Let’s talk about sex

The Amanjit Jhund NHS Column

As we are moving into the party season, with all of the attendant celebrations and festivities that accompany this time of year, it is also likely that we will see a surge in the number of people having unprotected sex.

With this surge we will also see a less glamourised and publicised element of christmas: the surge in Sexually Transmitted Infections (STI’s) and consumption of the “morning after” pill.

Britain still has some of the worst statistics in Europe when it comes to sexual health.

While there are many fantastic organisations such as Brook offering advice or “survival kits” for the festive season, they are often stop gap measures which target the outcome rather than address the cause: a cultural deficit in Britain.

Low rates of STIs and teenage pregnancy in the Netherlands has resulted in it being held up as the gold standard for sex education schemes everywhere. Much of the success in the country has resulted from the openness with which sex is discussed in the media and within families.

In 2007 Dr Paul Kocken, from the Dutch research organisation TNO Quality Of Life carried out a survey of sex education. When he compared it to a similar survey carried out in Britain, he found the results surprising: in both Dutch and British schools sex education is patchy. His conclusion was that it’s not sex education which is important, but culture, and parent-child relationships.

Like most people the sex education that I received from my parents was non-existent. It was certainly not a subject that we discussed. While we do need sex education in our schools I believe that we also need to educate adults and encourage them to communicate more with their children and each other on these matters.

In fact in many cases it is the younger generation who are better informed about STI’s and contraception. In a Department of Health Survey, 21% of males aged between 16 and 24 did not recognise chlamydia as a sexually transmitted infection. At the other end of the population, 40% aged between 45 and 49 and 48% of those aged between 50 and 69 were not aware of this fact.
We have to look to move past sex as a ‘dirty’ or taboo subject. I believe that we will be able in time to make this cultural shift but we have to accept that it will not happen overnight.

In the past while at University I had reason to attend a Genito-Urinary Medicine (GUM) Clinic myself when I had a condom tear during sex. I was happy enough to discuss the matter with my peers and I have never had any shame about the incident as I know that it was the sensible and responsible thing to do. But I do have friends for whom the entire subject is still something of a taboo and certainly not something that they would want to admit to or even discuss. At the time I even had to persuade a friend of mine who was also a medical student but had had unprotected sex several times to attend the GUM clinic himself, his reluctance stemming from embarrassment at attending such a clinic.

It’s not simply our attitude towards sex education itself that needs to be altered but also to sexual health clinics and advisory centres. We have to ensure that where risky behaviour occurs, by accident or by design, there is no stigma attached to seeking out or making use of professional help.

Also while a medical student, I taught sex education at a number of schools in Edinburgh from state schools such as Leith Academy to private institutions like our current Chancellor’s alma mater, Loretto. At the time it was one of the most rewarding and difficult things that I had ever done but it did highlight to me the importance of intervening early.

I found that when addressing a class full of sixth formers they were either uninterested because they felt that they had heard it all before, or were unwilling to display any level of sexual ignorance in front of their peer group. The most rewarding session I taught was to a class of 11-12 year olds. It was at this point that I found that the children were both keen to learn more and comfortable in asking questions. I was rather shocked when one lad even pulled a condom card from his wallet (and from what he told me I was left in no doubt that he was already having sex), as to be honest, at his age I was only really interested in computer games.

I found that even at the age of about 11 there was a small but significant minority who were already engaging in sexual acts and that is why when earlier this year the government announced that children would begin ‘relationship’ education at the age of 5 progressing through to sexual education, I applauded their initiative.

Although we need to make a cultural change, many of these children will have grown up by the time any such change occurs and many will not benefit from full and frank discussions within their family unit, which is why it is important that we look at practical initiatives such as this now. It simply represents one strand of a multi-targeted approach that we have to adopt.

The problems with sexual health in our country will not be solved by better sex education in schools alone but it must be accompanied by better adult education, more frank and open discussion in the public domain and within families themselves. I do not see it as a replacement for discussions within the family but rather as an addition that can help to stimulate and structure that discussion. We also have to ensure that the safety net of state education is there for those who are for one reason or another unable to discuss these matters with family members or where the family members are lacking in knowledge themselves.

Whether its STI’s or GUM clinics we have to be prepared to both educate and discuss the issues with not just the young but our own peers. It’s the only way to create the cultural shift that we need to combat our shocking sexual health statistics.

Anyway I’ll just finish by wishing you all a very merry (and sexually safe) Christmas!