Reports of the death of adolescent sex are premature. Some pundits point at falling teenage pregnancy rates and conclude that young people shun physical contact in favour of phone sex, solo porn use, or other non-contact sports. But high sexually transmitted infection (STI) rates among young people suggest that actual IRL sex is alive and (un)well.
Of course the landscape has changed, adding rising rates of syphilis and gonorrhoea, antimicrobial resistance and new STIs to work previously focused on chlamydia. There are potential new challenges from the impact of anonymous sex via dating apps; less safe sex practices in the context of chemsex; early access to pornography that largely lacks representation of condom use or consenting safer sex, and more.
It remains a challenge to both destigmatise and encourage testing and treatment, while also finding strategies to address these new behaviours and actively promote and prioritise primary prevention through condom use.
All this is happening within the context of, what the Terrence Higgins Trust and British Association for Sexual Health and HIV’s State of the Nation report describes as, ‘brutal cuts’ to public health funding and sexual health services. Our own young people’s specialist services are cut year on year, pushing young people into overstretched all-age services, or endless waits for GP appointments.
Can Relationships and Sex Education (RSE) be the answer to sexually healthy young people?
When people think about STI education they wince at the thought of magnified microbes blown up on classroom whiteboards, or worse still, gory pictures of infected genitals. Not only is that bad practice, but it suggests that STI prevention is simply a clinical issue.
If we want young people to become young adults with more ability to prevent STIs, we need to do important foundational work within a holistic RSE curriculum from the earliest years of school, and then through every stage of their school life.
This work includes understanding and celebrating the diversity of our bodies and what they can do, along with an appreciation that this is your body for life and needs to be healthy for you to enjoy life.
We must embed understanding of consent and bodily autonomy, including that your body is yours and only you decide who touches it and how it is touched, along with the communication skills to talk about what you want and how you feel. All the information and health promotion in the world will not impact if young people are too embarrassed, ill-equipped or scared to negotiate in sexual relationships: to refuse unwanted sex, or to insist on condom use.
RSE must be LGBT and disability inclusive, focusing on the common elements that all good relationships share, regardless of people’s sexuality, gender identity or bodies. Hearing positive messages about healthy relationships helps to stop people internalising the shame and prejudice that reduces their ability to care for themselves and makes them more vulnerable to coercion or abuse.
Also important are the clinical aspects of STIs and STI prevention, understanding risk behaviours, knowing about different STIs, their symptoms and outcomes and how STIs may present or when to get tested, how clinics work, and young people’s rights to confidential, respectful treatment.
Until RSE is recognised as a specialist subject, with teachers opting into it at the point of initial teacher training, we cannot expect all those delivering RSE (potentially any teacher in a school) to be knowledgeable or confident enough to teach the more challenging lessons on sexual behaviour and sexual communication or the clinical aspects of RSE. It is vital that funding is made available to support external sexual health experts into schools to address some of this information.
Young people have the potential to be tomorrow’s sexually healthy adults, with the shared values, knowledge, skills and confidence to have consenting, wanted, enjoyable and safer sex – seeking timely help from clinical services when needed. With a new budget coming soon and a sexual and reproductive health strategy in the pipeline, our message would be that investing in young people’s education and their clinical services is crucial. It will be time and money well spent.