 | "Children are naturally curious about growing up, how their bodies work and how humans reproduce. Their questions need to be answered honestly, using language and explanations appropriate for their age and maturity, thus avoiding unnecessary mystery, confusion, embarrassment and shame” Brook [i] One of the things I hear most from the young women I work with is “why didn’t anyone tell me this at school?” Anyone with any contact with young people will know how important it is for sex education to tackle issues like consent and sexual pleasure and the unrealistic and sometimes alarming way that porn (and the media in general) presents sex, especially for girls. But that isn’t the whole story. A bit more biology could help to |
reduce “mystery, confusion, embarrassment and shame”. It could also help to reduce unplanned pregnancy.
Now I know that Sex and Relationships Education teachers don't have much time, and that many schools don't even do SRE. So this might be a tall order, but anyway, here’s what I think young people should know:
1. Lady liquid isn't just cleaning fluid
Discharge is a pretty good place to start a discussion about fertility.
I think it’s fair to say that boys and men are – or become - very familiar with what usually comes out of their penis. For them there is no mystery in the routine message that people should visit the sexual health clinic or GP to check for an infection if they experience any unusual discharge.
It’s different for girls, and for many women. What comes out of their vaginas can be a potentially embarrassing and confusing business.
Periods are one thing – and fortunately a routine part of sex education in most primary schools. It’s pretty radical that women shed the lining of a key organ every month or so. No girl should be scared or shocked when their periods start.
What comes out of vaginas the rest of the time is trickier. For one thing there’s lots of confusion about what to call it. A discussion about that might fit well with one about other important terminology like vulva and clitoris.
Vaginal discharge might be the medically correct term but discharge is not the greatest word for helping anyone to feel comfortable about their body. It sounds like something that oozes from a wound, not a natural and normal thing. Mucus isn’t much better.
Vaginal fluid isn’t a bad description, but perhaps shrouds the origins of most of the fluid (the cervix) in a bit too much mystery. Cervical fluid or cervical secretions are more accurate alternatives, but they do sound a bit formal and I love that there’s friendlier terms around. Lady liquid, cooch juice, gloop…I’ll let you carry on with that train of thought…
Back to the main issue. Lady liquid isn’t just about cleaning fluid.
Of course it's great to get out the message that vaginas are self-cleaning - I personally won't be happy until every last douche manufacturer goes out of business - but vaginal fluid/discharge does more than clean the vagina and make sex more slippery, it also makes the vagina friendly, or unfriendly, to sperm.
This means that (unless you’re using hormonal contraception) there will be a few days each cycle when a thick, clear and stretchy substance a bit like raw egg white – sometimes lots of it – comes out of your vagina.
This egg white is a sign that a woman is extra fertile. It is produced by the cervix – the entrance to the womb - so it’s called cervical fluid. It appears when a woman's body is about to release, or has just released, an egg. It acts like a “sperm motorway” helping to speed up the sperm’s journey to an egg.
It is still possible to get pregnant from sex when the most fertile cervical fluid isn’t about.
Fertile cervical fluid can be white, creamy or sticky. This is like a “hang-around” fluid for sperm. It means that sperm can hang around for up seven days waiting for the egg to make its entrance.
Once girls and women get used to noticing what is normal for them in terms of discharge (including arousal fluid), they’re far less likely to be confused or embarrassed and far more likely to know when it’s time to visit the doctor or sexual health clinic.
2. Women are not fertile for every day of their cycle.
Telling young people about fertile and very fertile cervical fluid means they could realise that they have days when they don’t notice any cervical fluid and so might not be fertile.
Some will be concerned that this knowledge will encourage risk taking and increase unplanned pregnancy, but maybe letting young women know that they are not fertile for every day of their cycle could be a good thing.
Think of the money and worry that might be saved on ovulation kits and even IVF later in life if more people knew what fertile cervical fluid looked like.
Not to mention the unplanned pregnancies that could be avoided by those who currently assume that they are infertile because they had unprotected sex without getting pregnant[ii].
Telling young women that they’re not fertile every single day of the month shouldn’t stop them using emergency contraception if a condom breaks, but it could save them worrying that they're infertile.
No one wants to encourage risk-taking, so children and young people should be told that it's not easy to know exactly when you are fertile. It’s not rocket science, it’s something you can learn – that’s what natural family planning is based on – but guessing is not a good plan.
One reason to avoid risk-taking is that teenage cycles are often very irregular. They can change from 22 days to 38 days or longer without warning.
Even once cycles have settled down, they vary from person to person and from cycle to cycle, especially if a woman is stressed or ill. A regular 28 day cycle is pretty unusual.
3. Sperm is not kryptonite, but it can linger.
It's much easier to pick up an infection - including a sexually transmitted infection - than it is to get pregnant.
Posts like this one from the wonderful Bish UK suggest that there are some misinformed people out there.
Sperm is not kryptonite. Unlike the flu virus, it can't stay alive on your hands. It can't crawl through your underwear and swim up your vagina. If some gets on a hand and that hand goes near a vagina it is very unlikely, not impossible but VERY unlikely that the woman will get pregnant.
But, but, but. If a sperm gets into a vagina during sexual intercourse, then it can speed its way to an egg in one minute flat - if the egg is there (remember, it's only there for one or two days). Or sperm can hang around for up to seven days waiting for it to appear. Yup, seven days. That's why sex before the egg appears (ovulation) is more risky than sex after ovulation.
4. Withdrawal isn’t brilliant but it is way, way better than nothing.
I don’t recommend pulling out for anyone keen to avoid pregnancy, but the reality is that people have different motivation levels and different views on risk and unplanned pregnancy.
Withdrawal relies on a very cooperative and self-controlled partner, and isn't a method to use when there’s fertile cervical fluid about, but it has been associated with some of the lowest birth rates in history, for example in Eastern Europe after the Second World War.
Telling young people that withdrawal doesn’t even count as a contraceptive method is deeply unhelpful.
As Professor Guillebaud[iii] (contraception guru) says “It is unfortunate that many unplanned pregnancies among young people having intercourse unexpectedly are probably caused by the conventional teaching of doctors and nurses. Withdrawal is not even attempted…because the message that it is “ineffective” has been so well conveyed.”
So if someone has got “carried away” and not used a condom it IS still worth pulling out. It’s not the greatest method of contraception but it’s considerably better than nothing.
5. Aim to complete your family by the time you’re 40
There might also be a place in sex education for discussing what age to have babies. The ideal might be to have children before the age of 35, but people’s lives don’t always work that way and the decline in fertility after the age of 35 may have been overstated if the abortion rates for those aged 35 and over are anything to go by[ii]. A more realistic and helpful message might be to encourage women to aim to complete their families by the age of 40[iv].
6. Different contraception suits different people at different stages in their life.
Some people think that because I’m a fertility awareness practitioner I must have a secret plot to persuade the entire world to use fertility awareness based contraception. The truth is that I just want women to be happy with their method of contraception, and to have a proper choice.
I’ve met plenty of women who are very happy with the pill or their Mirena or IUD and that’s brilliant. It’s also no surprise that many women want the “contraceptive equivalent of Trident[v]” after an abortion, but not everyone wants – or gets on with - the standard options.
Different contraceptive methods suit different people at different times in their life. Choice isn't just about getting people to use the methods that we find acceptable.
We need to give women more options and respect their bodily autonomy. A recent study of young women in London who had stopped using the contraceptive implant found that some of them had to return to their healthcare professional up to three times in order to get it removed. Trying to persuade young women to persevere with a method that isn’t working for them can lead to a breakdown in trust and make them less likely to use other methods of contraception[vi].
Too Much Information?
For all sorts of reasons, some people will find this list too much to handle. They might think "better safe than sorry", that a few unneccessary trips to the doctor about vaginal "discharge" are no big deal. They might think it is unethical to inform people about "less effective"* and less easily prescribed methods of contraception, and that unplanned pregnancy must be avoided by whatever means necessary.
They might say it's tough enough getting schools to do any sex education, that presenting a list like this could put them right off. Better to keep things simple.
They could be right. I don't work in schools, I haven't carried out a controlled trial to test these views, but the young women I've worked with make me believe that more could be done to raise young people's knowledge of their fertility and their contraceptive options.
Resources
* Fertility awareness (natural family planning) is up to 99% effective (according to the fpa), so long as it's done right. It works best when taught by a specialist (and that's not just me saying that, that's the fpa).
____________________
References
[i] Brook.(2014) Sex and Relationships Education Supplementary Advice.
[ii] BPAS. (2014) UK: Abortion and contraceptive failure. BPAS Reproductive Review.
[iii] John Guillebaud. (2009) Contraception, your questions answered. 5th ed.
[iv] Jean Twenge. (2013) The impatient woman’s guide to getting pregnant.
[v] Caitlin Moran. (2012) How to be a woman.
[vi] L. Hoggart and V.L. Newton. (2013) Understanding LARC Adherence: an in-depth investigation into sub-dermal contraceptive implant removal amongst young women in London, funded by the London Sexual Health Commissioning Group.
Further reading
Ofsted. (2013) Not yet good enough: personal, social, health and economic education in schools.
Department of Health. (2013) A framework for sexual health improvement in England.
Now I know that Sex and Relationships Education teachers don't have much time, and that many schools don't even do SRE. So this might be a tall order, but anyway, here’s what I think young people should know:
1. Lady liquid isn't just cleaning fluid
Discharge is a pretty good place to start a discussion about fertility.
I think it’s fair to say that boys and men are – or become - very familiar with what usually comes out of their penis. For them there is no mystery in the routine message that people should visit the sexual health clinic or GP to check for an infection if they experience any unusual discharge.
It’s different for girls, and for many women. What comes out of their vaginas can be a potentially embarrassing and confusing business.
Periods are one thing – and fortunately a routine part of sex education in most primary schools. It’s pretty radical that women shed the lining of a key organ every month or so. No girl should be scared or shocked when their periods start.
What comes out of vaginas the rest of the time is trickier. For one thing there’s lots of confusion about what to call it. A discussion about that might fit well with one about other important terminology like vulva and clitoris.
Vaginal discharge might be the medically correct term but discharge is not the greatest word for helping anyone to feel comfortable about their body. It sounds like something that oozes from a wound, not a natural and normal thing. Mucus isn’t much better.
Vaginal fluid isn’t a bad description, but perhaps shrouds the origins of most of the fluid (the cervix) in a bit too much mystery. Cervical fluid or cervical secretions are more accurate alternatives, but they do sound a bit formal and I love that there’s friendlier terms around. Lady liquid, cooch juice, gloop…I’ll let you carry on with that train of thought…
Back to the main issue. Lady liquid isn’t just about cleaning fluid.
Of course it's great to get out the message that vaginas are self-cleaning - I personally won't be happy until every last douche manufacturer goes out of business - but vaginal fluid/discharge does more than clean the vagina and make sex more slippery, it also makes the vagina friendly, or unfriendly, to sperm.
This means that (unless you’re using hormonal contraception) there will be a few days each cycle when a thick, clear and stretchy substance a bit like raw egg white – sometimes lots of it – comes out of your vagina.
This egg white is a sign that a woman is extra fertile. It is produced by the cervix – the entrance to the womb - so it’s called cervical fluid. It appears when a woman's body is about to release, or has just released, an egg. It acts like a “sperm motorway” helping to speed up the sperm’s journey to an egg.
It is still possible to get pregnant from sex when the most fertile cervical fluid isn’t about.
Fertile cervical fluid can be white, creamy or sticky. This is like a “hang-around” fluid for sperm. It means that sperm can hang around for up seven days waiting for the egg to make its entrance.
Once girls and women get used to noticing what is normal for them in terms of discharge (including arousal fluid), they’re far less likely to be confused or embarrassed and far more likely to know when it’s time to visit the doctor or sexual health clinic.
2. Women are not fertile for every day of their cycle.
Telling young people about fertile and very fertile cervical fluid means they could realise that they have days when they don’t notice any cervical fluid and so might not be fertile.
Some will be concerned that this knowledge will encourage risk taking and increase unplanned pregnancy, but maybe letting young women know that they are not fertile for every day of their cycle could be a good thing.
Think of the money and worry that might be saved on ovulation kits and even IVF later in life if more people knew what fertile cervical fluid looked like.
Not to mention the unplanned pregnancies that could be avoided by those who currently assume that they are infertile because they had unprotected sex without getting pregnant[ii].
Telling young women that they’re not fertile every single day of the month shouldn’t stop them using emergency contraception if a condom breaks, but it could save them worrying that they're infertile.
No one wants to encourage risk-taking, so children and young people should be told that it's not easy to know exactly when you are fertile. It’s not rocket science, it’s something you can learn – that’s what natural family planning is based on – but guessing is not a good plan.
One reason to avoid risk-taking is that teenage cycles are often very irregular. They can change from 22 days to 38 days or longer without warning.
Even once cycles have settled down, they vary from person to person and from cycle to cycle, especially if a woman is stressed or ill. A regular 28 day cycle is pretty unusual.
3. Sperm is not kryptonite, but it can linger.
It's much easier to pick up an infection - including a sexually transmitted infection - than it is to get pregnant.
Posts like this one from the wonderful Bish UK suggest that there are some misinformed people out there.
Sperm is not kryptonite. Unlike the flu virus, it can't stay alive on your hands. It can't crawl through your underwear and swim up your vagina. If some gets on a hand and that hand goes near a vagina it is very unlikely, not impossible but VERY unlikely that the woman will get pregnant.
But, but, but. If a sperm gets into a vagina during sexual intercourse, then it can speed its way to an egg in one minute flat - if the egg is there (remember, it's only there for one or two days). Or sperm can hang around for up to seven days waiting for it to appear. Yup, seven days. That's why sex before the egg appears (ovulation) is more risky than sex after ovulation.
4. Withdrawal isn’t brilliant but it is way, way better than nothing.
I don’t recommend pulling out for anyone keen to avoid pregnancy, but the reality is that people have different motivation levels and different views on risk and unplanned pregnancy.
Withdrawal relies on a very cooperative and self-controlled partner, and isn't a method to use when there’s fertile cervical fluid about, but it has been associated with some of the lowest birth rates in history, for example in Eastern Europe after the Second World War.
Telling young people that withdrawal doesn’t even count as a contraceptive method is deeply unhelpful.
As Professor Guillebaud[iii] (contraception guru) says “It is unfortunate that many unplanned pregnancies among young people having intercourse unexpectedly are probably caused by the conventional teaching of doctors and nurses. Withdrawal is not even attempted…because the message that it is “ineffective” has been so well conveyed.”
So if someone has got “carried away” and not used a condom it IS still worth pulling out. It’s not the greatest method of contraception but it’s considerably better than nothing.
5. Aim to complete your family by the time you’re 40
There might also be a place in sex education for discussing what age to have babies. The ideal might be to have children before the age of 35, but people’s lives don’t always work that way and the decline in fertility after the age of 35 may have been overstated if the abortion rates for those aged 35 and over are anything to go by[ii]. A more realistic and helpful message might be to encourage women to aim to complete their families by the age of 40[iv].
6. Different contraception suits different people at different stages in their life.
Some people think that because I’m a fertility awareness practitioner I must have a secret plot to persuade the entire world to use fertility awareness based contraception. The truth is that I just want women to be happy with their method of contraception, and to have a proper choice.
I’ve met plenty of women who are very happy with the pill or their Mirena or IUD and that’s brilliant. It’s also no surprise that many women want the “contraceptive equivalent of Trident[v]” after an abortion, but not everyone wants – or gets on with - the standard options.
Different contraceptive methods suit different people at different times in their life. Choice isn't just about getting people to use the methods that we find acceptable.
We need to give women more options and respect their bodily autonomy. A recent study of young women in London who had stopped using the contraceptive implant found that some of them had to return to their healthcare professional up to three times in order to get it removed. Trying to persuade young women to persevere with a method that isn’t working for them can lead to a breakdown in trust and make them less likely to use other methods of contraception[vi].
Too Much Information?
For all sorts of reasons, some people will find this list too much to handle. They might think "better safe than sorry", that a few unneccessary trips to the doctor about vaginal "discharge" are no big deal. They might think it is unethical to inform people about "less effective"* and less easily prescribed methods of contraception, and that unplanned pregnancy must be avoided by whatever means necessary.
They might say it's tough enough getting schools to do any sex education, that presenting a list like this could put them right off. Better to keep things simple.
They could be right. I don't work in schools, I haven't carried out a controlled trial to test these views, but the young women I've worked with make me believe that more could be done to raise young people's knowledge of their fertility and their contraceptive options.
Resources
- Female Fertility Explained by Bish UK. Pretty good except...see my comments below the line.
- Cycle Savvy. The Smart Teen's Guide to the Mysteries of her body (book)
- Withdrawal (Pull-out method) - Planned Parenthood (US)
* Fertility awareness (natural family planning) is up to 99% effective (according to the fpa), so long as it's done right. It works best when taught by a specialist (and that's not just me saying that, that's the fpa).
____________________
References
[i] Brook.(2014) Sex and Relationships Education Supplementary Advice.
[ii] BPAS. (2014) UK: Abortion and contraceptive failure. BPAS Reproductive Review.
[iii] John Guillebaud. (2009) Contraception, your questions answered. 5th ed.
[iv] Jean Twenge. (2013) The impatient woman’s guide to getting pregnant.
[v] Caitlin Moran. (2012) How to be a woman.
[vi] L. Hoggart and V.L. Newton. (2013) Understanding LARC Adherence: an in-depth investigation into sub-dermal contraceptive implant removal amongst young women in London, funded by the London Sexual Health Commissioning Group.
Further reading
Ofsted. (2013) Not yet good enough: personal, social, health and economic education in schools.
Department of Health. (2013) A framework for sexual health improvement in England.