One thing that has marked this election is the growing focus on science issues. This has partly been down to the interest of some politicians in the subject, and mostly due to the activism of a number of scientists (natural and social), science journalists and bloggers.

The focus of these discussions has been around tackling key issues around science (funding, support, listening to expertise etc). And while it is really important these topics are being debated, I’d invite a step back to think a little bit more about the way politicians understand and use ‘evidence’ from science and healthcare in practice. Otherwise we may miss opportunities to work with politicians and inform political thinking – and in turn help the public on key issues around health, education, innovation and technology.

In order to explore some of these core issues I’d like to reflect on my experiences of working with the Department of Health (DH) on their sexual health campaigns, where I had the chance to see where there are major barriers to using, applying and understanding good approaches to sound science. Which results in misleading information and a lot of money wasted.

I began volunteering on the DH campaigns in 2001 and between then and 2008 I increased the work I was doing, eventually becoming both a consultant and spokesperson on the public sexual health campaigns RUThinking, Playing Safely, Want Respect? Use A Condom (see also their great ad campaign), and Condom Essential Wear. Most of which have now been updated for Sex and Young People and Sex, worth talking about (where I currently volunteer for NHS Choices answering questions on psychosexual health topics).

This work involved identifying core evidence to underpin key messaging and liaising with civil servants, ministers and PR companies to ensure accurate, accessible and engaging messages were shared at a variety of different audiences in diverse formats (print, online and broadcast media as well as live events like music festivals).

I came to this work through my background as an academic who teaches healthcare practitioners and policymakers internationally how to access, critically appraise and understand evidence. And through my research which has focused on the sex and relationships health topics of education, service improvement of reproductive health, and addressing psychosexual problems, with a particular interest in media and public health campaigning. All of which I apply via advice giving through educational events, practitioner training and the media.

I was honoured to be part of the campaigning work and believe there were a number of key areas where major achievements were made around getting sex talked about within the media, and particularly with young people. There were some great examples of innovative practice and in the activities I was involved in we ensured work was ethical, based on sound evidence, while still being engaging.

However, during the seven years of working on the campaigns I noticed a number of core problems. I don’t know if these are repeated within other government departments, but it would be worth investigating whether the issues outlined below are happening elsewhere. My hunch is they’re not unique to health.

It was for that reason I asked the Guardian’s Science Test of politicians (by Martin Robbins) to clarify how political parties intended to oversee and manage public health campaigns and associated PR companies.

Here are the key areas I noticed problems around the application and interpretation of research and evidence:

Bidding for contracts
The majority of public engagement activity run by the government (and via political parties) is organised through PR companies. That in itself is not problematic, PR companies are experts in ensuring messages reach the right people in a timely fashion. What is problematic is for health, education and other campaigns there seems to be frequent bidding process orchestrated by different government departments. Meaning several months on any contract will be spent preparing to bid to renew it (in competition with other PR companies). And until any bids have been renewed no new activity can take place. Which restricts the amount of work you can do to reach the public.

There is also the difficulty posed when a PR company is replaced. Where the company who has held the contract has built up their own contacts, messages, experience in delivering information and goodwill among the media. Because they are a commercial organisation this information remains with them if they lose the contract. Meaning the incoming agency has to begin from scratch building up these contacts, there is no organisational memory, and a lot of time lost in repeating activities. It also means experience built up on campaigns can be lost.

Uncertainty of messaging
During the time I worked on the DH campaigns there were periods where ministers were unsure about the direction in which they intended to go. That was not because they were engaged in a systematic review of the evidence which might help them decide, but because they were anxious about media and public responses to their messages. Particularly relating to sensitive issues like contraception, teenage pregnancy and STIs. It took three years to move the more fragmented ’sex lottery’ campaign of 2003 into the national media run ‘Condom Essential Wear’ launched in 2006. [This was the first widespread government-backed public media campaign on STIs since the HIV/AIDS one of the 1980s]. Fear over how the press/public will respond led to haphazard delivery of messaging, also hampered by a limited budget.

It has also led more recently to overlooking evidence of good practice – which is about easier access to services, accessibility of testing and treatment, combined with prevention messaging. Instead the government has opted far more towards promoting testing, and has moved away from their 2006 approach which suggested prevention based messaging/normalising condom use. This appears to be based around cost decisions and attempts to deal with rising STI rates. While it is right that we alter messages depending on new information from research and evaluation, it is problematic if politicians and civil servants do not understand this process, or ignore it in favour of activity that is based around anticipated public opposition or healthcare spending cuts. And equally worrying given it muddles the public and healthcare staff around what they should be doing.

Reinventing the wheel
In the past decade our public sexual health campaigns have begun with the Sex Lottery, which became Playing Safely, which morphed into Condom Essential Wear and is currently Sex, worth talking about. And that’s just the campaign aimed at young adults. Teen campaigns for sexual health, general health and pregnancy have also morphed in similar ways. This has included new websites, logos, branding and core messaging for each iteration of the campaign. And within each development an additional range of agencies working on digital, creative, and marketing tasks. While material written for the web has been reused for some of these campaigns, in many cases new content has had to be created although again not always based on core evidence. It results in confusion to the public who are presented with different names, brands, and websites to find. Individual NHS trusts paying for their own sexual health websites that replicate content found on government ones wastes additional money. All of which results in a lot of activity, a lot of money spent, but no real sense of outcomes – the impact such campaigns have had. Sadly the focus of evaluation is often reduced simply to mentions within the media or visits to the campaign websites. Again indicating a lack of awareness of how to fully assess activity undertaken.

Flashy, gimmicky, but has it worked?
One aspect of the public sexual health campaigns has been a focus on getting young people involved. That has included viral videos, myspace pages, interviews with celebrities and texting services. More recently England’s Sexual Health Quiz was launched. Critics have questioned why this uses a kids vs parents approach (given evidence indicates competitive based education in this area is rarely successful). Other concerns have been expressed about the accuracy of the questions (particularly relating to cancer) and whether knowing how much water a condom holds really tells you anything about your ‘knowledge’ of sex and relationships, or your sexual health needs.

All of these activities are clearly costly, and most of them are focused online, which excludes large numbers of the population. We also have no idea how much they have cost, or what impact they have had. When asked, the Department of Health’s response to me was the latest quiz encourages ‘friendly conversation’ between parents and teens and provides right and wrong information. They had no information about whether this approach had been successfully piloted or was working to increase communication between parents and young people.

We have no idea whether, post election, the current quiz will still exist, or whether the data will be used to inform public health campaigning in the future.

Activity that doesn’t make the headlines
While we may be concerned over the quality of public engagement activity, there is the additional problem of campaigns that are paid for, but fail to reach the public or make much impact. For example one survey called ‘pulling pants’ was carried out for the DH by Tickbox which was to identify whether people chose ‘lucky pant’s to go out in. The survey indicated people spent time thinking about what underwear to wear – and clearly did have special undies they wore in the hope of pulling. But they did not put the same focus on taking condoms with them. This was a playful message, but actually quite important if you think about intentions to have sex. However, despite the survey being designed, run, data collected and the PR and polling company paid, it never made it to the media as ministers and civil servants were worried about the underlying messages. While I have a copy of the data, I do not have the costs for this particular project, but it would be equivalent to a standard public survey of 1000 participants spread across the UK.

Another activity that did make the headlines, but not in any great way, was the Alesha Dixon photospread run in 2008. It produced a series of gorgeous photos, but hardly any media outlets picked up on it (if memory serves only a couple of online editions of tabloid papers ran it). Which again represents a lot of money spent for very little return. [This is not a criticism of Ms Dixon who showed a genuine commitment to a campaign on a topic very few celebrities will be associated with]

It is not unusual within mainstream research or any public engagement activity for ideas to change, for messages to occasionally fail, or for problems to arise. But in relation to the cost of these campaigns – particularly when front line services are being cut – this is a worry. Not least when you add it to the fees for the more online activities, surveys run and time lost while rebidding for contracts.

Part of the problem of messaging being ineffective is the timing of them – Valentine’s Day, for example, is such a busy period to get any media pickup. But it’s also not a particularly good time to run public sexual health messaging – a better time would be around Christmas/New Year when people are more likely to have unprotected sex.

Policy/public health education and the role of the PR Company
By far the biggest problem around evidence-based approaches to public messaging is related to PR companies. In 2008 the Telegraph reported the government were spending approximately £1million per week on polls and focus groups and it may be the figure is far higher if you factor in consultations, and other public facing activity such as websites run by different government departments.

This issue has not really been fully explored and I think a canny journalists might be able to identify a far larger spend than already suggested.

These surveys and focus groups are not run to identify people’s key problems or needs, nor to improve services or our wellbeing. Instead they are run to collect information that will be used to inform media activity. Because nowadays most journalists won’t cover stories unless they can pin them to a survey or similar.

This wastes time and money on a number of levels. It firstly overlooks existing evidence on health, education or business that may well be useful to help us understand or deal with an issue. Peer reviewed research is rarely consulted or used to underpin such activity. Instead we see a number of leading questions used to get answers that in turn will generate headlines and discussions points for radio. Which can work if you have a spokesperson allied to a campaign that can translate that information into accurate and contemporary advice. But this is sadly not often the case given the use of PR companies of spokespeople who may not be the best qualified within an area to interpret and share information.

Research to inform public health is led by PR companies, not academics/practitioners
Over the years there has been a shift within public health campaigns where instead of being informed by key academics/practitioners about current evidence of best practice there is now the approach that the PR Company comes up with the idea for an activity as well as being responsible for promoting it.

A key example, and one that led me to resign from supporting the Department of Health’s sexual and reproductive campaign, came from the new PR agency they appointed. They had heard about some research covered in the Daily Mail where researchers counted the number of mentions of alcohol in the media. They suggested the same approach be used, but focusing on condoms.

Their recommendation was for someone (an academic) to observe the media over an unspecified period, and from that they could indicate how little condoms were mentioned in the media, and flag this up as a problem. They also incorrectly claimed no similar research had ever been conducted on this before (because they had not found any in searches they had undertaken).

Civil servants at the Department of Health seemed impressed with this idea. My opposition to it ran as follows. Such an activity if carried out correctly is very time consuming and costly. It would require very clear parameters around what media would be studied over what period. Given that we already know condoms are not mentioned much within mainstream media there is probably little point in doing such an in depth activity. But given we also know that integrating safer sex messages into mainstream media works see here and here and here and here, perhaps using that knowledge might allow us to bypass the research and focus instead on working directly with journalists – particularly in television where often plot lines in soap operas can be requested to focus on core issues (e.g. sexuality, bullying, teenage pregnancy). My advice was ignored.

On 20 February the Department of Health announced they had commissioned research that looked at media coverage of condoms in a report called ‘Mis Selling Sex’. The report still has not been publicly launched, and there is no clear information on who did the analysis, how it was conducted, and how much the activity cost. Moreover, there is no clear information on how the findings would be implemented outside of talking to television companies, which, as we already have seen, could have been done without having to do a full-scale study.

It is sadly a common problem within health research where people repeat studies, but in the case of a government department being advised they did not need to do this research – and could have used their money elsewhere – it is worrying such advice was ignored. If we do not see particular changes within mainstream media, this work will have been wasted. And even if we do see such messages in media they need to be sustained and supported.

What did I learn from my time in the field?
It would be wrong of me to imply those working on various government health campaigns are not doing their best or lack good intentions. My experience of working with ministers, civil servants and the PR companies behind the campaigns suggested a lot of well meaning people. There were also a few practitioners like me who volunteered our time and skills to inform campaigns and improve sexual health.

However, high staff turnover, fear of the response of the Daily Mail, a reliance on ‘desk based’ research and the focus towards ‘policy based evidence making’ rather than ‘evidence based policy making’ meant many good ideas were blocked, and weaker activities green lit.

Given sexual and reproductive health services are so underfunded, and yet given our equally worrying rising STI rates, it is vital any activity we undertake is cost effective, appropriate, built on evidence and evaluated. And that it directs people to the services they need. Spending money on campaigns that do not achieve this means people won’t go for help and while services continue to struggle with lack of funding.

I wonder how much better we may have done if money simply had been spent on improving services, and telling people where they could find them?

As mentioned I cannot speak for the rest of the activities run in different government departments but it is my belief that money and time has been wasted elsewhere. It is also my belief that politicians and civil servants will continue to struggle after the election because they are not supported by the public or by scientists/practitioners to use evidence to inform policies and services.

While we debate science and how important it is, we need to be aware of the real life problems encountered on the ground that means very often poor practice is allowed to continue because nobody is adequately checking what is being done, and few practitioners volunteer to ensure good services can be offered.

Please, while you’re campaigning for science, think about offering your services and scrutiny to ensure we can stop wasting time and money in the name of government backed health research and education.

Why is there all this fuss about sex education? Is it really a problem?
In the UK we clearly have issues that need addressing through sex education. The ones you are most likely to have heard about are high rates of teenage pregnancy, rising rates of Sexually Transmitted Infections (STIs), and problems around coercion and sexual violence among young people. However there are also wider problems you may not be aware of. Young people have complained existing sex education focuses too much on the biological aspect of reproduction and not enough attention has been paid to tackling feelings, emotions and negotiation – and the practicalities of enjoying a relationship.

The needs of lesbian, gay, bi and trans teenagers have not always been adequately met although homophobic bullying is recognised as a problem within schools. Teachers have complained they don’t always feel supported to confidently deliver sex education, particularly once it moves past the biological basics. Parents, generally, are in favour of sex education (despite what you may have read in the media) but worry they don’t know how to adequately deliver this in what they perceive to be a highly sexualised modern culture. And there’s been an ongoing concern that sex education has been delivered in a haphazard manner with different schools offering different approaches. Meaning some young people get excellent sex education, others get patchy advice, and some get nothing at all.

As a result there are problems around what is being taught, the quality of teaching and issues about the underlying messages of sex education which often remain negative and are based on warning youth against pregnancy or infection rather than preparing them to anticipate sex as something pleasurable to enjoy when they are older.

For these reasons it’s been recognised that sex education needs to change and be delivered in a far more effective manner.

What’s actually happened with sex education in the UK?
Over the past few years there’s been an ongoing consultation about sex education. This has involved contributions from the public (particularly parents and young people), faith groups, teaching and healthcare organisations and academics involved in researching sex education and youth culture. It has also involved expert input from a core group of professionals involved in researching or delivering sex education within schools.

This has fed into the Children, Schools and Families Bill 2009-2010 which seeks to make sex and relationships education (SRE) a statutory part of the school curriculum. You can see the progress of the bill here and here and view the actual bill here. The parts you should focus on in relation to sex education are sections 11-14 of The Curriculum. In particular point 13 which details the provision of SRE and 14 which outlines exemption from SRE.

This week the bill passed its first reading in the House of Lords where it was agreed that sex education would be compulsory for all schools. Faith schools will have the right to explain their view on key issues (although they’ll still have to teach all aspects of the SRE curriculum), and parents will have the right to withdraw their child from sex education up until the age of 15.

There are additional readings of the bill to follow over the coming months so it is not completely guaranteed these suggestions for SRE will be upheld.

Is sex education now compulsory in schools?
At this time all schools in the UK are required to teach SRE within the context of biology (basic reproduction). They are able to opt out of teaching topics they may not agree – homosexuality, abortion, contraception for example. School governors can also restrict what can be covered, who delivers sex education and what they talk about. Many schools do already offer good quality sex education.

I heard Catholic schools will be able to teach abortion, homosexuality and contraception are wrong. Is that correct?
There has been some controversy this week where Minister Ed Balls was seen as backtracking when he explained faith based schools would be allowed to teach SRE “in a way that reflects the school’s religious character”. Mr Balls stated “There is no opt-out for any faith school from teaching the full, broad, balanced curriculum on sex and relationship education and that is a huge step forward…Every school will have to teach the full curriculum in a balanced way that respects equality and is not discriminatory, but of course what we are saying is they can explain the views of their faith…Catholic schools can say to their pupils that, as a religion, we believe contraception is wrong, but what they can’t do is therefore say they are not going to teach about contraception.”

Secular groups have been understandably upset by what they feel is a climb down over sex education, while sexual health and LBGT groups have expressed concern this will lead to schools being able to promote homophobia or incorrect messages over abortion or contraception.

It is disappointing this decision was taken, but it is my understanding it was made after considerable pressure was made by faith groups (particularly the Catholic Church) against the proposed bill. There was a fear that this might derail the bill completely. So although this is a compromise it may have been made to ensure that compulsory SRE could still be assured.

Before we panic over this issue, it’s worth noting that whether this compromise had been made or not, there is no guarantee that teachers at faith or non faith schools would deliver SRE effectively – even if it was mandatory. After all ‘compulsory’ is not a byword for ‘good’. There are plenty of teachers delivering compulsory subjects on the curriculum in substandard ways. Even if a school delivers sex education well, a child will also be exposed to negative messages from their peers, parents, or their Church, Mosque or Synagogue.

And let’s not forget the media here. While the press was shouting against Ed Balls it seemed to escape everyone’s attention that by far the biggest voice against SRE in the UK is the press. So even if schools are delivering sex education well, the media are likely to continue in their efforts to scupper it.

My hunch is rather than faith based schools delivering a class on abortion or homosexuality as prescribed, following it up with ‘well that’s bad’, we’re more likely to see these topics covered but in a lacklustre or inaccurate manner. And sadly that may apply in non faith schools too. The challenge will be to identify where poor practice is happening and work to rectify that when the time comes.

Given we live in a multicultural society with different faiths and views about relationships it’s not unreasonable to have this reflected in our teaching of SRE. That is not, however, the same thing as allowing faith groups to decide what can and cannot be taught, nor to undermine basic teaching that is essential to the psychological and physical wellbeing of young people.

If I don’t want my child to have sex education, will I have the right to stop them going to lessons?
Once sex education becomes compulsory you will be able to withdraw your child from lessons up until they are aged 15, after that you will not be able to do so. This age seems very late to many educators as many of our most vulnerable youth are sexually active much younger than this age and they need help far earlier. However, currently parents will be able to opt out up until this age.

I hope that parents won’t want to do this. Here’s why. School sex education is an additional source of information for your child. Sometimes hearing someone other than a parent talk about a topic can help a child appreciate an issue. It also means if you and the school are talking about sex and relationships then the likelihood of your child picking up misinformation from peers or the media is reduced. We must remember that for many vulnerable children it is not possible to talk to a parent, or that often very well meaning parents simply do not feel able to talk about sex with confidence. Sadly sometimes parents, with the best intentions, provide misinformation about sex.

Most schools show parents what they will be delivering to young people in SRE before the children see it, giving parents the chance to ask questions and be aware what their child will want to know about. Organisations like the Family Planning Association and Parentline Plus offer additional support and classes to parents, as do many Primary Care Trusts. So the aim should be for schools and parents to work in tandem. If that isn’t happening currently you should speak to your head teacher about it.

Parents I talk to worry that schools will teach too much too soon or be explicit or rude. It’s easy to believe this from the media, but this should not happen in SRE. Young children are not going to be taught about using condoms or sexuality, but they will be told how to name their body parts, how a baby is made and introduced to gender differences and ideas about friendship and respecting others. As they grow information will be added to suit their developmental needs.

So rather than seeing the school as undermining you it’s better to think of them as an ally in raising your child.

Whether parents or teachers talk to young people about sex and relationships, kids are definitely talking to each other about it. So to ensure they’re on the right track we need to be there to answer their questions and explain what positive relationships look like.

If sex education isn’t compulsory yet, will there be any classes covering sex education issues?
Yes. Schools are already covering SRE to varying degrees and this will continue. You may expect to see some schools working to improve what they are already delivering in the run up to SRE becoming compulsory (anticipated in September 2011).

What’s actually going to be taught in sex education?
At this point the SRE curriculum is still being debated. It will definitely include topics like contraception, STIs (including HIV), coercion and abuse, and pregnancy. But it is also expected to cover sexuality, pleasure, delaying sex, confidence, communication and positive relationships. The consultation on the curriculum is open until 19 April 2010 and you are invited to have your say on what may be covered. If you are interested in SRE do please take the time to read and respond.

Why has sex education failed in England?
It’s wrong to say sex education as ‘failed’, or that it is taught badly. The problem we have in the UK is our sex education has never been valued or well funded. There’s never been an effort to deliver it in a compulsory manner and so what has been taught and the standard of teaching has varied widely. Unfortunately because we provide some sex education the media and some faith groups claim this causes teenage pregnancy and STIs. In truth we have problems with teen pregnancy and STIs for numerous complex and often interrelated reasons – poverty, poor education overall, the exclusion of young people, barriers in accessing contraception and healthcare services, lack of family support, aspirational limitations.

There are plenty of dedicated practitioners, teachers, parents and researchers all working to ensure young people learn more about sex and relationships. Young people themselves are not passive in this process and also usually seek out information. Simply providing SRE is not going to tackle wider social issues so we also need to invest in tackling those. However, not providing SRE (or delivering inadequate messages) is not going to help young people manage a commercialised sexual culture which they may not always know how to negotiate.

Often when we hear the sex education has failed mantra it’s a precursor to ‘so we should stop it completely’. The answer to our problems with SRE is not to ban it, but to ensure it is delivered to a high standard to all young people.

My husband thinks if we teach sex education it encourages young people to experiment or take risks, is that true?
This isn’t true, but it’s again something the media and some faith groups claim is a by product of SRE. If you simply tell young people not to have sex, or that they must wait until marriage for sex (but provide no other SRE information) then often young people do have sex – and are less likely to use contraception. If you talk to young people about sex as something to look forward to in the future and provide them with information about contraception, talk about negotiation and safer sex, confidence and delaying until they feel ready, then yes they may have sex but they are more likely to use contraception – and wait until they are older.

Young people do ‘experiment’ – I’m sure we can all remember lustful teenage feelings even if we didn’t act on them. And while we as parents often worry that teenager are all involved in sexual activity it is worth remembering the majority do not have sex until they are over 16 and most do think about contraception and safer sex.

As parents we want our children to grow up to enjoy positive relationships and pleasure. We want them to be confident and able to avoid coercive situations and toxic relationships. We don’t want them to be abusers or victims of domestic violence. We don’t want our children to have sexual problems when they were adults because they were not given enough information about sex or taught it was dirty or shameful. Young people have the right to know about sex and relationships and we have the responsibility to deliver that information in supportive ways.

If we introduce compulsory sex education, what difference will that make – and how soon will we notice it?
It is hoped that sex education, if delivered uniformly and to a high standard, will:
Reduce STI and teenage pregnancy rates
Reduce the number of terminations young people are having, and in the future prevent rising levels of infertility
Increase young people’s uptake of contraception services
Reduce coercion, abuse and exploitation
Tackle homophobic bullying and reassure young people about sexuality
Improve young people’s confidence to talk about sex and negotiate relationships
Highlight the importance of positive relationships

The difficulty with some of these issues is we won’t notice any changes for a long while (for example tackling future infertility). And sometimes if you do introduce more education you see a rise in the uptake of services so it could be likely we see a rise in STI rates for a while.

Even if we do introduce really great SRE across the UK it will take time to bed down and we will need a period of support for teachers and parents. We will be learning throughout this introductory process and undoubtedly there will be some quick wins and stumbling blocks. But SRE is only one part of the puzzle and we will only see benefits if we also tackle other issues around access to reproductive healthcare, reducing poverty and dealing with other inequalities.

What is the biggest barrier you see to SRE provision?
The media. We’ve had endless negative coverage about how dreadful we are at tackling teen pregnancy, STIs and other anti social behaviour among young people. The media has for the most part stood in the way of every initiative to try and improve SRE when they could have supported ventures. Instead we’ve had judgemental pieces most of which end up in girl blaming and hysterical misrepresentations (shag bands, anyone?). Specific editorial decisions are made to be unsupportive and we must not lose sight of this.

Journalists frequently cite the Netherlands as a gold standard of good practice, complaining how we fail in comparison. Never noting the reason the Netherlands do so well is partly cultural, partly about education, but mostly because their media are supportive of SRE.

What’s going to happen next?
The bill is still going through the Lords so there will be more discussions. I will update on those as they happen. In the meantime we can expect to see more efforts in training the trainers activities and support for parents.

Hopefully that’s answered your questions about SRE in the UK, but if you do have any more please let me know.

I’ll be returning to some of the issues raised here in future blogs, particularly around training for sex education teachers and nurses and what parents can do to talk effectively about sex and relationships.

What’s the difference between sexual, reproductive, psychosexual and relationship health?

Sexual health refers to dealing with either sexually transmitted infections, or physical or psychological sexual problems (also called sexual dysfunctions).

Reproductive health refers to your fertility – either advice on getting pregnant, information on contraception, supplying contraception (to prevent pregnancy), or helping you deal with an unplanned pregnancy.

Some clinics specialise in sexual health, sexual problems or reproductive health, other services will offer treatment or advice for any of these issues.

Psychosexual health services tackle deep-seated sexual problems that could be caused by psychological and/or physical factors.

Relationship counselling services help with problems ranging from sexual communication difficulties, to jealousy and coping with arguments or life after infidelity or divorce.

These services are dependent on your location – there may be more services available in certain countries/states. The politics or religion of different countries/states may affect service delivery or approach. Many clinics offer free support and advice, some private clinics do charge a fee, as do some doctors in certain countries – if you live outside the UK check your health care policies for more information.

Many sexual health services particularly those for sexually transmitted infections are often overwhelmed by patient demand. Part of the reason for this is that people pick the wrong service for their needs – so consult the list below to ensure you get the right help at the right time. And tell your friends so they get it right too!

Your Doctor (GP/Family Practitioner)
What can they offer?
• Advice about contraception and prescribe (and sometimes provide) contraceptives for you
• Advice on sexual problems (dysfunctions)
• Health checks relating to sexual problems (e.g. pain during/after sex, loss of erections)
• Information about menstruation, menopause, fertility (getting pregnant), pregnancy and abortion (termination), pregnancy testing
• Physical examinations of your genitals (including smear tests for women or testicular exams for men)
• Referrals to counsellors or other specialists in the case of sexually transmitted infections, sexual dysfunctions, previous or current sexual abuse, genital cancers
• Assessment and testing/treatment for STIs
• Advice about pregnancy/fertility, antenatal and postnatal support
• Advice and referrals for termination of pregnancy (in countries where abortion is legal)

Your doctor or practice nurse can perform external and internal genital checks, swabs and blood tests. They can test and treat you for STIs, or related infections. Depending on your location they may be able to provide you with condoms or refer you to a condom clinic. In many countries, GPs are the main providers of contraceptive services, so they’re not shy about talking about sex. Some people do feel embarrassed discussing sexual health with their doctor, particularly if they’ve known their doctor for a long while – or in cases where they may have an STI through an extra-marital affair or unprotected sex. If you would prefer to see someone you don’t know as well, you can either speak to a different doctor at the practice or go to a Genito Urinary Clinic for STIs or Family Planning/Reproductive Health Clinic for contraception/fertility advice (see below).

Useful links
NHS Choices has a dedicated section on sexual health
Patient.co.uk (links, resources and helpsheets on a variety of health issues)

Genito Urinary Clinic/Sexually Transmitted Infections Clinic
What can they offer?
• Tests and treatment for sexually transmitted infections.
• Advice about contraception (some clinics also prescribe contraceptives and provide condoms – at some clinics these are free).
• Information about safer sex.
• Advice on how to tell a partner you have an STI – some clinics will notify your partner(s) for you.

These clinics (also sometimes known as ‘sexual health clinics or centres’) will test and treat you for STIs, and provide safer sex advice and information. Some clinics work on an appointment basis, others on a ‘drop-in’ system, or a ‘first come, first served’ basis. Some have set times for teenagers, women or men to attend. You may want to telephone first to check appointment times and whether there’s a waiting list for treatment. You shouldn’t have to wait long to get an appointment, but in many countries where there is high demand for services the wait could be longer. You can get condoms from Genito Urinary Clinics.

Useful links
NHS Choices: Sex, worth talking about includes guides to sexually transmitted infections, including locate your nearest clinic and symptoms and signs of STIs
Planned parenthood’s guide to STIs (also available in Spanish)
Go ask alice! (your sexual health questions answered)
STIQ answers common questions about STIs, testing and treatment

Family Planning/Reproductive Health Clinic
What can they offer?
• They can advise you about contraception and give you contraceptives
• Information about how to get pregnant, or options if you have an unplanned pregnancy
• Pregnancy testing and referrals for termination of pregnancy (abortion) if you require it
• Smear tests for women

These clinics can perform smear tests (internal exams for women), and offer contraception and pregnancy advice. They can provide contraception such as birth control pills or injections, or condoms. If you want contraception only, then make an appointment at one of these clinics. If you think you have an STI, it’s better to see your GP or Genito Urinary Clinic.

Useful links
Family Planning Association guide to contraception, pregnancy and STIs
Brook sex advice for under 25s
Planned Parenthood advice on contraception, STIs and sexual and reproductive health – in English and Spanish
Marie Stopes global reproductive health advice source

Your Pharmacist
What can they offer?
• Home pregnancy testing kits (some pharmacies will do the tests for you)
• Over the counter treatments for cystitis, thrush, period pains (menstrual pains), folic acid (for those planning to get pregnant or during pregnancy and breastfeeding)
• Condoms and lubricant
• Give you contraceptives as prescribed by your doctor

In some countries, community pharmacists are taking a more active role in health care. For problems such as thrush or cystitis you can get confidential advice from your pharmacist. You can also get condoms, the morning after pill (emergency oral contraception), and lubricant from many pharmacies. In parts of the UK, US and Europe, you may also be able to be tested and treated for certain STIs by your pharmacist. If you think you have Chlamydia or Gonorrhoea, the pharmacist can provide you with a urine kit, which you return to them or post to a local laboratory. Results are returned in a few days and you’ll be given the all clear, provided with antibiotics by the pharmacist, or referred on to a Genito Urinary Clinic or your doctor if further tests or treatment are required. Not every pharmacy can offer this service, those that do will usually advertise testing with posters or leaflets. All pharmacies should be able to signpost you to your local Genito Urinary Clinic who will be able to help.

Psychosexual Therapy (Also known as sex therapy)
What can they offer?
• Identification and treatment of psychosexual problems (e.g. erectile dysfunction, loss of desire)
• Overcoming sexual problems due to past or present sexual abuse
• Dealing with sexual problems due to worries about sexuality
• Sexually compulsive behaviour
• Referrals to other healthcare services (e.g. urology, gyneacology) if needed

Many countries offer psychosexual advice and services. In some cases, they are free to patients with severe sexual problems, although have to be referred through a medical doctor, and can have a long waiting list. In countries where psychosexual services are free, patients can also book to see therapists privately. This cuts down the waiting time, and will cost money, but allows the client choices who they get therapy from (e.g. a religious person may prefer to have sex therapy from someone who understand and respects their religion; a lesbian or gay client may prefer a ‘pink shrink’). In other countries, psychosexual services are entirely private, and have to be paid for. These services may not be covered by medical insurance, check your policy. Some countries do not offer any services, or a limited number of therapists.

Useful resources
Overcoming sexual problems by Vicki Ford (Constable and Robinson)
Women who love sex: an inquiry into the expanding spirit of women’s erotic experiences by Gina Ogden (Womanspirit Press)
Our bodies ourselves: a new edition for a new era by Boston Women’s Health Book Collective (Touchstone Books)
Sexual health for men by Phillip Kell and Vanessa Griffiths (Class Publishing)
The new male sexuality by Bernie Zilbergeld (Bantam Doubleday)

Basrt (British Association for Sex and Relationship Therapy)
Sexual Dysfunction Association includes advice and support on male and female sexual problems
Women’s Health gynaecological and other women’s health advice
Male health information from the men’s health forum

The above organisations cater to gay or straight couples – however if you’d prefer to see a gay or lesbian-friendly counsellor you can contact:
Pink Therapy
Pace

Relationship Therapy/Counselling (also known as couples counselling)
What can they offer?
Counselling for individuals and couples for issues like…
• Communication skills
• Increasing sexual confidence
• Overcoming common sexual problems
• Dealing with jealousy
• Coping with infidelity
• Reducing arguments
• Planning for parenthood

Relationship therapy is offered in different forms in different countries. In most cases the service is paid for by the client – but is often means-tested, meaning those on a low income may pay less. Medical and psychosexual services can refer clients to relationship therapists, and clients can refer themselves. Many religious groups or other support networks offer relationship therapy – again this may be free or paid for and evidence underpinning advice may be patchy. Medical insurance may not cover costs for relationship therapy – check your policy. Some therapists will tackle domestic violence and reputable therapists will not see a couple together while one party is being violent. If domestic violence is a problem within your relationship you need to alert your therapist to this as soon as you can.

Useful resources
Overcoming relationship problems: a self-help guide using cognitive behavioural techniques by Michael Crowe (Constable and Robinson)
Loving yourself, loving another: the importance of self esteem for successful relationships by Julia Cole (Relate Guides)
Gay relationships: how to find them, how to improve them, how to make them last by Tina Tessina (Jeremy P Tarcher)
Relate
British Association of Counselling and Psychotherapy
Couple counselling Scotland
Relationships Australia
American association of sexuality educators, counsellors and therapists (AASECT)
BBC Relationships has a collection of resources and referrals addressing domestic violence

The above organisations cater to gay or straight couples – however if you’d prefer to see a gay or lesbian-friendly counsellor you can contact:
Pink Therapy
Pace

Hopefully you can work out from the list above what service suits your needs best. If in doubt call the service/clinic and ask if they can help you. If they can’t they should be able to explain a source of support.

Where to get advice about your sexual, reproductive or relationship health by Dr Petra Boynton is licensed under a Creative Commons Attribution-Noncommercial 3.0 Unported License

Without further ado, let’s find out the answers to the questions I posed as part of the Science Late evening of sex event on Wednesday. How did you score?

1. What are the most common methods sex researchers use to study sex?
a. By looking – watching people have sex in a laboratory or on film
b. By measuring – assessing sexual behaviour via brain scanning, blood tests or heat sensors
c. By listening – recording answers from surveys or interviews
d. By participating – having sex with the people they are studying
e. Not sure

Correct answer = C

The most commonly used methods in contemporary sex research globally are surveys or interviews/focus groups. Brain scans, heat sensors or blood tests can be used, as can observational studies (where people have sex within laboratory settings). However, these latter two methods are used less as they’re often more difficult to recruit representative participants for studies. With the internet the opportunity for people to film their sexual activities and share those with researchers, and methods where participants film or document their own lives may become increasingly popular in the future. One thing we don’t do, but which people often assume happens, is have sex with the people we’re studying and then write about it. This would be considered unprofessional and unethical in research nowadays, and would focus the study on the researcher rather than a wide range of participants.

Want to find out more?
Check out the Kinsey Institute and the Magnus Hirschfeld Archive for Sexology who provide information about sex research being undertaken and provide answers to your frequently asked questions about sexual behaviour.

You might also find these guides helpful too:
Want to be in a sex study? Tells you about how sex research is conducted and how you can get involved

Sex research since Kinsey’s day – explains the different methodological approaches that can be used to study human sexual behaviour.

What’s it like to be a sex researcher? answers the frequently asked questions I’ve received about studying sex.

How to run a sex study outlines the steps you’d undertake to carry out a scientific study.

2. How often does the average UK couple have sex per week?
a. 7-10 times
b. 4-7 times
c. Once a week or less
d. Not sure

Correct answer = C

Robust and reliable research indicates that younger people do have more sexual encounters annually than older people. You can see links to research where frequency has been addressed here. The UK Natsal study found the average for heterosexual sexual activity per month was around 6 times. If you account for sexual behaviour over a wide range of ages the average is once a week or less. However, reputable sex research focuses more on quality rather than quantity. We would usually ask people for a range of sexual behaviours they engage in (masturbation, oral sex, intercourse) and whether they enjoyed them. That way you might find someone doesn’t report much ‘sex’ (as in intercourse) but they enjoy masturbation on a regular basis and are happy with this.

This contrasts with the media’s description of sex where ‘sex’ is usually only considered in terms of intercourse and quantity is taken as a measure of ‘great sex’.

Want to find out more?
Set yourself an experiment. Look at magazine or newspaper coverage of sex/relationships over the next month and see how ‘great sex’ is described. Is it written about in terms of exploration, variety and pleasure, or described in terms of quantity and penetration.

3. The average penis size is 5 inches long
a. True
b. False
c. Not sure

Correct answer = B

Many studies do give the average erect penis length as 5 inches. However, there are numerous problems with studies on penis size as they vary in the methods used to collect data. Some studies relied on self report, others on a researcher either measuring an erect or flaccid penis. Critical reflection on penis size studies suggest there are problems with the inconsistency of measuring penis size (summarized here). Interestingly research in this area suggests men (gay and straight) are more worried about length than girth, although women seem to be more interested in girth. And partners of men (male or female) are usually most bothered about their partner’s technique and the way they treat them. With anecdotal evidence suggesting men with larger penises don’t try so hard to please their lovers.

4. Women and men are equally stimulated by visual images of sex
a. True
b. False
c. Not sure

Correct answer = A

Women and men are just as likely to be turned on by visual images of sex. This may run counter to common knowledge of this issue, particularly since the media often repeats the idea that men are visual creatures and provide various evolutionary and biological explanations for this. What science is now discovering is that women, like men, do get aroused by sexual imagery. There is a diverse range of what turns women on – as with men. There is often the myth that women prefer erotica and men like porn, or women need their sexual imagery served up with a warm slice of romance. Yet studies where women have been asked about or shown sexual imagery suggest they do respond to a variety of arousing stimuli.

Interestingly many of the studies assessing response to visual images of sex (usually done through showing a series of images or sexual film clips and measuring genital response) did not include women. These were conducted on male participants (often undergraduate students) who were tested in response to viewing sexual images to see if exposure to said imagery had led to them feeling more hostile towards women.

More recent studies of women show they report enjoying a range of sexual imagery but do often worry more than men about the content of materials and how they’re made. Debates around the impact of porn, and whether the content is sexist, can often make women feel guilty for looking at/enjoying sexual imagery. Interestingly we’ve focused more on asking women critical questions about how they respond to porn than we have inviting men to reflect on their porn use.

Want to learn more?
Violet Blue’s written a fascinating book called The Ultimate Guide to Adult Videos which discusses how to pick porn to view, and answers some of the common concerns people have about content.

Alternatively there is a vigorous debate about porn/sexual imagery that’s ongoing. Some view porn as innately sexist and degrading to women, others feel it’s a symptom of a sexist culture but not a direct contributor to sexism/abuse. While some believe porn could help improve relationships, or at least has no harmful effects. You can find debates ongoing across different websites (particularly those with a feminist/political focus). Read up on the issues and see where you fit in.

5. Men can fake orgasm
a. True
b. False
c. Not sure

Correct answer = A

Men can, and do, fake orgasm. We don’t know exactly how many do this, but therapists and educators are increasingly hearing from men who are worried about faking orgasm. Reasons for doing so include being tired, sore, wanting to bring sex to an end, and not wanting to let a partner down. Men report feeling the need to fake because of pressure to perform sexually. It is unclear whether this pressure is experienced more or less acutely by straight or gay men. Interestingly, we tend to respond to women faking orgasm as being an inevitable (partly linked to the stereotype of women being less sexual). We tend to respond to the idea of men faking with disbelief or humour. This does little to help either gender if they feel the need to fake.

Want to find out more?
Comedian Richard Herring has written a great book called Talking Cock which although based on humour is a useful survey on male sexual behaviour and includes some discussion about faking orgasm.

If you’re a man and find it consistently difficult to orgasm it might be you have delayed (or retarded) ejaculation. More information about this condition and treatment options available here.

6. Men reach their sexual peak at 17 years old, women at around 40 years old
a. True
b. False
c. Not sure

Correct answer = B

Although this is often quoted in the media it doesn’t make sense in social research terms. The data seems to have come from surveys in the first half of the 20th century on sex where young men could record an interest in sex, but young women couldn’t. Culturally young women weren’t supposed to be sexual (particularly before marriage) and so either were unable to report on sexual behaviour, or were too afraid to disclose what they may have done. Older women who were married and had experienced sex were in a stronger position to report on their experiences. So early surveys measured behaviour and found younger men were able to report sex positively, as were older women. This is not the same as hitting a sexual peak during lifespan.

Although studies do still about that reinforce this myth or suggest particular ‘peak’ times for sex, reliable research suggests that rather than their being specific peak times for sex, there will be times when people enjoy, desire, and have sex more or less. This will be influenced by many factors including health, parenthood, financial security, relationship quality, and lifestyle factors (such as work stress).

Sexual activity may reduce as people age, and certainly we do see young people reporting having more sexual encounters. However, this does not mean the same thing as pleasure or desire or exploration. Older people do also report they may not have as much sex as in their youth, but the sex they have remains important and pleasurable.

Part of the misrepresentation of sexual behaviour across lifespan as having one off peaks is linked to the quantity over quality. A more accurate way of looking at this issue would be to see sex intertwined with other factors (listed above) and to expect points in your life when you’ll have no sex (with a partner), lots of sex, and occasional sex – with quality differing also.

Want to find out more?
Keep a diary for the next year and record when you had sex. Note periods when you enjoyed different sexual activities (masturbation alone, oral sex, intercourse), who you were intimate with, and when you were or were not enjoying sex to identify what else was happening. It might be something negative like being made redundant, or something positive like starting a new job where you put your energy into that activity.

7. Animals (other than humans) can be gay
a. True
b. False
c. Not sure

Correct answer = A

Homosexuality has been observed in numerous species from dolphins to monkeys, dogs to sheep. We have only recently begun to learn more about this topic as science has in the past often misrepresented homosexuality in animals, describing it as ‘immature sexual behaviour’ or reporting it as something that only happens because no other sexual partners are available. Or simply not discussing it at all.

Want to find out more?
The question of sexuality is one that fascinates people – and can be a reason for concern or celebration. If you want to find out more about your own sexuality why not try the Kinsey scale which gives you a score from heterosexual through to entirely homosexual. You can even get a t-shirt to proudly display your rating.

Within the scientific community we’re still debating homosexuality and for two differing takes on this issue you might consider Queer Theory which sees sexuality largely as a social construct or contrast this with Qazi Rahman and Glenn Wilson’s excellent book Born Gay.

There’s also widespread discussion about whether homosexuality can be ‘cured’. Evidence shows it cannot (because it’s not a disease or dysfunction). You might find these papers interesting – they feature interviews with psychiatrists and patients who were part of treatment programmes to ‘cure’ them of homosexuality.

8. Where do most people get their sex information from?
a. Friends and family
b. School/college sex education
c. Self help/sex experts
d. The media (magazines, films, television, internet)
f. Pornography

Correct answer = D

Most people do use the media, and particularly the internet (where available to learn more about sex). Friends can be highly influential, although more for young people than older adults. The self help/sexpert market (which often influences media content) is worrying given that many sex experts are not adequately qualified to discuss sex and relationships issues. Porn is not the first place people look for information, however evidence suggests it is somewhere people will turn to if they can’t find answers elsewhere.

Want to learn more?
If you want to find useful places to get quality sex information (aside from the links above), I’d recommend:
Paul Joannides – author of Guide to Getting it On
Cory Silverberg – who writes Sexuality About
Good Vibrations magazine
Dodson and Ross – sex tips, advice and information
DIY sex education from All About My Vagina
Susie Bright gives great sex advice over at Jezebel

9. What’s the most popular area in sex research currently?
a. Desire and pleasure
b. Sexual problems
c. Sexuality
d. Sex addiction
e. Love, romance and courtship

Correct answer = B

The most funded and most prolific research globally focuses currently on sexual problems. That’s things like sexual dysfunctions and sexually transmitted infections (particularly HIV). While these are issues requiring investigation, there are problems about other issues such as love and romance, desire and pleasure receiving far less attention. In particular concerns have been expressed about the ‘medicalisation of sex’ (for women and men) and the way sex research has been influenced by pharmaceutical funding.

Campaigners working within sex research are working to try and broaden the range of topics studied in this area, but limitations around funding and academic priorities do still influence what gets studied. This is a problem since many members of the public have many unanswered questions about sex which are currently not being addressed.

Interestingly, the area of sex addiction is hyped up a lot in the press but is not being researched to the same degree within academia/therapy. That’s because the concept is not agreed upon by practitioners. You can find out more in this great discussion between Susie Bright and Leonore Tiefer on the topic, or see just how problematic the diagnosis of sex addiction is in my blog ‘Help! I’m a sex addict and I didn’t even know it’.

10. Why do sex researchers study sex?
There are numerous reasons why we study sex. To find out more about human sexual behaviour, to get people answers to questions they have. To reduce problems – STIs, anxieties, fears. To promote sexual pleasure. Or to encourage abstinence (not all sex researchers are sex positive). Some sex researchers are motivated to research sex because they want to offer help, to share pleasure, or to learn more about themselves. Some may have had a personal experience (positive or negative) that’s motivated them to study a particular area of sex.

As part of the Science Museum event I asked guests to share why they thought we studied sex and I’ll blog all their ideas next week – along with some updates from real life sex researchers about their motivations.

So, are you a sexpert? You may have scored well or badly on this test. It doesn’t really matter. Many of the questions were deliberately tricky. Hopefully what the test has revealed to you is that there’s a lot more to sex research than you may have imagined, it’s an area that spans many academic areas (science, medicine, history, anthropology and zoology to name a few). It’s a growing subject area and one with a real application to human life. By continuing to read up on sex (using some of the links above) and ask questions about all the sex stories you read in the press (and anyone who calls themselves a ‘sexpert’) you’ll be well on the way to sexpertise.

If you work in science communication, sex research or sexual health you are welcome to use this quiz (and answers) in your own activities (with acknolwedgement). Please do research all answers before presenting to ensure you fully understand topics, and perhaps you can bring in questions and resources of your own to add to the quiz.

Last night the Science Museum in London hosted one of its fabulous ‘Lates’ events. The theme of the evening was ’sex and science’ and there was a great range of things to do. From learning more about yourself in the ‘who am I?’ tour, through to speed dating, finding out about the history of sex toys, salsa dancing, an experiment in ‘dance, hormones and sexual selection’ and some sexy punk science. Condoms were available to all guests, just in case things got extra fruity, and judging by the amount of drink and giggling going on I think people had a good time

I hosted a talk called ‘So you think you’re a sexpert?’ where we took 10 commonly asked questions about sex or commonly quoted sex ‘facts’ and put them to the test with some interactive voting to find out how smart our audience were about sex.

I’d like to give a great big thank you to everyone who came to Science Lates last night. I thought it was a novel way to share science, and the range of talks/events going on ensured we could create a balance between the fun and frisky and the serious and scientific.

For those of you who weren’t able to make it, I’ve reproduced the ‘So you think you’re a sexpert?’ quiz below, and I’ll give you the answers tomorrow, along with incorporating questions from the audience last night.

1. What are the most common methods sex researchers use to study sex?
a. By looking – watching people have sex in a laboratory or on film
b. By measuring – assessing sexual behaviour via brain scanning or heat sensors
c. By listening – recording answers from surveys or interviews
d. By participating – having sex with the people they are studying
e. Not sure

2. How often does the average UK couple have sex per week?
a. 7-10 times
b. 4-7 times
c. Once a week or less
d. Not sure

3. The average (erect) penis size is 5 inches long
a. True
b. False
c. Not sure

4. Women and men are equally stimulated by visual images of sex
a. True
b. False
c. Not sure

5. Men can fake orgasm
a. True
b. False
c. Not sure

6. Men reach their sexual peak at 17 years old, women at around 40 years old
a. True
b. False
c. Not sure

7. Animals (other than humans) can be gay
a. True
b. False
c. Not sure

8. Where do most people get their sex information from?
a. Friends and family
b. School/college sex education
c. Self help/sex experts
d. The media (magazines, films, television, internet)
f. Pornography

9. What’s the most popular area in sex research currently?
a. Desire and pleasure
b. Sexual problems
c. Sexuality
d. Sex addiction
e. Love, romance and courtship

10. Why do sex researchers study sex?
This was an open-ended question we gave to the audience last night. I’ve got all their answers to sort through and I’ll be posting those in a blog next week, along with some answers from real-life sex researchers and educators.

Come back tomorrow and you can find out whether you’re a sexpert, and learn more about each question.