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Abstract
Clinical sexual health consultations with young women often focus on avoiding ‘risks;’ namely pregnancy and sexually transmitted infection transmission. They also typically fail to explore how contraception use can impact on the capacity to enjoy sexual relationships. In contrast, this paper argues that sexual pleasure should be a starting point for all sexual health consultations and education work with young people. Drawing on our experiences of working for a UK sexual health charity for young people we suggest that excluding pleasure from sexual health consultations creates its own risks. A pleasure deficit model not only detracts from a full and frank exploration of sexuality, which is bound up with notions of sexual subjectivity and agential practices, but can also limit concerns regarding the adverse effects of contraception such as loss of libido. Using the example of long acting reversible contraception we note there is a tendency to privilege adult/‘expert’ advice over young women’s bodily knowledge. We also indicate how silence and discomfort regarding sexual pleasure may confound contraceptive consultations, for example in the case of emergency hormonal contraception provision. Establishing sexual pleasure as a starting point will provide a broader, positive and less risky focus on sexuality and sexual health.
Notes
1. For examples see Free, Lee, and Ogden (Citation2005), Brown and Guthrie (Citation2010), Suvivo, Tossaveinen, and Kontula (Citation2009), Hoggart and Newton (Citation2013), and Cheung and Free (Citation2005).
2. This is articulated in the NHS Constitution. See the Choice Framework (2014) www.nhs.uk/choiceintheNHS.
3. Although our focus is on UK practice, similar drives for LARC are observable in countries such as the USA. For example, see Higgins (Citation2014).
4. The contraceptive injection lasts for 12 or 13 weeks and thickens the mucus in the cervix, stopping sperm reaching an egg. It also thins the womb lining and, in some, prevents the release of an egg. The sub-dermal implant lasts for three years and stops the release of an egg from the ovary by slowly releasing progestogen into your body. Progestogen thickens the cervical mucus and thins the womb lining. This makes it harder for sperm to move through the cervix, and less likely for the womb to accept a fertilised egg. Intrauterine contraception comprises the intrauterine device (IUD) made from plastic and copper, as well as the intrauterine system (IUS) which releases progestogen (www.nhs.uk).
5. The Quality Outcome Framework is a voluntary annual reward and incentive programme for general practice surgeries in England. This LARC indicator (CON003) has been retired since the distribution of 2014/2015 QOF as increases in LARC uptake have been cited to signify that recommending LARC is now suitably integrated as part of good practice. See: http://www.networks.nhs.uk/nhs-networks/london-qof-network/documents/QOF%20Guidance%20The%20Green%20Document%202009-2010_Final.pdf.
6. The Faculty of Sexual and Reproductive Healthcare is a UK based organisation that provides a clinical advisory service, publishes the Journal of Family Planning and Reproductive Health Care and grants diplomas, certificates, fellowships and equivalent recognition of specialist knowledge and skills in sexual and reproductive health care. See http://www.fsrh.org/.
7. The coil refers to two methods; the IUD made from plastic and copper as well as the IUS which releases progestogen (www.nhs.uk).
9. See, for example, Jolly, Cornwall, and Hawkins (Citation2013); www.bishtraining.com and www.thepleasureproject.com.
10. Emergency contraception refers to two methods of preventing pregnancy which can be taken post-unprotected sex. These are, the IUD which prevents fertilisation or implantation and two forms of pill; Levonelle and EllaOne which delays ovulation (www.nhs.uk).