems.

You may also be interested in responding to the classifications of psychosexual issues in the revised DSM (deadline 15 June), or learning more about the Medicalisation of Sex from this recent conference in Vancouver.

There’s been a substantial amount of media attention today for a survey by BBC Radio One’s Newsbeat and the Portman Clinic. Suggesting porn ‘use’ among men is endemic and in many cases problematic.

It’s led to a slew of scary headlines including:

Men view two hours of porn a week – The Sun
Young men worried about the amount of porn they watch – Mirror
Men ‘worried’ about heavy online porn use

What did this survey cover?
This survey heard from 1057 18-24 year old women and men (no information available about how many males and females made up the final sample). They completed an online survey via TNS Market Research Company between March 18-21 2011. It asked about their porn consumption and attitudes to porn and relationships.

What were the main findings?
8/10 men and 1/3 women had looked at porn online
The most popular place to access porn was free websites
The ‘average’ man in study (no figures given for this) looks at porn for 2 hours a week, the average woman around 15 minutes
4% of male respondents ‘used’ adult sites for more than 10 hours per week – these were reported as having a ‘problematic and potentially compulsive’ condition
¼ men said they were worried about the amount of time spent looking at porn
¼ men said they were worried about the content of porn
61% of respondents (gender unspecified) said porn could make you less interested in sex with a partner

Should we be concerned about these findings? Not until we’ve looked more closely at this survey.

Problems with the survey
It is not clear exactly how participants were recruited/heard about this research. Market Research Company TNS administered the online survey but it’s unclear who responded, the characteristics of those who didn’t respond, and how representative of the wider population respondents were. The survey was only run over a three day period which is not unusual in commercial online surveys, but doesn’t always allow for generating reliable data – particularly about sensitive issues.

The full list of survey questions have not been made publicly available. Without these you can’t work out what people were asked. Whether questions were leading, potentially distressing, counteracted/contradicted each other, were confusing or didn’t match the final data reported.

I’ve spoken to nine journalists from different broadcast outlets about this survey over the past two days. All have called me for comment about the survey. All have taken it at face value. None had seen the original survey questions. None had asked to see them either.

This isn’t something unique to this Radio One survey however. Most commercial and academic surveys don’t make their original survey questions available when press releasing their work. It remains a problem as you cannot make any judgements about how useful a survey is without seeing what people were asked. This survey may have been amazingly well designed, carefully piloted, developed and run. Or it may not have been so stringently managed. The problem is without making both the methodology behind the research and the survey questions public it is impossible to know whether to trust in the data or not.

One question was reported in the Radio One report of the study. It asked ‘How have you ever looked at porn?’ It then gave respondents the choice of magazines, DVDs, TV, Free and Pay websites, mobile phones and file sharing.

The problem with questions phrased like this is they may look sensible at first glance, but actually are highly problematic and potentially meaningless.

If we take ‘ever looked at’ first, what does that mean? Ever looked at as in sat down, watched a lot and masturbated yourself stupid? Or ever looked at as in was shown by some mates for a laugh, or ever looked at as in accidentally found when looking for something else online or on TV?

‘Ever looked at’ seems to be taken here to mean regular porn use, or at least some porn use. Whereas it doesn’t tell us anything about the context people are viewing porn – or the amount. I may have ‘ever looked at’ porn once ten years ago and never again. But this survey would put me in the same category as someone whose ‘ever looked at’ definition included looking at porn several times a week over months or years.

The lack of clarity in the question also doesn’t explain whether people are looking at porn alone, with a partner, when single or a relationship. Nor address whether their porn ‘use’ is consistent over time or varies depending on their relationship status or other life events.

Also what does ‘porn’ mean in this survey question? Is it an erotic scene in a movie shown on mainstream TV? Tuning into Babestation? Reading Nuts, Zoo or Cosmo? Visiting YouPorn? This survey asked respondents to state the format in which they access porn, but they are not asked to explain what they mean by porn. That means we’ve no idea what it is they’re looking at.

This is a classic problem in poor survey design. That terms used aren’t operationalised. Meaning neither the respondents or the researchers actually have any idea what it is they’re asking about, or what the data means when it comes back.

‘Heavy’ porn use was described in this survey report as 10 hours or more. But it is not clear how this was decided upon as a measure of ‘heavy’ use.

¼ male participants stated they were worried about the amount of time they spent looking at porn. But since we don’t know what they were asked we can’t tell if this was based on a leading question, or whether they would have said they were worried if not prompted. It doesn’t tell us what exactly they were worried about (i.e. did they think they were spending too much time in general online, or had a specific concern re porn use).

¼ respondents also said they were worried about what they were looking at, but we can’t tell from this whether this meant they’d already stopped looking at the problematic porn. ‘Worried’ by content doesn’t tell us whether they had issues over the wellbeing of actors in porn; a person’s sexual prowess in comparison to what they were viewing; or whether their gender, sexuality or relationship was being challenged by the things that they found a turn on. In short we may know a fair number of participants expressed concern, but we’ve no real clue about the source or magnitude of that worry.

Usually with media surveys of this kind the standard approach is back of the envelope question design, based around a predetermined angle that’s being picked to generate publicity. Radio One aren’t unique in this approach (although they do have form for running similarly questionable sex surveys in the past). It is likely this current survey is more about generating publicity for Radio One and Newsbeat than really addressing issues about our relationship with sexually explicit materials. It seems the main purpose of the survey was both to inform a report for Newsbeat and draw attention to said programme.

Unusually this research has teamed a media outlet (Radio One) with clinicians from an NHS trust. Specifically practitioners from the Portman and Tavistock NHS Trust who apparently designed the survey.

This raises more complex issues than just the usual shoddy media approach to surveys. If NHS staff are involved in research they ought to be grounding this within a critical appraisal of the published evidence in this area. They also ought to ensure they employ research tools correctly (in this case completing a quality survey, piloting and reviewing it – or better still basing it on an existing measure). And if they’re doing the work on NHS staff or patients or in their role as an NHS clinician then it ought to be subject to ethical approval.

Not all health research is subject to peer review, but usually if a survey is going to be made public – either through publication in a journal or through a report launch or similar – then you would expect a thorough peer review of the work before it hit the headlines. Peer review here could have helped spot potential problems in both survey design and delivery, and ensure the relevant background literature (of which there is a lot in this area) had been carefully consulted. It would also have guarded against making claims that go beyond the data.

This may have happened in the case of this survey but that information has not been made transparent. If that is the case it is a pity since it doesn’t put the research in context nor show it in a good light. If these checks and balances hadn’t been put in place again transparency might help us assess whether this work is reliable or not.

Given the example of the questions asked of participants along with conclusions drawn it does raise serious questions about the quality of the survey. Along with the ethics of using such a tool to draw clinical conclusions – as has happened around the diagnosing of those with ‘heavy’ porn use.

Journalists I spoke with about this survey felt the inclusion of medics in the survey meant it was more trustworthy. One said to me that because a doctor had designed the survey it had to be good. As someone who’s been teaching medics internationally how to evaluated, design and use surveys in health research for the past fifteen years; I can confidently report most are pretty dreadful at this craft. Indeed, as with any other social research skill it takes time to learn how to create a quality questionnaire. Without disrespecting the skills of the medics in this survey, you cannot conclude because a doctor helped put the survey together that it’s automatically accurate.

There are in fact many people actively studying pornography – some of whom can be found here. All of whom Radio One could have teamed up with had they genuinely wanted to explore our relationship with porn. This IS an important area that is worth studying and is currently hampered by a lot of poorly conducted academic studies, mostly based on undergraduate student samples. So we need to have more quality work conducted and there are plenty of people Radio One should have involved. The fact that some of the leading names in this area weren’t even mentioned or consulted points to either a lack of awareness of the subject area. Or deliberately avoiding to engage with those who may not be fitting with a predetermined porn/shock angle. Radio One should have been clearer about why did they pick this particular team from the Portman to collaborate with? Were there any agendas there? Certainly given the worries over medicalising our sexual behaviour one might argue it could be in a clinic’s interest to set up a figure of ¼ men being anxious about porn use. After all if you’ve identified a problem you are in a very good position to offer a cure.

Finally there’s no real context about why Radio One thought this was a major area worth studying. Given it’s a youth channel it could have easily picked up on numerous other social issues – poverty, employment, education, university fees. Or if they wanted to be sex campaigners to perhaps look at the issue around how sex education is haphazardly (and often poorly) delivered in schools. Are all young people really worried about online porn, or are there other things directly affecting their lives that may be more relevant (but perhaps less publicity generating?).

Despite all the percentages shown in this report and warnings about ‘heavy’ porn use there seems to be no take home message for people about what this means. If you suspect, after reading about/hearing Newsbeat’s survey, that you have a ‘problem’ – what should you do? If you have questions about porn, where could you ask them? In this case the audience are given some dire warnings but no referrals to sources of help or advice. Which again makes the overall purpose of this research unclear.

I may be being very disingenuous about the researchers from the Portman. But it worries me that their relationship with this research has not been fully declared. No doubt they acted with good intentions, and obviously drew upon their experiences as psychotherapists (one author has written about internet porn and psychoanalysis). But it is concerning that journalists covering this story didn’t think to ask more about who was doing the research, and what their motivations might have been.

Which brings us on to…

Problems with media coverage
I’ve already mentioned how the journalists I’ve talked to hadn’t seen the survey nor saw this as important. What was more worrying was the unquestioning pickup of this story. Journalists weren’t asking what was asked in the survey, of whom and why. What they were doing was accepting the figures from the survey – particularly the amount of time men were spending looking at porn, and how they were worried about porn use.

They were then using this as a jumping off point for other discussions. For example to talk about porn addiction, how pornography use could change men’s brains, what women felt about men who used porn. As a psychologist they wanted me to come and talk about neurological changes from porn use, and as a female psychologist they wanted an insight ‘as a woman’ to talk about how all women felt about their men’s porn use (more on this later).

What journalists didn’t want, was me talking about this survey from the perspective of someone who teaches survey design. They didn’t want the survey critiqued because their editor/producer had already fixed it as their angle. Indeed they’d already accepted it as ‘true’. Most worryingly those from the BBC seemed least keen to critique the research. One researcher calling from BBC Radio 5Live Drive Time confirmed they didn’t want to question the survey because it was done by Radio One – and as such they couldn’t challenge the output from a sister station.

It really does beg the question what is going on with the BBC College of Journalism that such problematic research can be put together to begin with – and how it can continually be endorsed even when flaws are being pointed out. (Sadly I’ve tried previously to help the BBC College of Journalism to think more critically about sex research but have got nowhere. I have alerted them to the current Radio One survey and uncritical coverage on twitter today. Let’s hope they decide to take this further) .

This case has been a useful example in seeing how journalists lack the understanding to critique research, but also the practical reasons they’re unable to do so. Moreover it gives us an ….

Insight into journalists views of sex/pornography
If you look at the press coverage of this survey (alongside reflecting on the discussions I had with journalists today) some very definite patterns of how journalists/the media see sex/relationships and porn.

The view from medialand is as follows:

Who looks at porn? Well, it’s men. They are all straight and the porn they are seeking out is also heterosexual. Women are constructed as having problems/concerns about pornography – but only in relation to their (male) partner’s use of it. ‘Pornography’ as a term is used to mean one genre from one format (the internet). Looking at mainstream porn in moderation is okay, but if you do it often then it becomes a problem. Quite often described in the medicalised language of addiction.

Men are naturally sexual and so can’t help liking porn, but if they do look at it they’ll become abusers or change their neurological makeup or sexual behaviour. Women don’t like porn, those who do are presented as being in a minority, probably deluded, or liking romantic/couples-based/equality-based/feminist porn. Porn within relationships is only permissible if it’s to spice things up (or encourage reluctant wives to get in the mood). LGBT folk aren’t even thought about.

Alongside this is a widespread acceptance that porn influences sexual behaviour (i.e. shaving pubic hair, trying anal sex, different positions etc). There is no insight from journalists or often the public that these issues all have – and continue to be – widely covered in mainstream media, not just porn.

If you’re starting from this as your standard position it makes thinking critically about pornography difficult. It means journalists will be tasked (or choose) to find evidence to stack up this world view. It also means it’s risky to find other ways to think about/explore porn for fear of being seen to endorse it.

Why is coverage of porn research so poor?
Coverage within the media tends to be poor because journalists are always on tight deadlines, lack skills to evaluate both research and critically reflect on their own assumptions about ‘normal’ sex. Finding experts who can talk clearly on the topic or searching through evidence is often difficult. And not helped when the standard way to approach this issue is in a false debate format where you have to find a pro and anti porn person in the mistaken belief there are clearly defined ‘sides’ in this area.

The pressure from editors to fit particular (and usually sex negative) agendas leaves little autonomy for journalists to tackle problems they may spot with research. Freelancers in particular may struggle as if they don’t write what the editor wants they won’t get a commission. Staffers may struggle with bullying if they don’t deliver an angle to deadline.

Journalists are not impartial. Many lack basic sex education or have particularly sex negative views. It is threatening for them to have this questioned – especially when on deadline. And if something seems intuitive then it won’t be questioned. Indeed if you try you’re more likely to be seen as a crank. Or unhelpful.

Part of our problem is there is a lack of funding to really investigate porn use in sensitive and open ways. Where quality research is undertaken in this area it’s often more nuanced and doesn’t lend itself well to scary headlines and battle of the sexes style debates. This means quick and dirty studies get completed and hit the headlines far more readily, and inform public opinion more often. That can be dangerous and misleading, particularly when behaviours that may not be a problem become medicalised.

What can be done about this issue?
Offer better training for journalists to understand surveys and other social methods. You might find these guidance papers I’ve written on the topic helpful:
Administering, analysing and reporting your questionnaire
Selecting, designing and developing your questionnaire

Reaching beyond the white middle classes

Make editors and broadcasters more accountable – challenging them when they run poor research or give bad science uncritical coverage.

Require media outlets that create surveys need to be completely transparent about the work they’ve done (as we equally should with academic researchers).

Encourage the public to engage in discussing and critiquing sex research from media outlets via social media. Today we saw two things happen. The media lost the news, while the public via social media (particularly on twitter) got to the bottom of a problematic story and had a much more interesting time doing it than if they’d relied on old media coverage alone.

Yesterday evening (05_01_11) Channel 4 News featured a story about the contraceptive implant (Implanon). They revealed a number of NHS trusts have paid £200,000 in clinical negligence compensation to women who’ve become pregnant or experienced injury when using the contraceptive implant. 584 women have reported unplanned pregnancies, and 1067 complained about scarring or other injuries to the Medicines and Healthcare Regulatory Agency. At this time it is not clear how Channel 4 heard about this story. It could be through their own research, from a tip off within the MHRA, or direct contact from a law firm.

This story was hotly adopted by the rest of the media, particularly broadcast media and newspapers, with coverage like:

Evening Standard – Ban this contraceptive implant pleads mother scarred for life
Telegraph – Woman whose marriage collapsed after Implanon implant ‘failed’ among those suing NHS
Guardian – Hundreds become pregnant despite contraceptive implant Implanon

The majority of these reports were characterised by a lack of context for the numbers given, and no reproductive health care experts/medics to put this data into context. I’ll focus on why this is a problem shortly, but first, here’s what you need to know about the contraceptive implants.

Contraceptive Implants (Implanon)
Implants are small, flexible tubes around 4cms long that contain the hormone progestogen and are injected under the skin in a woman’s upper arm. They are a form of a hormonal contraception, so they release hormones over a period of time (3 years) and fall into the category of Longer Acting Reversible Contraception (LARC). (Implants used before 2010 go under the brand name Implanon, those fitted after this date are called Nexaplanon. The latter has reportedly been designed to be easier to insert).

This kind of contraceptive is suitable for women who find it difficult to remember to take the pill every day, and who are certain they don’t want to be pregnant for a set amount of time. It’s around 99% effective if fitted correctly and used according to instructions. But, as like any form of contraception it isn’t 100% effective and because it only prevents pregnancy, condoms should also be considered to protect against STIs.

It has a number of side effects including periods stopping (which some women see as an advantage), irregular bleeding, acne, sore breasts, mood changes, and reduced sex drive.

Its use is recommended only after considering other contraceptive options and a thorough discussion and health assessment with your GP/Family Practitioner or Reproductive Health Clinic.

You can find out more about the contraceptive implant here, here, and here. (A statement from the MHRA on implanon can be found here).

Why is the media coverage problematic?
Press coverage on this story has been largely context free. That has meant we’ve been told how many women have experienced problems but not within any timeframe; how many problems were reported as compared to women not experiencing difficulties; how the implant compares with failure rates of other kinds of contraception; how many of the pregnancies were present before the woman went on Implanon and how many occurred due to incorrect fitting of the implant?

Without this information the majority of media coverage suggests that the Contraceptive Implant is not an effective form of contraception, is always painful to fit and remove, will cause disfigurement when removed, and result in an unplanned pregnancy where women will be forced to have a termination.

Because this information is misleading, and doesn’t come with additional reproductive health details to put it into context, it fails to make clear the positive aspects of implants for women who choose this method, nor that the majority of women who select the implant do not experience problems.

The coverage is also irresponsible because of the timing of the story. The post-Christmas and New Year period is always busy within General Practice and Reproductive Health Clinics. Not least because of people who have had unprotected sex over the holiday season will be anxious about pregnancy and seeking advice about their options.

The difficulty in criticising the story as it stands, is that you can find yourself easily cast in an unsympathetic role. In healthcare terms proportionally 584 cases compared with the number of people using contraceptive implants (1.4 million according to the Department of Health) is pretty low. That is of no comfort to those who experienced an unplanned pregnancy when they thought they were protected by a contraceptive. So in critiquing the media coverage here we need to be mindful it is based on difficult and upsetting cases that will have had widespread impact on people’s lives.

It is negligent of the media to not report this within any appropriate context. The result is scaremongering and is not helpful to anyone. Including those who have had bad experiences with the contraceptive implant.

What does the data show?
The contraceptive implant was introduced in the UK in 1999. It has been used by around 1.4 million women over the past 11 years. This figure comes from the Department of Health although is still unclear if that means women in UK or Europe. Some practitioners feel the 1.4 million figure is high, even over an 11 year period. Part of the problem with this story is the uncritical media coverage is throwing numbers around like there’s no tomorrow, but health agencies have also been somewhat unclear on exact figures and where they’ve sourced them from. This leaves us with the less than ideal situation of matching unclear data from media coverage with unclarified data from the Department of Health/NHS. NHS advice is the 584 pregnancies reported seem to be mostly related to incorrect insertion of the device rather than the device itself being faulty. It is not clear how many of these pregnancies had begun before the device was fitted. Currently around 800,000 women in the UK are believed to be using this method of contraception. 14 women have been compensated for either getting pregnant while using the implant or being injured through incorrect insertion or removal (source info here). While the figures from media and health sources remain unclear what does seem to be fair to claim is the number of women who use the contraceptive implant without difficulty far outweighs those who have experienced problems.

Long Acting Reversible Contraception has been recommended for use by the National Institute for Clinical Excellence (NICE) (details here). This has resulted in reproductive health practitioners recommending the use of the contraceptive implant and other LARC options (e.g. the IUD) to women seeking contraception. The guidance states women being offered LARC should have this as part of ‘women centred care’:
“This guideline offers the best-practice advice on the provision of information and care for women who are considering or using LARC. Treatment and care should take into account women’s individual needs and preferences. Women who are considering using or who use LARC should have the opportunity to make informed decisions about their care and treatment. If a woman does not have the capacity to make decisions, healthcare professionals should follow the Department of Health guidelines, Reference guide to consent for examination or treatment (2001) (available from www.dh.gov.uk).
Good communication between healthcare professionals and women is essential. It should be supported by the provision of evidence-based information offered in a form that is tailored to the needs of the individual woman. The treatment, care and information provided should be culturally appropriate and in a form that is accessible to people who have additional needs, such as people with physical, cognitive or sensory disabilities, and people who do not speak or read English.”(p.5)

Whether this was always completely followed in a drive to encourage women to opt for LARC is not clear. Careful assessment of this should be made within the context of health care practitioners working hard to encourage their clients to have a range of contraception choices. It should not detract from wider discussions about uptake and overall safety, but is relevant if health practitioners or patients felt pressured towards LARC as opposed to other forms of contraception. This is a highly sensitive area to address and given the media’s poor record of talking about the issue so far is a worry that critical discussions around the promotion and uptake of LARC could be further used to devalue health professionals or scaremonger around contraception choices.

What could the result of this coverage be?
Perhaps unsurprisingly the media coverage has led to a lot of anxiety among the public. Women are worried about whether they were right to choose this method of contraception – and whether they might still find themselves pregnant or will face painful removal procedures resulting in permanent scarring.

Anecdotal reports from reproductive health clinics and GPs, as well as reproductive health charities suggest the number of calls from concerned women and their partners have risen dramatically today. We will have to see longer term what could also be the result of this coverage but it is not unreasonable to assume it could lead to women using the implant wanting it removed. Other women may be put off selecting this method, seeing it as ineffective and unsafe. It is reminiscent of the 1990s when media scares over the contraceptive pill led to widescale rejection of this method (and subsequent unplanned pregnancies).

Was the media wrong to cover this story?
No, they weren’t wrong. This is an interesting story. However it’s not exactly ‘news’ (problems with the contraceptive implant and legal actions have been noted for some years). It didn’t need to have been reported right now, particularly during a time when health services are under pressure. It should have been reported within a clear context to allow people to understand there have been problems with the contraceptive implant, but it is a method of contraception that suits many women, is effective and widely used.

What to do if you are worried?
If you are already using the Contraceptive Implant and are not experiencing any problems you probably don’t need to worry. However if this coverage has concerned you then you can speak to your GP, Reproductive Health Clinic or call the FPA on 0845 122 8690.

Remember this form of contraception is more than 99% effective and for the majority of women who opt to use it they experience no problems and are happy with it as their contraceptive choice.

If you’re using the Contraceptive Implant and are experiencing side effects or think you may be pregnant see your GP or Reproductive Health Clinic as soon as you can. Make your situation clear when you call so they can prioritise you for an appointment.

If you can feel your implant below the skin near where it was inserted it will continue to work effectively (but again do ask for a second opinion if you are worried). If you cannot feel your implant or are in any way worried it isn’t working then either avoid sex or use condoms until you have seen your GP or Reproductive Health Clinic.

It goes without saying that you should not try and remove the implant yourself. This has to be done by a professional and only if you are experiencing problems.

If you are thinking about using the implant but are now worried to do so, talk to your GP or Reproductive Health Clinic staff who can discuss your contraception choices and see which suits you best.

If you are not using the implant but still have anxieties about your contraception choices then do talk to a health professional about your concerns.

What health professionals can do
In the first instance you may need to recheck and advise women fitted with the contraceptive implant. It’s worth remembering the reasons why a contraceptive implant may fail and increase a risk of an unplanned pregnancy:
- Unrecognised non-insertion
- Unrecognised pre-existing pregnancy, or pregnancy risk, at the time of fitting
- Concomitant use of interacting medications
- Use beyond its 3 year lifespan.
If you are unsure about your skills in fitting implants or need retraining or support your local PCT or Sexual Health Service Provider should run courses. Book a place now if you feel underconfident or stressed by this story breaking.

You may find this story has increased your workload at a busy time so you may not be feeling inclined to tackle this story. However if you are able to do the following it could be very useful:
- Provide easily accessible information to your patients about the contraceptive implant
- Post resource information (such as the FPA details) around your clinic. A great resource has been created for you by @bishtraining (click here to download)
- Ask patients you know are using the implant or are considering using it if they have any concerns they need you to address
- Challenge poor or misleading media coverage if you are able
- Offer interviews with your local print and broadcast media to explain about the contraceptive implant and provide reassurance
- Request the DH/NHS who are circulating data about the use of contraceptive implants clarify the data (how long has it been collected for, where from, how much of an estimate is it) to help you put any questions your clients have in their proper context

What journalists can do
Much of this media coverage has been poor but there is still time for science/health journalists to challenge what has already been written and put a wider context on the story. Channel 4, after breaking this story, have now included more information on the Implant, but as others have noted this may be too little too late. All media covering this story in a simplistic and scaremongering way must bear responsibility of the repercussions on women’s reproductive health. It would be ironic if those papers gratuitously reporting on the NHS facing lawsuits over failed contraceptives could themselves be looking at similar lawsuits if they scare women enough to avoid contraceptive use and contribute to an unplanned pregnancy.

If you are in a position to rectify the poor coverage or explain more about the contraceptive implant that would be very helpful. This story, as with others on contraception, indicate journalists often have very basic understanding of contraception choices and how reproductive health services operate. If you know you’re not confident to cover stories of this time approach organisations like Brook or the FPA who can give you further information and advice.

Immediate tasks requiring attention from journalists are to:
- check the data that’s been talked about. Both from the MHRA and Department of Health. Source where the figures come from and put into specific context the number of problems women have experienced with the overall use of the contraceptive implant
- clarify the complaints made. How many of these were down to incorrect fitting of the device, faulty implants, pregnancy before the implant was fitted or injury from the implant or its removal (at present this information is not clear)
- try and track the source of this story. How did Channel 4 hear about it. In particular focus on whether this was brought to their attention by any law firms or a source within the MHRA.
- talk to the manufacturer of Implanon and identify from them their reports of problems/malfunctions/complaints recieved. So far most press coverage has focused only on MHRA and DH data (without clarifying those figures much). Additional attention should be paid to the manufacturers of the contraceptive implant who should have data on the number of devices provided along with complaints recieved and any legal actions taken. (They may, of course, not share this information, but it should still be sourced).
- provide information about the implant and what women can do if they want to use it, or are concerned about it, with links to sources of help
- give balanced accounts so while you may talk about women who’ve had awful experiences with implanon talk to those who may have had no problems and found it effective
- be careful not to make claims about the contraptive implant (or any form of contraception) without carefully investigating how it works.
- Talk to health professionals working in reproductive health to find out more about how the implant works, and which women it is suitable for (or not)

What everyone can do
If you spot poor coverage complain to the editor. If you are able to post comments to online coverage or call into broadcast media discussions do share accurate information about contraceptive implants and why this story is currently so problematic. The more we make it clear to the media we won’t put up with irresponsible reporting on our health, the less likely they may be to produce poor reportage in future. Obviously if you see good coverage, ensure this is flagged up and praised (some good examples here, here, here and here). If you have a blog, are on twitter or facebook you can also share accurate information and raise awareness over the poor media coverage.

With grateful thanks to
@DeborahAzizi for alerting me to this story and @dasilva_uk @K4Health @bishtraining @SexEdUKation @EdForChoice @bohaynowell @Abortion_Rights @NoRisks @BrookCharity @michaelgrayer @Matttskimo @dianthusmed for critical reflections on the coverage, data and health implications. And to my many friends working in reproductive healthcare and general practice for providing me with medical information for this post. (Please remember I’m not a medic and this isn’t a replacement for medical advice so speak to your GP or Reproductive Health Clinic or call the FPA on 0845 122 8690 if you are worried).

Fans of the movie Anchorman will no doubt be familiar with the men’s fragrance ‘Sex Panther’. If you hadn’t heard of it before, here’s your introduction…

The fantastic line ‘they’ve done studies you know. 60% of the time it works every time’ has become a well known catchphrase. But I think it deserves far wider use and so I’ve appropriated it to highlight dubious sex research claims.

Last week a Dallas TV station didn’t disappoint with an amazing Sex Panther statistic of their own, claiming ’80% of women have an enlarged labia’. You can see the coverage of the story here.

Even with my dubious maths skills this doesn’t make sense. Because if such a large majority of women report large labia then presumably this becomes ‘the norm’ rather than ‘a problem’.

Using a standard Sex Panther approach we’re told nothing about the origins of this statistic. Merely an assumption that science has shown us 80% of women have larger labia. So we don’t know how many women were studied to make up this figure, who they were, when they were studied, or whether they actually considered themselves to have a problem. We don’t know who did the research, or whether it was even published. We’re given no clue about how ‘enlarged’ labia must be before they become unwieldy. The statistic becomes even more ludicrous if we’re assuming ‘enlarged’ to mean ‘larger than average’. In which case we seem to be being told that 80% of women have larger than average labia.

And that’s before we get on to the problem of the programme makers not being able to differentiate between the vagina and labia.

Of course the piece is really only an advertorial for a “misses only makeover” and sadly amidst the coy references from the anchorwomen we see absolutely no investigative journalism to assess whether cosmetic surgery for well women is needed or to interrogate the concept of ‘enlarged labia’ and who is problematising our vulva shapes and sizes.

Had any research been undertaken the journalists may have learned there is no clear evidence for the effectiveness of cosmetic genital surgery in well women, but there is a growing trend within the cosmetic surgery industry to pathologise the female body as a means to creating a wider market in ‘enhancement’.

Although uncritical media reporting on genital surgery is not unusual there is fortunately an antidote.

THE NEW VIEW CAMPAIGN announces its THIRD Conference, to be held at the University of Nevada, Las Vegas, on Sunday, September 26, 2010.

FRAMING THE VULVA: GENITAL COSMETIC SURGERY AND GENITAL DIVERSITY

While the vulva surgeons are holding a conference on the Las Vegas strip, the New View, in collaboration with the UNLV Women’s Studies Department and Petals, will hold a counter-conference to examine the
personal and political complexities of the new female genital cosmetic surgeries.

Our one-day event will include a morning plenary session on the emerging issues in genital scholarship, activism, and art, and an afternoon of experiential and discussion workshops for participants to share strategies and build connections. The event will conclude with an evening reception, photography and craft exhibition, and film showing at the Erotic Heritage Museum.

Areas covered will include:
• Cosmetogynecology and the new genital perfectability industries
• The rhetoric vs. the realities of Western genital surgeries vs. “FGM”
• Collaborative models of activism
• The revival of “cunt art” in craft, film, photography and painting
• Sex education and feminist-owned sex shops
• The latest body modification trends, from Vajazzling to Vatooing
• Disease-mongering, marketing, and body surveillance
• Critical health studies perspectives on cosmetic genital surgery

Confirmed plenary speakers include:
• Virginia Braun, University of Auckland, New Zealand
• Leonore Tiefer, NYU Medical School, NYC
• Vanessa Schick, Indiana University, Bloomington
• Lynn Comella, UNLV, Las Vegas

Full registration, hotel, and contact information here.

Please share information widely and if you’re a health worker, activist, therapist or sex educator do try and support the event if you can – either by attending the conference or donating to the New View Campaign. Journalists may particularly want to attend to learn more about celebrating women’s bodies and accurate reporting on the growing trend for medicalisation.

In the meantime go on – love your labia! Or love someone else’s. And if a journalist tells you there’s something wrong with your genitals without explaining the science behind their statements be assured they’re simply selling you Sex Panther Statistics.

You may have seen or heard the news coverage yesterday suggesting a link between rising rates of Syphilis and hooking up via Facebook.

It came from a statement made by the Director of Public Health in Teeside who in a press release suggested an association between social networking and STIs. This was snapped up by the Sun, then the Telegraph. Both of whom ran with lurid headlines that Facebook was linked to a rise in Syphilis. Many other news outlets quickly, and unquestioningly, picked up on the story which soon went global.

But of course it is much more complicated than the media might suggest and you can read my deconstruction of the story and questions journalists should have asked about the statements from Teeside’s Director of Public Health here.

As the story has spread over the past 36 hours it has been a mixture of astoundingly poor media coverage, misleading health information, and superb examples of public challenge and sex education.

Here’s how it’s unfolded…

#Syphilis became big news
During the course of yesterday #syphilis became a trending topic on twitter. It began with inevitable questions of why people were talking about Syphilis and led to a thorough debunking of the study by bloggers (linked to above) and questions about what Syphilis actually is. Folk went looking on Wikipedia and elsewhere to find out more.

As discussions unfolded it became obvious that people are still very ignorant about this STI. Some seemed to think it no longer existed or saw it as something from history. Others reacted with revulsion talking about their neighbourhood being adversely affected by being linked with Syphilis, or expressing concern they might be exposed to infection. Judgemental attitudes about those who might have or get Syphilis abounded, many of which had a misogynistic subtext with promiscuous women seen as the source of the problem. General statements about Syphilis also indicated a lack of awareness of symptoms, prevention or treatment.

The sex educators step in
Seeing an opportunity to answer questions about Syphilis myself and sex educator colleagues from Bishtraining and Scarleteen joined in discussions, shared links to accurate resources on Syphilis and other STIs We encouraged people to share this through their blogs, social networking sites, on twitter and by word of mouth to friends and colleagues. We invited them to debunk myths about STIs, and highlight symptoms, prevention and treatment for Syphilis.

Poor media coverage continues
This morning it seemed like the Sun had developed some awareness of the damage they had caused, as they ran a feature focusing on how to spot Syphilis. However, this was actually an activity in further reinforcing judgemental stereotypes about the STI with a list of dictators and criminals from Hitler to Al Capone used as case studies with the infection. A few symptoms were described, but not accurately, and no information was given about where to get help if one was worried about STIs.

Meanwhile, the Telegraph pulled off an astounding feat of journalism where they followed up the Syphilis story they were partly responsible in starting, but reported it as though this was nothing to do with them, while citing a list of other cases where Facebook had been linked to various social problems.

Birmingham set a good example
Continuing with Teeside PCT’s message, health practitioners from Birmingham seemed to endorse the ‘social networking increases syphilis story’, with reports in Birmingham Mail describing risk taking among youths hooking up via social networking sites and a massive recent rise in Syphilis.

Again, this was challenged by bloggers and sex educators. And it turned out to be another case of inaccurate press reporting. The Outreach Worker Julia Hyland quoted in the story has given me this statement “I did not claim to be an expert in this field and the figures quoted did not come from me, I have called the Evening Mail they told me their figures came from Heartlands [another health trust in Birmingham]”

Julia’s prompt (and brave) response, along with a challenge from the University of Birmingham alerted the paper to their inaccurate reporting and the problematic story from Teeside. Birmingham Mail removed the story from their website.

In the mainstream media no such clarifications or removals have been made. Teeside PCT and their Director of Public Health have seemingly made no such efforts to challenge or clarify. Practitioners are still chasing them for further information (see links in my blog post from yesterday).

Health media seems out of touch with the story
While we might expect the mainstream media to provide poor sexual health coverage, we should expect better from the health press. Sadly this didn’t seem to be the case with Nursing Times leading on the story in a completely uncritical way.

NHSChoices were questioned on twitter why they had not challenged or followed up this story. They responded with “No plans to cover it. No evidence to assess & just a wildly OTT headline”, although they noted “We’ve got a wealth of evidence-based info on sexual health & STIs” (while fairly explaining they don’t offer training to healthcare professionals as they’re a public resource).

Worryingly, although NHSChoices do have excellent resources on Syphilis which practitioners have been using as public information throughout this situation, there seemed to be no consideration from the organisation they should be publicising these resources as the Syphilis story continued to trend. This is despite their remit being public outreach with a specific twitter, blog and website facilities for this purpose. Only when prompted by several sex educators/consultants (particularly Matthew Greenall and Bishtraining) did they start sharing links on Syphilis. These were eagerly picked up and retweeted by NHS Trusts and other parties, but were done only after pressure was applied and 1.5 days after story went global.

Bloggers and sex educators did the job the media ought to have done
There have been some real heroes in this story – aside from Bishtraining and Scarleteen who gave up several hours of their day yesterday and today to challenge and educate, HIV consultant Matthew Greenall has tirelessly chased up information on social networking and STIs and challenged the inadequate handling of this issue from the NHS and Nursing times. Ben Goldacre has been chasing Teeside for more information and sharing his frustrating experiences with them on twitter. Jo MacIver supported Outreach Worker Julia Hyland and encouraged other bloggers (including myself and Ben Goldacre) to hold fire on attacking the story until she had properly investigated the Birmingham angle. Countless people on twitter took up the challenge of being sex educators and shared links to STI awareness and debunked the media coverage. In particular @regordane @silv24 @Heresy_Corner @DrMarkBurnley @The_MediaBlog and @viviane212 were active in challenging, questioning and keeping this story trending.

The past 24 hours continue to show us how many media and healthcare staff don’t seem to understand social media. Mainstream media with only a few exceptions (here, here and here) have failed to ask basic questions over accuracy of story. Some healthcare organisations have also failed to critique the statements coming from Teeside, or have not responded promptly to issue. To date nothing has been said by either the Department of Health or the Health Protection Agency.

It has been left to bloggers and sex educators volunteering their time to actively engage through social media to challenge this story and share accurate information.

Ironically in a story about the evils of social networking, it has been social networks that have challenged the story and turned it from a piece of scaremongering into an internationally shared opportunity to spread sexual health awareness.

There are still many questions to be answered – not least from the papers who spread the story, and from Teeside’s Director of Public Health. Facebook has not really become involved as yet and there is speculation on whether they might take action (and in what form).

In the meantime, let’s not lose momentum on this story. We can all continue to be sex educators and media critics. We can find poor coverage and alert readers to why it is bad. And we can keep telling or friends, neighbours, colleagues and folk we’re connected to via social networks about STIs, how to prevent them, and where to get treatment if we think we’re at risk.

Over this weekend the story broke that pharmacies were going to give teenagers the pill – as a means of tackling teenage pregnancy.

News coverage included:
Teenage girls offered contraceptive pill over the counter in a drive to cut pregnancies – Daily Telegraph

Teenagers to get pill without prescription – Independent

Girls get the pill on demand: now teenagers can get the contraceptive without prescription

Teenage girls to get contraceptive pill in pilot scheme

You’ve got to love these ‘girls get the pill on demand’ style headlines – which kind of ignore the fact that contraception is free and available within the UK – and yes you can ‘demand’ it if you like!

From the press it sounds like girls across the UK are going to get the pill from the pharmacy – is that really the case? Well, before we get to that, let’s look at what we do know about providing contraception via pharmacies.

What’s the evidence?
The papers have not clearly indicated this is a pilot scheme, perhaps in their hurry to promote a shock/horror response they overlooked this. They also seemed to overlook the wider evidence base about oral contraceptive provision, and managing teenager pregnancy.

So what do we know about this issue? Well, we do know our teenage pregnancy rates in the UK are high. Most of those pregnancies are terminated, but the prevalence of termination (particularly repeat terminations) are of concern to healthcare providers. As a result there’s been a push within reproductive/sexual healthcare over the past decade to rethink how contraceptive services are delivered – and how teenage pregnancy rates can be reduced.

There is already an established evidence base that pharmacies can provide some forms of contraception and sexual health support – for example condom sales, testing for Chlamydia and providing emergency contraception (morning after pill).

Here the pharmacy becomes an additional service for providing contraception/sexual health support, alongside existing reproductive health/family planning clinics or GPs.

Young people are frequently blocked from accessing services due to unclear signposting of services (so young people don’t know where they are); restricted opening times which often don’t fit with young people’s timetables; problems with location; uncertainty over what happens in a clinic; worries about confidentiality; or just basic information (many young people still wrongly think you have to pay to get contraceptives).

Add to this problems with sex education and general problems around poverty and social exclusion, there are understandable reasons why young people get pregnant. Culturally we’re often quick to blame them without appreciating the lack of access to information and contraception that affect some teenagers. You can read more about how poverty, lack of education and healthcare barriers contribute to sexual and reproductive health problems here (with an ongoing investigation into the issue reported here)

Part of a response to our current sexual health crisis been a shift to making sexual health less clinical and more about self management. This has been suggested to reduce strain on services and make aspects of care that can be managed in other settings more effective. So pharmacies can be one additional place to deliver care, as might school nurses, or even cafes and nightclubs. More choices and more places to get advice and services are a step to reduce teenage pregnancy and termination rates.

There is no evidence that making sexual health services more accessible increases teenage pregnancy (as some media reports have claimed). Although it’s worth noting that many of the schemes trying to reduce teen pregnancy are being rolled out in areas where teen conception is already very high.

What’s actually happening?
This is a pilot scheme being run in a deprived area of London with a high prevalence
of teen pregnancy. You can read about the area’s history on this issue here. This borough has received charitable trust funding to modernise a variety of services, including sexual health. You can read an independent evaluation of that work here.

Within this modernisation work, practitioners have already investigated delivering sexual health services within community settings, including assessing whether community pharmacies were suitable locations for Chlamydia testing.

This latest pilot is part of an ongoing project looking to modernise, improve and make more accessible sexual and reproductive health services for a resource poor community. All activities have been based upon evidence and completed in consultation with the community.

So rather than the pill being given to all teenagers across the UK, this is simply a pilot scheme to see whether providing the pill to younger people within community pharmacy settings is feasible – and works to reduce teen conceptions. If it does, then the scheme will be rolled out to other pharmacies. If it doesn’t work then alternative approaches will be considered.

Why do we need to be cautious?
My first question about this story is ‘is this really news?’. It created a widespread splash in the papers, but it was actually launched to the press last year, and there was some coverage of the proposed scheme in August 2009 too.

We need to discuss why this story got back into the papers. It isn’t clear. But what is clear is the majority of coverage was judgemental or negative, and has discussed a pilot scheme within the press before it has even really got started. That’s a problem as it can scupper a pilot and mean we never get to see if it can work or not. It can lead to people interfering with the delivery of a service – particularly those who’ve been led by the media to see such a pilot in negative ways.

We don’t know if this will work – that’s the point of a pilot. To investigate and explore. So media coverage should really only happen when a study has been completed – not speculation before it starts, or during any study.

We’ve seen similar problems with the media outing interventions to reduce teen pregnancy in the past. You could be forgiven for believing some media outlets simply don’t want us to tackle the problems we’re experiencing with teenage pregnancy and sexual health.

Generally health evaluations work better if left undisturbed and can be reported faithfully whether they work or not. We really do need to challenge this practice of reporting on pilots until they are finished. Particularly in the restrictive way the media approaches this which is to find a practitioner (usually from a faith based group) to say how such a scheme will inevitably make things worse. What may help more would be to put such schemes within the context of wider evidence, and if you want a debate to talk about whether other approaches – like better sex education, tackling poverty or increasing aspirations for young people – might be equally or more effective.

For the record this pilot scheme does not mean all teenagers are going to be offered the pill. It’s a pilot taking place in a specific part of South London. Even within the pharmacies in the pilot it doesn’t mean that pharmacists will be pouncing on all young women entering their stores and giving them oral contraceptives. Any young woman requesting oral contraception will have consultation and be assessed for competence and the pharmacist can refer to other services if needs be.

Parents don’t need to worry that pharmacists will be slipping the pill to their daughters behind their backs. Even if some journalists have misled them that this will be the case.

For now, all we can do is wait and see if this pilot works. And in the meantime additional focus will continue to address ways for reducing teen pregnancy in
poor/deprived boroughs.

Yesterday afternoon I dodged the ongoing downpours by popping into our local cafe for a quick latte and a catch up with the Sunday papers. Which were quite dull until I came across this snippet in the News of the World:

A sexual position
£31K-a-year University job to investigate lap-dancing

A TOP university is adverting for a new researcher – to investigate lap-dancing.

And there should be no shortage of qualified candidates. The researcher has to have “prior experience of conducting research in the female sex industry”.

Predictably the NOTW approached this in a kind of “phwoar fellas, look at that sexy research you can do at a TOP university” format. (They weren’t the only ones, a fair few other papers also ran the same story). Yet the tone of the piece suggests that despite being at a prestigious institution it isn’t proper research because the successful candidate’s going to visit strip clubs and talk to dancers. The salary and mention of government funding are used to detract from, rather than enhance the seriousness of the job.

Because of course to NOTW, other newspapers (and probably many members of the public) this cannot really be serious. After all, sex isn’t a topic taken seriously by the press and people tend to have a mixed response to erotic dancing – a combination of excitement and disapproval.

I can completely see why many people reading this would either dismiss it as a joke or go for the ‘ooh is that what they’re wasting tax payers money on now’ reaction. It may not be particularly clear why this research is necessary (I’ll explain why in a bit). Some people may mistakenly think that funding studies like this means research on other issues around health/wellbeing may be neglected (it’s not true, but it’s very difficult to convince people otherwise).

The salary may also seem very high to many people. Particularly when NOTW suggest the only work involved is chatting to a few hundred dancers. Whereas the successful candidate is going to have to search the literature for other research on this topic; create a questionnaire (after reviewing existing measures); design the interview schedule they’ll be using to shape their conversations with dancers. They’ll need to obtain ethics approval (which can take several months to prepare) if it’s not already been granted; and they’ll need to conduct, oversee the transcription of, and analyse the interviews. [If you work on the basis that one hour of interview can take up to ten hours to accurately transcribe, and that many of these interviews will be longer than that, it'll give you some idea about how much work will be involved]. Transcripts will need checking with dancers and reports for the funding body will need writing. Outcomes from the survey will need analysing. And there’ll be the obligatory writing up academic papers based on the study.

The pay represents the grade of the researcher needed to do this work – someone who is experienced in social research. Who’ll not only need a PhD, but also extensive postdoctoral experience.

Even here I can imagine the sniggers of what ‘postdoctoral experience’ may mean in relation to lap dancing. Yet to research this area you need to be able to work sensitively with people, to understand the female sex industry, to be transparent in your interviewing and reflexive in how you approach your data. It’s not just about asking questions in a careful and balanced way. It’s also about being able to represent what’s said by dancers fairly, and analyse resulting data faithfully.

While this might explain what this job involves, it doesn’t sound quite so sexy (or dismissive) as NOTW’s interpretation.

Unfortunately many journalists are unaware there’s any such thing as ethical and professional research on the sex industry. The media’s forays into lapdancing is either smutty or prurient. This is partly why such research is needed – because the understanding of lap dancing is limited and what exists are either stereotypical or hysterical media reports, or highly biased and flawed studies commissioned to prove lap dancing is bad by researchers with fixed agendas against erotic entertainment (click here for an often cited example of research practitioners view as problematic). Of the balanced and ethical studies that do exist, these tend to focus more on the client, with the voices of dancers still largely absent.

The skill required for this current post will be to listen carefully to dancers, to record their experiences, but not to use the research to push any predetermined agendas. No doubt the women interviewed will reveal good, bad and mundane experiences with lap dancing and all those will need clearly explaining.

The NOTW’s approach suggests that anyone can study this area by dint of having an interest in erotic dance. While there’s no reason an erotic dancer couldn’t apply for the job, they’d only get the post if they additionally had the relevant academic experience. Strangely the NOTW’s take on sex research represents the way journalists often talk about sex studies – in a way that’s unique to sex research. You never hear them suggest that if you’ve had a suspected heart attack you’re suddenly a cardiologist, or you can only study cancer if you’ve got it yourself, or the only people who might apply for a project on diabetes must be diabetic. Yet when it comes to sex research the assumption is anyone who feels a bit frisky might suit the job, or the research is entirely based on personal experience – not social/science, awareness of critically appraised research evidence, or years academic training.

Sadly it’s coverage like this that means academics who research sex and relationships are suspicious of the media. Countless research jobs are advertised weekly, yet the press only seem to get in a fluster when there’s a sex-related job available. How sad that journalists fail to grasp that making such a fuss they draw attention to a forthcoming study which can very well compromise results and make participants unwilling to speak to researchers. It could also affect the safety of the researchers on the project or subject it to ongoing scruitiny which would make carrying out a balanced study. And it completely devalues the achievement of getting independent funding to look at erotic entertainment – no mean feat for any academic.

Of course, you can’t just blame journalists here. After all, some researchers have, in the past, gone to the media with their planned research on lap dancing before it even started. So you can appreciate the average journalist may assume this is common practice and feel it’s fine to out a study before it’s even got started.

Unfortunately each time something like this happens academics, therapists and healthcare providers working in the area of sex and relationships are reminded that the media (and often the public) don’t take what they do seriously. And that it’s very difficult to challenge this kind of reporting without seeming humourless.

Here’s hoping this study drops out of the public gaze and continues as it should. Without any further attention, and with the possibility of letting erotic dancers speak openly about their lives. The next time we hear about this study should be when results are presented. And until then I wish the research team and whoever gets the job all the best with a much-needed and timely piece of research.

* Illustration at the start of this blog is by illustrator Dan Avenell and was the front cover on the MyPole charity calendar 2005.

What made me start blogging?
Five years ago I sat down on a dark November evening and wrote my very first blog entry. It was a bit ranty. I’d been misquoted by a journalist and was anxious it would get me into hot water (again).

I didn’t have a game plan when I started blogging. My partner (who’s way more tech savvy than I am) thought it might be a good way of sharing ideas I was struggling to convey via the mainstream media (I was writing several advice columns in magazines at the time, as well as hosting a regular radio phone in for BBC Five Live).

I approached the blog as a form of therapy. I wanted to work with the media but was getting a lot of stick for it professionally (I’m an academic as well as a sex educator). Having a place to blog would allow me to correct any errors in reporting and disclose bad journalism. I even hoped it it might even let me bring evidence into sex/relationships reporting – and show it was possible to do so without things becoming worthy or dull.

One thing I felt sure of early on was this blog was something I enjoyed writing, but I wanted to be useful, and most importantly to deliver things about sex, relationships, science and journalism that readers wanted to know about. Which is why the blog has always been shaped by things you’ve asked for.

Readers make this blog (or “why don’t you have comments?”)
Last summer I asked regular readers to give me feedback on this blog and got some very helpful responses. It’s taken me a while to implement some of these, but I have now upgraded the blog to include the things you asked for – photos and images to liven things up, a better blogroll, summaries at the start of most entries so you can decide if you wish to read on. And categories. Something I didn’ think about five years ago and really wish I had. I’m now in the process of going back through all the 800+ posts and adding categories to them, which I hope will make this blog a lot more useful to you.

The one thing this blog doesn’t have is comments. I did start off having them, but encountered several problems. As I was offering advice within columns and websites elsewhere I hadn’t planned to also answer problems on this blog. However, not all readers understood this so I frequently found requests for advice on anything from infidelity to penis size included in discussions about blogs relating to research design or journalism ethics. This sometimes led to some readers mocking those asking for advice, which of course is completely unacceptable for me as an educator.

Moreover, I’ve always blogged openly – never behind a pseudonym. I work within the community on sex/relationships projects and educational activities (in the UK and internationally). This meant I was very accessible, and felt vulnerable when those whose comments were deleted or not posted, made very personal threats.

I found moderating the comments was time consuming and took me away from other educational activities which I felt were more worthwhile. So I decided to remove the comments option. When I’ve asked readers if they want them back the general response is ‘no’. That’s mostly from people who feel the blog’s a safe space to get information which they can use as they wish elsewhere.

Of course I strongly welcome respectful email feedback and am always happy to add information or correct errors within the blog. You’re always welcome to start discussions on other forums or your own blog about issues raised here. For now I’ve no plans to reinstate comments, but since I’m occasionally asked why I don’t have them I thought this was a good a time as any to clarify the issue.

Achievements so far
Having read back to 2004 I’m pretty pleased with this little blog. It’s nice to see it’s grown into a resource that people trust and enjoy reading.

The things I’m most proud to have written are activist blogs that highlight medicalisation, exploitation and abuse. These include the debates around female sexual dysfunction, questioning high street stores stocking ‘herbal’ erectile dysfunction drugs (not approved by the FDA), exposing the Advanced Medical Institute’s aggressive sales technique for men affected by premature ejaculation, or highlighting misleading media coverage of the availability of Viagra on the high street.

I initially planned to use the blog to set right bad sex coverage in the media (or occasions where I’d been misquoted). This has been a theme within the blog although I think it’s become more focused over time (although not necessarily less ranty than my very first post). I can’t say whether it’s made much difference to journalists, and I hope it’s not put people off working with the media. I’ve found it helpful to describe poor practice – not least because the general trend for ‘experts’ working with the media is to act grateful for any exposure, not publicly discuss poor experiences or document bad practice. Gems for me include an expose of GMTV sending a cab to my home at 6am on the off chance I might wake up and come to their studio. Or how a TV show wanted to discuss female sexual confidence without mentioning genitals or masturbation. Or some rather nasty experiences with snotty TV producers just after I’d had a baby. Not to mention the hilarious case of the science journalist who really took a dislike to me (and colleagues). Oh, and let’s not forget the journalist who wanted me to recommend them an ‘unethical psychologist’ .

Of course, the past five years have not been spent simply slagging off journalists. No. Sometimes I’ve also turned my gaze to bad science too. Where it’s been depressing to report on a carnival of studies which seem to set us back sexually. Studies complaining women orgasm too easily, or there’s a ‘clitorocentric conspiracy’ against the vagina, how sex with a partner is 400% better than any other kind of sex you might have, and you can tell whether a woman has vaginal orgasms by her walk.

Let’s not forget my other bugbears. The fake formula and shonky surveys and my goodness this blog’s a treasure chest for those. And if I’m not being irritated by that, then there’s always the problem of psychologists talking about celebrities, or the general ethical issues raised by Big Brother for me to moan about.

Of course, it’s not all been bad news. Anyone would think this blog is only about gripes and grumbles. I’ve always wanted to showcase a variety of sexual experiences within this blog and not just think about sex just for a Western audience. I’ll continue to discuss issues relating to sex and seniors; teenagers; disability; transsexuality; lesbian, gay and bi issues; open relationships; BDSM; sexual health; contraception; prostitution; pornography; reproductive health; pleasure; desire; asexuality; dating; psychosexual problems; showcasing great sex pioneers; talking about safer sex; and as many other topics as I can find for you to read about.

Where to next?
Unlike five years ago, I’m now thinking strategically about this blog – who it’s for, what it does, and seeking to find ways to assess any impact it may have. I’ve noticed over the years it sometimes deviates into areas that interest me, but may not appeal to all readers. So my aim is to ensure the focus of the blog remains around the core things you’re most interested in when you visit – sex, science, and media.

I’m currently involved in overhauling the site so in the new year I hope to have far more open access materials available for you – relationships and sex guides, information about sexual and reproductive health, more advice and links to sources of help, along with practical information for journalists, healthcare professionals, parents, teens and teachers.

I’ve been asked by many readers for more information about how to become an agony aunt/media sex educator, so I’ll be blogging about this – as well as how to write a sex blog – in the not too distant future.

I’ll also be making use of twitter soon, as sometimes I blog about issues people need to hear about fast (particularly developments in science/health), so hopefully that will make messages more accessible. I’ll let you know once I’ve sorted it.

Obviously I’d like to hear what you’d like to see. How would you like this blog to develop over the next year (or five!). Are there any particular things you’d like to see more/less of? Topics you want covered? People you’d like me to interview for the ‘quickies’ section of the blog? Campaigns you want covered? Let me know what your vision is for this blog.

So, happy fifth birthday blog. Big birthday kisses to those of you who’ve been with me from the beginning. For those of you who’ve only recently found this blog I hope you like it enough to stick around for the next half decade. I notice one of my favourite other blogs Mind Hacks has also celebrated it’s fifth birthday too, so congratulations to them.

Time to blow out the candles and make a wish. Of course, I can’t tell you what it is. You’ll have to come back in five years to find out if it’s come true.