It would be naïve to claim all of these changes are responsible for the identification of record levels of STIs, nor that all of them have been effective. But it is worth noting (and the HPA report acknowledges) that some of the increased detection of STIs will be down to higher levels of screening. So from that perspective the figures are more positive – it tells us we are identifying and treating people with STIs more than in the past.

Alongside these healthcare initiatives there are other, less positive reasons why STI rates are rising in the under 25s. These include:

Our lack of comprehensive, quality sex education
Sex education remains patchily delivered across the UK with some places doing excellently, others not so well or even teaching negative messages (more information here and here). Young people generally are afraid of unplanned pregnancy (and overestimate rates of unplanned pregnancy), but less aware of STIs. This is particularly the case if education focuses on teaching the names of STIs and showing gory symptoms, but doesn’t explain how you get and prevent STIs or talk about how many are symptomless.

Public Health Campaigns
While we have had government led public health campaigns aimed at the under 25s for the past twenty years these have been patchy, underfunded, and subject to numerous changes in messaging resulting in confusing ideas shared (my insider view of the problems with UK government backed sexual health campaigning can be found here). Despite the limitations of sexual health campaigns from the previous government it is worth noting the current coalition appears to be doing little in the way of public health campaigning for sexual health services.

Access to and funding of services
GU clinics have traditionally been referred to as the ‘Cinderella service’ – not as well funded nor respected as other areas of healthcare. Getting appointments also remains a problem with some services struggling to give appointments in 48 hours or less. In many places waiting times can be weeks rather than days. While demands on services continue to increase, along with the workload of staff rising massively, funding to match these demands is not forthcoming. Perhaps unsurprisingly some staff aren’t always sympathetic which can be off putting. Meanwhile despite underfunding, over expectation and cuts, it is generally staff who are blamed if services don’t hit targets.

Aside from getting seen within services is the wider problem of people knowing how to find them. Many clinics still struggle with promoting their services to the public, or being open at accessible times.

To see how it works in practice, try this experiment. Imagine you’re 16 (or thereabouts). You still live at home. You need to find where a sexual or reproductive health clinic is in your area. Your school hasn’t provided you with any advice, you can’t ask your parents and your friends aren’t much help. Without using the internet, how do you find a clinic locally? Look around your neighbourhood. Can you spot any posters or leaflets? Is there information at your pharmacy or GP practice or library? Are there any youth centres or clinics offering support – and if so when are they open? If you find services are there any that are open at times you could get to? (To make it more challenging imagine you were under confident, struggled with literacy or language, or perhaps had very strict parents who needed to know your whereabouts – this may further limit what you would be able to access).

Silo working
While there is plenty of research on sexual health services and initiatives to improve waiting times, accessibility, youth friendliness and treatment/testing options, alongside evaluations of what works within sex education, we sadly do not see much in the way of collaborative working. This is often referred to as ‘silo working’ where individual practices, organisations or individuals may well have great ideas but do not share them together. Alternatively work may be replicated (including mistakes) or opportunities for collaborative practice are missed. While services are overstretched, underfunded and pressurised it is difficult to find the time or enthusiasm to network.

Culture, attitudes and sexual climates
Norms and values relating to sexual behaviour have undoubtedly shifted over the past few decades. Pre and extra marital sex is no longer viewed as taboo by the majority of the UK population. Contraception to prevent pregnancy has enabled people to have sex for pleasure. Discussions about sex within popular culture have become more prevalent and some may argue more explicit, although this has not been matched with education to enable people to negotiate a culture that may well feel more sexualised to some. New technologies, the internet and shifts within publishing have allowed easier access to sexual imagery. These are not in themselves a problem but may become one if people do not have the life skills to interpret what they see and enjoy respectful relationships.

Our media undoubtedly plays a role here by covering sexual health stories with a mix of salacious scandal mongering and moral judgement. Every time sexual health data is released the media’s approach is to hysterically report a crisis and speculate on the reasons for it, but at no point to campaign for any initiatives to improve sexual health. The media COULD help by being supportive about sex education, campaigning for more funds to GU services, highlighting how to access services (for local news) or providing accurate sex advice to help people negotiate pleasurable safer sex.

Confusing/mixed messages on safer sex
STI rates can be reduced by condom use. Many young people do use condoms, but they may not consistently use condoms with partners over time. And they may also not get screened for STIs before using a non barrier method of contraception. The focus on testing and treatment without including prevention messages means some young people assume regular testing is sufficient to cope with STIs. Clinicians and sex educators often give mixed messages with some suggesting regular testing is mandatory, others advocating self management and using barrier methods of contraception is better. So people can be confused about what the right approach to managing their sexual health should be.

Confidence and communication
Evidence suggests young women in heterosexual relationships find it difficult to negotiate condom use, while young men will use condoms but won’t necessarily mention them unless a girl does (for more on condom negotiating styles and gender see, for example here). Varying sexual health initiatives have attempted to encourage girls to carry condoms and insist on their use or enable young men to do the same. Some have also focused on clearer communication and negotiation skills both about safer sex but also around discussing other intimate and pleasurable topics together. Studies on men who have sex with men indicate older men tend to be more aware of condom use but there is still variable use within relationships and condoms tend to be used more for anal sex than during other activities like oral sex or masturbation. Both straight and gay couples can assume condoms only need to go on just before a man is going to ejaculate so have penetrative vaginal or anal sex without a condom, putting one on before a guy comes.

‘Risk’ and ‘responsibility’
Negotiating safer sex is more difficult when alcohol is involved, and most people do not assume their partner is likely to have an STI. When you’re thinking about how much you fancy someone you’re not necessarily considering their sexual history. There can also be the view that STIs are things that happen to dirty, bad or promiscuous people – other people, not you. Sexual health messaging – particularly through education and public health campaigns often overemphasise morality discourses of ‘risk’ or ‘responsibility’. These tend to be ineffective as many young people do not consider being intimate as inherently risky or irresponsible. Such an approach also assumes older adults act in different (and more ‘appropriate’) ways than younger people, which is neither fair nor true. Within much sex education and healthcare lies the subtext that ‘good’ sexual behaviour is always being prepared, always having condoms to hand and always effectively negotiating their correct use, while sober. What may be great in theory often simply does not happen in real life.

How did the media (and public) respond to this story?
The media response to this story was interesting. Most coverage I saw repeated the HPA’s press release pretty much, some adding additional comment about why STI rates were so bad (most of them missing key areas as outlined above). While the coverage was perhaps not as hysterical as recent discussions on young people and contraception or abortion, there was still very much a subtext of blame and judgement among much coverage. Accompanied by a lot of handwringing about the state of our nation’s sexual health with relatively little discussion of what we might do to improve our wellbeing.

The overwhelming majority of coverage did not clarify that much of the increased prevalence in STIs was down to testing initiatives and treatment programmes. The focus suggested the STI rates were solely down to young people having multiple partners.

It seemed most journalists did not consult the HPA report nor particularly interrogate the data. Those called upon to comment were not generally selected from GU services or sexual health research. Instead it seemed anyone who’d ever written something about sex, sex therapists or generalists on the topic were asked to give their opinion about young people and their behaviour rather than appraise or expand upon the HPA data. Some of the comments made by sex experts on twitter, broadcast and print media clearly showed they had also not consulted the HPA report but still commented on its findings. It is very worrying when both a journalist and the person they ask to explain a report have not actually looked at said data.

Additional input from experts and the public shifted the debate towards a more blame-focused narrative generally blaming young people, or repeating memes such as:
- young women are all victims, they cannot make decisions for themselves
- young men are all predators, who are at the mercy of their overactive sex drives
- feminism has caused young women to act like men
- Sex and the City has taught young women to be promiscuous
- Young men are being blamed for STI rates
- Young women are being blamed for STI rates
- Young men’s needs are being ignored
- Young women’s needs are being ignored
- Young people are feckless, irresponsible and simply don’t care about STIs
- ALL young people undoubtedly know ALL about STIs and cannot claim otherwise
- Sex education/pornography/rap music etc is to blame for rising STI rates
- STIs were not a problem for previous generations
- Scaring young people about STIs will put them off having sex and combat this trend
- Young people who get STIs (particularly repeatedly) should be punished/refused access to healthcare
- STI rates are just as bad in the over 40s, if not worse than in the under 25s

While some of these are more extreme than others it does show how often this debate is further hampered by moral and opinion based discussions that have very little to do with the realities of why young people get STIs. Rather than exploring reasons and finding solutions we are encouraged instead to blame, shame and generally judge people who have STIs – not focus on wider causes or feasible solutions.

What can we do about our STI problem?
This is not a case of us having a problem but not knowing what to do about it. Our epidemiological data for STI rates is improving every year, sexual health services are modernising and new initiatives for testing/treatment are available, alongside prevention messages and strategies to promote safer sex. We know quality sex education increases safer sex and the likelihood of people being able to communicate their sexual needs assertively while reducing coercive behaviour. We know that training up teachers and health professionals to talk about sexual health issues with confidence – and to see these issues as important is necessary. We know young people are interested in such information. We know services would work better with more funds and resources, and if collaborative working was encouraged – and if the media supported rather than scuppered sexual health initiatives.

There is no mystery here. We have ample evidence to fix this. We are failing to do so because our debates on this issue focus on blaming young people and those with STIs and not focusing on the systemic problems that need to be fixed. This is not to say people are not responsible for their own sexual health, but with our current haphazard approach we also do not enable people to take control over their sexual wellbeing.

Data like this always tells a story – about people affected by STIs. But it perhaps masks the discomfort, anxiety, nuisance, distress or fear having an STI may cause. It misses what can happen to relationships, people’s self esteem, or future fertility.

It’s very easy to sit in judgement on those who have STIs. Assuming you don’t have one (are you sure?) or you would never have unprotected sex. It is very easy to believe we’re facing rising STIs purely because of feckless youth. But it completely misses the point. This is a major health crisis – and it affects us all.

Sources of help, advice and further resources
Sexual Health Helpline call 0800 567 123
NHS Choices on Sexual Health includes resources, advice materials and the facility to find your nearest sexual health/genito urinary clinic by postcode
Manchester Sexual Health Network has created the most comprehensive list of related links on GU/SRH I’ve found
NHS Evidence – Sexual Health Services links to resources, data and research on sexual health in the UK

See what you think about the case described below. What would you do if you were the healthcare practitioner, the patient, or the carer talked about in the story?

Darrell, a newly qualified physiotherapist was talking animatedly with his colleagues over lunch about a new patient Ketan, a six-year-old boy recovering from a car accident that had left him with severe leg injuries. ‘He’s amazing’ enthused Darrell, explaining how Ketan was slowly learning to walk again, ‘here, let me show you’. Darrell produced his mobile phone, and after pressing a few buttons showed his colleagues a series of photographs. There was Ketan concentrating hard, frowning as he performed his exercises. Next a shot of the injured leg, followed by a beaming Ketan giving a gap-toothed grin and thumb’s up to the camera. Louise, one of Darrell’s co-workers was the only one to appear concerned. Raising her voice above the ‘isn’t he adorable?’ comments of her colleagues she asked ‘is it okay to take pictures like this?’ ‘Oh yes’ Darrell reassured her ‘I asked Ket’s mum and she said it was fine, in fact, here they are together’. A fourth photograph was shown, picturing a smiling Ketan seated on his mum’s lap, pointing at his leg, whilst she looked uncertainly into the camera.

Darrell’s case probably isn’t that unusual. With new technologies it’s now easier than ever to capture a memorable moment, and that includes colleagues, patients and their families. Darrell wasn’t using the images for research or training, he was inspired by Ketan and wanted to share that feeling with others. He genuinely meant no harm. Ketan was clearly happy to show off his ‘poorly pins’ as he and Darrell had come to name them. Ketan’s mum probably was happy that such an enthusiastic health professional admired her son enough to take his picture.

But would she have agreed so readily knowing Darrell intended to show the picture to his colleagues, friends, and relatives? Perhaps Ketan’s mum thought that Darrell’s photo taking was part of his job, so didn’t question it. Or maybe she felt unable to say no. Given many people aren’t aware you can take photographs with mobile phones Ketan’s mum might not have even been properly aware that pictures were being taken.

Consistently we ask patients to share their stories, lend us their images, and let us sample bits of their bodies. We use this to diagnose, help and treat patients, to teach medical students, or to make new discoveries in research. Patients can expect to be asked to share their histories, be photographed, filmed or audio taped. That doesn’t mean they always understand what they are consenting to, nor have control over how the information, images, or samples they provide will be used.

And outside of this process are the health care staff like Darrell with their own agendas. They collect images or stories to explain their work, to move others as they’ve been moved, or even to make themselves look good in front of friends and colleagues. Maybe like Darrell they show a picture of a cute case study, or perhaps regale squeamish friends down the pub with a story of a particularly gruesome illness or difficult patient. Shouldn’t we be training our staff to respect patient confidentiality and privacy? Or in criticising someone like Darrell are we stifling their skills, and denying them job satisfaction?

In an era where public access is greater than ever, where we’re used to seeing candid shots of celebrities, Darrell’s behaviour isn’t out of place. But in a hospital setting where his job is to provide care, is it appropriate? Ketan’s recovery made a remarkable story – but maybe it wasn’t Darrell’s to tell.

I’ve been working as an ‘Agony Aunt’ (advice giver) in print, online and in broadcast media for the past eight years. I’ve written advice columns for magazines like Grazia, Beauty Zambia and Men’s Health; for websites like mykindaplace and mansized; and presented on radio programmes on national and regional stations in the UK and worldwide. I’ve also advised broadcasting organisations internationally on how to provide quality health advice to their audience. I currently answer reader problems in a weekly column for More! Magazine and answer questions at NHS Choices Talk. Before and during my time as an Agony Aunt I’ve researched the concept of media advice giving and the role of advisors. [Details of how I became an Agony Aunt plus list of related publications can be found at the end of this post].

Because of this work I’m frequently contacted by people who want to know how to become an Agony Aunt. In fact over recent months the number of requests for information about how to do this job has increased – it seems people wanting some extra income during the recession see it as a means to make a bit of extra cash.

So for all of you wanting to know about how to become an Agony Aunt/media advisor here’s the answers to the questions I’ve been asked. If anything isn’t clear do please let me know.

How can I get a job as an Agony Aunt?
This is the number one question I’m asked. There are three general routes in:
Journalist route – either through being on staff at a magazine where you’re required to answer problems, or through making a career as a columnist who answers people’s problems (such as Irma Kurtz or Deirdre Sanders). You may also be an established writer who crosses over into advice giving.
Celebrity route – in recent years celebrities such as Vanessa Feltz, Abbie Titmus, Jodie Marsh, Jordan (aka Katie Price) and Jeremy Kyle have fronted advice columns, some already have a link with advice giving in other media (radio or television) and extend this to print media (and vice versa). Others are offered a column on the basis of being well known.
Practitioner route – psychologists, medics, and therapists who already have a practice in teaching, research or healthcare are picked to write columns based on the skills they have in their working lives. They may already have had some experience working in other areas of media.

What qualifications do you need?
It varies. Journalists have a background within media practice; some have undertaken specific training as a journalist. However there is no accredited course for being an advice giver and quite often the role of answering questions is given to reasonably junior staff. Some journalists have a team of people to help them answer the questions they get (on bigger publications) which can be as involved as actually finding answers to problems or stuffing envelopes to send out pre written standard answers/fact sheets. Celebrity advisors tend to have no formal qualifications for advice giving although there are some who are celebrity counsellors/therapists who have a formal qualification. It is worth noting not all celebrity Agony Aunts write their own columns, in many cases they are paid a retainer to front the column which staffers at the magazine write for them (although many magazines deny this practice is commonplace). Practitioners are often qualified in terms of certification in therapy, counselling, clinical practice (as a medic, psychologist or psychiatrist). However not all media advisors who are professionally qualified provide contemporary advice and some may struggle to give advice outside their area (for example a counsellor asked to give medical advice or vice versa). Usually practitioners who are not media trained are advised to undertake this before applying for a post as an Agony Aunt – it helps with the job but is not essential.

Can men write advice columns?
Yes, they can and do. As with women as advice givers the quality of advice given can vary. And it is more common for women to fulfil the role of Agony Aunts. However there are some excellent male advisors – such as Dan Savage and Cory Silverberg.

How much money can you make?
It can range from absolutely nothing to a three figure sum (in the case of some celebrity advisors). If you’re a journalist already employed to work for a magazine then you won’t be paid any extra for answering questions on the advice column. The exception is if you are a well known columnist working for a publication with a high circulation rate and an established and popular problem page (or similar for television or radio programme with popular advice slot), or if you are a celebrity. Freelancers are usually paid the standard rate for content. External contributors (professionals from health/psychology etc) can be paid per letter – sums can vary from £10 to £100. Usually you only answer a few letters per week, month or fortnight. So if you are lucky you might make between £500 to £1000 per month. Which sounds like a lot but in most cases you make a lot less than this. In fact the general trend among many publications is not to pay at all. Instead people are offered a column as a means of promoting their additional books/products/services. In a nutshell this is not a job to take on if you expect to make a lot of money. A minority of people make a living as an Agony Aunt or Uncle. Most people who do the job don’t make a lot of money. It’s also not a job that’s particularly secure (more on this in a bit).

Will it make you famous?
It varies. A few people have become very well known for being advice columnists, but the majority of advice givers don’t have a particularly high profile. It depends on where you are offering advice (a prime time television show or high circ newspaper would have more impact than a small, independent radio show). It also depends on whether you’re already famous, if you have an agent who can push you into the limelight, or are willing to do this yourself. Even then it’s no guarantee you’ll get famous. And if you’re only in the job for fame you may find this runs counter to your ability to give advice ethically – and may also lead your work to be subject to greater scrutiny by other professionals. So if you want to be famous, make sure you’re also highly skilled. (Unfortunately in the real world of media these two things often don’t go together, but since we’re talking good practice it’s worth aiming high).

What does the job involve?
Depending on where you are giving advice it will involve answering one or more questions in print, online or through broadcast media. In print you’ll usually have a selection of letters sent to you, on websites a similar format applies (unless you’re doing a live chat). Broadcast media can involve live advice giving sessions where callers ask for advice, or pre recorded programmes based on particular themes. A general overview of the role is summed up in this earlier post.

What skills do I need to do the job?
To be a competent advisor you’ll need to be an excellent communicator – either via text or verbally (or both). You’ll need to be aware of a wide range of social and health issues (from eating disorders to self harm, domestic violence to psychosexual problems, and the positive and negative challenges we may address throughout our lifespan). You’ll also need to be able to signpost people to a range of reputable agencies and organisations to help with their problems. Indeed you don’t spend much time telling people what they should do, but you are expected to tell people what their problems may be due to, and offer potential solutions, sources of help and how to access them. You’ll need to be up to date with current social and healthcare trends, which includes any political changes or shifts within the evidence base. You’ll need to undertake regular training (although most media outlets don’t check whether you are doing this) and that training needs to be contemporary and accurate. In most cases you will be provided with no training, supervision or support so you should seek to implement this informally or formally yourself. You will also need time – to familiarise yourself with evidence, to go on training courses, to be updated on current practice and to answer questions. Some questions can be done in a matter of minutes; others could take hours or even days to get right. You’ll need to be able to work to deadlines, be comfortable working in print or broadcast media and if appropriate take on additional campaigning/mentorship/patron roles.

This job won’t suit you if…
You are very judgemental. You will hear a range of problems from people and it is not your job to tell them what you think about them personally (although a minority of publications do use ‘outspoken’ advisors as their particular selling point). It is your job to ensure they deal with whatever their problems are appropriately. In most cases you won’t know whether they’ve acted on your advice, but you have to be able to live with the knowledge they may not listen to you at all. You are probably not the only person they are approaching for advice so all you can do is give accurate information and hope they act on it. You shouldn’t go into the job if you want to cure, fix or save people. Your role is to be a signpost to support services. Certainly you should not be mocking or belittling people who need help, or using advice columns to preach about right and wrong behaviour, or simply telling people what to do without telling them how to do it.

It’s not a job to undertake if you don’t like uncertainty – aside from not knowing what the outcomes of your advice are, or what you’ll be asked, it’s not a job that tends to last. And you can be dropped by the media very quickly and often quite nastily. I’ve experienced losing advice columns by magazines muttering something about restructuring and then you hear nothing more from them, or sometimes they simply drop your name from the masthead and your column from the magazine but don’t even bother to tell you. It’s not unusual for another advisor to be brought in when a new editor/producer takes over, or if the publication wants a particular agenda promoted, or if a celebrity is considered a better bet to generate sales. In short you can, and may often be, replaced. It doesn’t matter how good you are or how long you have worked somewhere. You will rarely be thanked by the media outlet you work for and will probably never hear thank yous from those you’re offering advice to. If you want a job that makes you feel indispensable it’s not going to give you this buzz. Finally you shouldn’t take the job on if you’re not willing to train and retrain, listen to feedback, and put yourself out of the picture. A good advisor does not use their column to talk about their own experience and nor should they talk about ideas that aren’t evidence based. Sadly we know this happens a lot, but again we’re discussing what advisors should be aiming for here so again it’s worth aiming high.

Do I get to pick what I answer?
It depends. For some magazines, websites and broadcast formats you get to pick what you answer. In some cases you answer all you are sent. In most cases you don’t have any say on what you are sent and may only see/hear a fraction of the questions people want help with. Media outlets tend to pick problems that fit within their particular agenda – which may be an overall focus on particular issues or tagged to a particular theme of the day/week etc. It is not unusual for letters to be edited so what you answer may not be exactly what appears in print or on air. Sometimes answers are restricted because the questions asked are not clear. If you can’t quite work out what the person is getting at unfortunately those letters tend to be dropped. In most cases media outlets get far more requests for help than they are able to deliver. That knowledge can be distressing for some advisors.

Can I offer specialist advice?
You can. Some advisors stick specifically to psychosexual advice, or healthcare. Others focus on particular age, sexuality or ethnic groups. It can help to be more specialist to ensure you work within your area of expertise and also checks you don’t step outside any professional boundaries. For example I don’t answer medical questions because I’m not a medic. Many questions don’t require any specific expertise but do need a good general awareness of considering problems and possible sources of action/help. Some media outlets have teams of advisors working for them or a variety of advisors with columns so you can pass on letters that fall outside your area of expertise to an appropriately qualified colleague.

Can I set up my own column?
Anyone can be an expert. You can set up your own blog or website offering advice. Some people do this for free, others as part of their therapy service, some charge for the advice they give. Obviously if you are offering advice as part of wider work (as a healthcare provider, therapist etc) then you must ensure any activities within advice giving adhere to current evidence based practice and fall under your codes of conduct and supervision. If you have no particular qualifications you still can offer advice, although it may be specific to your area of knowledge/experience. For example if you’ve been a foster parent to many children you might give tips on childcare. If you’re into bondage you might tell folk how to do this safely. If you’re a sex worker you might want to offer tips on sex and relationships based on your observations on clients. Advice giving doesn’t have to fit the standard ‘problem page’ format, but can focus around questions you answer. Again this approach could get you a reputation and help you get a regular column somewhere, but it’s not guaranteed. Whether or not you intend to charge for your services do remember that you can also be held liable if you give poor advice or information someone claims was harmful. So you need to consider insurance and supervision. Using advice giving to sell products or make money may work but we are becoming more aware of poor practice so those only intending to do this work for profit or scam should be aware they could be chased up.

What does being an advice columnist qualify me to do?
Pretty much what it says on the tin. The job involves offering advice. So you can extend that role into other media formats, and give talks about the work you do. If it’s an extension of your professional work you may also draw upon your advice giving experiences in teaching and training sessions you run. Writing an advice column does not make you medically qualified or give you any qualifications in counselling or therapy. You cannot claim such skills simply from writing a column nor charge for professional services on that basis. If you have been writing an advice column but want to be a therapist or healthcare practitioner you need to retrain in those professions.

How did you get to be an Agony Aunt?
I was fascinated by advice columns when I was a teen and used to read Jackie magazine’s ‘Cathy and Claire’ problem page (mostly under the desk during physics lessons). I used to imagine what advice I’d give if I were writing the column. I mentioned wanting to be an Agony Aunt when at university and was firmly told by my personal tutor such work was very competitive and I should forget about it. And that it was journalism (therefore not academic and ought to be avoided). During my PhD research part of my thesis focused on media advice giving on sex and relationships and I undertook several studies post doctorally assessing media sex coverage and relationships advice in the self help market. From 2000 I began writing to editors when I spotted poor sex and relationships advice in their magazines (I obviously had a lot more spare time then!). And in 2002 two editors (one from Men’s Health and one from the teen site mykindaplace both approached me in the same month and offered me an advice column). From this start I was offered different columns in different online and print publications, leading to offers to host advice shows through broadcast media.

I found the experience fascinating and from researching the media from the outside began more participatory research on the role of being an Agony Aunt and action research involving readers on issues such as self harm (for teen girls) and men’s sexual problems (with adult male readers). I have never applied for an advice giving role but have been head hunted for them. Not all have ended up in work. Quite often what I’m asked to do is judgemental or unethical or will be heavily edited to fit a ‘lite’ format – in which case I refuse. I’ve felt every job I’ve had, whether it’s only lasted a few weeks to several years has been a privilege. Not for the cachet of being in media, but for the trust expected of me by those who chose to share their worries and problems. I am currently working to have the job accepted as a recognised part of social and health care, a suitable area for in depth academic investigation, and an occupation with definite standards of good practice.

Where are Agony Aunt jobs advertised?
Usually via invitation or through journalism networks. Sometimes offers are sent out to agencies to find suitable candidates. Some people have got the role through having an agent who has approached publishers/broadcasters, while others have found a role after writing to editors/producers. Given the media is currently struggling financially there are very few openings for paid roles for advice givers and those that do become available tend to go to established experts, celebrities or existing staff.

That’s not to say you can’t consider the job, and you may find you do it informally helping out friends and colleagues. Remember the tradition of advice giving in media is really only an extension of the way real life communities operate – with particularly informed folk offering their ideas and support to others.

The Sexademic recently wrote an excellent related post on how to be a sex educator – which may also be useful if you’re considering an advisory career.

Related publications from my ‘Adventures of an Evidence Based Agony Aunt’ Project
‘A different picture of Africa’ A review of advice giving in the magazine Beauty Zambia
Example answers from Beauty Zambia (apologies the text is hard to read, but should give an idea about questions and replies) here and here.

‘I cut because it helps’ narratives of self injury in teenage girls co-written with Annie Auerbach this chapter uses discussions from young women talking about deliberate self harm generated within media advice giving formats. This became an online community initiative to share experiences and recommend good practice for teachers and health providers.

‘Advice for sex advisors: a guide for ‘agony aunts’, relationship therapists and sex educators who want to work with the media’ is a opinion piece published in the journal Sex Education.

Beware the sexperts is an opinion piece I wrote for the Guardian based on the problem of using celebrity advisors to front columns.

The value of agony aunts I wrote this when elements of the right wing media and legal changes suggested Agony Aunts could be censured for offering information to young people.

Whatever happened to Cathy and Claire? Sex advice and the role of the agony aunt this book chapter reflects on my time as an advisor working through problem pages aimed at young women and men and how the questions they ask have changed over time. It also highlights how we can use advice giving in the media to inform sex and relationships education.

‘Enough with tips and advice and thangs’ The experience of a critically reflexive, evidence-based Agony Aunt in Feminist Media Studies. Again this paper draws upon my experiences and critically reflects on the sexualisation of the female advice giver and the poor quality of advice offered on sex topics.

The UK appears afflicted by ‘soaring’ numbers of sexually active girls, who lie to parents, enabled by GPs.

Is it accurate?

No.

Here’s why.

Where did the story come from?
These reports are based on figures from the General Practice Research Database (GPRD), indicating 1000 11-12 year olds annually are prescribed hormonal contraceptives (usually the pill or injection).

This was picked up by firstly the Sunday Times then spread to other newspapers, websites and broadcast media. As we’ll see journalists did not show due diligence in investigating the story.

Are 11 year old girls using hormonal contraceptives?
Yes. But despite the media hype there are many medical reasons why young girls might be prescribed hormonal contraceptives including:
- Heavy periods (resulting in excessive bleeding, vomiting, diarrhoea)
- Acne
- Endometriosis
- Polycystic Ovary Syndrome (PCOS)
- Irregular periods
- Amenorrhea (no periods due to extreme weight loss, anorexia, or side effects of radiation/chemotherapy)

Taking hormonal contraception is, for many girls, a means of ensuring they don’t miss school. It reduces symptoms that could be painful, distressing and single them out for bullying. When the pill is prescribed for medical reasons usually it is parents, in discussion with their daughters, who initiate contact the GP.

Of course hormonal contraception also prevents pregnancy. But being on the pill is not an indicator of having underage sex.

Approximately 26% of young girls have sex before the age of 16 Most are around 14-15. Fewer very young girls have sex and those who do are more likely to be coerced, regret the experience, struggle with access to healthcare and education, and lack family support. They are also far less likely to use any form of contraception. [More information on underage sex here]

What did the GPRD data say about different uses of hormonal contraception?
Unfortunately the data from the GPRD does not break down reasons for prescribing hormonal contraception to young women, so we cannot conclude precisely why they are using it. This hasn’t stopped media speculation it’s primarily for pregnancy prevention, wrongly suggesting all young girls on the pill are sexually active lolitas.

The media says teens don’t need parental consent to talk to a doctor. Is that true?
It is true practitioners do not have to tell parents if a young person consults with them (about any issue), guidance such as Gillick Competence and Fraser Guidelines (specifically for contraception). These set out the circumstances under which young people can get help without parental consent, and when parents or social services need to be involved. All of which happens with the awareness of a young person.

Generally practitioners want a parent or carer to be involved in supporting a young person. So providing health advice on any topic without a parent being involved tends to only happen in specific circumstances (explained in the links above). Before giving any advice practitioners are keen to establish the young person’s situation and find out what options they see themselves as having.

Aside from access to healthcare being a basic human right for any child or teen, there are sometimes very good reasons why a young person needs to talk about sensitive issues to their doctor. This may be when they live within a very strict home, or where their parents are absent or neglect them, or where they are subjected to abuse by their parents (or by others but are not protected by their parents).

So did the media make this story up?
Clearly ‘11 and 12 year old girls prescribed hormonal contraception with parents consent to prevent health problems’ doesn’t have the same salacious ring as ‘sexually active 11 year old girls’. The uncritical coverage does not refer to evidence based practice nor particularly includes reproductive health practitioners. Instead it relies heavily on the Christian Medical Association who have an anti sex education (and anti pre marital sex) agenda.

It wasn’t that the media lied about this story, certainly teens are using the pill for medical purposes and to prevent pregnancy. But this is not new. Doctors have been prescribing hormonal contraception to treat numerous complaints for decades. Just because it’s news to the media doesn’t mean it is not standard clinical practice.

Is sex education to blame?
Several news reports suggested the phenomena of young women using hormonal contraception was down to sex education – or would be made worse if sex education was implemented for young people. Indeed coverage on this was very confused on the actual or possible role of sex education in all this.

Currently sex education is not statutory across the UK and standards of delivery vary widely. Ofsted has recently produced a damning report on the state of UK sex education, while NICE is currently consulting on improving sex and relationships education in the UK. [More on what young people want from sex education here]

It seems much of the press coverage on the GPRD data is aimed at discrediting Ofsted and NICE’s suggestions that sex education be improved and appropriately tailored relationships education could begin with children aged 5.

Why was this coverage so poor?
There is an ongoing crusade by elements of the media to be anti young people, particularly young girls, and against all forms of sex education. And as we’ve already heard scandalous headlines about teenage nymphos sound a lot more exciting than a small subgroup of girls having the pill mainly for medical reasons.

However there are several other important reasons why the coverage was so bad.

Reproductive health is always framed as a two sided, moral debate
As you’ll see from the stories linked at the start of this post the media sets these stories up as moral debates where there are distinct baddies (doctors, trampy teens and anyone offering sex education) and goodies (Christian/Family groups, parents). The media focus is not to explore reasons why young women might use hormonal contraception, but to demonise young women generally and the medical profession alongside them.

Broadcast media tends to take this a step further inviting live debate between practitioners and moral authorities, and most of the calls I took from journalists today were seeking to pitch me into battle – cast in the unwinnable role of the ‘pro sex bogeywoman’ (as @badhedgehog observantly noted on Twitter).

Unsurprisingly this atmosphere does not allow clear information to be shared that might reassure parents or young people. Nor does it challenge poor media coverage, leaving the public still believing that loads of 11 year olds are a. on the pill and b. all promiscuous.

Many journalists have a poor understanding of reproductive health
Discussing this story with journalists provided a fascinating, if frustrating, insight into how many of them simply lack the basic sex education that would enable them to evaluate reproductive health data.

During the course of today I’ve spoken to 15 journalists, mostly working for radio and TV news stations, and 13 of which have been male.

Through these conversations I discovered none of the journalists knew hormonal contraception had medical uses. All of them assumed hormonal contraception was simply used to prevent pregnancy. And because of this assumption it hadn’t occurred to them to find out what else hormonal contraceptives might be used for.

They also were confused over what hormonal contraception was, in several cases not realising the pill was only one form. Most seemed to believe hormonal contraception just meant ‘the pill’. One journalist thought the injection couldn’t be a form of hormonal contraception because it wasn’t ‘a pill’, while another believed the contraceptive injection was ‘worse’ than the pill as it ‘lasted longer’ and made girls ‘more likely to have sex’.

Most of the journalists couldn’t work out why a young woman might opt for a hormonal contraceptive in injection form. They interpreted opting for an injection as easier for some than remembering to take a pill regularly as further evidence of fecklessness. This reinforced for them the stereotype of sexually lax behaviour they associated contraception use with.

Even those who accepted hormonal contraception could have additional uses still returned to the idea the main reason young people were using it was to have sex. Or believed if they were given hormonal contraception it would automatically lead to sex soon after. Or make girls more likely to act in loose ways.

Persuading them parents are mostly involved in decisions of hormonal contraception use with young girls proved pretty difficult. One journalist said ‘you’d go as far as saying a girl should go on the pill if she has heavy and painful period?’. Well, yes if that’s what she and her doctor agreed would help her. This particular journalist then asked me if I could come on air and say the first bit (parents should put their daughters on the pill) but not the second bit (explaining why they’d want to do this). Obviously I refused but you can see how even when presented with evidence to show a story is wrong journalists won’t move away from a particular angle.

Sadly while most journalists I spoke to did seem interested to learn about the medical reasons for using hormonal contraception and finding out more about it, once it became clear I wasn’t willing to participate in a ‘debate’ about whether young girls are sexually active or not, they were not interested in discussing things further. (It could be the journalists I spoke to aren’t representative of the media generally or were trying to make a particular debate point with their questioning, but my interpretation was most genuinely seemed ill informed about reproductive health)

Healthcare agencies, particularly in reproductive health, did not speak up
The whole case has highlighted for me the need for agencies promoting sexual and reproductive health to offer basic training for journalists. There is obviously a great need for many journalists to have information about how to understand clinical data, but also having an awareness of sexual and reproductive health to help them interpret this information.

Sadly the majority of organisations dealing with reproductive health (including NHS Choices, Nursing Times and the Department of Health) remained silent during the day – even when requested directly through twitter and email to get involved. This is sadly a common pattern where organisations miss key opportunities to deliver health information.

While this may be partly due to the way the media frames stories like this and practitioners don’t want to be cast as the bad guy, if enough people spoke out we could achieve so much.

As much as I have criticised the media here it is worth noting there were also many other responsible broadcasters and writers who did want to cover the story but they were struggling to find anyone to talk to them.

We cannot complain about poor media coverage if, as health practitioners and educators, we do not offer our services to ensure accurate information is shared.

How should the media have treated this story?
This really is a non story, but if the media had wanted to report it accurately they should have looked at the reasons why the contraceptive was prescribed, whether parents had consented to their daughter using hormonal contraception, and indicated proportionally how many young people were prescribed the pill for pregnancy prevention without parental consent. Indicating the numbers of 11-12 year olds on the pill as compared to the wider population in this age group would put this in perspective in terms of prevalence. And they should have written this in a way to highlight how to safeguard young people most at risk. Who we know mostly do not seek out medical help and are often also unable to get help within their families.

The take home message is?
Sadly bad science, scaremongering rhetoric and poor journalism makes it difficult for parents and young people to get accurate information. This may result in making young people more excluded from the health care they need.

Unfortunately if we do not challenge it we will continue to leave parents terrified and young people disempowered.

This piece appeared in a shorter form for The Times Science today as Too much too young: most 11-year-olds aren’t on the pill for sex

With grateful thanks to everyone on Twitter today who challenged this story, shared information about young people’s rights, and generally kept me going when I was getting fed up shouting about it!

The current issue debates the statement ‘Sexual pleasure empowers women!’ and opens with an outline of core issues relating to women, development, health and empowerment in relation to sexual pleasure, written by the awesome Susie Jolly. Jolly provides a very helpful overview of sexual and reproductive health and human rights, highlighting how often well intentioned programmes to tackle women’s problems and gender inequality have either ignored the idea of pleasure, or only focused on sex negative or victim/pity models.

This opening essay is expanded upon with an interview with Hania Sholkamay who talks about her views on the concepts of sexual empowerment within a development context.

The remaining part of the issue includes short responses from key practitioners working within International Health and/or Sexual/Reproductive/Rights based programmes. Drawing on work, experience and practice from different cultural settings (and subject positions) these essays discuss and expand upon the ideas set out in Jolly’s original piece. These include essays from
Sylvia Tamale from Makerere University in Uganda
Li Yinhe from the Chinese Academy of Social Sciences
Sonia Correa from ABIA AIDS and Sexuality Policy Watch in Brazil
Pinar llkkacaran from Women for Women’s Rights, Turkey
Shivananda Khan director of the Naz Foundation in India
Each contributor has a different interpretation on what pleasure means and how important the concept of sexual pleasure is within the wider arena of women’s health, human rights and international development.

I was proud to be asked to join the discussion, my contribution can be found here. It hinges around my acceptance of the importance of pleasure but my anxiety over how concepts like sexual pleasure and sex positivity may be understood and applied within an international health context, given my awareness of how critical and evidence based practices within this area are often absent or overlooked. I drew upon my experience as a Social Psychologist working within International Sex and Relationships health – both as an academic teaching and supervising healthcare professionals in their postgraduate studies, and as a practitioner educating healthcare and journalism colleagues worldwide to appraise and deliver sexual health programmes. I also wrote the piece during the Clitoraid debacle that took place earlier this year – which was divisive and unpleasant but served as a chilling reminder of how good intentions around sex positivity can often fail if introduced in a top down fashion in developing country settings.

Hopefully you’ll find all the essays provocative, interesting and useful. They will be particularly helpful to you if you work within sex research, education, development and health. While they take a global view the messages within this special issue are relevant to women in many country settings – not just in the Global South.

I’d particularly encourage the sharing of this open access resource to those working internationally within sexual and reproductive health where critical thinking and considering concepts like pleasure often doesn’t get talked about – not least because people aren’t sure where to begin. These essays give a great opportunity to begin dialogue about the importance and meaning of pleasure, as well as encouraging us to review existing research to inform better practice, and to evaluate activities we’re currently involved in.

Enjoy!

These stories have generated a lot of public attention and added to the general anxiety about parenting, sex education, and wider social and moral issues. Most share the common theme of judging young people (and their families), particularly girls (who are more harshly viewed for having sex). Other subgroups of young people are also demonised (the poor, socially excluded or ethnic minorities).

As a result, discussions on the topic are difficult and usually framed in a moral context. Much of the debate hasn’t focused broadly on understanding early sexual debut, or to identify potential solutions to encourage young people to delay, or to identify what pleasurable and safe experiences young people might be exploring. Instead underage sex is mainly framed in the language of STIs, unplanned pregnancy or coerced sex. This often leads to discussions of sex and teenagers that centres around the age of consent – purely in chronological terms – which sex educators and researchers feel is not a very useful indicator of sexual behaviour.

What do we know about this issue?
Public concern over youth sexual behaviour is mirrored by the tone of a lot of the research within this area which tends to focus on early sexual debut with associated negative risk factors (such as STIs, abuse, unplanned pregnancy).

The literature uses a number of different ways to approach the issue from straightforward legal definitions of age of consent, although as you can see from this resource the legal age of consent for girls and boys, gay and straight varies internationally. Unsurprisingly countries with more repressive regimes, gender inequality and homophobic values tend to criminalise homosexual sex while fixing the age of consent for girls at a young age. Go figure who this benefits.

Other definitions refer to more ambiguous concepts such as ‘early sexual debut’ or ‘first sexual encounter’. Even within this what is defined as ‘underage sex’ varies depending on different research projects or educational interventions with some referring to sexual contact and petting which includes penis/vagina intercourse, while others present it as specifically about penis/vagina sex.

Critics have complained the focus of both research and education in this area has focused predominantly on problem based or sex negative consequences for heterosexual audiences. The specific issues of sexual debut for LGBT youth is frequently overlooked, while the experiences of certain BME groups is under researched or based around racial stereotypes.

Seeing underage sex purely in terms of penises in vaginas has been identified as unhelpful for a variety of reasons, most of which are summarised in this excellent discussion from Scarleteen. There is the assumption from many parents, practitioners and the media that if a young person has sex before the age of consent they continue to have regular penis/vagina sex from thereon in. This may be inaccurate as some young people may have ‘sex’ before the age of consent but not have it again until they are older. Linking of penis/vagina sex also tends to focus more negatively on young women – particularly around the idea of ‘losing’ virginity and ‘breaking’ of the hymen – an idea which current research disputes on medical grounds seeing it more as a cultural and religious construct rather than any real physical one-off event.

Why are we so anxious about this issue?
Clearly thinking about young people’s wellbeing is important, but it is often unclear in debates about underage sex what is the specific issue adults are most anxious about? Are they worried about pregnancy risk? Of a young person requiring a termination or having a child when young? Or a young person catching a sexually transmitted infection? Do they fear it may lead to promiscuity? Or are they seeing as an adult a situation that is exploitative but that a young person perhaps does not recognise as such (or maybe is aware of as abuse but is still subjected to)? All of these are reasonable fears and ones parents and teachers do raise. They also talk about fears of their child or children in their care getting a reputation (more so in the case of girls) or their being judged as an unfit parent or teacher if they are associated with a young person who has underage sex. As this issue is so often framed as a moral debate it makes it very difficult for us to articulate exactly what our specific anxieties are about underage sex.

Why do young people have sex before age of consent?
Reasons Young People have sex before the age of consent varies. It can include curiosity and experimentation to wanting to experience pleasure or feel close to a boy or girlfriend. It may be something they feel they need to get out of the way or believe everyone else is doing. Or it may be down to feeling coerced, being forced or just being bored. We generally focus on the more negative issues, particularly in relation to age gap relationships (or relationships that are unequal in other ways). Discussing more positive aspects of underage sex tend to be avoided for fear of encouraging sexual activity, seeming to endorse such practices, or the concern among adults that they are potentially abusive or attracted to children. This, accompanied by a media which is largely negative about teenagers having underage sex, makes it very difficult to have a clear conversation about this issue in a balanced way.

What are the risks to young people?
Clearly it would be remiss to present this discussion without looking at the specific problems linked to young people and underage sex. The well documented negative issues include:
STIs
Unplanned pregnancy
Young parenthood
Regret
Risks to reputation (particularly for girls and for LGBT youth)

However this is still very much focusing around penis/vagina (heterosexual) sex. Discussions with young people about kissing, cuddling, communicating desire via text or talking, and masturbation (alone or with a partner) tend to be a lot more positive. Where the focus is on penis/vagina sex under the age of consent there are subdivisions of problems – so unplanned sex with casual partners where condoms or other forms of contraception are not used are seen as inherently more risky than sexual activities which are part of a longer term relationship with a cared for person and where contraception is used.

Given the stigma associated with the first three issues it is understandable people want to prevent them, but sometimes in focusing on them so negatively there can be unforeseen outcomes. Not least those who do seek terminations or become young parents feeling judged negatively, or perpetuating the myth that any sexual encounter will result in either an infection or pregnancy. Such messages give young people false ideas about sex and make it less likely for them to use contraception (particularly condoms) which in turn has the additional effect of making it more likely they may get an infection or become pregnant. So clearly simply focusing on negative outcomes without putting them in any real context or providing advice about prevention is unhelpful.

Moreover it ignores that many young people are exploring sexual experiences with their peers that they enjoy but feel they cannot discuss for fear they are breaking the law, or feel anxious about as they are led to believe any sexual activity under the age of consent automatically is either abusive and/or has negative consequences.

Are particular young people at risk?
Evidence suggests there are particular groups of young people who are more likely to experience underage sex, although they may differ from the stereotypes we expect from the media. The kinds of things that would make it more likely you have sex underage include:
Lack of parental supervision and support*
Lots of pocket money, lots of free time
Lack of hobbies or after school activities
Reduced aspirations
Exclusion from school*
Socio-economic disadvantage
Low educational achievement*
Being from particular ethnic groups (e.g. in the UK African Caribbean boys and White girls are more likely to have sex before the age of consent)
A large age gap relationship*
Peer pressure/bullying
Low self esteem*
Lack of sex education from home or school
Being in looked after care
* also related to not using contraceptives or getting contraception advice/support

So the issue is not just about having sex before the age of consent, it’s related to how young a person is, how in control of the situation they felt, whether they consented to the encounter, whether they enjoyed it, and whether contraception was used (or the sex was planned). The context of the relationship also matters – in terms of whether it was with someone they felt affection for, how soon into a relationship they had sex, and when/how it ended. Many of these factors interact, so lots of free time + a lack of supervision + a lack of hobbies + few aspirations can work together to create situations where a young person might have sex before they felt ready. However other factors can produce contradictory results so while being disadvantaged economically may seem like a very big risk it tends to only be a real problem if accompanied by low educational achievement. So a young person from a poor background who is in a supportive home and being encouraged to achieve at school plus has aspirations and interests will be less likely to have sex underage than a young person who is from a poor background but also is excluded from or doing badly in education.

Prevention – do we need to make kids ‘just say no’?
Clearly situations which are abusive, coercive or unequal are a problem – particularly those that end in violence, unplanned pregnancy or STIs. Simply focusing on negative outcomes is not particularly helpful as already mentioned, and prevention is not likely to be effective if only couched in negative terms of focused specifically on penis/vagina sex. What would help young people is better sex education that focuses on relationships issues and addresses feelings, emotions, confidence, respect, assertiveness and communication skills. Education that focuses on relationships skills as a lifelong learning experience rather than one-off lessons or ‘big talks’ is vital. Delivery from parents and teachers is considered important, and peers are also very helpful. Shifting discussions from this issue from a moral debate to one about empowerment and wellbeing is vital – and our media could do a lot more to assist on that score. Finally reframing this as a youth wellbeing issue rather than a sex one is really important so we focus on aspirations, goals, interests and activities – supporting young people and making them feel valued and respected. Most importantly listening to young people is essential – and often a lot more reassuring than you might imagine.

‘Sexual Readiness’ – a more accurate measure than age of consent?
Research has indicated that a focus on chronological age within a legal framework does not adequately represent sexual maturity. ‘Readiness’ or ‘preparedness’ for sex may be equally important indicators for sexual debut. Meaning not all young people will be sexually mature at any given country specific age of consent. Some 16 year olds may well feel ready and interested in exploring a sexual relationship but not all will. And what constitutes a sexual relationship may vary among young people. Focusing on feeling prepared for a relationship, being able to negotiate with a partner, plan contraception use and be aware how to explore intimacy together is not something that can simply be expected to happen when a young person passes a particular age. Instead we should focus our attention on multiple factors that include physiological, psychological and biological maturity – and how young people feel about their experiences.

Because the focus of research and teaching practice in this area is negatively focused (often for well intentioned reasons) it means we know very little about what young people think about their sexual experiences. Given many fear they will be judged for admitting to underage sex often they tend to focus on (or be asked about) purely negative outcomes. Although controversial if we do not ask young people about a range of experiences they have encountered relating to sex, then we will not be best placed to offer them the in depth sex education they need. It also makes it difficult to differentiate between consenting and coerced experiences and makes it more difficult to safeguard young people most at risk from exploitation or abuse.

What’s the role of parents here?
Parents are often anxious to discuss sex and relationships issues with young people for fear of encouraging early sexual behaviour or being judged by other parents. It is important to talk about sex and relationships issues (see sources of advice below for more on how to do it). Focusing on the positive aspects of relationships a young person can expect to look forward to as they get older is more useful than simply warning about the bad things that may happen – infections, pregnancy etc. Threatening these are inevitable consequences of underage sex, or implying a young person will be criminalised for having sex underage may make it less likely your teenager will talk to you. Remember, a young person who has questions about sex is not necessarily having sex and may be looking for information or reassurance. If they are considering an intimate relationship then discussions with you can help identify who they are in a relationship with and any causes for concern you need to be aware of (age gaps, potential exploitation, issues of control and contraception). These are not always easy issues for parents to consider and you may find talking to other parents, to your child’s school or college or getting advice from your local outreach/health promotion services could be of use in such a situation.

Parents know their children well and are often excellently placed to put advice and education in context. You may be aware your child is interested in adult relationships and will want to prepare them for this and answer their questions while highlighting what positive and equal relationships are about. Or you may notice your child does not seem to be keen on discussing such topics and you may want to reassure them about relationships at a level appropriate to their maturity – not avoiding topics but ensuring they are covered in a way that best suits the needs of your child. Again, reflecting on the messages you are sharing with other parents or friends can be very useful to ensure you are pitching things at just the right level.

Certainly don’t leave any ‘sex talk’ until your child is over the age of consent for your country or state, they will need information well before this. And remember just because they’ve not asked you doesn’t mean they’re not picking up ideas about sex and relationships from other places (like the media and their peers). Talking about sex and relationships spans your child’s life – it doesn’t have to wait until their 16 and doesn’t stop once they pass this age.

Sources of advice/help
This previous post addresses what young people want in relation to sex education and includes evidence about what young people want to learn about positive relationships. It also links to other posts and resources containing advice on how to talk to young people about sex and relationships.
Hawes, Wellings and Stephenson’s excellent review ‘First Heterosexual Intercourse in the United Kingdom: A review of the literature’ (2010) Journal of Sex Research is essential reading for anyone wanting a systematic overview of the literature on this topic, which clearly outlines the different studies addressing sexual behaviour in young people.

Recently I’ve been asked to talk about why I blog through activities like the ‘Bloggers Behind the Blogs’ series on psychology/neurology blogs or at Science Blogging Talkfest 2010.

Talking about why I blog or being introduced at any event as a blogger involves mentioning the name of my blog. ‘Dr Petra’. Or ‘Dr Petra’s Blog’. Which I find a bit embarrassing.

Why? Well, given the amazing, witty, fun and quirky names many people have for their blogs, particularly in the areas of health and science, mine seems to have a very dull title. Or perhaps seems to be the work of a raving egomaniac.

The truth is I had a website called ‘Dr Petra’ long before I had my blog, and so when I added the blog five and bit years ago I didn’t think to call it anything fancy. Mainly because it was largely experimental and I wasn’t even sure it was something I’d stick with.

As I became more familiar with blogging I realised how some folk had truly fantastic names for their blogs. I also learned how giving a blog a title based on your name is probably not the best idea – although a lot of that advice comes more from the world of commercial blogging rather than science blogging. Either way, but the time I’d realised it may be a plan to think of another title people had got used to ‘dr petra’ and I worried a rebranding might lose or confuse readers.

This didn’t stop me fretting the blog’s name implied a certain kind of arrogance I didn’t wish it to have. And disconcertingly that played out in real life where people I met seemed to be under the impression I wanted to be called ‘dr’ at all times. Which in spite of me getting a PhD being a very big deal to me (more on this in a bit) I’m actually not that fussed about.

All of which got me thinking what I might have called it if I’d been foresighted enough to consider a snazzy name might be important.

‘Confessions of a sex researcher’ was my first choice. Quite catchy, and I’d already written a short piece using that title for Libido Magazine. But then the blog’s not always about sex or research so I felt it might make it seem too focused and abandoned that idea.

On a naughtier level I considered ‘Red hat, no knickers’ or ‘Fur coat, no drawers’ either of which are a nod to my interest in sex work and represent my fascination with how we talk about female sexual behaviour. But I discarded these as they implied a blog that was someone talking about their sexual experiences or fantasies. I’m a fan of blogs that do just that, but my blog doesn’t detail my sexual diaries, and people arriving hoping to hear about some erotic encounters might be sadly disappointed by the regular discussions of research governance, ethics and survey design.

So then I thought about ‘The Ruined Maid’ again focusing on my interest in sex work, but thought that might suggest I was a sex worker and detract from the many excellent sex worker blogs out there. I also didn’t want to offend sex worker bloggers who have complained about ‘faux ho’ websites that describe fictitious encounters, speak for sex workers (rather than being an ally) or talk about pornography/prostitution in ways that put sex workers at risk.

Still on the fallen woman motif I tried ‘No better than she ought to be’ – a hat tip to how women who study sex are often sexualised through what they do (and are put down for it by academic colleagues and sometimes the public). But that reminded me too much of my schooldays when I was told I was ‘thick’ and to leave at 16 without going on to further education. In fact, still feeling bitter about being pigeonholed as ‘the kid who wouldn’t amount to much’ I toyed with using that line for the blog. Changed tack when I realised Robbie Williams had got there first with his poem Hello Sir, which is sampled in One Giant Leap’s fantastic ‘For My Culture’.

As a psychologist I ought to know dragging baggage around isn’t all that helpful and I don’t feel a blog title based around past problems is all that healthy. Besides I’ve preferred to work through those demons by doing action research on access to higher education for disadvantaged young people (examples here and here).

Leaving the opportunity for passive aggressive blog titles behind I considered an historical take with ‘The Net Braider’s Granddaughter’. My maternal grandmother was a net braider as well as a wife, mam, party activist and all round wise woman. I owe her a lot and strongly identify with the life skills and values she taught me. I still love the idea of this as a title for the blog as it sums up a sense of weaving together different areas of my work and life. But while it holds sentimental value to me it doesn’t really tell anyone what the blog’s about, which I felt might be confusing.

Focusing back on my academic work I thought about The Research Companion, as a lot of my lecturing is based around making research accessible, ethical and safe for people working in the social and health sciences. Having published a book using this title I thought it was too nice to not recycle. Then I worried that as the blog often deviates from discussing research and prances into sexy chat, those people turning up who only wanted to talk about research governance, ethics and survey design might be somewhat offended – or wildly aroused.

My work is a mix of many things. It straddles the sexy and the scientific. Sometimes it’s about advice, sometimes about activism. Often both. Sometimes the sex topics are highly sensitive and serious, other times they can be erotic or humorous. In between there’s interrogation of method, discussion of media processes and reflections on research in the social and health sciences. So finding a blog title that accurately represented all these things proved pretty much impossible.

My readership is also fairly broad and I didn’t want to exclude anyone with a title that seemed overly flippant, explicit or dull. And since a lot of the work I do focuses around sex education and the rights of young people I also didn’t want a title that would prevent younger people from reading the blog.

So there you are. Due to a lack of real forethought the blog is what it is. Call it what you will, just keep reading and keep telling me what you like and dislike about it – and what you want me to talk about.

After all, the blog is for you and represents something for everybody.

While you mention it ‘Dr Petra: something for everybody’ has a nice ring to it.

(And I believe someone I admire a lot used it as a catchphrase too).

Following complaints from men, an investigation by Trading Standards in Westminster has led to AMI ceasing trading. The company still practices in Australia where it has it’s main offices.

While it is good news AMI is no longer operating in the UK, there are still issues about the company we need to urgently address and I would encourage you to do this if you’re a journalist, blogger, healthcare practitioner or men’s health activist.

We need to find out answers to the following questions:

What has happened to the men who’ve had ‘treatment’ from AMI?
We know the approach taken by AMI hinged around bullying men and making them feel anxious and inadequate for their sexual problems. There was also pressure not to consult with the medical profession (GPs particularly) or counselling services. This could have caused a lot of harm to men already anxious about psychosexual problems. We need to try and reach men in this category and share information with them about how to get help – particularly talking to their GP and getting referrals to psychosexual therapy if appropriate. We also need to try and identify just how many men were affected and learn lessons from their experiences to ensure this kind of exploitation can be avoided in the future.

Campaigning for refunds for those who’ve paid for treatment
Those who have paid AMI for products they’ve either not received or were ineffective are entitled to a refund, however with the company no longer trading it is unclear how this will be addressed. I would recommend men who are worried about this to contact Westminster Trading Standards directly or you can also get more information about claims from Consumer Direct (thanks again to our friends @SuffolkTS for this recommendation and for their continued advice/support in investigating AMI). Those in a position to campaign more widely on this may want to try and help men affected.

Investigating the doctors who worked for the company
AIM were not just a bunch of salespeople. The patient history and approval of products were taken/given by medics, most of whom I believe were NHS staff working as locums for AMI. This raises questions about ethical and appropriate conduct of medical practitioners who could have been in no doubt of the company they were working for. Given how dreadfully men have been treated by the company I would not think it unreasonable that doctors identified as working for AMI should be reported to the GMC. If you are interested in exploring this further please do email me as I have information that could help in this case.

We should not let this story end here. I cannot stress enough how appallingly men were treated by this company and the long term physical and psychological harms that have been caused as a result. Because this is a psychosexual topic it’s easy to see it as trivial or even joke about it. It truly isn’t. Let’s please give this the attention we’d pay to other health topics and seek help and recompense for men affected – and a full investigation into the medics who were happy to collude with AMI’s unethical practices.

I promised I’d share my presentation here, so here’s an outline of where we are currently with sex education, some of the opportunities and barriers we’re currently facing, and an idea about what we need to do to enable young people.

Relationships education: the current situation…
We’re in a place of political uncertainty, with a coalition with very different views on SRE and related issues. Anxieties have been expressed that the Conservative Party in particular has a poor history on sex education (indeed has been known to block it), and also has a record of homophobic legislation (such as Section 28) and being anti abortion. Therefore how our current government will respond to providing sex education, or even what could be delivered, remains to be seen.

Although many people believe sex education is a compulsory part of our school curriculum this only relates to providing basic information on reproduction – delivered usually (but not exclusively) through science lessons. Additional SRE (sex and relationships education) is currently delivered in a patchy way within schools. Some do an excellent job of covering a variety of issues in an appropriate way, others do not address the topic in depth (if at all) while still more specifically discuss sex in negative, incorrect or frightening ways – or provide teaching that’s age inappropriate. Because sex education was not made statutory in the reading of the Children, Schools and Families Bill: April 2010 the opportunity to share quality sex education across all schools was lost. While statutory sex education doesn’t guarantee quality teaching it was at least the start of getting this important issue safely housed within the school curriculum.

While we don’t have statutory sex education we have had several consultations on the matter including a recent DCSF (now Department of Education) one, and a new NICE PHSE consultation which is currently open for contributions until 15 July 2010.

Meanwhile we have also had a series of reviews into ’sexualisation’ – one excellent investigation completed by the Institute of Education for the Scottish Parliament, and a less robust one conducted for the UK Home Office. The latter gained a lot more media attention than the former. You can see copies of all recent sexualisation investigations (including the Scottish and UK ones) along with resources for evaluating them here.

We are currently seeing a lot more focus towards the role of parents, which is very reassuring. Not least because young people do often want sex and relationships advice from parents and parents do want to offer such support. They often feel sidelined by the media who make out parents are being denied the chance to give sex ed simply because it might exist within schools as well. And often parents worry they may say the wrong thing in the wrong way at the wrong time. So current plans are looking to include parents more within planning for sex education and delivering training to them to enable them to talk more to their kids. Organisations such as the Family Planning Association are active at delivering this.

Although sex education is not statutory and there are organisations within healthcare who speak to schoolchildren (such as school nurses, outreach workers etc), delivery of sex education still often falls to teachers who feel unsupported, untrained and uncertain how to provide the diverse messages young people want.

Given we’re currently in a recession and have just seen dramatic budget cuts to educational spending (if not to healthcare) there are concerns that providing sex education or training for parents and teachers may not be invested in.

Why is (good) SRE important?
What with all this uncertainty it may be questionable whether sex education is even needed. But if you look at the evidence around the benefits sex education can bring, you find it delivers a lot of very useful stuff. Much of it not about sex at all, but a lot of it very helpful for interpersonal relationships of all kinds – not just intimate or sexual ones. Sex education helps us because it…
- Answers young people’s questions
- Reduces stigma, fear and anxiety
- Encourages delaying sex
- Increases communication skills
- Increases likelihood contraception used
- Avoiding pressure/coercion
- Reduces STIs, teen pregnancy
Of course this is dependent on sex education being delivered in effective ways, no sex education or programmes that are confusing or judgemental don’t help young people.

We currently recognise sex education is important, or at least parents, teachers and the media fret a lot about related issues like STIs, teen pregnancy, termination rates, and sexualisation. We do seem more aware of issues relating to consent or coercion, and also violence within relationships. And there is a recognition of peer educators and parents playing a vital role in sharing SRE messages alongside formal/informal educational networks, outreach and the media. Plus a growing awareness that we should focus on the positive aspects of relationships and sex.

Current problems with SRE
Aside from teachers and parents feeling disempowered and the problem of teachers’ lacking confidence to deliver SRE, we also struggle with other barriers that need urgent attention. These include:

Lessons are often not based on evidence. So you have well intentioned activities that may not be reflected on, correctly delivered to a target audience and not evaluated. It’s not unusual for practitioners to take the fact they’ve delivered a lesson, game or activity (or screened a DVD or similar) within their SRE remit and assumed because they did something and young people were in attendence that it was effective. Clearly we need to move from simply delivering information (particularly just via handouts or in didactic ways) and incorporate what we know works within SRE and ensure we evaluate what we do and base it around current evidence. Unfortunately many teachers, healthcare staff, youth workers or parents aren’t aware of how to do this or lack the time or skills to reflect on what they are saying about relationships. (There are organisations who can help, however, such as the PHSE Association, PHSE Solutions, NSCOPSE, BISH Training and BASE.)

We struggle because parents, teachers and healthcare staff often haven’t had good sex education themselves. Particularly covering topics around difference and diversity. This can result in educators either not discussing topics as required by young people or supporting stereotypes. In particular BME youth, LGBT young people and young people with disabilities or learning difficulties report sex education often excludes them – or places them in unsafe spaces where they feel exposed and vulnerable.

There is also the fear held by many parents, teachers, and health providers that if we talk about sex with young people this will encourage experimentation. This global belief is often cited as a reason to restrict sex education, suggesting if we don’t talk about it then young people won’t have sex. It ignores that many young people aren’t sexually active at a young age but those who are require information and all young people need to know about positive aspects of a relationship they can look forward to in adulthood and be given the life skills to help them put this into practice.

We also find where teaching is ‘consequence based’ (a current buzzword), adults interpretations of ‘consequence’ equals listing all the appauling things that might happen. Rape, coercion, domestic violence, STIs, unplanned pregnancies, having a termination, getting a reputation. And while negative issues do need to be planned for and discussed, there are positive consequences around relationships which we consistently miss out on. Whether this is a hangover from old style sex education which utilised scare tactics to discourage activity is unclear. But certainly if we’re going to focus on consequence based training it needs more reflection and a wider scope than some are currently offering.

Partly our struggles in this area are due to branding. The focus on ’sex’ in ’sex and relationships’ education upsets adults who are worried about young children being corrupted or hearing inappropriate messages. Media coverage often uses the ‘children as young as five’ line to terrify us into thinking sex education will be delivered in explicit and inappropriate ways to young children without parental consent. Instead if we think about life long learning about relationships (sexual and non sexual) it is often reassuring to adults and also reminds us we’re really focusing on a wide range of topics under the umbrella term of SRE.

While these remain practical problems largely within education and the home, the media also causes us headaches when it comes to delivering sex education. This might include contradictory messages such as this recent effort here and here from the Telegraph which managed to frame young people as feckless as well as misrepresenting the facts about termination rates. Or mislead parents, such as the Mail’s response to the NICE PHSE consultation (which implied it was about to be inflicted onto children, not a discussion with parents, teachers and healthcare staff). Or it may well present as being about supporting children but really be about girl blaming, or youth negative narratives that hinge around biases towards race or class. Such as the Mail’s recent ’slut shaming’ piece.

These approaches make parents anxious, but they also deny the agency young people have, ignore the voices and experiences of young people, and often contradict current evidence as well. Indeed journalists covering such stories seem to either be unaware there is research out there that tells us very clearly what young people need and how we might deliver this (for example this review addresses a lot of the questions about repeat termination which the Telegraph might have considered). Alternatively journalists do know about evidence but deliberately ignore or misrepresent it in order to gain a good headline. Print media aren’t immune to this practice, in fact television can be just as bad – an issue I raised when speaking previously at Channel 4.

None of which helps young people as what begins as a discussion about the welfare of young people quickly results in narratives of blame and shame which presents young women as victims, young men as abusers, implies black and working class youth are feckless and promiscuous and silences completely the voices of LGBT, disabled or rural youth. It also sets up an argument that goes along the lines of ‘how dreadful, something must be done!’ Ignoring what already is being done, what we know should be done, but suggesting in its place ideas such as abstinence or blame which do not address any problems of sexual and reproductive health young people may be facing.

What do teenagers want SRE to cover?
Knowing what we’re doing wrong is one thing, but luckily when it comes to sex and relationships issues we do have a good idea what young people want (a summary of the evidence on this can be found here). Young people want parents, the media, youth workers, teachers and healthcare staff to deliver information that
- Moves beyond biology/contraception
- Tells them how to access sexual and reproductive health services (and lets them know what happens at health clinics)
- Covers feelings and emotions
- Gives them practical tips about how to ‘manage’ relationships
- Provides core life skills around communication, negotiation, and assertiveness
- Uses ‘Real life’ examples that answer the ‘what’s it like?’ questions young people may have
- For older children there’s a request to include pleasure and desire, for younger children basic answers to questions about gender differences and where babies come from
- Includes information about STIs is important, although in a practical sense with a prevention focus preferred
- Makes SRE sensitive and inclusive for LGBT and BME youth, as well as young people with disabilities and from diverse backgrounds
- Hosts classes that feel interactive, secure and fun
- Have sessions that are led by educators young people trust – like youth workers, parents or peers (those working in healthcare have to do more to make themselves accessible and trusted by young people)

What can we do to ensure Young People are supported?

Again, we’re very lucky to know what young people need, our problem is simply about ensuring this is provided. You can do your bit to campaign for sex and relationships education, and here’s your checklist for activities to sort out!
- Acknowledge young people’s agency, awareness, opinions. And LISTEN to young people!
- Campaign for a consistently delivered, wide ranging and inclusive curriculum
- Ensure what is taught is age/ability appropriate
- Address core issues of friendship, confidence, communication from early years
- Focus on relationships
- Empower parents, teachers, health and social care staff as well as peer educators
- Challenge poor media coverage
- Ask critical questions (of ourselves as well as of the media and educational systems)
- Review and utilise the evidence (there’s a lot of very useful stuff out there for us to use!)

And finally we need to reframe this as a human rights issue, rather than a moral debate. If we’re consistently talking about the rights or wrongs of sex education we miss the needs and rights of young people themselves. Avoiding the moral discussion helps us move into an educational one. We want young people to grow up to enjoy positive relationships in a safe and consensual way, to be realistic about relationships and have the skills to maintain positive relationships and deal with negative ones assertively.

All of us are responsible for tackling sex and relationships education – and in doing so not only will young people benefit, we will too. It’s amazing how much your own relationship can be improved once you start trying to teach others to enjoy theirs as well.

The consultation is open from 17 June to 15 July 2010 and you can access all the relevant documentation here.

If you are working in the area of PHSE as a teacher, governor or healthcare provider then do please consider reading the NICE proposals and commenting on them. Parents, youth workers and young people’s groups are also encouraged to respond.

Currently the situation with sex education in the UK is unclear. As you may remember, sex education in the UK is not going to be statutory as we had expected due to a political U-turn earlier this year. So the more we can focus on ensuring quality education is kept in focus for both health and education the better.

What is particularly important about the focus from NICE is the emphasis on the role of parents in delivering relationships education, which will reassure those parents who’ve been led to believe by sex-negative media coverage that inappropriate sex education will be delivered to children without parental consent or involvement.

Please share this information and encourage people to respond to NICE. The more we discuss this issue the better off young people will be. And the more likely it will be they can experience happy and healthy relationships as adults.