Next Friday evening (19 March) from 7-9.30pm why not join me and comedian Bev Fox for a night of fantastic food, science, sex and a whole lot of fun.

We’ll be finding out what science can teach us about about erogenous zones, aphrodisiacs, arousal, and attraction. You’ll find out all kinds of secrets about sex and science – and learn more about your sexual self.

It’s an all women event that’s open to straight, bi, lesbian and trans women of all ages.

More information about the evening, menu and booking information available here. You can also follow the whole festival on twitter and you can also ask questions about sex and science for us to cover using #sciencefest or direct to @sciencefest or @drpetra.

Hope to see you there – I’ll be blogging a report on what we get up to for those of you who’re not able to make it.

Given the Consultation may well inform policy and practice and will certainly influence educators, healthcare providers and journalists, it is important the work is carefully assessed.

If you have not already read the report in full (and my hunch is most of the media outlets covering the Consultation have not) I would recommend you do so and form your own conclusions. This is particularly worthwhile if you work within education, health or social care, or if you are a parent or teenager.

To help you do this I’ll use this blog to provide you a backplot to this Consultation, including links to previous similar investigations into Sexualisation carried out in other countries, and resources to help you evaluate the Consultation process from inception to report.

What is Sexualisation?
You might not be familiar with this term which suddenly seems to have become a buzzword. It has, in fact, been used extensively within research and education on sexual behaviour for some time, but has only recently entered into mainstream public language. It’s actually not an easy term to define, but generally refers to either making an individual or group of people seem sexual, or to encourage someone to become sexually aware. This alone isn’t problematic, but the term is usually negative as it draws attention to an individual or group being sexualised without their consent or in an inappropriate manner, or someone being made aware of sex or sexual practices at an inappropriate time.

Most commonly, then, we see this applied to children who we may view as being encouraged to act in a sexual manner or become aware of sex while still very young. Sexualisation here is constructed as potentially abusive, something that objectifies and is forced onto people, who have little or no agency to resist/understand/be aware of it.

While intuitively we may agree such sexualisation is a bad thing, particularly if it involves the potential exploitation or abuse of children, there is a problem with the term and who it applies to. It is easy to state what sexualisation might involve, but more difficult to truly define and measure (particularly in any causal way). This has been something that has caused numerous problems for those trying to research it, not least because it may be difficult to transparently research something that seems so important and emotive. It is very difficult to undertake critical and thoughtful work in this area without appearing to dismiss issues young people are facing, or be criticised for ignoring or perhaps even appearing to advocate the abuse of children.

What work already exists on this topic?
There have been several large scale investigations into Sexualisation carried out in different countries. The majority of the work has focused attention on girls as being most at risk from a sexualised culture (sometimes also referred to as a ‘pornified’ culture), although most work also draws attention to the impact on boys.

The first Consultation, launched in 2007 was conducted by the American Psychological Association by their Task Force on the Sexualization of Girls. This report also included a range of materials to support parents and young people. Australia also commissioned a Consultation into the Sexualisation of Children in Contemporary Media which was released in the summer of 2008 (all documentation related to the process here). While in January 2010 the Scottish Parliament reported back on their inquiry into Sexualised Goods Aimed at Children led by researchers from the Institute of Education, London.

Outside of these large scale reports there have also been numerous pieces of research addressing either the concept of Sexualisation directly, or using the concept of Sexualisation to underpin investigations, or looking at related topics of sexual behaviour (and the use of pornography in particular) in young people.

The APA report was welcomed on its launch for picking up on an issue many teachers, parents and healthcare providers felt was important and believed was a problem. However over time the report attracted some criticism (as did its Australian counterpart) for not truly critically appraising the evidence used to support claims of Sexualisation’s existence and impact. There was also some concern that in trying to tackle problems facing young women the reports constructed them as having no understanding of the wider media or no agency to act or make decisions about their own sexual behaviours or beliefs. Critics argued the reports characterised young women as passive beings, objectified by wider culture but having little or no understanding or control over it.

The Scottish investigation, by contrast (and perhaps learning from the pitfalls encountered by its predecessors) took a different approach. It worked to identify what worried young people and parents, to see whether Sexualisation was an issue for them, and if so how that might be manifested. Given the increasing concern about commercialised sexual products for young people (for example Playboy bunny pencil cases or t shirts) they also sought to find said products to see how available/accessible they were and in what context they were sold to young people. Their findings also indicated there were issues about consumerist culture and young people’s developing sexuality.

However they also suggested that ‘Sexualisation’ is not an issue that immediately worries parents or teens, but when prompted it seems parents are far more worried about it than young people, and are often more concerned about the sexualised behaviour of other children rather than their own child. Indeed their work suggested a lot of parental anxiety over Sexualisation manifested itself in parents talking about how girls should behave and act in appropriate and modest fashions. Young people, meanwhile, seemed more aware of the media and potential sexualising influences than expected, although the authors acknowledge there are still issues about sexuality needing addressing. In short they concluded sexualisation is a complex issue that can’t be fixed with simplistic suggestions for policy change.

These reports are important as they help put the UK Consultation into context, and the Scottish investigation in particular serves as an excellent example of good practice because it:
- critically evaluated the existing reports on Sexualisation
- included a thorough search of additional evidence on sexualisation and related issues
- tested the idea of what Sexualisation might be using innovative participatory methods
- investigated what Sexualisation was, how it manifested itself and how it was interpreted and experienced by parents and young people
- did not set out with the assumption Sexualisation was prevalent, nor looked for confirmation of its existence. Instead it questioned the concept and looked to see what issues were problematic and positive for young people and their parents

I would recommend you read through all three reports before considering the UK version.

Background to the UK Consultation
The UK Consultation was launched in March 2009 by then Home Secretary Jacqui Smith, psychologist Linda Papadopoulos and model Danielle Lloyd as part of a the ‘Together we can end violence against women and girls strategy’. Respondents were asked to submit evidence and several roadshows/public events were held where people could talk about their experiences of/views about Sexualisation. A survey was also launched to identify people’s views about other issues relating to violence and abuse (including prostitution, rape, domestic violence, forced marriage and Female Genital Mutilation).

Dr Linda Papadopoulos was appointed to lead the Consultation. A counselling and health psychologist with a background in dermatology and author of several self help books she was also well known to the public after appearing on television programmes like Big Brother and other regular media appearances. Being a well known figure at the head of a Consultation clearly attracts media attention and public interest and can be important to reach a wide range of respondents.

However, critics questioned the appropriateness of appointing someone to lead a Consultation evaluating how sexualised/commercialised media impacts on young people who also had their own line of beauty products (the Psy Derma range) and an established career as a consultant/spokesperson for numerous commercial companies but not a track record of actively researching the area of sexual behaviour/sexualisation and young people.

Putting those criticisms to one side, the issue at hand is the quality of the UK Consultation. From the way it was commissioned and conducted to the final report and recommendations. Any Consultation report at this level has the capacity to influence policy, practice and public opinion. So it is important we assess any report of this kind to ensure it is robust enough to have this influence.

The Sexualisation of Young People Review can be found here and tackles a number of topics relating to Sexualisation while making recommendations about what to do to address the issue in the UK.

Resources to help you evaluate these Consultation documents
Consultations are not always accessible and critically appraising them is more than simply reading them through. It is easy to look at a lengthy report that contains numerous references and recommendations and take this as a sign of a thorough and evidenced approach. However, this may not be the case, so below are a number of tools to help you evaluate all the Sexualisation reports listed above. (If you are very busy I’d suggest you simply focus on a detailed appraisal of the UK report for now, but I would still urge you to read all three preceding reports too).

Trish Greenhalgh’s How to read a paper includes this chapter Papers that summarise other papers (systematic reviews and meta analysis) which can help you assess the appropriateness of the reviewed literature in the UK consultation. Her chapter Assessing the methodological quality of published papers also provides a checklist to assessing individual papers, so you may wish to track down papers listed in the references to the UK Consultation and evaluate those in terms of methodological quality and relevance to the overall report. Although this is time consuming, it is important since it is one of the key areas both the APA and Australian Consultations were criticised for not doing.

You may also find this Checklist for evaluating Consultations I’ve designed helpful. It applies to any Consultation, not just the Sexualisation report, and helps you focus your critical appraisal of the Consultation process and reporting. It also invites you to consider your own baggage in relation to a Consultation, so you don’t accept or dismiss something just because it fits or challenges your world view. Instead you should allow the quality of the work undertaken to decide (easier said than done, I know!).

There is also this guide from the UK government that covers Good practice in consultations which sets out what should happen in a public Consultation activity (scroll down to the middle of this page to find the links to the resources). You may wish to compare this with the published report or use it to inform further questions you may have about the work undertaken.

As you can see this represents a lot of work, so you can appreciate that while the media have been quick to respond to (and largely support) the Sexualisation study, the academic community will probably take a while longer as an appraisal of a Consultation is not a quick process.

You may work within healthcare or education and might like to set this as an activity for yourself or for your colleagues/students. If you are a journalist I would encourage you also to do this, even though it is time consuming, as it may help you with future stories you are writing – particularly if you intend to continue discussing the issue of Sexualisation.

I will post at a later stage my appraisal of the report, but not until I have thoroughly assessed it and followed up key issues and questions.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Last November you may remember drug company Boehringer Ingelheim reported at a conference on their trials of a drug called Flibanserin, aimed at treating hypoactive sexual desire disorder (HSDD) in women. In lay terms HSDD means a lack of sexual desire, sometimes also described as a lack of libido.

The trials did not indicate strong findings individually, but with combined data from different country sites it suggested a women who took the drug reported 0.7 more sexually satisfying sexual experience per month as compared with placebo. You can read a summary of the history of Flibanserin, information about the trials, details of how the drug company have tried to involve practitioners and appraisals of the drug and trials here.

While aspects of the drugs effectiveness and safety long term are still being investigated, and while approvals are being sought from the FDA and EMEA the drug company appear to be continuing efforts actively promote the concept of HSDD.

Late last week the company released findings from a survey of women with low desire and associated distress at a women’s sexual health conference. Dubbed the DESIRE study (Desire and its Effects on female Sexuality Including Relationships) it reported on 65,129 women ages 18-88 from five European countries. Participants completed a computerised Decreased Sexual Desire Screener (DSDS) a five-question diagnostic tool which is apparently designed to assist “non-expert clinicians in the clinical diagnosis of generalized, acquired Hypoactive Sexual Desire Disorder (HSDD)”. 7,542 (11.5% of original sample) answered “yes” to all four questions and 5,098 (8% original sample) women further chose to participate in the in-depth survey.

It’s not clear what participants were asked in the survey, nor whether these women were part of the wider Flibanserin trials. But we can see the DSDS screening tool, which asks five questions to which you should answer yes or no:

- In the past, was your level of sexual desire/interest good and satisfying to you?
- Has there been a decrease in your level of sexual desire/interest?
- Are you bothered by your decreased level of sexual desire/interest?
- Would you like your level of sexual desire/interest to increase?

In a fifth Yes or No question, women are asked to note any factors from the following list they feel may be contributing to a loss of sexual desire or interest.
- Medications, drugs or alcohol you are currently taking
- Pregnancy, recent childbirth, menopausal symptoms
- Other sexual issues you may be having (pain, decreased arousal or
orgasm)
- Your partner’s sexual problems
- Dissatisfaction with your relationship or partner
- Stress or fatigue

If you say ‘yes’ to questions 1 to 4 and ‘no’ to all the questions in number five you can be classified as having HSDD.

However, let’s go back and look at this study again. Firstly the title of it – DESIRE. It’s unclear if this is how it was introduced to participants, but it is worth noting that using potentially coercive titles in study acronyms is ethically frowned upon in research. Regardless of whether participants were told this was the name of the study, the branding of the research as ‘DESIRE’ is certainly making a point and one might add is part of an overall marketing strategy.

Moving on to look at questions 1-4 again. They don’t contain clear parameters so ‘in the past’ could mean anything from ever in your life to the last few weeks or months.

They’re also vague ‘has there been a decrease in your level of sexual desire/interest?’ A decrease compared to what? How I’ve felt over the course of my life? How I feel now as compared to when I met my partner? How I feel with my current partner compared to how I felt with a previous lover?

See also ‘are you bothered’. Well, maybe I’m bothered because my partner bugs me I don’t seem to want sex enough. Or maybe my partner’s great and never pressurises me but I still feel inadequate. Perhaps I feel bothered about a lack of desire not because I don’t feel any, but because I’m not in a relationship currently. Or maybe I’ve lost desire for reasons I understand, it does bother me, but I also know that the situation may change or I can do something to solve the issue. Being ‘bothered’ can mean very different things to different people at different times in their relationship.

The questions are also leading. ‘Would you like your level of desire/interest to increase?’ Well most of us would probably say yes. But even if we did say this, does it really tell us much. If I say I don’t want my levels of desire to increase it may not also tell you that I would like the opportunities to explore pleasure to be more forthcoming. Or perhaps I’d like more opportunities to have the time to spend on intimacy.

If you’re setting up a diagnostic you need to be really clear about what it is you’re asking people to measure their experiences/behaviour against. Otherwise it becomes all too easy for people who’re probably not that troubled by something to be classed as someone who is in difficulty.

Let’s not lose sight of what are the main causes of desire problems in women – see how many of these you consider to be a ‘medical’ condition:
* Concerns over body image
* A lack of sex education or knowledge how your body works
* Not knowing what turns you on, or the inability to share what does turn you on with a partner
* Psychological or physical health problems (including sexually transmitted infections)
* Past or present sexual abuse or domestic violence
* A partner who has a sexual problem
* A partner who does not know how to turn you on effectively
* Relationship difficulties including arguments or jealousy
* Being overworked and lacking support from family and/or partner
* Having a young family (particularly if there’s little support provided to care for them)
* Concerns over fertility, problems with contraception use
* Lack of privacy to relax enough for sex
* Poverty and related issues of limited access to healthcare
* Focusing on vaginal sex instead of wider sexual activities, particularly clitoral stimulation

Aside from the DESIRE study a ‘patient registry’ will now be collating data on women classified as having HSDD who will be followed up long term. This will be supported by an ‘unlimited grant from Boehringer Ingelheim’ (see press release above).

What’s interesting about the reports on the DESIRE study and launch of the patient registry is there is no mention on the press release about Boehringer Ingelheim’s development of medication specifically to treat HSDD. This is important if you need to put both their investment in this study and the registry in context.

Sadly the media covered this story uncritically and without asking key questions about it. Not least about the funding of the research, registry and additional studies being conducted on medications to ‘treat’ female desire disorders.

Instead we heard coverage that women with a lack of desire suffer from emotional distress, in reports that indicated this was a widespread crisis that needed immediate attention.

Now many women do report dissatisfaction with sex, but that does not mean they are dysfunctional, nor does it mean they are always distressed. Problems around desire affect women and men, gay and straight, partnered or single. And they can be due to a variety of often interrelated factors – physical, psychological and social.

What we are currently seeing is a shift towards setting up a lack of desire as a widespread, distressing, clinical condition that requires drug treatment as a first port of call.

There are questions to be asked about why a drug company would invest in surveys and patient registers to indicate there is a disorder, while at the same time creating medication to treat this condition.

[Non UK readers may be wondering what the 'am I bovvered?' phrase in this title refers to. It's a catchphrase of a character, surly teenager Lauren Cooper, in UK comedy programme The Catherine Tate show, shown in the picture at start of this blog]

This week’s national condom week, and in case you hadn’t been thinking about male or female condoms it’s a good time to reflect about what they can bring to your sex lives.

Long gone are the days where condoms are thick, smelly and come with the spermicidal pessary that bleaches your boyfriends carpet (yes I’m talking personal experience here).

Nowadays condom manufacturers have caught on to the opportunities offered by making condoms sexy so not only do we have a huge range of size/shape combos, we also get ones with different textures, colours, flavours and lubes to go with them that can increase sensitivity or prolong sex. In short, condoms are the new sex toys. Even adverts for condoms and lube have got good

So hopefully you’ll join in the celebrations this week and think about using condoms and what that can do to enhance your sexual health – and pleasure. Even if you don’t usually use them for contraception, give a flavoured or textured one a go – it all adds to the fun.

And to keep us in the mood Logan Levkoff’s written an Ode to Condoms. While here’s my guide for busting those ‘condoms don’t fit me’ type excuses. Seriously, don’t make me come over and spank you for not gloving up.

You could send someone you fancy a naughty condom e card. Or check out this podcast from the BMJ on the importance of condoms fitting.

Finally Scarleteen asks us to celebrate your ‘condomversary’ – the number of years you’ve been using condoms.

What’s your number?

Sit back, relax, and let’s begin.

Can’t help lovin’ dat man of mine – Showboat (1936) (Actually this song’s all about making excuses for a hopeless partner, but the clip does feature the gorgeous Paul Robeson so it makes the list for that reason alone).

Bewitched, bothered and bewildered – Pal Joey (1957)
What can I say? Rita Hayworth and such a seductive song…

I’ll see you again – Bitter Sweet (1929)
Here’s the master, Noel Coward showing us how it’s done.

If I loved you – Carousel (1956)
For anyone who’s ever fallen for someone they shouldn’t have – well we’ve all been there, haven’t we?


As long as he needs me – Oliver
Shani Wallis breaks your heart in this clip from the film version of Lionel Bart’s musical (1968).

What I did for love – Chorus Line
This is a more recent recording (2006) (although I prefer the 70s cast version), but it’s still lovely. ‘But I can’t regret what I did for love’. Sigh.

There are worse things I could do – Grease

This never became a big hit from the Grease soundtrack, and yet it should have been. Perhaps because of the context of the song it never got the credit it deserved. This is for all the girls who identified with Rizzo, rather than Sandy.

My man – Funny Girl (1964, 1968)
Well we had to have a bit of Babs to make this list complete, so here she is…


Losing my mind – La Cage Aux Folles (1973)
Great musical, but here’s the version most folk know. Featuring Liza with a Z of course (and the Pet Shop Boys)

One hand, one heart – West Side Story (1957, 1961)
There are so many love song choices from this musical but this is my favourite. Wonderful.

Have a very Happy Valentine’s Day.

So yes, in a couple of days time it’s St Valentine’s day. A time for celebrating love, friendship and romance.

It’s very easy to get cynical about the day and grumble on about commercialisation. So in the spirit of true love here are some romantic smackerels for you to enjoy alone or with those you cherish.

Firstly check out Charlie Murphy’s fantastic exhibition Anatomy of Desire which builds on her ‘kiss in’ work – capturing kisses and transforming them into glass sculptures. For those of us who study sex we’re indebted to Charlie for showing us how you can hold a kiss in your hand.

The Wellcome Trust invite you to vote which of these 1920s Valentine’s day cards you like the best.

Going one better the Kinsey Institute are sharing their short film showing a collection of vintage sex ‘toys’ (or perhaps a better descriptions might be sex curiosities). Which is both charming and sexy. (Although I wish they’d used ‘Please Mr Hemingway’ as a backing track – this is an okay version, Elsie Carlisle does it better and a lot more saucily).

A few years ago I took part in a Valentine’s event at the Dana Centre called Comics’ Carnal Knowledge where sex researchers and comedians were teamed up to have fun with the science of sex. You can watch the whole event here.

Sex ed campaign ‘Where is your line?’ have a lovely Valentine’s inspired film about love and sex, through the medium of writing your desire in Sweethearts. Yum. (Seriously, you should really get on board and support these guys, they’re great).

“Ask Me” from Nancy Schwartzman on Vimeo.

And while we’re in a sweet as candy groove here’s the Valentine’s song that comes toddler approved – it’s our current top fave for dancing and singing along to – actually it’s not really romantic, but it is very bouncy!

Back by popular demand is the Department of Health Valentine’s promotion from a couple of years ago. There was a choice for the DH on this campaign where they had two spokespeople – Alesha Dixon, and me. There was the option to put spokesperson naked into a bath full of condoms and one in a studio to talk about safer sex. Alesha got the bath. I think we’re all agreed that was by far the best choice. (Little known fact, this is one of the most searched items on my blog, hardly surprising, eh?).

Meanwhile, for all my geeky friends xkcd comic has a Science Valentine cartoon which made me a bit sad….

So to get on to happier things, let’s finish with some romantic homework. Go track down Steve Tasane’s wonderful ‘Bleeding Heart’ (available in the book of the same name) and Benjamin Zephaniah’s ‘Cybersex’ (he also has an edited book of love poems that’s worth reading).

And I’ll leave you with one of my favourite romantic poems by ee cummings, which you’ll probably already know but it’s still lovely to share.

‘i carry your heart with me (i carry it in my heart)’

i carry your heart (i carry it in my heart)

Come back on Valentine’s Day when I’ll be going even more mushy on you and sharing my top ten love songs from musicals. Be warned, it might get a bit camp. And I might even make you cry.

Today sees the launch of the draft version of the latest incarnation of the manual – the DSM5. It’s been worked on over the last decade and you can now see how mental disorders are being conceptualised (including what disorders have been amended, removed or added to). The whole draft is available here although I am most interested in how sexual functioning, gender identity and paraphilias are being approached.

In particular hypersexuality appears to be moving towards supporting diagnostics around sexually addictive/compulsive behaviours, which requires close attention as we already know this is one area full of very poor science, political and faith based ideology and a whole slew of homespun (but largely unevaluated) therapies.

If this is to be included in the DSM5 there needs to be a strong evidence base underpinning anything we want to label as ‘hypersexuality’ and robust reflections on how we classify problematic behaviour to ensure we don’t pathologise certain forms of sexuality (ie adultery, masturbation or alternative relationships) that particular faith based and neo conservative groups/professionals disapprove of.

The classifications around gender identity have proved controversial with critics questioning whether such guidance should be developed – particularly given a weak evidence base in this area. You can see how it is being approached in children here (approaches for adults also outlined in this part of the DSM5 draft). Mainly the debates around the classification in children have focused less on the issue of identifying problems and more about evidence based evaluations of treatment interventions for young people.

Sexual interest/arousal disorder in women is also an issue requiring close attention as we know this is an area where there’s been an ongoing issue about medicalising female sexual behaviour, suggesting women who don’t want sex for practical, relationship or health based reasons require hormonal or SSRI-type interventions.

You can expect to see discussions of this particular classification on sex blogs in the coming weeks, although it’s worth also looking at the additional classification aimed at men, and compare how these are new classifications as distinct from existing categories of orgasmic disorder aimed in women and men.

The existing DSM classifies difficulties in experiencing orgasm as a dysfunction, while the proposed new version would add to this lacking in desire for sex. Some people will welcome this seeing the lack of desire as the barrier to orgasm, others may conclude that there are many reasons women and men don’t feel desire or experience orgasm and classifying them as a mental disorder may be overmedicalising a range of normal human sexual responses.

If you’re interested in how we understand sexuality and human sexual behaviour I’d recommend reading through the entire list but focus your attention particularly on what’s being proposed as now needing classification, what’s being subsumed into existing categories and what established diagnostics look set to remain.

From this you should consider the evidence (shown by each category) and see whether you feel this is fair, balanced and whether it comes with any conflict of interest (you may need to track down the cited papers to do this). You could also reflect on what categories are being added, who is suggesting them and who might benefit or face discrimination from them should they be classed as a mental disorder. You may also want to think about what happens if any categories are added to or removed from the DSM – in terms of how we’ll be approaching research, therapy, drug treatments or surgery for sexual dysfunctions, and gender identity disorders and how those plus legal sanctions may be applied to the classification of paraphilias.

I’m not arguing here that all the items listed in the ’sexual and gender identity disorders’ aspect of the DSM should be overlooked (for example nobody’s going to dispute paedophilia is a problem, although we need to be sure the way we classify this means those anxious about being potential abusers can get help and treatment). Yet we do need to cast a critical eye over some of the definitions activities that might come under the umbrella of fetish and kink, and also problematise those who apparently have too much or too little sex (or interest in sex).

No doubt colleagues far better versed in understanding mental health classification will be discussing the ramifications of the DSM5 draft in the coming weeks and I’ll add their reports to this blog.

In the meantime you have until 20 April 2010 to respond to this or any other aspect of the DSM5 draft. I would recommend we all do this as individuals or collective groups of practitioners or activists as this process will be used to inform how we define, research and treat mental disorders. If you feel there are particular areas which should be included or excluded from the DSM now is the time to have your say.

Professor Graham Scambler discussed core concepts of stigma and particularly focused on how we understand sex work. He also addressed issues of diversity within sex work (how people are involved in it and what their health needs might be) as well as reflecting on agency and wellbeing on sex workers – particularly in relation to debates on trafficking.

Professor Helen Ward focused on her work with female sex workers, particularly around physical, cultural and psychological barriers they encountered in relation to accessing healthcare and maintaining wellbeing. Drawing upon interviews with sex workers she outlined how stigma is enacted and how this impacts upon those involved in prostitution.

My contribution drew upon my past research background in this area and more recent practice in working with healthcare practitioners to embed evidence within their sexual health practice. Focusing on experiences of training practitioners globally and the wider evidence base on stigma related barriers to healthcare I talked about the problems experienced by practitioners, NGOs/charities, sex workers and communities in providing adequate, accessible and appropriate healthcare.

All three presentations questioned concepts such as stigma and sex work and particularly addressed the problems facing healthcare staff in knowing how to access and apply evidence to inform good practice. We also focused on challenging the rhetoric that can often run around terms like ‘evidence based practice’, ’stigma’ and ‘trafficking’ and encouraged the audience to think about ways to improve their research and healthcare provision, engage sex workers in decision making about their care, and reflect on what their role was as healthcare providers/researcher in relation to addressing sex work.

You can see the each presentation (including our slides) and the following panel discussion here.

Please feel free to share this link, which should be of particular interest if you are…
- a student or practitioner in healthcare (particularly global health)
- working for a charity, NGO or other organisation involved with addressing prostitution
- a sex worker or ally
- a researcher studying sex work
- a lecturer in medical education and/or evidence based practice

If you’ve any questions about the presentation feel free to contact me and I can pass them on to the relevant speakers. And if you’re working in health care (as a practitioner, charity or other organisation) and want further training on improving the care offered to those involved in sex work please get in touch if you think I can help you or your organisation.

The event provided a lot of discussion during the panel and afterwards and I know has led to further activities among researchers and practitioners. I’ll post updates on some of those activities in a future blog.

This year the theme of the week is focusing on unplanned pregnancies in the over 35 age group, something that’s common but often underreported – and unexpected when it happens to women.

More information about the campaign and evidence underpinning it can be found via the Family Planning Association where you can also find out information about contraception options – whatever your age.