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.

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 educatorss/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.

Several papers carried the worrying story today suggesting links between social networking sites and sexually transmitted infections (STIs)
Facebook ‘linked to a rise in syphilis’ – Telegraph
Facebook ‘sex encounters’ linked to rise in Syphilis in North East – Metro
Sex diseases soaring due to Facebook romps – The Sun
Web casual sex sparks syphilis rise – Press Association

All of which sounds pretty scary. Are we really facing a syphilis epidemic linked to social networking? Where did the story come from? It seems to have been sparked by claims in the papers made by the Director of Public Health for Teeside, Professor Kelly, that the region has seen a rise of reported syphilis cases from 10 in 2008 to 30 by the end of last year.

According to press reports Professor Peter Kelly, claimed to have found a link between the rise in syphilis cases and young people using social networking sites. The details of how this was researched and measured have not been clearly reported. So it is unclear whether this is a health practitioner describing mapping of STIs to social behaviour; results of an epidemiological study on STIs in the North East; or speculation based on patient information that there could be a possible association between syphilis and using social networking sites. [A separate picture of sexual health in the NorthEast as compared with the rest of the UK that gives you an idea about the accuracy of these claims can be found here and a breakdown of regional data for STIs (including syphilis) is here - with thanks to Ben Goldacre]

Several papers document ‘research’ that indicates widespread social networking site use in the North East that’s higher than the UK average. Although it is not completely clear where this evidence comes from. Is it data the papers have included, or the information Teeside PCT were using.

While syphilis is an STI that’s on the rise, we have to be careful with headlines like this. They may sound dramatic but the first rule of understanding potential links between behaviours and infections is to remember correlation is not the same as causation. Just because some young people do seem to be using social networking sites for meeting others for sex it doesn’t mean that is directly responsible for rising STI rates.

Health professionals are often panicked by media moral crusades and currently anxieties over social networking sites are running high. Young people do report using such sites as well as other mobile technologies. So understandably practitioners may well question about such behaviours during consultations and form the conclusion that social networking sites are the cause of many sexual health problems.

However, just having this opinion doesn’t mean it is true or directly linked and would need closer investigation. Consultant Matthew Greenall is currently trying to find out from Middlesborough PCT what research was undertaken by Professor Paul Kelly to inform his view that social networking sites and STIs are directly linked. NHS Middlesborough’s press release that seemingly started the media coverage states “Unprotected sex, especially with casual partners, is the biggest risk for syphilis. Social networking sites are making it easier for people to meet up for casual sex. It is important that people avoid high risk sexual behaviours and practise safe sex to protect themselves from sexually transmitted infections”. However, additional quotes within newspapers make a more specific link between syphilis and social networking sites – so it is unclear if additional interviews were given, or whether the Professor has been misquoted. Or whether the papers just made up additional quotes (hey, we know that happens). At this time a number of practitioners are investigating exactly what was said and what evidence there may be about risks posed by social networking sites to the youth of Teeside.

As the story spread across Twitter several bloggers questioned the accuracy of the story, beginning with Science Punk who spotted the piece first, through to Enemies of Reason and Dungeekin who both provided a satirical take on the media coverage of the story. Meanwhile My Sex Professor highlighted issues around syphilis using the story as an opportunity to reinforce health messages and Heresy Corner discussed the prevalence of syphilis and the claims made in this story. The excellent Tabloid Watch focus more specifically on the discrepancies between the statements from Prof Kelly (which seem to be more about safer sex) and the media scaremongering. Similar discussions also come from The Media Blog and Roy Greenslade at the Guardian (read the comments for this, NHS Teeside respond to criticise Greenslade but apparently not the Telegraph or Sun’s bad coverage).

Within the online discussions it became obvious the link between social networking sites and syphilis was questionable. In fact the whole story appeared flawed as it seemed to have accepted a practitioner’s concern about rising STIs but no clear measure that they were linked to social network use. [If it turns out this is not the case and there is robust data to support the claims I’ll update this blog accordingly]. Indeed even if young people are using such resources to set up meetings with other people which lead to sex, the problem is presumably about a lack of safer sex when they meet, rather than the hook up itself? This wasn’t clear from media coverage and it would be worrying if health practitioners were being judgemental about sexual behaviour. The issue is about unprotected sex, not who you sleep with (or how you get to meet them).

No breakdowns were offered in the research about who the 30 people were with syphilis. Were they all straight? Had they all contracted syphilis from social networking sites – and how was that proven? How was ‘using’ social networking sites defined and measured? Were there any other STIs that were also associated with social networking hook-ups? And how were these connections assessed?

We rarely expect the media to deconstruct a moral panic story, particularly if it is about social networks or sex. However on this occasion it seemed that as well as not fully investigating a story before spinning it into an STI crisis, the reportage deliberately misrepresented aspects of social networking sites.

Facebook was named as the cause of the syphilis outbreak, and yet if you read the statements from Professor Kelly Facebook is not mentioned. Social networking is described. So why did Facebook get the blame compared with other networking sites? Could it be the papers who were leading on the story are owned by Rupert Murdoch who in turn owns Myspace social networking site, who are a competitor of Facebook?

The take home message from this case is it seems to be an example of practitioners speculating on the cause of a rising STI rate, the media spinning this into a causally linked epidemic, and then further manipulating the story to have a pop at their rivals.

What’s lost in the case is the issue of syphilis itself. It is an infection that currently predominantly affects gay men (in the UK) but is on the rise in heterosexuals. It needs addressing as although we have worked hard to raise awareness of highly prevalent STIs like Chlamydia, the public may believe Syphilis is an infection of the past. And may have no idea what symptoms to look out for or how to prevent the infection.

Some have argued the attention the story has generated has also raised the profile of syphilis, so that’s a benefit of the poor media coverage. Indeed #syphilis has become a trending topic on twitter as a result. Unfortunately if the focus remains on poor media coverage or the myth that Facebook causes syphilis then the opportunity to raise sexual health awareness will be lost.

Let’s show social networking can do good as well as the often claimed evil. Find online coverage of this story and use the comments to highlight the suggested link is not concrete, the media coverage is scaremongering, but most importantly to share accurate information on syphilis prevention and symptom spotting. Then tell your friends to do the same.

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

1. Get educated – then share the knowledge
There are many ways to learn about sexual health and wellbeing. You can bring yourself up to speed with information about HIV/AIDS here (contains links to quizzes, resources, forums and advice sheets). Or you can test your knowledge with Avert’s Quizzes (on sex, pregnancy, HIV/AIDS, contraception). Teen site Scarleteen includes loads of frank and helpful information, as does Go Ask Alice!, Kinsey Confidential and Cory Silverberg at About.com’s Sexuality section.
You can also make use of Planned Parenthood’s toolkits and resources, while All About My Vagina explains how anyone can become a sex educator (with links to resource materials).

2. Bust those myths!
Despite education and advice, many people are still confused about HIV and AIDS. You might want to check out some mythbusting courtesy of About.com; questions, answers and papers about areas of confusion about AIDS from The Body while New Scientist lists the top 5 myths about HIV.

3. Don’t just focus on sex
HIV can be transmitted through sexual contact, but it is also passed on from mother to baby through breast milk, through blood transfusion (if infected blood is transfused – this is less common nowadays), by sharing needles, needlestick injury, or unsterilized/unhygienic needles or other sharps used routinely in healthcare. Further information on transmission can be found here. The problem with messaging around sex is we tend to focus on confusing or mixed messages, or advice that’s difficult to put into practice (for example asking people to be faithful in countries with massive gender inequalities). Telling people to abstain only, or even instructing against condom use is very dangerous. Discussing sex only in the context of intercourse (vaginal or anal) leaves out wider contexts around relationships, desire, and coercion. We need to focus on clear messaging around sexual transmission of HIV (with actionable solutions and life skills offered), but not forget there are other means of getting the virus. This is of particular concern given a recent study from Swaziland that suggests 1:5 babies are infected with HIV through dirty needles or other clinical equipment.

4. Challenge and tackle inequalities
HIV is more prevalent in countries or communities where there are high levels of gender inequality, restricted access to healthcare, poverty, discrimination over sexuality (including transsexuality), and high levels of illiteracy. Challenging homophobia, gender inequality, and discrimination against sex workers can help – for example in the views you hear from other people, biased media coverage, or discriminatory practices expressed by organisations. You can also support campaigns that address poverty and literacy along with wider access to healthcare. You might even decide to become an activist – and if you do Global AIDS Alliance has created a free toolkit for just this purpose.

5. Volunteer and/or fundraise
There are many ways of getting involved in tackling HIV, inequalities and poverty. You might want to volunteer on a sexual health helpline, or help out at an HIV/reproductive health clinic – on reception, as a health advisor/advocate, or interpreter (either signing or different languages). Or you could always donate toys or magazines to clinics.

Unwanted clothing, shoes, blankets, toys can be donated to charities supporting those affected by HIV (particularly orphanages worldwide and clinics supporting the homeless, refugees or those fleeing domestic abuse).

You could give of your time locally – for example seeing if your local health or educational authority needs any support (which may include administrative duties that free up healthcare providers to see patients). You might want to prepare nutritious meals for people living with HIV, or if you’re currently breastfeeding you may want to donate some of your milk to feed babies whose mothers are HIV positive.

Spare cash? Well, the recession’s still on, but as the saying goes ‘every little helps’. Financial donations can be made nationally and internationally. If you do wish to donate I’m always happy to recommend trustworthy charities and healthcare providers working to treat and prevent HIV (and other health issues). The Terrence Higgins Trust are always worth supporting, or you might want to help the Jabulani Foundation whose innovative approach to healthcare was recently reported in The Lancet (sadly not open access).

You can save your pennies in a jar, or raise money through car boot or jumble sales, or even sell stuff on ebay and put your profits to a good cause.

Donating materials can also help – old computers, digital cameras, access to educational materials are always welcome in resource poor communities. Offering to help with fundraising (including creating advertising, designing and maintaining websites) is also welcome. Here’s an example of what one charity needs. Search on the web to find more you could contribute to.

Maybe you’re not able to contribute cash but have other skills you might share? Gardening, cooking, sewing/needlework, knitting or craft can be applied to help those affected by HIV/AIDS, raise funds, teach new skills, or generally raise awareness. Knitted items (hats, booties and baby clothing) are always welcomed by orphanages – although don’t forget clothing for toddlers and older kids (particularly shoes, kids do get through a lot of shoes!). You can donate your children’s unwanted items, with the added opportunity of raising their awareness about HIV.

Maybe you’re a drama buff, artist, musician or film maker – in which case those talents can be used to help people find new ways to share messages around HIV/AIDS, safer sex, communication skills, and desire.

If you’re good with words or numbers then why not volunteer to help people who might be struggling with HIV alongside other disadvantages related to literacy/numeracy. Help may well be appreciated with filling in forms, applying for benefits, balancing budgets, or following medical advice.

6. Target problematic practices
There are well meaning campaigns that promote abstinence only as a response to HIV. While it is appropriate to recommend delaying sex until someone is ready (and has sorted contraception/condom use), many abstinence campaigns focus on simply telling people not to have sex – with no additional information about relationships, pleasure, confidence, or negotiating skills. In particular suggesting adults abstain from sex until marriage without any additional sex education, and recommending this approach in countries/communities with major gender inequalities, does little to reduce the spread of HIV. For a balanced view about abstinence based educational approaches see Avert’s review, plus this systematic review from the Cochrane Collaboration indicating abstinence only approaches are not effective. Speak out against those who promote HIV programmes that are only focused on abstinence because it doesn’t reduce the prevalence of HIV.

Linked to some abstinence campaigns is anti-condom propaganda, promoted by some faith based organisations, governments and NGOs. This includes misinformation such as ‘condoms don’t work’, which is untrue. Of course no barrier method is 100% effective, if used correctly then condoms are 80-97% effective in preventing HIV transmission. Other claims include condoms usually break – again untrue if used correctly (in such cases condoms are 98% effective). Or that there are minute holes in condoms that the HIV virus is small enough to pass through. This is false. Condoms are a barrier method and the HIV virus cannot pass through latex or polyurethane condoms. More information about condoms and how to use them can be found courtesy of Planned Parenthood.

Here’s how to use the male condom


And the female condom

Use this awareness of what condoms do and how they are an effective method of preventing HIV transmission, and support educational campaigns that not only distribute condoms but also give people the life skills to know how to use them correctly and negotiate using them with a partner.

Unfortunately sexual health – particularly around HIV/AIDS – is often based on good ideas from well intentioned people, but not necessarily practices based on the latest evidence. To find out what’s going on you can use PubMed and Google Scholar to search for research papers, or organisations like MedFash or BASSH. If you work in education or healthcare ensure your staff are supported to learn about effective ways of promoting clear messages around HIV prevention or how to manage if you are HIV positive. Ask for additional training if you are a staff member or volunteer in this field and ensure you’re obtaining (and attending) continued professional development (and not just for the per diems or certificates – you need to show clear outcomes in your practice and benefits for your clients).

Added to this is the problem of staff who are working in the field of HIV/AIDS but may lack basic training, be unsupported or require more intensive supervision – particularly around reflecting on current evidence and how that might underpin their practice. Without this we see staff giving advice that goes outside their area, not referring to medical specialists when they should, or being highly negative/judgemental.

In many cultures there’s a mix of a lack of sex education, often a negative cultural attitude to sex, alongside sexual messages within the mainstream media – often with different messages for women and men (so men are expected to be hypersexual, women less so). So often people are not sure about HIV, what it is, how to prevent transmission, or what to do if you’re positive. Creating educational and awareness campaigns that aim at diverse audiences (teens, parents, LGBT, sex workers) and allow people to discuss any areas of confusion can really help. If you want to assess the effectiveness of an HIV intervention, this free toolkit by eminent researcher Doug Kirby is invaluable.

It’s no surprise that HIV is rising in countries where governments have not taken enough appropriate action against HIV or poverty, or to promote balanced sex education. Where politicians are opposed to/negative about pre-marital sex, homosexuality, drug users, or sex workers and do not invest in healthcare and education, then it’s not surprising their electorate suffer. Lobbying, protesting and drawing attention to how government’s do not tackle HIV effectively is one way forward – as is making the treatment and prevention of HIV an election issue. Make politicians accountable – and expose those who are not willing to tackle HIV.

Many people struggle with accessing services that provide education, prevention advice or treatment for HIV due to access to or availability of services. This may be simply because they cannot afford medications, or the cost of travel to get to clinics. Or it may be that services are available but clinic opening times and directions are unclear – or are not available at the time when you need to go (for example early afternoon or weekend for teenagers, evenings for adults). Alert clinics that aren’t making their availability clear. Offer to distribute leaflets or display adverts showing opening times. And campaign for low cost or free access to healthcare, drugs, education, baby milk (for infants who can’t have breast milk) and condoms.

We’re all fighting to prevent HIV/AIDS but that doesn’t mean you shouldn’t question fundraisers that claim to make a difference. There are those who exploit this area, and even where there are well meaning campaigns they may be more about fashion than fundraising/awareness/empowerment. If you want to make a difference then the Buy Less campaign may be more appropriate

7. Healthcare practitioners and teachers – speak out!
As well as promoting more evidence based practices (see above), tackling colleagues who are judgemental about HIV/AIDS (or related areas – for example prejudiced towards homosexuals, transsexuals, prostitutes or drug users), then work towards better training and support for them – and if this fails then complain to management and ensure they are not harming others with their views.

Challenge NGOs and funding bodies promoting that only promote abstinence only/anti condom messaging (see above), or who will only fund HIV programmes that don’t mention safer sex or other sex positive/educational messages. Where possible ensure your services do not take this approach and link with colleagues to ensure you offer a balanced service based on the latest evidence. If you are working in a resource poor country you may find making links with established academics/practitioners in other countries can help you access materials you need for your work (please email me if you’d like me to put you in touch with some).

If you are struggling to access drugs, medical supplies, sterile clinical products and syringes, or basic supplies like bedding or clothing, then again you may find making links with colleagues in other countries can help. Western medical students, for example, are often keen to fundraise, volunteer and access/share sterile items.

We’ve already heard about the political barriers to sorting HIV, but if you are experiencing this as a healthcare provider, educator, parent or volunteer then expose it – to local papers, through a blog (which can be anonymous if necessary), or through the HIV research/practitioner community. That might be discussing a school or health authority promoting negative or mixed messages, or denying access to condoms. Or national blocks on sex education, or politicians openly supporting AIDS denialism, being homophobic, or harassing those with HIV.

If you don’t feel able to speak out yourself, then alert people like me and we can try and help you find ways to share your story anonymously.

8. Empower people to protect themselves
As well as becoming a sex educator (see point 1 above), encouraging peer to peer education initiatives can make a real difference to young people, although adult to adult peer support schemes work well too (for example to raise awareness among sex workers, or gay men). The 15 and Counting Campaign provides a wide range of resources for setting up sex education activities – and to help people campaign within their communities for better access to HIV/sex education.

Alternatively, you may want to support existing HIV initiatives aimed at teaching skills and raising money for people who are affected by HIV. For example the Positive Beadwork Project.

You could encourage clubs and pubs to provide condoms, or work with HIV charities or health authorities to hand out condoms in social spaces. (Remember it’s not just about dishing out the condoms, it’s also about giving people the chance to ask about safer sex and relationships, pleasure and communication).

Supporting open access organisations like the (wonderful) Hesperian Foundation http://www.hesperian.org helps people learn more about their health and HIV – including how to prevent, treat, and live with the virus. Their books are free to those in resource poor communities (the rest of us quite rightly pay). Titles worth sharing are listed below (and many come in languages including Bengali, Chinese, Indonesian, Urdu, French and Spanish).

HIV, Health and Your Community
Helping Health Workers Learn
Where there is no doctor: a village care handbook
Where women have no doctor
Where there is no dentist

9. Question bad science
Sadly there’s a lot of misinformation in the name of HIV/AIDS, and often this comes from science – or people pretending to be scientists. The worst offenders are the AIDS denialists, who not only promote their views across the internet, they’re also active within the media (see this recent report on the inclusion of an AIDS denialist movie at a cultural festival).

It is important to tackle AIDS denialists, and there’s a particularly useful list of resources here about spotting pseudoscience relating to this issue.

Added to this are those who (usually well meaningly) offer alternative treatments to those affected by HIV. There is no evidence that homeopathic remedies ‘cure’ or ‘prevent’ HIV, and those who promote such treatments – particularly when encouraging standard medical treatments for HIV (antiretrovirals) are discontinued – are extremely dangerous. Unfortunately there are some who are not averse to maliciously exploiting this virus and will offer a variety of cures, spells, amulets, or other products with the promise of curing or preventing HIV – but in fact simply a means of parting people with their money. We need to do more to stamp out quackery in this area and educate people to use established treatments and methods of prevention.

One of the major criticisms raised at the HIV/AIDS research community is about ensuring studies are focused, relate to/develop existing findings (rather than replicate them), and have measurable benefits to communities. Critics have argued that research in HIV may build academics careers but do little to enable people in ‘real life’ settings, or the focus on HIV detracts from other equally important issues within healthcare. While some of these accusations are often unfounded, there are questions to be asked about the quality of some studies on HIV/AIDS, and the ethical conduct of researchers. We should question any research on HIV/AIDS that doesn’t appear to have ethical approval, or does have approval but still seems to be putting participants at risk. Two examples of this come from sex workers in Cambodia and a Canadian study taking part on prostitutes in Nairobi. If you have concerns about ethical and governance issues in research then you should speak to the ethics committee overseeing the work. Established scientists can help if you need support with this (I can refer you to some if this is an issue for you).

We also need to be wary of research that doesn’t fit with the wider body of evidence (or contradicts it). Particularly in the case of studies that seem to be detracting from general HIV messages, or appear to promote anti-condom messages.

Those of us working within research in sexual health/HIV need to do more to explain our methods, make evidence more accessible and directly applicable, and link carefully with communities where we’ll be working. It is important to work ethically and transparently, but also nurture community relationships as it is unfortunate that some studies are scuppered not because researchers were unprofessional, but the negative reputation of science resulted in opposition to research.

10. Don’t forget, there are 365 World AIDS Days a year
It’s easy to think about HIV/AIDS on World AIDS Day, but not always so easy to remember it all year round. Hopefully the list of ideas above may give you some pointers for things you can do throughout the year that will make a difference. Setting aside time to regularly engage in an activity (like fundraising, volunteering or community education) means you don’t forget about HIV and you help those affected by it.

If you’ve found these tips helpful then please feel free to circulate widely.

I’ll leave you with a link to the official World AIDS Day site, and this short film that reminds us why we cannot stop fighting HIV and supporting those affected

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.

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.