Teaching consent

Sexual health educators have been teaching about consensual and non-consensual sexual activity for decades.  Despite gains made by the women’s movement since the late 1960s, sexism is far from eradicated.  Rape culture, although under scrutiny and challenge, is still the norm.  Sexual harassment and assault are as common as dirt.  How can we make a fundamental change in our society through education?

If all genders are not on board with the concept that consensual sexual activity is enjoyable and fulfilling, we will not make any headway.  If boys and men in particular are not included as allies in this struggle, classroom education will remain no more than an exercise.

I created a lesson plan about sexual assault at least 20 years ago which continues to be used by former colleagues.  It is a two part activity.  In the first part, the facilitator reads a series of statements and asks students to agree, disagree or indicate that they are not sure; in the second part, students work in small groups and read through two scenarios, one told from a girl’s point of view where it is clear there was no consent; and the other from the boy’s.  Then they answer questions on the board which are later discussed by the whole group.

One of the statements in the first part, “It is OK to say no at any time” (during sexual activity) provoked a grade 8 boy to insist that once you had initiated sexual activity, you couldn’t stop.  I asked the class why someone might want to stop (fear, pain, flashback, changed their mind etc.), but this kid wasn’t budging.  So I said, “Suppose you’re on top of her and you can see that she is in pain”.  He said, “Turn her face away”.

That is an unusual response from a 12 year old, but indicative of the far end of the consent spectrum; viz., a total lack of empathy and clear exercise of power.

After each group reads their story, I read them both out loud, where it becomes clear that what happened was not consensual.  I remind them that there are medical issues that need to be explored (Emergency Contraception, Sexually Transmitted Infection testing) psychological/emotional issues (the need for counselling since most people blame themselves after an assault) and legal issues.  Because the stories are written in a way that demonstrate a miscommunication based on the popular cultural ideas we explored earlier, exacerbated by alcohol, I suggest that if the police came to this boy’s door and said they were investigating a sexual assault, he would probably say, “Who got raped?”  We end the class by brainstorming how it could have been prevented.

Gray zone

Girls and women are still seen as gatekeepers in heterosexual relationships.  In spite of the current support for affirmative, ongoing consent, it continues to be difficult for a girl/woman to live this new norm.  Societal ambivalence rules: is it really OK for women to want sexual activity and say yes to it?

I remember teaching that to say no, it is important that tone and body language be congruent; i.e., to say no in a way that is clear and unequivocal.  But no to what?  No means no to a particular sexual activity at a particular moment in time.

People are complicated and so are their desires – they can change during the course of any sexual encounter.

In a more sophisticated discussion with older students, this can be illustrated with a continuum: from enthusiastic mutual consent to playful seduction; to giving in; to coercion; and to forced sexual contact.

People may move back and forth along the continuum from mutual consent to playful seduction during a single or multiple encounters.  One may not initially want to engage in a particular sexual activity, but could become interested.  There is a difference between talking someone into it and turning them on.

There is also a difference between hearing no and ignoring it.  We are familiar with the power dynamic and the culture that facilitates this crime.

For boys/men, saying no to sexual activity with girls/women may be difficult for other reasons.  Society tells them never to refuse what is handed to them on a silver platter.  Women who sexually assault men are more likely to use shame and coercion than force for obvious reasons.

Same gender assault involves many of these same dynamics.

Politics and pedagogy

We want affirmative, ongoing consent to become the norm.

We detest rape culture and want it eradicated.  We are appalled when images and videos of assaults are posted as entertainment.  Good pedagogy includes teaching empathy for survivors in order to eliminate this ghoulish feasting on others’ misery.

While it is useful to explore the underlying ideas that lead to assumptions, miscommunication and/or predation – a simple unpacking may be preferable to political rhetoric.

In their fervour to drive home the harmful outcomes of rape culture, some educators are using materials that are more likely to alienate the boys and young men in the classroom than to enlist them as allies.  We want them to accept the premise that there is an advantage to mutuality in relationships.  I read recently that consent culture is a resistance movement to rape culture.  It is a lot to ask for young men to see themselves as freedom fighters against rape culture and sexual assault.

I think Wiseguyz is on the right track in the way they address young men directly.  There are also some excellent public campaigns like the one from Norway “Dear Daddy” and New Zealand’s “Who are You?” that bring home these messages in a simple, clear and direct manner that appeal to the positives.

Because good lessons on consent and sexual assault are so hard to come by, well thought out print materials can play a role.  I would love to see a good pamphlet which includes the language of consent and refusal as a guide for young people to take home.

There is work to be done.

 

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Birth Control: is it in you?

At a recent meeting of the Sexual Health Network of Ontario, health care providers came together to examine and extol the virtues of the Intra Uterine Device (IUD).  The IUD is a plastic device wrapped with copper that is inserted into the uterus.  I have always been a proponent of this method of birth control, especially for women looking for an alternative to hormonal methods.

The IUD had to overcome a terrible reputation from the bad old days of the Dalkon Shield.

I remember the Shield well.  I was a very young married woman when I had one inserted.  I complained to my gynecologist that I had ongoing pain on one side which lasted several days a month.  It felt like there was a plumb line attached to my ovary.  It wasn’t until returning from overseas that I had it taken out – or rather dug out – because that’s what it felt like.  The little claws were embedded in my uterus.

It was a deadly device.  The Dalkon Shield’s strings acted like a wick, drawing bacteria into the uterus, causing infections – and in nearly two dozen cases in the US – death.  The deaths in developing countries continued as “developed” countries offloaded their products abroad.

However, in the early 1980s, long after the discredited Shield had tarnished the reputation of all IUDs, new research indicated that the newer copper IUDs were both safe and effective and, in particular, did not cause ectopic pregnancies.  It also became clear that they functioned as a true contraceptive by creating an unfriendly environment in the uterus which repelled sperm.  This opened the door to women who had worried it was an abortifacient.

Copper IUDs

Dr. Sarah Warden from the Bay Centre for Birth Control updated our information on IUDs.  Copper IUDs are 99 – 99.8% effective.  In those rare cases where pregnancy occurs with an IUD in place, the pregnancy can continue as long as it is not ectopic.  Statistically, pregnancy outside the uterus is more likely with an IUD; but given its high effectiveness rate, the risk is very low.  A copper IUD can usually be removed if there is a pregnancy; but that would increase the risk of miscarriage.

A woman with average or no cramps and average bleeding is a good candidate.  She can expect a 10 -20% increase in cramping and bleeding with a copper IUD.  Counselling has changed over the years with regard to multiple partners.  Health care providers were concerned about untreated Sexually Transmitted Infections (STIs) causing Pelvic Inflammatory Disease (PID) with an IUD in place.  However, now STIs can be treated without removing the IUD; although, clearly, a woman with more than one partner is encouraged to use condoms.

Adolescents and women who have not been pregnant can also use the IUD.

Copper IUDs can also be used as emergency contraception up to seven days after unprotected intercourse.

There were a number of questions asked during the presentation; for example, the reason why some IUDs can stay inside the uterus longer than others.  Copper IUDs vary in the number of years they can stay in place: 3, 5 or 10 years.  The main difference between one copper IUD and another is the quantity of copper used.  Although Nova-T is a five year IUD, one practitioner said that they do not use it beyond 30 months because, after that point, they have found an increased risk of pregnancy.  10 year IUDs are larger and more difficult to insert and may cause more cramping on insertion.

The only contraindications to the use of a copper IUD include allergy to copper or other components of the IUD, pregnancy, endometriosis, an abnormally shaped uterus, very heavy bleeding or cramping; or active Pelvic Inflammatory Disease. There are a few risk factors, like perforation of the uterus with insertion, but perforation is rare and the uterus often repairs itself.

Intra Uterine System (IUS)

This progestin-releasing device can assist women with severely heavy bleeding as well as women with endometriosis .  By three to six months, most women who use Mirena (the first IUS on the market) experience dramatically reduced bleeding.  About one third of women will stop having periods after 12 months.

Because it uses the synthetic progestin levonorgestrel, it causes similar effects to Depo Provera which also uses a synthetic progestin; i.e., changes in the cervical mucus and uterine lining, making it harder for sperm to reach the uterus.  And similar to Depo Provera, there may be side effects, including:

  • bleeding and spotting between periods
  • heavier bleeding during the first few weeks after device insertion
  • headache/migraine
  • nausea
  • bloating
  • breast tenderness or pain
  • weight gain
  • changes in hair growth
  • acne
  • depression
  • changes in mood

As always, it is important that health care providers explain fully what a woman may expect.

I learned about some newer IUS devices aside from the more commonly known Mirena: Jaydess, a smaller, low-dose version, good for three years; and Kyleena, which releases the lowest dose of hormones for the longest amount of time.  Mirena has the highest dose of progestin of the three and is approved for five years, although data indicate it is effective up to seven.

The IUS can cause spotting for two to six months.  During the presentation, I had noticed two Orthodox Jewish women and a Muslim woman in attendance.  I made a comment about my birth control counselling at clinic regarding spotting.  Because there may be religious strictures about having intercourse in the presence of blood, I always made sure that women for whom this was an issue were well informed.

Speaking of blood, there was an interesting discussion around using a menstrual cup with the IUD.  Because of the suction on the vaginal walls with a cup, to avoid expulsion it is best to gently break the suction before removing the cup.  Another precaution would be not to use a menstrual cup for two months after an IUD insertion because the risk of expulsion is highest in those first two months.

The copper IUD is an excellent choice for women who want long-term, safe and effective contraception, but prefer not to use hormones.  Make sure that your health care provider has plenty of experience with insertion.