How to teach about sexual health: empowerment instead of shame

teaching methods used to help young people understand the importance of safe sex often use shame and shock to get the message across - but this is ineffective and even harmful.

Showing pictures of genitalia presenting symptoms of sexually transmitted infections has long been used a way to teach young people about the risks of unprotected sex. The rationale given is that these pictures shock students into taking sexual health seriously. However, despite the widespread use of this teaching device, School of Sexuality Education argues that not only is this method ineffective in aiding students’ learning, but it can also instil attitudes that negatively impact someone’s sexual health.

The distraction the pictures create inhibits learning

For most students, these images will be the first time a teacher has shown them a photo of genitals in school. Whilst we live in a society where grown adults use euphasisms to talk about the gentials, young people cannot be expected to respond in a way other than with shock and horror - and in fact, the learning outcomes are reliant on their collective disgust. But this emotional response creates a distraction which means students will be less able to productively engage with the key learning messages about sexual health. Sexual health, as with all aspects of physical well-being should be approached with a calm, rational and positive mindset: this is feeling we should aim to create in RSE.

The key learning messages are misleading

Importantly, focussing on symptoms of STIs can skew a vital learning messages: that a large proportion of STIs are asymptomatic. By looking closly at symptoms students could be left with the inaccurate impression that they will have visible symptoms if they have an STI (not necessarily); symptoms look the same for everyone (they don’t, of course); and that they could self-diagnose through learning about these symptoms (definitely not). Effective sexual health teaching therefore focusses on prevention and good personal health practise. This involves learning about different methods of protection and correct use; when to get tested; what testing involves (stressing that STI screening is very normal, sensible and should be treated as just another part of your personal self-care); getting to know your own body; and the importance of open and accurate communication with sexual parters and medical professionals.

The shame associated with sex is detrimental

There is still an enormous amount of stigma surrounding sex and sexual health. This culture of shame directly damages the attitudes and behaviours we need to promote in order to reduce sexually transmitted infections. Namely, we must feel empowered and confident in order to discuss using protection; to access sexual health services with the recommended frequency; and to communicate any relevant information to both medical professionals and sexual partners.

The affected response of the class - again, arguably the intended response - is one of repulsion. This crowd-judgement of a picture of someone’s genitalia with an infection is extremely powerful for contributing to our internalised shame around our bodies and sexual health. It reminds us that our genital health is something that is shameful and should be kept a closely-guarded secret, otherwise we will be subject to this same disgrace. Our response, naturally, may be that we avoid or delay speaking up, to the detriment of ourselves and others.

All of this raises the question: why have these photos stuck as a teaching strategy for so long? Most likely, because they align with the long-standing trend of abstinence-based SRE, in which scare tactics are used to try and discourage people from having sex. It’s time we move onto a scientifically accurate, empowering and useful approach, which young people need and deserve.

Our book ‘Sex Ed: An Inclusive Teenage Guide to Sex and Relationships’​ ​ is out​ ​now.

Internet disinformation: The blue waffle myth

By Dr emma Chan

Sometimes being a facilitator for School of Sexuality Education involves attempting to hold the attention of young people through wit, honesty and sheer confidence as you explain a specific curriculum point as your unembarrassable self. At other times it involves asking questions your audience may not have considered before and standing back whilst a tide of answers hits you.

“Can anyone name any sexually transmitted infections?” My colleague asked of a group of year 10 students just outside of London. Three of us were delivering a workshop on sexual health. This was definitely going to be one of the latter type of encounters. Luckily, this group wasn’t a shy one and answers came flooding forward.

“Chlamydia”, “syphillis”, and “gonorrhea” were proffered. All good answers and affirmed as such.

“Mono” was suggested, the infection also going by the name of ‘mononucleosis’ or ‘glandular fever’ – the ‘kissing disease’. By our extremely wide definition of ‘sex’ (any behaviour that someone finds arousing) completely valid and a good opportunity to bring this in.

Illustration by Dr Emma Chan

“HIV” was another suggestion, to me offered surprisingly late. Once seen as the sexually transmitted infection in the UK, hopefully this reflects a reduction in stigma and fear around this disease as treatment and prevention becomes so incredibly effective.

“Crabs” one pupil proffered - a nice segue in to talking about parasites. Another good talking point.

And then it came. The complete surprise.

“Blue waffle” one student called out.

This caught me by surprise a little. I had heard of this before, but only come across it in training and never actually in the classroom before.

If you haven’t come across it before, blue waffle is a fictional STI. It was something that Amelia and Hazel, School of Sexuality Education’s founders, remembered from their own school days, and had come across when talking to children in their research. The story doing the rounds at the time was that blue waffle was a disease contracted by women who had had a large number of sexual partners. Sometimes the ‘main’ blue waffle image is just shared around for shock.

At the time a google image search would return pictures of vulvas covered in lesions - very nasty looking lumps and bumps. To my clinical eye, some of the images looked to be lesions caused by genital warts. Others, including the ‘main’ picture, looked like erosion and growths caused by vulval cancers.

There are also fake-medical webpages dedicated to “blue waffles disease”.

Interestingly (and perhaps not surprisingly) the rumour ran that it was transmitted to people with vulvas and did not trouble penises at all. Even though this is how the disease was said to be spread. Turns out misogyny can be a powerful vehicle for keeping a lie alive – who’d have thought it!

This turned out to be the case for the young person who had introduced it in to the classroom in this instance. He was quite resistant to my telling him that it was a made-up thing.

“But Miss, if you look on Google, there are pictures!”

I tried to gently unpack this, explaining what I thought these images were actually of. It was a nice opportunity for a discussion about being critical of sources, particularly those on the internet. However, I left with the distinct impression that I had only created an aura of doubt in this person’s mind. I had not completely convinced him it was a total urban myth and an element of belief in blue waffle remained.

Our book ‘Sex Ed: An Inclusive Teenage Guide to Sex and Relationships’​ ​ is out​ ​now.

Why education that promotes equality and diversity should not be up for debate

School of Sexuality Education has published a response to the no outsiders protests and why education must be inclusive of all - available here.

Elmer by David McKee is one of the No Outsiders books.

Debate has recently been raised as to whether or not education should be LGBTQIA+ inclusive at all ages. This has been in response to the No Outsiders programme, a scheme of work developed by teacher Andrew Moffat for primary schools.

In fact, to describe the protests as being in response to LGBT inclusive education for primary school children is almost a bit of an overstatement. The No Outsiders programme centres around a series of lovely children’s books that promote equal rights regardless of race, religion, gender or sexual orientation, including And Tango Make Three by Justin Richardson and Peter Parnell, and Odd Dog Out by Rob Biddulph. In reality, what is being challenged are children learning messages like, “did you know we are all different, and that’s a good thing” or, “by the way there are families that exist where there are two dads”.

The rhetoric surrounding the challenges to the No Outsiders programme has been strongly reflective of Section 28, which banned the so-called ‘promotion’ of homosexuality in schools. Although it was repealed in 2003, its legacy remains, resulting in the attitudes we have seen here.

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School of Sexuality Education provides LGBTQ+ inclusive sex and relationships education workshops for secondary schools, youth groups and universities, and training for staff. If you would like to work with us please get in touch.

Thank you to our volunteer Eve Pardoe for designing this piece.

Our book ‘Sex Ed: An Inclusive Teenage Guide to Sex and Relationships’​ ​ is out​ ​now.