 | "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.
I know Sex and Relationships Education teachers don't have much time, and many schools don't even do SRE. So this might be a tall order, but here’s what I think young people should know:
1. Vaginal fluid is more than cleaning fluid
The message that vaginas are self-cleaning is important. I won't be happy until every last douche manufacturer goes out of business, but vaginal fluid 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 the official name is either cervical fluid or cervical secretions (though I prefer vaginal fluid).
This extra fertile fluid appears when a woman's body is about to release, or has just released, an egg. It acts like a “sperm motorway” and helps sperm speed along to an egg.
Other fluid can get you pregnant as well - mainly by making the vagina a sperm-friendly place.
This sperm-friendly, fertile cervical fluid appears before the extra fertile kind and can be white, creamy or sticky (like hair conditioner or handcream). This kind of fluid means sperm can survive in a vagina for up seven days (I know) waiting for the egg to be released.
Once girls and women get used to noticing what is normal for them in terms of fluid (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.
2. Think about language
There's some fairly neutral and even affectionate and fun terms for what comes out a penis during sex - ejaculate, spunk, cum, semen, seminal fluid, jizz. All that.
The most routinely used terms for what comes out of vaginas - discharge and mucus - are not so great.
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.
Cervical fluid or cervical secretions are more accurate alternatives - the fluid does come from your cervix, but they sound a bit formal.
We want girls and women to be comfortable with their bodies and language is an important part of that.
My preferred term is vaginal fluid - or simply fluid. It's good to see that being used more and more.
I also love that there seems to be an increasing number of more affectionate terms around. Lady liquid, cooch juice, even gloop.
What terms are folk using? A discussion of this would sit well with one about all those other important words, like vagina, vulva and clitoris.
3. 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 might worry 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 maybe even IVF 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 fails, but it could save them worrying that they're infertile.
4. Fertility awareness can work as contraception - once your cycles have settled down.
The world has changed. Period tracking, fertility and contraception apps mean the cat is out of the bag.
Women and girls know that they are not fertile every day of their cycle.
The tricky bit is getting those days right. Many apps will confidently announce exactly when someone is fertile or infertile - based on nothing more than day one of their cycle.
Some of those apps are reasonable, and some aren't, but they are not ideal for teenagers as their cycles are often very irregular and can change from 22 days to 38 days or longer without warning.
So under 18s should not use fertility awareness as contraception. But they should not be scared off it either.
It is not for everyone but fertility awareness can work very well if you do it right. It also helps if your cycles don't vary by more than seven days - and you know how to use condoms.
I'd love some of the basic biology and maths behind it to be taught in school.
It would help people to understood more about the contraceptive apps and devices that are out there. And knew why they might be entirely reliable.
So many of the women and men that I see are angry that they didn't learn anything about the method in school.
It would be good to fix that.
5. Sperm is not kryptonite, but vaginal fluid is kind of magical
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 Bish 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 close to a vagina when that extra fertile fluid is about then it is possible for pregnancy to occur. Unlikely but possible - this is how "contact pregnancies" occur.
Which is another reason to know about vaginal fluid.
6. Pulling out isn’t brilliant but it is way, way better than nothing.
I don’t recommend pulling out or withdrawal for anyone keen to avoid pregnancy, but the reality is that people have different motivation levels and different views on risk and unplanned pregnancy.
Pulling out relies on a very co-operative and self-controlled partner, and isn't a method to use when there’s fertile 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 pulling out 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 yes pulling out is not brilliant but it is way, way better than nothing.
7. 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].
8. Different contraception suits different people at different stages in their life.
I am a fertility awareness practitioner but I do not believe everyone should use fertility awareness based contraception. 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 some 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 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?
Those I've worked with, and my daughter, have made me believe that more could be done to raise young people's knowledge of their fertility and their contraceptive options. But what do you think? Are these reasonable requests or irresponsible ones? It would be good to hear your thoughts - email sarah@befertilityaware.co.uk
____________________
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.
__
Revised May 2019
I know Sex and Relationships Education teachers don't have much time, and many schools don't even do SRE. So this might be a tall order, but here’s what I think young people should know:
1. Vaginal fluid is more than cleaning fluid
The message that vaginas are self-cleaning is important. I won't be happy until every last douche manufacturer goes out of business, but vaginal fluid 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 the official name is either cervical fluid or cervical secretions (though I prefer vaginal fluid).
This extra fertile fluid appears when a woman's body is about to release, or has just released, an egg. It acts like a “sperm motorway” and helps sperm speed along to an egg.
Other fluid can get you pregnant as well - mainly by making the vagina a sperm-friendly place.
This sperm-friendly, fertile cervical fluid appears before the extra fertile kind and can be white, creamy or sticky (like hair conditioner or handcream). This kind of fluid means sperm can survive in a vagina for up seven days (I know) waiting for the egg to be released.
Once girls and women get used to noticing what is normal for them in terms of fluid (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.
2. Think about language
There's some fairly neutral and even affectionate and fun terms for what comes out a penis during sex - ejaculate, spunk, cum, semen, seminal fluid, jizz. All that.
The most routinely used terms for what comes out of vaginas - discharge and mucus - are not so great.
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.
Cervical fluid or cervical secretions are more accurate alternatives - the fluid does come from your cervix, but they sound a bit formal.
We want girls and women to be comfortable with their bodies and language is an important part of that.
My preferred term is vaginal fluid - or simply fluid. It's good to see that being used more and more.
I also love that there seems to be an increasing number of more affectionate terms around. Lady liquid, cooch juice, even gloop.
What terms are folk using? A discussion of this would sit well with one about all those other important words, like vagina, vulva and clitoris.
3. 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 might worry 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 maybe even IVF 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 fails, but it could save them worrying that they're infertile.
4. Fertility awareness can work as contraception - once your cycles have settled down.
The world has changed. Period tracking, fertility and contraception apps mean the cat is out of the bag.
Women and girls know that they are not fertile every day of their cycle.
The tricky bit is getting those days right. Many apps will confidently announce exactly when someone is fertile or infertile - based on nothing more than day one of their cycle.
Some of those apps are reasonable, and some aren't, but they are not ideal for teenagers as their cycles are often very irregular and can change from 22 days to 38 days or longer without warning.
So under 18s should not use fertility awareness as contraception. But they should not be scared off it either.
It is not for everyone but fertility awareness can work very well if you do it right. It also helps if your cycles don't vary by more than seven days - and you know how to use condoms.
I'd love some of the basic biology and maths behind it to be taught in school.
It would help people to understood more about the contraceptive apps and devices that are out there. And knew why they might be entirely reliable.
So many of the women and men that I see are angry that they didn't learn anything about the method in school.
It would be good to fix that.
5. Sperm is not kryptonite, but vaginal fluid is kind of magical
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 Bish 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 close to a vagina when that extra fertile fluid is about then it is possible for pregnancy to occur. Unlikely but possible - this is how "contact pregnancies" occur.
Which is another reason to know about vaginal fluid.
6. Pulling out isn’t brilliant but it is way, way better than nothing.
I don’t recommend pulling out or withdrawal for anyone keen to avoid pregnancy, but the reality is that people have different motivation levels and different views on risk and unplanned pregnancy.
Pulling out relies on a very co-operative and self-controlled partner, and isn't a method to use when there’s fertile 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 pulling out 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 yes pulling out is not brilliant but it is way, way better than nothing.
7. 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].
8. Different contraception suits different people at different stages in their life.
I am a fertility awareness practitioner but I do not believe everyone should use fertility awareness based contraception. 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 some 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 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?
Those I've worked with, and my daughter, have made me believe that more could be done to raise young people's knowledge of their fertility and their contraceptive options. But what do you think? Are these reasonable requests or irresponsible ones? It would be good to hear your thoughts - email sarah@befertilityaware.co.uk
____________________
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.
__
Revised May 2019