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

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

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

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

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

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

Unsurprisingly, more outrage followed.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Some of this comes through support organisations such as

SANDS
FSID
Winston’s Wish
Child Bereavement Charity
Miscarriage Association

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

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

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

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

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

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

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

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

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

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

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

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

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

If you are still looking for presents for loved ones, or perhaps are just feeling full of seasonal spirit, I’ve a few suggestions for folk who’d appreciate your support.

I have selected 8 charities/organsations in the areas of sex, relationships and reproductive health. Some are faith based, some secular. You may want to support the one you feel most impressed by – or perhaps give a small amount to several of these very good causes.

And to celebrate the holiday season I hosted a virtual Charity Christmas Concert over on twitter. You can catch up with all the seasonal goodies I shared there at the end of this post – there’s music, comedy, quirky things and the occasional NSFW treat.

Hesperian Foundation
Hesperian is a non-profit publisher of books and newsletters for community-based health care. It produces free resources in various different languages on topics such as Where There Is No Doctor, Disabled Village Children and Helping Health Workers Learn. Here are ways you can get involved, which don’t just involve financial donations – you can also volunteer, translate and review books, and let other people know about the work Hesperian are doing.

Jabulani Rural Health Foundation
Jabulani is a non-profit organisation that supports Zithulele Hospital and its surrounding community. Zithulele Village is situated in a remote part of the Wild Coast (Eastern Cape Province, SA). Founded in 2007 by four Christian doctors, our focus is on healthcare, education, poverty relief, environmental issues and care for those affected by HIV/AIDS. Practitioners at Zithulele have introduced a number of innovative programmes for rural health which have been reported in The Lancet and SAMJ and include nutrition, maternal health, occupational therapy and education projects. Donation information can be found here
Become a friend of Zithulele here

A short film about the hospital can be found here:

Scarleteen
Scarleteen is an independent, grassroots sexuality education and support organization and website. Founded in 1998, Scarleteen.com is visited by around three-quarters of a million diverse people each month worldwide, most between the ages of 15 and 25. It is the highest-ranked website for sex education and sexuality advice online and has held that rank through most of its tenure. While Scarleteen is held as a benchmark in quality youth advice giving Founder and Executive Director Heather Corinna explains “we do not and have never had any state, federal or foundational funding, but are supported solely by individual donations. We do what we do with insanely small amounts of money: most years our budget has been smaller than the median household income for one family here in the states. For the majority of the years we’ve been around, our budget has been far lower than that”. More info here . Donate here

Outsiders
Outsiders is a community for people with physical and social disabilities that enables people to meet, make friends, overcome isolation and form relationships. It coordinates local meet ups, provides advice and hosts numerous events to raise funds for greater advocacy for people with disabilities. It also operates a peer support network, lobbies for greater rights for disabled people, and informs health and social care practice around sex, relationships and disability. As well as providing financial assistance there are other ways you can help Outsiders including lobbying on issues around disability rights, and assisting the organisation with research, advocacy and resources. More information on how to give here.

Education for Choice
Education For Choice is the only UK-based educational charity dedicated to enabling young people to make informed choices about pregnancy and abortion. “Education For Choice’s work is focused on the word choice. Whilst we concentrate on the issue of abortion, as it is the issue that receives least attention, we believe that work with young people should value all pregnancy choices equally. Our ethos is that the best outcomes of unintended pregnancy occur when the woman involved has been able to make her own informed choice”. Donate here

The New View Campaign
“The New View Campaign was formed in 2000 as a grassroots network to challenge the distorted and oversimplified messages about sexuality that the pharmaceutical industry relies on to sell its new drugs. The goal of the New View Campaign is to expose biased research and promotional methods that serve corporate profit rather than people’s pleasure and satisfaction. The Campaign challenges all views that reduce sexual experience to genital biology and thereby ignore the many dimensions of real life”. More information on donating and volunteering for the New View, as well as implementing its ideas into policy and practice can be found here

Bliss
“One in every nine babies in the UK is born premature or sick. That is over 80,000 babies every year. Bliss is the only national charity dedicated to improving both the survival and long-term quality of life for babies born too soon, too small or too sick to cope on their own”. You can give to this invaluable organisation here.

The Miscarriage Association
“Founded in 1982 by a group of people who had experienced miscarriage. They felt strongly that someone needed to provide the support and information which they had found lacking in their medical care, and so they set up a new charity. Nearly thirty years later, the Miscarriage Association has grown and developed in many ways, but we still pursue those founding aims:
• offering support and information to anyone affected by the loss of a baby in pregnancy
• raising awareness of miscarriage and
• promoting good practice in medical care”.
This organisation offers advice and information to women affected by miscarriage and their partners. Giving to this organisation helps offer care and challenge taboos around this area. You can donate here.

I hope you are able to support one or more of these charities/organisations either financially or as a volunteer.

Thanks for your continued support for this blog. Your feedback, suggestions and ideas for content (and how to improve the blog) is always very welcome.

The Charity Christmas Concert
Kicked off with Kate Rusby’s carol ‘Sweet Bells’ (as recommended by @BrightNomad)

At Christmas we love some snow. And also naked men. And tea trays

Matt Whistler’s Merry Christmas 2010 Southover Street Brighton from Convict Films on Vimeo.

One for children of all ages – Rudolf the Red Nosed Reindeer

Rudolph The Red Nosed Reindeer – Original Movie by goldrausch

Next up in the concert it was time for Dickie Valentine and his Christmas Alphabet

This is one to save for later, when you have a spare two hours and a stiff drink. Yes it really is THAT BAD – it’s the Star Wars Holiday Special

Then it was on to a song. A very bouncy version of Joy to the World – from the amazing Klezmonauts.

You probably have a collection of embarrassing family photos. But probably none as bad as this collection. It’s Awkward Family Photos – Christmas Special (watch out for The Full Monty).

The Shepherd Who Stayed – Theodosia Garrison for all of us who sometimes feel our work’s not noticed.

Christmas meets safer sex messaging in this super HOT video – Little Taiko Boy. Turn this up LOUD!

Ever wondered what goes into those letters to Santa? Find out here (be warned, some of these will make you cry). Or you could make your own snowflake.

The best ever Nativity, as told by the kids from St Pauls Church, Auckland (and shared with me by my Uncle)

One for the geeks now, Dot Matrix Printers play Czech Carol Nesem Vam Noviny

It’s a Father Ted Christmas – and what could be behind the Advent Calendar door?

Some more music with Vince Guaraldi Trio playing Christmas Time is Here (from A Charlie Brown Christmas).

And a reminder that we live in a Wonderful World

All finished off with my favourite carol. In The Bleak Midwinter (words here).

Wishing you a very Merry Christmas a Happy Hanukkah or a Blessed Solstice. And all the best for a happy and healthy New Year.

Predictably the media reported on this story with scary headlines like:
Teen girls who engage in group sex are often coerced, study says – NY Daily
Group sex is the latest ‘trend’ for teenage girls, disturbing report reveals – Daily Mail (The research excited upset the Mail so much they ran coverage of it twice)
Teens as young as 14 engaging in group sex, study finds – ABC News
‘Sexting’ is related to teen group sex trend, says study – New Jersey News Room (the study doesn’t say this at all, in fact recent research suggests the phenomena of teen ‘sexting’ is over exaggerated).

While we sadly are used to the mainstream media sensationalising sex research (particularly on young people), other sex blogs and medical news outlets covering this study have been equally remiss at reading the original research and critiquing it. Which is depressing.

So let’s do the job the mainstream media should have done. Let’s critically appraise the research and see if we do need to worry about MSPs and young people.

First, a quick disclaimer. Researching young people’s sexual experiences is important. Such work should focus on their needs, report faithfully any adverse issues they may be at risk from, and take their mental and physical wellbeing seriously. Research on teens should always involve young people at all levels and avoid being a top-down process where adults define teenagers’ experiences. In critiquing this research I am not suggesting young people are not experiencing problems within their relationships. I am also not saying the researchers were anything other than well intentioned.

Strengths of the research
The paper’s plus points are that it tackles a topical issue. While group sex among young people is (as this paper acknowledges) pretty unusual, it is something that has gained media interest over the past few years. So trying to collect any data about this phenomenon is important to reassure and also to direct sex education and public health programmes. The researchers seem to have developed the study over time, basing the survey they used on a series of in-depth qualitative interviews. The paper does acknowledge early on that multiple sexual partner experiences may be consensual and non consensual (more on this in a bit).

Sampling and sample size
Participants were recruited from a youth sexual health clinic. This is not unreasonable at all. It’s an excellent place to find out about young people’s sexual health. But it does mean those going there may be in need of help or support so might not be representative of teens generally.

The authors acknowledge this but I suspect that fact will pass a lot of journalists by when they report this. Media focus, I imagine, will be on all teens, rather than a subset of teens.

The paper tells us researchers were aware of 1224 female clients at the youth clinics, with 747 identified suitable for the study. Why the other clients attending the clinic weren’t suitable for the study is not explained. That, I think, is a problem. Information about participants who were unsuitable for the study, or who refused to participate (and why) should have been clarified just to help us interpret this data. I’m surprised reviewers didn’t ask for it to be included in the demographics table as is standard practice. Of the 747 clients identified, 495 (65%) agreed to take part. A 65% response rate on a sensitive topic is not a problem, but it does reduce the number of people responding further, which in turn affects how representative the sample is.

It is not declared whether the participants were Cis or Trans Women. This would have been helpful to disclose.

Table 1 in the paper provides details of 328 participants. I’m unsure if these were the final sample that was used in the study/analysis. Regardless of all this we learn right at the end of the paper only 24 of those who completed the survey had had a Multiple Sexual Partner experience. And of those, their analysis indicates, 35% said the experience was consensual.

Does this represent a major new trend in youth behaviour?
No. The paper reports of the patients attending the youth clinic very few of them had experienced non consensual group sex. It does not mean we should not be very concerned about these young people or others like them. But it does mean journalists covering this story should put this into context. The study is not showing a major trend in teen girls being forced to have group sex. It is saying non consensual group sexual activity among teens does not seem to happen often, but when it does it is highly distressing and increases the risk of psychological and physical ill health.

My worry is the media coverage of this will not read the original paper and will suggest there is an outbreak of teen sex parties happening regularly, that young girls are forced to participate in. The study did not find this and nor has it identified a major public health problem. But I doubt that will be made clear. This in turn will worry parents, mislead teachers and healthcare professionals, and probably lead to slut shaming of young women (as this kind of coverage invariably does). All the while ignoring the role of boys at best, or presenting them as gang rapists at worst. None of which is directly helpful to the needs of young people.

Problems with phrasing and terminology
The paper seems to use terms like ‘sex parties’, ‘multiple sexual partners’ and ‘gang rape’ interchangeably in places. This is confusing for the reader but I imagine also for participants in the study. This is recognised as a limitation later in the paper where the authors talk about participants who’ve experienced gang rape not necessarily seeing what they experienced as a multiple sexual partner act.

The focus of the study appears to be on heterosexual teens, although this is not really clarified.

The age range of 14-20 is important as this is a wide age range in terms of young people. While some 14 year olds may be mature and some 20 year olds immature, in general the needs and experiences of those who are in the younger age group in this study will be very different from older participants. Any of these participants could be exploited, abuse has no age barrier. However, older teens/young adults may well be better able to consensually engage in sexual behaviours younger teens cannot. This was not explored in enough detail in this paper.

The main drawback with the study, to me, is the question used to identify if participants had engaged in Multiple Partner Sex. It asked:
“Have you ever had sex (vaginal, oral, or anal) with more than one person at the same time or with more than one person at the same place? (This might be called group sex, a threesome, an orgy, or pulling a train).”
The paper doesn’t clearly explain how participants were invited to answer this question, although does suggest it was via a yes/no response (or similar). Imagine I said ‘yes’ to this question. What am I saying ‘yes’ to? That I had vaginal, oral or anal sex? The wording of this question means there’s no way of differentiating between participants who had all of these experiences and those who had one of them.

There is also no way of identifying how often participants had engaged in these various activities and whether they experienced them positively or negatively. It could be completely possible for a participant to have experienced oral sex positively but vaginal sex negatively (or vice versa). But the question phrasing does not allow for this to be explored. It also doesn’t allow participants to indicate if they were giving or receiving these sexual activities (or both).

Once you get past this confusion participants are still being asked about these sexual activities AND whether they’ve done them with more than one person. How do you answer if you’ve engaged in said activities but with only one person? The question doesn’t allow for this.

Participants could also easily be confused by a question that doesn’t make clear if the mention of ‘sex’ here refers to penetrative sex (and if so is it via a penis, finger or sex toy) or oral sex. That is important as we know from sex research unless you are very specific about what you’re asking about you’ve no real idea what participants are reporting.

The question is also confusing a group sex act (i.e. having sex with more than one person at a time) with multiple partner sex over a period of time (i.e. sleeping with more than one person in a day, evening etc). In fact this becomes more confusing as these behaviours are asked as if they’re the same thing but with no time period specified. Most of us who’ve had more than one partner could easily answer ‘yes’ to the question, assuming you have been intimate with different partners on different occasions in your home.

Deconstructing this question may seem like nit picking but in fact is very important when we are designing surveys. Unless our questions are meticulously phrased we have no real idea what participants are responding to. This in turn makes a difference to the conclusions and recommendations we can make.

Elsewhere in the paper the researchers conflate group sex and an orgy (which usually involves several people) with a threesome. They also don’t clarify who might be participating in these activities. The assumption seems to be that it’s a girl and all boys. But it could well be all girls or a mix of girls and boys.

Does ‘pornography’ and ‘sexually explicit’ mean the same thing?
Participants were also asked
“Many people come into contact with pornographic, x rated, or other sexually explicit material. How many times in the past 30 days have you viewed pornographic, x rated, or other sexually explicit material?”

This is an interesting but again problematic question. What do the researchers mean by ‘pornographic’ or ‘sexually explicit material’? Are they the same thing? Are they including explicit mainstream media such as music videos or magazine articles talking about sexual positions? That could be considered sexually explicit but not necessarily pornographic. Is this a particularly accessible question to ask a young person? Asking how often they’ve viewed such material also isn’t clear. Do they mean how often someone has watched pornography/sexually explicit material and masturbated? Simply seen it in passing? Or perhaps laughed at it with friends (as is very common among teens)? Was it watched alone or with a partner? What did it feature?

This information IS important because the researchers did find an association with multiple sexual partners and reported porn use, but it isn’t clear what relationship the young women in the study really had with porn. In order to better educate women about issues around porn we need to know more about what they are watching and how they feel about it. It is worth noting if participants said anything other than ‘no times’ they classed this as having viewed porn. So that means someone might have seen porn once in passing and be categorised in the same way as someone who viewed porn regularly and was aroused by it and someone who was forced to watch porn occasionally but against their will.

Another question asked
“Has anyone ever insisted (without using force or threats) that you do sexual things they saw in pornographic or x-rated magazines, websites, or movies when you did not want to?”

This is not an unreasonable question, but it is not necessarily something that’s easy for a teen woman to answer. For example they may well have been coerced to do something they did not want to do, but unless they asked the person coercing them if they had seen this in porn they would not necessarily know for sure this was the case. They may have a good instinct they were being asked to perform something inspired by pornography, but they wouldn’t know for sure – and would not be in any position to ask if they felt threatened.

Given the age of participants it may be someone did coerce them to do something they didn’t like but had not got the idea for this from porn. They may have got the idea from a sex tips feature in mainstream magazines like Cosmopolitan or Men’s Health, or from their peers, or from a TV show. Much of the mainstream media talks about anal sex, threesomes, oral sex etc so this could have just as easily informed the coercive behaviour.

I would have liked to see more focus on the nature of the coercive behaviour, why participants felt this was linked to porn, and if it wasn’t linked to porn where they felt the driving force behind the coercion came from. I say this not to dispute porn may play a part, but to identify exactly what is driving coercive behaviour as if it’s features in mainstream magazines or peer pressure we need to tackle this just as urgently as any perceived threat from porn.

The focus here seems to present young women’s relationship with porn as something that is done to them by young men. Young men are presented as the consumers of porn and use it to get ideas to coerce young women into doing things they don’t want. This does not explore where young women may like or dislike porn, or young men having a critical view of porn. It does not include young people who have little or no exposure to porn. It presents young women as passive, as victims. And as heterosexual. This is often taken up by the media who use debates on sexualisation or pornification to demonise or ignore young men and victimise and slut shame young women. In both cases we find it becomes a situation where adults (either academics, medics or journalists) speak for young people.

Multiple Sexual Partners – a problem in itself?
In their reporting of the results the authors say:
“While there may be a subset of girls who initiate or make self-actualized decisions about MPS participation during adolescence, it is important to consider whether social norms that encourage hypersexuality may contribute to expectations about sexual activity that make it very challenging for adolescents to resist engaging in MPS, even though they would not perceive their MPS participation as nonconsensual. The strong association between exposure to pornography, having been forced to do things that their sex partner saw in pornography, and MPS suggests that pornography may have influenced directly the sexual experiences of the girls in this sample, as has been found elsewhere. Importantly, even if participation in MPS is voluntary for some adolescents, it is crucial to know how this early experience shapes their sexual behavior trajectory and affects their lifetime risk for negative sexual, reproductive, and other health risk behaviors”.

This statement concerned me for three reasons. Firstly it suggests a kind of false consciousness idea that no young woman could ever really consent to a MSP experience. This is disingenuous to the participants in this study who stated they had willingly enjoyed a MSP. I suspect it betrays more of the researchers own values about MSPs.

Secondly it implies that even if a young woman does consent to a MSP this will be because pornography has informed her choice. Yet we know from the way they asked about porn they don’t really have strong enough data to make this conclusion. It would have been interesting to explore if mainstream media might have influenced their choice as well, but not to have decided for participants that they didn’t really know their own minds.

Thirdly there is the implication that having a MSP as a young person will inevitably lead to problems in future relationships. That seems like a leap beyond the data and also I suspect unfair to those who consensually, as adults, explore non monogamous relationships. Moreover we know many people who never have MSPs as young people (or adults) have problems in their relationships as adults. So to make this claim really requires more than a small sample of 24 participants who were asked some confusing questions. The researchers do say this ought to be followed up in future research and I don’t disagree there, but I hope they would be less judgemental and aware of sexual diversity in doing so.

Where are the experiences of young men?
There is no focus on young men in this paper and I think any study that is tackling coercion in heterosexual youth (as this paper appears to be doing) really needs to also study young men. The assumption is they are coercing young women, but are young men also feeling coerced in relationships? Is the pressure of masculinity leading to risky sexual behaviours or are they acting respectfully with their partners? Are the experiences of young gay or bi men different from their heterosexual peers? How do young men feel about being portrayed as sexually coercive? Are there issues around communication and consent we need to focus on with young men and women – and how should we be addressing this issue?

I worry media coverage will report this as though young men have been included or present young men as predators, when again the number of participants reporting negative experiences from forced group sex or pornography was low.

Should this paper have been published?
I critically appraised this paper, but does not mean I think it should be ignored. Had I been asked to review it for publication I would have asked for major revisions (based on the comments above). I find many Public Health studies on youth sexual behaviour (and sexual behaviour in adults) are well intentioned but often problematic due to heteronormative approaches. In this case this can be seen with the focus on heterosexual activity and underlying subtext that group sexual activity is never truly consensual and non monogamous relationships are not presented positively. This can alienate or pathologize many people inadvertently, while trying to help another group of people. A better awareness of thinking around diverse sexualities would help ensure generalisations about group sex among consenting adults are not pathologised while trying to tackle gang rape of teens.

I hope coverage of this will be responsible but fear it will not. I suspect it will be further used to demonise young people and worry the public. In turn ignoring the fact most young people are not engaging in group sex or coercive behaviour. In fact that most aren’t having sex at all. They may well have questions and worries about sex, but these may not be addressed while we focus on more sensational topics.

Creating a moral panic in which we shout a lot about the behaviour of young people but do very little to actually help them. And in cases where research is poor or ambiguous it may direct our efforts to help young people in the wrong direction.

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

I was wrong.

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

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

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

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

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

I was wrong here as well.

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

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

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

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

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

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

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

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

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

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

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

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

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

Sadly these claims are rarely put to the test.

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

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

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

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

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

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

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

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

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

I am currently setting myself a timescale of early Autumn before I consider blogging again, but I may take longer, depending on how I am managing motherhood.

Where time permits I’ll use twitter (@drpetra) to share information on forthcoming events, conferences, papers and other interesting stuff. I’ll be checking in on twitter regularly, but won’t be tweeting for the next month or so. In the meantime check out the folk on my lists who are all worth following and will keep you up to date with sex/relationships, science communication and healthcare issues.

While I’m away, here are some useful resources based on the main things folk ask me about via this website. You might find the links to sites and blogs I posted last time I went on maternity leave useful to rummage through as well.

If you’ve a personal problem
Here are some places you can get help and support on sex/relationships/reproductive health issues:

COSRT
FPA
Sexual Dysfunction Association
Brook
Scarleteen
Bish Training
Mermaids
The Site
NHS/Sex worth talking about

You can also get support from many of the people and organisations linked to in the blogroll.

If you are a journalist
I won’t be able to help with media requests until the autumn. Please email me (info@drpetra.co.uk) from October onwards and if I can help you I will. In the meantime if you are working on sex/relationships/health features or programmes you may want to contact the following organisations:

British Sociological Association
British Psychological Society
Royal College of Psychiatrists
Onscenity Network
Kinsey Institute

If you’re organising a talk or event
If you are planning something you’d like me to speak at please note I’m taking bookings for science/public communication from Summer 2012 onwards. If you have events coming up after that date please do email me. [As ever my speaker activity is based on my timetable and your event being low cost or free for audiences. I don’t charge a speaker fee but you will need to cover my travel, accommodation and reasonable expenses; and I don’t appear at events to promote pharmaceutical/commercial companies]

If you need an academic paper
Or help with your research, want me to review something, need feedback on a grant proposal, or any academic related activity please note I’m having a year’s maternity leave from University College London and will not be undertaking any academic activity in that time. If I am already in touch with you about ongoing projects I will make individual plans about appropriate contact during my leave.

While I’m away, don’t forget…
5th July 2011 – Channel 4 is hosting a meeting between programme makers, production companies and sex/education/health professionals. This follows complaints from a collective of UK practitioners concerned over the Joy of Teen Sex series (more info here). Unfortunately there are additional problems with the recent series The Sex Researchers that presented a misleading view of both sex research and sex information. Practitioners and researchers concerned about this problematic series will also be complaining to Channel 4 and those it commissions on the basis that programmes are not concerned with accuracy or ethical practice. You may also want to write to the Channel if you feel their sex broadcasting is poor.

9th July 2011 – There will be a Pro Choice Demo in London on 9 July 2011. More information here or follow on Twitter @ProChoice9July or #prochoicedemo2011. Additional information on this demo here and here plus information on reproductive rights in the UK here.

The government’s plans to tackle Sexualisation (along with other media outlets running their own campaigns). These still require follow up, interrogation and public discussion. The government will be reporting further on action taken regarding this review in the Autumn. I’ve linked to a number of forthcoming events conferences that will be tackling this issue at the end of the linked blog post. Academics and practitioners (including myself) have now formally declared how we feel this review is flawed and many of us will continue to push for better political decisions based on critical thinking about research, not ‘policy based evidence making’.

Other media outlets are planning programmes on sex/relationships in their Summer/Autumn seasons, so use this media appraisal guide to assess their quality.

Ongoing debates around sexual and reproductive health, teen parent blaming, regulation of pornography, sex work, and termination of pregnancy are all likely to be in the public domain over the coming months. They’ll need following, questioning and discussing. Where possible I’ll highlight information on these along with related conferences, campaigns or core issues on Twitter.

When I come back…
I’ll be using this blog to focus on some specific areas. Mainly sex/relationships and conception, pregnancy and parenthood. I planned to do this from the start of this year but ended up being sidelined by more interesting, challenging and topical issues. I’ll be aiming to be a lot more focused and disciplined on my return!

Looking forward to catching up with you again soon, and in the meantime enjoy the summer months. Thanks for your continued interest in and feedback on this blog, it is much appreciated.

I’ll post an update here when there is some baby news to report.

Channel 4 responded, and the remainder of this post shares this and our reply, along with some additional updates about problems with sex/relationships programming at the Channel.

Channel 4′s response (25 February 2011)

“I am writing in response to your letter to Channel 4 of 8 February regarding The Joy of Teen Sex. As the head of Channel 4′s features department which commissioned the series I have been asked to respond on David Abraham’s behalf.

Channel 4 values feedback from viewers and experts and we have considered your letter carefully. I think it is important to confirm, before discussing any of your points, that we share your overarching belief of the importance of young people having access to open and honest information on sex and relationships.

It was in light of the Government’s 2007 Review of Sex and Relationships Education in Schools that we developed a slate of sex education programmes that would address the systematic issues raised in the Review, in particular the paucity of and poor quality of sex education in schools; the importance of complimentary information being provided in and out of school; and that sex and relationship education should be inclusive and meet the needs of all young people. Television is a powerful medium through which we can provide information in a way that is educative authoritative and entertaining, and which can draw-in significant audiences, both watching on their own or with friends and families. Channel 4 has a particular resonance with younger people who see us as a friend and youthful presence, and characteristics that make us uniquely able to bring effective sex education to the screen.

Over the last few years we have provided a range of sex education programmes and online resources – each seeking to reflect different aspects of sex and relationship education. The Joy of Teen Sex formed part of that mix, alongside programmes such as The Sex Education Show, KNTV Sex or Underage and Having Sex. We are proud of our track record in this area – both in terms of a frankness and relevance that young people rarely have access to – and crucially the impact that the programmes have had.

After last year’s Sex Education Show: Am I Normal, Channel 4 commissioned a public value case study, on the impact of the programme among teenagers. The research found that overall the show did a great job for teenagers:
- 78% of 14-19 year olds agreed it told them things that they would be too embarrassed to ask about
- 70% said they learnt things they didn’t know before
- 60% said that the programme made them feel more confident about themselves
- 62% of those who watched ep2 or 4 said they had changed their attitudes towards disabled people having sex
- 76% prefer learning about sex on TV than at school

Although we do not yet have comparative data for The Joy of Teen Sex, we have had some anecdotal evidence that the programme has had a positive impact on young people. Dr Rachael Jones has reported a marked upswing in attendances at sexual health clinics and that often The Joy of Teen Sex has been cited as a motivator for attendance.

In addition, the Sexperience website, which has sat alongside both the Sex Education Show and Joy of Teen Sex strands, has been immensly popular (attracting up to 5,000 user comments/questions a week), providing a forum for discussion and advice sharing. That the programmes and website have had a positive effect on young people seeking sexual healthcare advice or changing behaviour is evidenced by their being referenced or included in various NHS booklets and websites as well as their use in secondary schools.

In response to your particular points of concern about The Joy of Teen Sex, I would first like to reassure you that the programme was commissioned with the intention of providing accessible, relevant, entertaining and empowering information about sex and relationships to young people. Its purpose was to inform and educate by offering a platform to discuss any problems, questions or anxieties they might have. The programme was aimed at teenagers over the age of 16 (and their parents) and deliberately sought to be up-front and honest and to reflect the issues that young people wanted to discuss. Throughout the course of the series we sought to represent a wide variety of young people from different cultural backgrounds; heterosexual, homosexual and bisexual contributors featured alongside single people and those in steady relationships; sexually active young people as well as those considering their first sexual experience.

The series deliberately did not shy away from the fact that many 16-and-overs are sexually active and want to lead fulfilling as well as healthy sex lives. In tone and content it was also not an attempt to replicate The Sex Education Show – which is more focused on adolescents and the care to be taken before sex becomes part of a young person’s life – but was aimed at at the issues confronted by youngsters already having sex or being pressured by their peers to do so.

In putting together the programme we worked with a number of experts in the sex education field, both on and off screen. This included Peter Greenhouse, Consultant in Sexual Health at Bristol Sexual Health Centre, who also worked on The Sex Education Show and the highly regarded Dr Rachael Jones of the West London Centre for Sexual Health, who featured in the series providing medical and contraceptive medical advice. The background of other contributors – including Ruth Corden, Billie JD Porter and Joanne Wierzbickia – was made clear as was their role in the series to add to the mix of viewpoints and expertise, rather than to provide medical advice. We believe that it is critical to the success of these programmes that they are supported by credible medical experts who are available to advise us on medical matters and vouchsafe the reliability and authenticity of any advice proffered either during the programmes themselves or through the supporting website. While we will not always agree with our medical experts on presentational matters or issues relating to the narrative conventions used in television, we will heed any advice we have sought from them on any specific medical matters.

Given Channel 4′s ongoing committment to provide content that deals with young people sex and relationships, we have been planning to hold a roundtable discussion about television and sex education in the next few months to bring together people involved in providing sex education in the health and education spheres and people involved in making TV content. We very much hope you will be able to attend the event, and that it will provide a forum for your concerns to be addressed more fully by a range of experts.

We will be in touch in due course about the event. In the meantime I hope this reply provides some reassurance about the intentions behind this programme and across our sex education output, and the positive impact that the series has had during and since broadcast.

Yours Sincerely

Sue Murphy
Head of Features”

Our reply
26 June 2011

Dear Sue Murphy
Cc: David Abraham, Andrew Jackson, Katy Boyd, Liam Humphreys, Kate Teckman, Dominique Walker

Thank you for your letter of 25 February 2011. We are glad to hear of Channel 4’s ongoing commitment to improving the quality of broadcasting and that you share our ‘overarching belief of the importance of young people having open and honest information about sex and relationships’.

Our previous letter outlined a lack of underpinning of Channel 4’s programming with strong evidence and critical thinking and we are concerned that your response does not fully engage with the issues we outlined. It appears to be justifying problematic programming rather than reflecting on areas where content needs to be improved.

As stated in our initial letter we agree television is a powerful medium to share sex/relationships information, something supported by the wider literature on media and education. You are right to state you have the trust of young people, placing you in a strong position to share sex information with them. However, our concerns over how you have been going about this – and will do so in the future – remain. It is because you have a position of authority and trust among viewers it is vital to ensure messages shared are accurate, informative and entertaining. We would invite you to revisit our first letter and consider many of the areas we identified as currently not being adequately addressed. As ever, our offer to help you improve upon the quality of your programmes remains.

You cite within your reply a ‘public value case study’ but you do not include full details of who this was run by, how it was conducted, on whom, or how representative of the public/viewing audience these participants were. While the figures from this ‘case study’ seem striking the outcomes are not completely clear. Respondents stated they learned things they did not know, but this is only positive if the things they learned were accurate – learning something you did not know that is also misleading is not the same as learning something that is accurate and explained in such a manner as to give you the life skills to ensure confident behaviour in sex and relationships. Claims that teens prefer learning about sex/relationships from TV rather than school are not particularly helpful given most teens will prefer learning anything on TV rather than school and is disingenuous to the many creative and thoughtful sex/relationships programmes already offered within UK schools.

Your claim from anecdotal evidence that Joy of Teen Sex had a ‘positive impact on young people’ is not particularly helpful. Those of us working in clinical settings can equally supply our own anecdotes that following Joy of Teen Sex screening we did not notice an increase in clinic attendance. Those of us working in pastoral/advice-giving settings have had to counter fears and anxieties raised by the programme, with young people requiring reassurance over misinformation shared. In particular the coverage of anal sex, STIs, lack of sexual desire and contraception shown on Joy of Teen Sex made young people we have contact with feel afraid of sexual and reproductive health services, or that they were abnormal for not identifying with the sex tips featured on the programme.

You state ‘we sought to represent a wide diversity of people from different cultural backgrounds; heterosexual, homosexual, and bisexual contributors featured’. Again we would draw you back to our previous letter that highlights how many of your messages within the Sex Education Show and Joy of Teen Sex were heteronormative and misleading over LGBT issues. Simply having some guests who may be LGBT or mentioning homosexuality is not helpful if your wider programming focus is through a heteronormative lens. By that we mean presenting diverse sexualities as ‘different’, problematic or unusual; or seeing heterosexual, monogamous and sexually active relationships as ‘normal’. Given the Channel’s stated focus on diversity we would also expect to see programming that made explicit how many young people are not sexually active until over 16 and that many enjoy relationships based on delaying/actively consenting to a committed intimate relationship when they are older. We disagree that you have included a wide diversity of cultural backgrounds and would welcome the opportunity to discuss with you what an inclusive and sensitive programming schedule that is culturally diverse could look like.

We note you spoke with experts to inform the series but we would again refer you back to our first letter. This clearly indicates many of us were also approached to inform the Joy of Teen Sex, shared our expertise – and our concerns – but were ignored. We are hoping a learning outcome for you from the feedback we have given in this letter and our previous one makes it clear that you need to listen to a wide range of practitioners – not just those who are agreeing with your programme remit. Indeed if experienced professionals are all telling you there are problems with your programmes and consistently offering to ensure you are both accurate and entertaining, you should listen to them. We would also remind you many of the counter signatories on our first letter and this one have extensive media experience delivering sex/relationships advice in print and broadcast media. Some of us have even been consultants and contributors on programmes such as The Sex Education Show or other sex programmes for your Channel. Or have spoken at Channel 4 events on education/health.

We remain concerned over the way the contributors finally selected in the series of the Joy of Teen Sex were portrayed, including some of the messages they were providing. We do not feel their qualifications were completely transparent – for example one appeared to be a qualified Social Worker but her status was later amended, while another had experience in sex toy sales but not necessarily the more complex and nuanced area of sex education/care. Equally concerning is the lack of young people’s voices and experience which could have been a feature of the series but was not included. In empowering sex/relationships education and healthcare the voices of young people as peer to peer advisors and consultants are central. We hope future programming acknowledges this.

We welcome your comments and are looking forward to your proposed round table discussion about your programming. We hope you will use our first letter and this response to inform some of the conversations at that meeting. We note Channel 4 have recently entered into a Memorandum of Understanding with Trans Media Watch which will ensure ‘accuracy, dignity and respect’ in its portrayal of transgender people. We hope a similar commitment to sex and relationships broadcasting could also be developed.

As ever we remain committed to supporting young people, sex and relationships information and media opportunities to deliver this.

Yours Sincerely
Petra Boynton PhD, Social Psychologist and Sex Researcher, University College London
Dr Stuart Flanagan, Genito Urinary Physician
Justin Hancock, Bish Training, trainer and consultant
Lisa Hallgarten, Director, Education For Choice
Wendy Savage MBBCh FRCOG MSc (Public Health) Hon DSc
Marge Berer, Editor, Reproductive Health Matters
Romance Academy – a nation-wide, holistic, relationships and sex education initiative
Dr. Meg Barker, Sex therapist and social psychologist, The Open University
Alice Hoyle, Sex and Relationship Education Advisory Teacher
Alison Terry, Second year student, Applied Community and Youth Work Studies, University of Manchester
K. Barratt, Second year student, Applied Community and Youth Work Studies, University of Manchester
Becca Thompson, BSc MA COT
Steven Norris, Student Teacher
Clare Bale, RGN, BA (Hons),MPH, PhD Candidate, University of Sheffield
Dr. Lesley Hoggart, Principal Research Fellow, School of Health and Social Care University of Greenwich
Matthew Greenall, advisor on international HIV & sexual health programmes
David McQueen, International Speaker and Youth Advocate
Janet Horrocks, Healthy Schools Project Officer
Joelle Brady, MSc, Researcher
Kendelle Bond, MD of Zest Consultancy, Public Health Consultant
Dr Jayne Kavanagh, Medical Ethics and Law Unit Lead, UCL Medical School and Associate Specialist in Sexual and Reproductive Health, Camden Provider Services
David Evans, Researcher and Chief Executive SRE Project
Peter Bone, Chair of the Advisory Council, PSHE Association

Further Issues
Comparing our first letter with Channel 4′s reply and our response makes it transparent how there are problems with the Channel’s approach to sex/relationships programming and despite their claims about delivering quality broadcast materials this has not been achieved. Indeed where core problems have been pointed out, I would argue the Channel has sidestepped discussing or dealing with them. I feel the Channel has not adequately considered the problems with their past and current broadcasting on sex and relationships. As we speak The Sex Researchers – a series that promised to promote accurate and empowering information on past and current sexology is being aired. Only it is misrepresenting sex research (and researchers), again rehearsing narrow views of sex, gender and sexuality. Making out quirky lab based studies on desire and attraction (heterosexual obviously) are representative of mainstream sexology. The sex research community, including the Kinsey Institute, who helped put the programme together are very upset about how our time has been wasted in putting together something that seems to ridicule our work – and mislead the public on sex/relationships information.

Since JOTS aired we’ve also seen another series of The Sex Education Show broadcast. This series focused on sexualisation. When researching this issue the programme makers asked how they might ‘test’ sexualisation. They were referred to the Buckingham (et al) report on commercialised goods which is an excellent critical discussion of the area and provides a template of how to investigate the concepts of sexualisation and commercialisation. Rather than using this template, and while going against information from experts solicited for the series, the Sex Education Show went looking for examples of sexualised goods then made a fuss in stores about their sales. This is despite other evidence from reviews like the Buckingham one which indicates such products are not that usual and are interpreted very differently by parents and young people, but the concern over them from parents is often tied up in anxieties about girl blaming. Indeed the discussion of boys are largely absent, while the subtext of class and racial prejudice (about the ‘type of girls’ who wear such clothing) is problematic.

When acting as a consultant on Series 2 of The Sex Education Show I suggested Sexualisation could have been a topic to cover (from a critical perspective) since it tied in with the APA report on this issue that had just been launched. This was ignored with a focus given instead to limiting access to internet porn. When it comes to sex Channel 4 and related production companies seem to want to focus instead on topical issues that are both televisual and capture a public anxiety over a popular concern – rather than looking at and using evidence in a critical way.

Indeed if you look at how discussions pan out on the Channel’s Facebook page for Stop Pimping Our Kids (the campaign part of the last series of The Sex Education Show) it seems any in depth critical reflection is avoided or only included under duress (for example, witness how they position critical blogs discussing sexualisation research by myself and Dr Brooke Magnanti). Channel 4 now has a campaign for one current series (The Sex Education Show) which calls for restrictions on sexualised media. But other series the Channel has recently created – such as JOTS or The Sex Researchers seem to be promoting sexualised media (particularly for a youth market). In fact you could argue these plus Series 1 of The Sex Education Show with its focus on pubic hair removal, burlesque classes and new lingerie to boost sexual desire (in a show aimed at teens) comes under the Stop Pimping Our Kids campaign to crack down on sexualisation.

We are currently left with a situation where Channel 4 as a broadcaster focuses on a lot of sex/relationships content in various guises (entertainment, advice and education). These seemingly fall within part (or all) of it’s Public Service Broadcasting remit. Consistent, public and vocal calls for programmes to be improved – by the public and professionals – have been ignored. Programmes have been made during the past year which fail to have learned from the input from experts and feedback from professionals about content, accuracy and tone. We have an ongoing situation where programmes are being made by the Channel that contradict each other (and even contradict themselves), while offers of help to sort this muddle out are generally overlooked.

I hope the meeting the Channel are hosting in the coming weeks will be productive and the Channel will listen and really apply the core messages being shared. Otherwise we will continue to have a situation where both Channel 4 and production companies it commissions to make sex/relationships programmes will be viewed with mistrust and suspicion. We cannot currently trust Channel 4 to make quality sex and relationships programmes. And that is a situation entirely maintained by the Channel in the face of ongoing offers of support.

How sad.

Tonight sees the first in a three part series ‘The Sex Researchers’ on Channel 4 (10pm GMT). It will focus on the history of sex research, explain what sex research involves, and tackle worries the public have about sex (particularly the obligatory ‘am I normal?’ question).

I’ve been a sex researcher since I started my PhD studies in the 1990s (academic background here). It’s a discipline I find fascinating. I love working in this area and I hope it shows. Over the past decade I’ve focused on trying to explain sex research to the public through writing for the media, public science events and training other researchers and practitioners in sex research methods. I also apply my work through advice giving in print, online and in broadcast media – using the evidence I take for granted and making it publicly accessible (and most importantly freely available). I work in different country settings, and am endlessly amazed by how similar and different our intimate lives are across the world.

So any programme that showcases sex research is going to get my vote. This post reflects on how sex research (and sex science) is portrayed in the media, reflects on the Sex Researchers series itself, and includes information about how you can learn about or get more involved in sex research.

Why do academics want Sex Research talked about?
The sex research community were excited to hear about this programme when it was first being researched last year. We’re keen to raise the profile of sex research – both to encourage people to participate in studies, and to enable them to be able to think critically about and apply sex research to their intimate lives.

Being involved in a programme about sex research also gave us hope we might be able to showcase the amazingly diverse range of sex ‘science’, which crosses multidisciplinary boundaries and can cover the social, cultural, biological, physical and more.

Why is media coverage of sex research important?
It’s important that sex research does get accurate coverage as often the media’s treatment of ‘sexology’ is either in terms of dodgy biological research, stuff about brainz, or cod evolutionary theory. None of which are particularly representative of the discipline. That’s alongside the slew of dubious commercial PR sex surveys and other ventures which are basically advertorials but the media accepts and shares as sex science. Editors and journalists don’t take sex seriously as a topic, often aren’t able to critically appraise sex studies. And can’t seemingly differentiate between a PR fluff survey, a drug company product push, and a kosher piece of detailed sex research. Which means the former two are far more likely to get media pickup, and the public are fed a steady diet of misleading information that in turn influences (but probably does little to help) their intimate lives. (More information on how the media gets sex stories wrong here and here).

Sex researchers also face major problems with the media (and public) with a general misunderstanding about what our work involves. Most journalists I have discussions with seem firmly wed to the idea that sexology is only carried out in laboratories; using brain scanning, thermal imaging or blood tests, conducted by white coat wearing researchers. Depending on the story the journalist is working on this stereotype can either be uber clinical, or rather kinky (sometimes even both!). It is difficult to convince the media (along with science communication event organisers too) that most sex research doesn’t happen in lab-based settings and doesn’t usually involve intimate physiological tests.

That’s not to say these don’t happen, but they’re not the staple part of a sex researcher’s toolkit. Instead things like surveys, interviews, focus groups, diaries, epidemiological research or visual methods (to name a few) are far more likely to be used. These give us a fascinating insight into our sexual lives, so where there is a (rare) chance to showcase these within the media sex researchers are keen to do so.

Unfortunately our diverse methods and philosophical approaches don’t often appeal to journalists because they don’t have the visual trappings of ‘science’ that laboratories, physiological measures and white coats do. For television in particular there’s an ongoing problem where ‘sexology’ is misrepresented or shown in outdated or judgemental terms because the only way a director/producer can envisage representing sex science is with gadgets and gimmicks. This means researchers whose work doesn’t fit in this area (particularly those of us involved in critical/community based practice) are ignored, forced to play out a make believe version of your job, or appear as some kind of clinician.

Another common problem we see in the media’s use of ‘sex science’ is cherry picking data. By that I mean finding a study (which may or may not be a genuine piece of sex research) that will help you support your particular story angle/agenda. This sometimes is called being ‘evidence based’ but actually is anything but. If you are taking an evidence based approach (a phrase which is still hotly contested) you would review all available literature on a given topic and summarise it all. Highlighting research similarities, differences, shortcomings and opportunities. Unfortunately the media; some (naughty) academics; and many organisations, charities and politicians lack the time, skills or incentive to do this. Meaning studies that are outdated, unrepresentative or flawed can be presented as having more importance than they actually possess.

Finally media approaches to sex/science can result in the quirkier areas of sexology (and often not really sex research at all) get a higher billing than our more mundane studies of sex and relationships in our daily lives. Coverage of oversized genitals, unusual fetishes or paraphilias are often presented as the norm in sexology (particularly with a judgemental angle which does not characterise genuine sex research). Work addressing how we experience sex, what we like or dislike, or how we interact with others are not so dramatic and so are covered less often. Indeed where they are covered you commonly encounter the default media sneering option of ‘wow, we could have told you that’. Implying that sex research is simply so obvious we needn’t bother doing it. An arrogant position that contrasts the media’s preoccupation with aspirational sex messages, and the public’s anxiety about how they measure up.

You may find this lecture I gave at my workplace (University College London) earlier this year helpful to expand on some of these ideas. It talks about some of the issues we experience in media sex education, which includes how sex ‘science’ is applied and shared with the public. [This is quite a long lecture so you might want to skip it for now and come back to it later]

Putting the ‘sex’ in sex research
To make things even more complicated, sex researchers (at least those that are on the ball and critical thinkers) also like to consider basic issues like what ‘sex’ means. While the media when making programmes or writing features about sex assume it means one thing – heterosexual penis in vagina intercourse. Sex researchers know from talking to the public about their sexual experiences, or recording sexual activity in other ways that there can be many activities that count as ‘sex’. Unfortunately the mainstream media aren’t always keen on this. Preferring to construct intimacy in fairly restrictive ways, thinking about ‘sex’ as penetration, heterosexual, monogamous, that happens in the bedroom between two attractive, able bodied, white people. Not surprisingly the ‘am I normal?’ anxiety that plays out in public and can be answered by sex research is often caused by media misrepresentation of the sex lives of us. This is another reason why sex researchers are keen to talk to the press about the work they do.

These limited roles also extend to how the sex researcher is seen. The media may well represent you as an academic or social/scientist but because there’s a lack of understanding of sexology as a discipline this is often overlooked. Instead you’re more likely to find yourself in the public gaze as the voice of doom about our sexual lives, the flirty sex doc sharing naughty tips, or the whipping boy/girl that has to justify other people’s perceived sexual ‘bad’ behaviour. Some practitioners will fulfil these roles, often acting unethically in judging celebrities or making sex science seem vacuous or over simplistic. Others simply shy away from them. Not that the media cares since their view of sex research is so confused often they’ll happily make out folk with no qualifications or experience are academically qualified – and there’s no shortage of ‘sexperts’ happy to take on this mantle.

It’s not just the media who causes us problems
Those are the barriers within the media, but there are additional barriers that come from our workplace. Not all of us are supported at work to talk to the press. The negative views some academics hold towards sex research means many are anxious about dealing with the media for fear their work will be judged, dumbed down, or make them targets for those with anti sex views. This can mean fewer practitioners engage with the media, or just see ‘public engagement’ as a one-off press conference following publication in an academic journal. It is only recently that public engagement in this area has been seen as part of our academic life and still many senior academics in this area look down upon or limit new researchers from public engagement.

That’s not to say sex research doesn’t have its own problems with poor practice, under theorised research or unethical studies. Certainly we do have to tackle overmedicalisation, simplistic quantitative approaches or an aversion to more critical, nuanced and qualitative approaches. This sometimes is an issue because many people doing said work may consider themselves social or health researchers but avoid the ‘sexology’ label. And it’s fair to say that any academic discipline has its own share of poor practice, bad science and dodgy researchers. It’s just sex research seems to be singled out more for the bad than the good. Maybe because of our anxieties about studying sex to begin with. It’s a handy silencing tool to simply state this is not a worthy area of study, nor is it ‘scientific’.

Those of you who work in media and want to write about sex/relationships more accurately, or those of you who work in therapy/education/healthcare/research and want to work with the media may find these resources on ‘Sex,Health and Media’ useful – from the Onscenity Network’s recent conference of the same name.

Being involved with The Sex Researchers Series
Talking to colleagues involved in contributing to The Sex Researchers suggested most of us found it a positive experience. Generally we felt sex research was taken as a serious issue, allowing people working in area to share their views/experiences. Those using different methodological/philosophical approaches were interviewed, which we hope will give the public an insight into the history of sexology (at least for the past century or so) alongside current examples of work. We were assured by programme makers that sexology would be presented as a relevant and important discipline, while illustrating some of the problems facing us in terms of science, ethics and funding – alongside problems with medicalisation and commercialisation of our sexual lives.

As you can see from the start of this post there are many reasons why sex researchers are nervous about working with the media. It’s probably fair to say not all the sex researchers featured in the series are representative of the whole discipline and there are many people whose work will not be showcased. There did seem to be a focus from the programme makers to initially start with the ‘usual suspects’ of sex research – those well known, experimental, positivistic folk (mainly from US institutions) who have had the most media coverage elsewhere to date. It seemed through taking a long term and more in depth approach to framing sex research that other researchers and academic branches of sexology were considered but it remains to be seen whether the series will rehearse the usual experimental/lab based/heteronormative/neo conservative version of sex research we’re used to seeing.

Those of us working in critical/cross cultural/community based settings were worried the focus of the series would be predominantly Western, focusing on a history and current practice of sex research from a Western European/American perspective. Obviously sex research happens globally and there are some amazing, critical and thoughtful projects happening everywhere. It’s always a let down to see this area only presented through the views of those in the Global North (or with those in the Global South presented in discourses of pity, shame, blame, abuse, sexlessness and inequalities). Even within Western settings we often see the focus on urban, young, able bodied, white folk. All of which fails to really showcase the true diversity of sexology.

Filming for The Sex Researchers unfortunately coincided with more worrying problems with Channel 4 and their series The Joy of Teen Sex a series aimed at twenty-somethings which caused anxieties among the research, education, healthcare and youth services for the way sex and relationships were presented. Many UK researchers felt unable to participate in a programme being made for Channel 4 at the same time the Channel seemed unwilling to acknowledge it was part of the problem in representing bad sex advice and misleading information on sex (particularly using poor data to stack up their programmes). All contributors were faced with a dilemma of challenging the Channel on its poor practice, while having the opportunity to showcase sexology. Ultimately many researchers opted out of filming because they lack trust in Channel 4. It remains to be seen how The Sex Researchers represent us and our work. Practitioners remain in negotiation with Channel 4 to try and persuade them to improve their sex and relationships broadcasting elsewhere.

My Contribution to The Sex Researchers
I was asked to talk about different methodological approaches, practical applications of sexology (i.e. evidence into practice through advice giving and similar), the problems of PR research, and how the public and media understand sexology. I refused to participate unless I was also able to discuss how poor coverage of sex/science in the media has negative public consequences (given my ongoing concerns about Channel 4’s approach to sex broadcasting). As with any TV series you’ve no idea if you’ll make it to the final cut, and given the media generally isn’t keen on self analysis I’d be surprised if most of my comments about media/bad science are aired. (In fact given my ongoing vocal challenges of Channel 4 I would be surprised if any of my interview is aired, but we will see).

This may be a really good series. I hope so. Myself and colleagues have given lots of our time (for free) to make this a success and to hopefully show the public what we do and why it is fascinating and important. I hope it introduces people to an area of importance and highlights the value in studying our sexual lives.

Want to know more about sex research? Here’s how!
Hopefully you may be keen to find out more – perhaps you’d like to take part in a study, maybe you would like to become a sex researcher, or perhaps you are already working in this area and want to highlight to others the importance of your work.

Here are some resources to get you interested in sexology/sex research
[Some of these are focused on Kinsey because I wrote them to tie in with the release of the film of that name. They are still relevant to sex research more generally]

Explore the Truth about Sex This is a lecture I gave for Science Oxford, talking about the way we study sex and relationships; the methods we use; and answering some of the most frequently asked questions about sex that the public want to know about from sexologists.

Want to be in a sex study? Find out how to get involved (and what really happens in sex research) here and here
Some of the methods we use to study sex
And a stepwise account on how you might run sex research
What’s it like to be a sex researcher? Answers to commonly asked questions
Why sex research is important What parents might want to know about sex research Barriers and opportunities in modern sex research Test your sexology knowledge

Useful sources of information
Kinsey Institute
Cory Silverberg’s fantastic blog About Sexuality
The Sexademic
Archive for Sexology
Onscenity Network
World Association for Sexual Health
Society for the Scientific Study of Sexuality
List of sexology organisations

Update 23/06/11
The first episode of the series is now available via 4oD and it continues to be discussed on twitter at #sexresearchers. Reactions from the sex research community to episode 1 are not positive. There is an anxiety that the sex lives of sex researchers from history have been mocked and misrepresented in places, made out to be comical, with some of the relationships of sexologists shown in homo/transphobic ways.

Given the efforts researchers went to in explaining to the TV company about what sex research is but also how it seeks to challenge heteronormative views of aspirational sex, and how the misrepresentation of sex/research makes our work difficult, it is worrying the depiction of what is sex research in this first episode is misleading. In particular the use of white, able bodied, attractive, young, slim women to illustrate research has bothered those whose research seeks to challenge such depictions of the body/intimacy as ‘normal’. However, you decide as you watch the programme and use the resources listed above to help you make sense of it. Among the sex researchers I’ve been talking to in the UK and elsewhere there is a sense of disappointment that what we were promised as a clear and fair approach to explaining our work has again been reduced to a bit of a joke. There is still hope the following two episodes will rectify the problems with episode 1.

Alongside the series Channel 4 have an viewer poll which asks ‘who benefits most from an active sex life?’ (with the options men, women or both benefit equally). If this were a poll thrown together by someone with no awareness of sex research we might dismiss it as the usual media sex question stuff up. Remember, however, this series was put together over months with hours of input from sex researchers all over the world. All of whom were explaining how important it was to think critically about how we measure sexual activity.

So it’s worrying to see that apparently little or no learning from this experience has happened to the Channel. Why? Let’s look at the question. First of all ‘sex life’ is not defined – what does it mean? Intercourse, masturbation, sharing fantasies, desiring a partner, talking about sex, oral sex? One core issue we pointed out to the TV company is the assumption we all know what ‘sex’ means, yet we know from research participants have very different ideas about what it might be. So there’s a lack of clarity in conceptualising ‘sex’. Next the term ‘active’. What does that mean? The amount you have sex in any given time period? The number of people you are intimate with? How physical you are during intimacy? Leaving such terms undefined means we don’t know what people are responding to. And ‘benefits’. What does that mean? Physically, psychologically, financially, emotionally or something else? Who is benefiting – you, your partner(s), and how does that benefit manifest itself?

The poll represents one of the core problems sex researchers contributing to this programme are anxious about – and one of the major ways the media makes our work difficult. It sets up the idea that your ‘sex life’ is (or should be) something that is ‘active’ and has ‘benefits’. Tapping into the current vogue of presenting sex as an aspirational activity that’s framed in the language of performance, positions, targets and achievement.

Finally there’s the choice of male or female (or both) with no accounting for trans or intersex people. Which again we know the media generally overlooks, but given the focus on gender and sexuality was an integral part of the TV company’s research for this series it is amazing they seem to have ignored pretty much all the input from experts about our methods, philosophies, and critical thinking about sex and gender.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[If you are interested in evaluating the review – particularly if you’re a journalist on a deadline - you may want to skip to the end of this post and focus on the section ‘Questions you should be asking about the Bailey Review’].

What is ‘sexualisation’?
Over the past few years ‘sexualisation’ has gone from a phrase that nobody had heard of (and nobody was particularly bothered by) to a buzzword beloved by the media and politicians. It has led to several separate reviews being commissioned in a number of Western countries, including those undertaken since 2008 in the UK alone (here’s a review of these preceding reports and tools to evaluate them).

As the term has become part of popular discourse a related problem has emerged where it is used a lot in media, politics, healthcare etc as though it’s an agreed upon and simple concept, and yet it is anything but . Something that becomes more obvious if you read through these critical essays reflecting on the term and the issues it raises courtesy of the Onscenity Network.

Background to this review
The Bailey Review follows in the steps of numerous other investigations and reports on youth/wellbeing. These have been framed within various contexts including: education/development (Byron), violence against women and girls (Papadopoulos), or commercialisation (Buckingham et al). All of these share the common focus of looking at potential areas of ‘harm’ and offering solutions to protect young people. They have differed in their focus with some looking at the impact of the internet, others addressing wider media formats (such as music videos), or commercially available sexual products (e.g. padded bras) aimed at children.

The assumption underpinning these reports, as well as the Bailey Review, is that sexualisation/commercialisation is a major issue affecting children and teens. However, with the exception of the review by Buckingham et al for the Scottish Government these evaluations have not interrogated the concept of sexualisation, nor focused on wider issues that might be facing young people. These may include: poverty, housing, nutrition, road safety, ‘failing’ schools, problems within health/social care that impact on young people, lack of parental support, limited provision of afterschool clubs, or inadequate availability of affordable childcare (to name a few).

Which leaves us with a consistently unanswered question: ‘is ‘sexualisation’ the main problem facing young people/parents?’ And does it warrant all these investigations?

What was Bailey Review tasked with?
The review was designed to address areas of parental concern with a focus on four key issues:
• whether and to what extent sexualised imagery now forms a universal background or ‘wallpaper’ to children’s lives;
• whether some products are inappropriate for children, and others in dubious taste: parents are anxious about what is appropriate;
• whether businesses sometimes treat children too much as consumers and forget that they are children too, with particular concerns about the kinds of marketing techniques associated with digital media;
• how parents can tell advertisers, broadcasters and retailers about the things they are unhappy about and how they can make an effective complaint.

The review was open to consultation and you can read a number of submissions to this process here. Some of these are more reflective and nuanced than others.

Concerns and Criticisms about the Bailey Review
Criticising sexualisation does not mean dismissing young people’s rights or ignoring abuse, exploitation or our changing mediated culture. It does mean thinking critically about the simplistic (and often moralistic) views of sexualisation used by politicians and the media – and how these can actually detract from the rights and needs of children and teens, while frightening and disempowering parents.

From the outset there have been numerous concerns expressed over this particular review and previous ones. These include:
- The number of recent preceding reports on the issue of sexualisation from various Western countries that (presuming sexualisation is a major issue) could have informed current policy and practice – but didn‘t.

- The varied quality of previous reviews. The Buckingham/Scottish Parliament report was innovative and thorough. While the Papadopoulos/Home Office report was problematic see here and here) based on limited and cherry picked data that failed to differentiate between academic research and PR campaigns and lacked rigour in reporting on findings (for example on focus groups used).

- Reg Bailey is the Chief Executive of the Christian organisation the Mother’s Union (MU) (although the MU have distanced themselves from directly being involved with the review). Some have questioned whether a transparent and independent review could be hosted by an individual with links to a faith based, conservative organisation. Not least because at the same time Bailey took on the review for the government the MU launched their Bye Buy Childhood campaign.

- Differing political approaches have led to a haphazard interpretation of ‘evaluation’ so the Scottish Report permitted academics to interrogate and investigate the idea of ‘sexualisation’ while the Australian and UK Home Office reports seemed to follow a remit of identifying a politician-identified problem then looking for evidence to support it (while ignoring any evidence to the contrary).

- With the Bailey Review, as with other recent sexualisation reviews academic concerns over simplistic, moralistic approaches/ignoring evidence/critical thinking have been largely ignored. Indeed many practitioners working in this area who want to inform debates on sexualisation/commercialisation and have concerns about the rights and needs of young people have struggled to have their voices heard.

- While purportedly about young people most of the investigations have not particularly included young people. Where they have been invited to contribute it has been within a very limited and top down framework where adults have set agendas and asked young people to respond to them.

- The reviews have mostly reinforced the theme of girl’s as victims/boys as oppressors (and a built in assumption all teens grow up to be heterosexual). Along with judgements around class (it’s usually working class girls who are seen as ‘the problem’ in this area); and race (black music/artists are frequently used to illustrate declining moral standards in music lyrics/videos).

- Critics have argued the preoccupation with sexualisation favours white, middle class parents (usually mothers) whose children are not generally facing particular hardships. It is easy for these parents to be worried about sexualisation because other concerns over family finances, nutrition, housing, safety within their community or their child’s educational needs are not so pressing. Indeed it can be argued that parents who are worried about sexualisation often engage in this debate in ways that judge or look down on other people and their children.

Has the media sexed up ‘sexualisation’?
When the American Psychological Association launched their review on this area in 2008 it was virtually impossible to get media coverage of it and generally it was seen as a sideline issue. However with the launch of the Home Office review in the UK the media has begun to see this as far more of a topical area. It’s become an ironic that the media, while taking a stand *against* sexualised/commercialised culture also use this topic to sell copy/generates viewing figures.

For example Mumsnet has been running their ‘Let girls be girls’ campaign, Psychologies magazine ‘Put porn in its place’ (ironically based on a survey of under 16s where parents weren’t told their kids were being asked about porn), and The Sex Education Show’s ‘Stop pimping our kids’. All may be well intentioned, but ignore much of the current evidence about young people’s lives. Worryingly when journalists want to cover the topic of ‘sexualisation’ they don’t go to academics or practitioners, they turn to these media outlets who often are not sharing a particularly nuanced or accurate perspective, but are getting a plug for their website/magazine/TV show every time they are asked to share their views. Put simply you may genuinely care about children, but you can currently also boost your audience if you talk about sexualisation.

We’re in a current situation where successive governments commission different reviews into sexualisation while various media outlets and charities host their own campaigns on the issue. Which again brings us back to the question: ‘is ‘sexualisation’ the main problem facing young people/parents?’ And given all these overlapping reviews and campaigns why aren’t we seeing any major outcomes from them?

Questions you should be asking about the Bailey Review
Before you ask these questions you may want to read up on previous reviews and utilise the free tools provided to evaluate them
- why the need for yet another review given the glut of them in recent years?
- how much all these reviews have cost so far?
- how much impact have the preceding reviews had? All had lengthy recommendations yet have any been implemented and if so have they ‘worked’?
- how have the various reviews differed from/added to/learned from each other?
- do the outcomes of the Bailey Review adequately match the four key issues (see above) it was initially tasked to evaluate?
- what methods has the Bailey Review used to gain an insight into what’s going on and how transparent is that information? (for example they’ve done a survey but is it any good? Who were the participants, how were they selected, what were they asked, why run this rather than using existing evidence?)
- how have young people been involved in the Bailey Review?
- how realistic are the recommendations from the Bailey Review, and what impact do they foresee them having on the wellbeing of children, teens and parents?
- how easy might the recommendations be to operationalise? (For example if there are to be restrictions on music videos will this be based on the lyrics, visual images or both – and who will decide what constitutes appropriate/inappropriate content?)
- how much will the recommendations from the Bailey Review cost to implement?
- are there any particular groups of children/parents who’ll be enabled or disadvantaged by the findings in the Bailey Review (i.e. is it skewed towards reassuring the middle classes?)
- is there a potential conflict of interest in Reg Bailey leading this review given his links to the Mothers Union and their own anti sexualisation campaign
- how has the Bailey Review approached questioning parents? Have people been presented from the outset with the view that sexualisation exists and is a problem or have parents and other organisations been allowed to talk about other worries they may have around their child’s wellbeing?
- how representative are the individuals and organisations responding to the Bailey Review? Do there seem to be any groups whose voices are heard or silenced?

And finally, let’s return to that most important question ‘is ‘sexualisation’ the main problem facing young people/parents?’

Join in the debate
The Bailey Review’s already being discussed on twitter on the hashtag #baileyreview. Once you’ve read the report you may want to share your thoughts on it there, or via your own blog. If you’ve any specific questions or comments about the review you can also put them to @educationgovuk (start with your question then include @educationgovuk so all your followers can see your question, RT their replies, and use #baileyreview on anything about this topic).

Update 07/06/11

Since the Bailey Review was released yesterday there’s been a lot of interesting discussion about the report, mostly on blogs rather than in the mainstream media. Here’s a lineup of some of the most interesting writing I’ve found on this topic (I’ll try to keep this updated with a range of issues represented):

Heresy_Corner (Nelson Jones) has a thorough and thoughtful reaction to the review with Children Being Children

Dr Brooke Magnanti (who did a grand job live tweeting responses to the data in the Bailey Review yesterday) gives her First Look at the review.

The fantastic Meg Barker tackles the issue of gender and sexualisation in Sexualisation and Gender stereotyping? One response to the Bailey review Similar issues are raised by Steve Greer who picks up on the ‘not said’ aspects of the review, particularly in relation to gender over at Queer Theory Reader. Quiet Riot Girl also discusses the masculinity issues, male objectification and the men’s media market which the Bailey Review overlooked in Nice Tits, Love! while Dan Avenell illustrates how the Bailey Review problematises lad’s mags while ignoring the mainstream older women’s magazine market over at The Bockingford Kid.

Over at the Ministry of Truth a somewhat different view is taken, looking at the ‘evidence’ making behind the Bailey review (probably also winning the best title of a post on this topic prize at the same time) Won’t You Fuck Off, Reg Bailey Additional concerns on the quality of the report (and how accessible it is) are raised by Think Base, while Jennie Kermode invites us to think about the core terms and assumptions underpinning the Bailey Review.

The Guardian’s CiF had a (predictable) ‘debate’ feature with different takes on the review. The first part from Holly Dustin might be somewhat more plausible if it didn’t rehearse the dreadful (and completely false) ‘statistic’ ’63% of girls want to be glamour models’. (From a PR survey that allegedly was never really completed: more criticisms of this statistic/survey here and here). Jane Fae Ozimek (whose writing style I covet) really gets to the heart of the problems with the review. Read both takes in Sexualisation and the Bailey Review.

Also at the Guardian their head of Media and Technology Dan Sabbagh writes probably one of the best accounts of this review from a mediated perspective (which makes you wonder why more media/tech expertise wasn’t included within the Bailey Review and preceding ones). His reflections can be found at ‘Sexualised Children’ -Is it always the media’s fault?. Mark Lawson also tackles media issues, this time picking up on how the Bailey Review appears out of touch with new media and youth access and how realistic a fixed watershed is within this context.

Richard Godwin in the Standard focuses around anxieties about childhood adults have in The problem is we’re scared of our children that ends with a quote which ought to focus all our reading and research on this issue ‘Childhood is generally what adults make it’. Meanwhile Libby Brooks returns to the wider concern about whether the Bailey Review addresses the most important issue facing young people, focusing on child poverty as a more pressing problem to tackle.

As you can see most of these posts have focused on the content, evidence and messaging around the Bailey Review. A different but equally interesting perspective from Caroline Farrow, who takes apart the review from a faith based perspective. Reflecting on issues of history, censorship and parenting. Here’s her post on The Bailey Review.

A lot of the discussions of the Bailey Review were rightly serious in tone, so it was good to have some light relief in the form of Andy Toots hilarious post Yippee-ki-yay,Mrs Dorries (which simultaneously also highlights the right wing media’s hypocrisy over the whole ‘sexualisation’ debate).

Update 10/06/2011
There are a number of academic conferences and events coming up between now and the end of the year
that will tackle issues of sexualisation and commercialisation. These include:

Girls, Sexuality and Sexualisation: Beyond Spectacle and Sensationalism. 30 June 2011. Cardiff

BSA Regional Seminar. Sexualisation: A cause for concern? 5 July 2011. Sheffield

BSSN 5th Annual Conference: Hard Science? Sex, Science and Technology. 15 September 2011. Brighton.

Sexualisation of Culture Conference. University of London. 1-2 December 2011. London.

Equally interestingly Westminster Media Forum have scheduled a Keynote Seminar on 18 October 2011 entitled Protecting children from commercial and other adult pressures: next steps for policy and business practice. A draft timetable is available here and a booking form here. The event’s not cheap (I don’t know why WMF always have such inaccessible pricing), but if you can afford to attend I would strongly recommend going and raising the many issues that have now been outlined relating to both the Bailey Review, preceding reports, and wider issues about evidence making, policy and practice.

Meanwhile MP Sarah Teather, Minister of State for Children and Families is asking for feedback on the Bailey Review. If you have any particular comments or questions please submit them here.

Update 13/06/11
The background literature review commissioned to inform the Bailey Review by Professor Ann Phoenix is now available. I’ve a lot of time for Ann and most people who’ve read her review have been impressed with how thorough it is. There is also this DfE Review by Ann and colleagues looking at how different countries attempt to regulate commercialisation/sexualisation. It is certainly worth reading this document and comparing it with the claims made by the Bailey Review. Critics have noted these reports were not made as accessible as the Bailey Review, and the literature review was not made public by the Department for Education until several days after the Bailey Review was released.

Brooke Magnanti returns to the Bailey Review, this time focusing on terminology and definition.

Suzanne Moore focuses on the issues about capitalism and poverty that the Bailey Review fails to address.

Charlie Brooker is typically cynical but right on the money with his take on gender, media and sexualisation.

Polling company YouGov have run their own research on sexualisation to tie in with the Bailey Review. Check the survey questions asked, there are some major problems with them – can you spot them?

Meanwhile the prize for the most offensive cashing in on the Bailey Review comes courtesy of The People who went undercover to film girls attending a ‘Pole Dancing Class for 3 Year Olds’, only to share images and film of said girls in their class as an example of ‘sexualisation’. This was later picked up by the Mail who also gloated over the photographs of said girls. Both stories ooze class judgement and girl blaming, suggesting an epidemic of pole dance classes for children across the UK (when in fact a possible 8 girls may have been involved in the classes reported on by the People). The comments on the People story are, fortunately, for the most part sensible. Our take home message? ‘Sexualisation’ is very bad. But filming little girls without their knowledge or consent and presenting them in sexually provocative photos in a national newspaper is seemingly fine.

Want to know what testicle size has to do with your relationship status? Whether a long tail may help or hinder you get a mate? Or what scents you might secrete to attract a partner? If so, head to London’s Natural History Museum where you’ll find a sexual surprise between now and October 2011. ‘Sexual Nature’ is an exhibition that focuses on attraction, reproduction and sexual behaviour in non-human animals.

In a climate where all too often our understanding of the ‘evolution’ and ‘biology’ of sex come in a package of bad science or gender stereotypes, it’s interesting to see an exhibition purely focusing on what different species do – rather than how they compare with humans. It gives you the opportunity to reflect on how animals are similar and different to each other – often challenging many beliefs you might have about monogamy, sexuality and reproduction.

Through the exhibition you’ll learn more about how the senses – sight, sound and smell particularly play a role in attracting a mate. Indicating how these factors may differ between species, while what you think might be desirable for a particular creature may not turn out to be advantageous when you factor in the risk of predators.

A wide range of animal activity is shown (although of course there has to be an appearance from dolphins and bonobos). Lesser known ‘sexy’ species are also included, with the chance to see the positions animals favour for mating, plus the chance to listen in to mating calls and smell desire.

There is a focus on homosexuality, monogamy and non monogamies, and different genders which is another pleasant surprise in an area which often tends to reinforce rigid gender/sexuality/relationship stereotypes. That said I think the exhibition would benefit from reviews from gender/sexuality experts who could unpack the core messages still further. Part of me suspects although a more diverse view on gender/sex/relationships is taken, it is still presented through a heteronormative lens.

A major treat is the screening of clips from Isabella Rossellini’s ‘Green Porno’ focusing on the diverse mating habits of fish, insects and other creatures). (Some clips from her work can be viewed here).

Along with the exhibition the Natural History Museum are hosting a series of debates, discussions and talks, rethinking how we view sexual behaviour, attraction, desire and sexuality. You can keep up to date with these here and don’t forget you can see the exhibition on a Friday night late night viewing (last Friday of every month).

You may want to know where humans fit into an exhibition on non-human animal sex, and those into narrative and discourse may be particularly excited to learn the close of the exhibition does include the human – focusing on how language shapes and creates sex, gender and relationships. I wasn’t expecting this aspect to the exhibition but found it a really fitting way to think about how humans ‘do’ sex.

Of course as with any exhibition there’s an obligatory exit through the gift store where I was pleased to see a range of STIs on sale – obviously in plush toy form (you can also view and purchase these here). I was disappointed the range of texts promoted alongside the exhibition were not really what I’d like showcased as explaining human or animal sexual behaviour. The works of Desmond Morris or sex tips from actress Kim Cattrall aren’t really cutting edge sexology. Worryingly some of the texts showcased represent to me some of the worst examples of bad sexual science. If you’re hosting a cutting edge exhibition on animal sex you’d really expect similarly high quality books available to buy. Not least because this area is riddled with dire sexpertise and the problem of poorly researched/misleading sex advice books has been well documented. Perhaps in the remaining months the exhibition is open the museum may change their stock – I’d certainly be happy to recommend them some suitable titles.

I’d definitely recommend a visit to this exhibition (although wish the entry price could be a little cheaper!). It could be an ideal outing for schools as part of tackling science/sex and relationships education (it is open to 16s and over, more information including teacher notes here). You might enjoy a visit with friends or perhaps as a date? Parents may wish to read about the exhibition before deciding whether to take children (more information here). Younger children may only understand the exhibition in terms of seeing different animals, while older children may experience a range of reactions (positive and negative). Knowing how comfortable your child is thinking about mating/attraction and how much awareness of sex/relationships/sexuality should determine whether you take them along. The fact your child may be learning about sex/relationships/sexuality issues with other people present may feel off putting to some so it’s important to consider your child’s comfort levels before and during a visit should you decide to go. This exhibition could be a useful addition to other sex/relationships education you’ve been sharing with your child but definitely is not a replacement! Elsewhere in the museum human reproduction and development is covered in more depth so you may wish to begin with this before viewing Sexual Nature.

More information, sneak previews and ticket sales available here.