If I Speak - 90: Are rightwing politics affecting my sex life? w/ Dr Annabel Sowemimo

Episode Date: November 25, 2025

We’re in Manchester tonight (25 November) with Lanre Bakare, author of We Were There – final tickets available from Contact Theatre! Then EartH in East London on 16 December with Jordan Stephens ��� get tickets from Dice. This week Moya and Ash talk to Dr Annabel Sowemimo about STI stigma, period-tracking apps, being disconnected from […]

Hello. Hello, hello everyone. Ash, are you there? Who can really say, if I'm here or not? In body, yes. In spirit, also yes. in mind. Not sure if I have one anymore, so help me, help me lock in. Why am I locking in? What special reason do we have to lock in? Well, we've actually recruited someone to do the mind bit for you. So we've got a guest today. We have a guess. I will introduce her briefly. So, Amo is a doctor, activist and writer, as well as being a sexual and reproductive Health Registrar in the NHS. She's also the founder of a community-based organization called Reproductive Justice Initiative.

And Annabelle, you're the author of Divided, Racism, Medicine, and Why We Need to Decolonize Healthcare, which is a fantastic book that I have read and do own, and in about three days I will have back with me because all my books are coming back into my possession. And you happen to be here today in the If I Speak Studio. Welcome. Thank you. you so much for having me and also I am now a consultant as well um yeah for the yeah for the last

couple of years I've been a consultant actually I went on Matley but yeah what you cannot see is that as well as Annabel being hugely um intelligent and qualified and well regarded in her field she has the best skin of anyone I've ever seen in my life I mean the radiance levels through the screen and you're telling me that as well as having a natural glow which could guide ships into harbour if you were put on a headland, that you've been made a consultant. I just think somewhere there is a South Asian auntie being like, see, you can be a doctor and beautiful as well.

Why are you neither? You know? I've got a lot of Nigerian aunties in the game that have been doing exactly that. But, you know, I'm very committed to saying that you can't juggle all of the things all of the time. So if the skin is glowing, something somewhere else is crying. Okay. Something is crumbling. I think that's so true. It's very funny as well that like beauty is, I mean, it's always

been such a pillar of things that we've had to upkeep. But it's interesting how much of my energy, like I'm looking at my work schedule and I'm like, I have to keep up with the gym as like top priority and then work. And it's like, well, what about the other things that I can be focusing? I'm like, no, no, no, it's these two, but those things will have to be. You cannot do it all. You absolutely can't do it all. You cannot. And I learned this the hard way again on the weekend because I just got back into running like I like boxing haven't been doing much of it I signed up to a half marathon in March I was like I gotta get back on the running and I went for like a like not even a long run for me like maybe like a five six k and I got back and I was like I'm out for the day like I'm

done that work that was supposed to happen is not happening anymore so you're either exercise or your work in my life and it's so true it takes me like two hours at the gym and then afterwards I'm like well I'm not doing any of the work that I was going to do now because it's done, I'm mentally done. Anyway, anyway, we have some questions. We're getting to know you too quickly because Ash has prepared some actual getting to know you questions in our segment, which is Ash.

73 questions minus 70. In the spirit of Condon asked 73 questions, but for an if I speak attention span, we have three quick fire questions for you. So, because of your work in the field of sexual and reproductive health, you may detect a little theme here. Question one, what in your view is the sexiest song? Oh, my God, this is going to be terrible. Like, I have to be honest, I am so mad with music.

Okay, this, I can't even think of one. It's probably like something like, I don't know, Davido related, and this is not quick. but I just love the genre of Afro beats particularly like the early Afrobeat genre early Wiz kid where they literally just like a banana they're like banana fall on you like you're just like amazing you're like hotter than pepper you are the sweetest spice of life I just think

the early Afro beat genre was great for me it's just like if you ever want a confidence boost that's it do you look at yourself sometimes and you know be like how am the sweetest spice of life. I am. You know, yeah, yeah, you have to, you have to believe in your own source sometimes and Afrobeet Swam. I was talking to some the other day about, you know, sexy songs and songs that you put on when you might be about to engage in sexual activity. And they, and they said to me, because I have like a playlist, which is for me feeling sexy and then I have

songs that I put when I'm actually going to have intercourse or maybe close to intercourse. And they went, is Solonjongon? I went, obviously, yeah. And they told me a story about how they brought someone back to the house. And they were going to get down to it. And they put Solange on and they just heard their housemate burst out that thing next to all. Because it was such a cliche to have Solange on when they were getting down to business. And I was like, okay.

A friend of mine was asked me to make them a sex playlist because of my impeccable taste in music. So I did. And as a joke in the. the middle, I put Paul Simons, you can call me out. So it was like sexy song, sexy song, sexy song, and then da-da-da-da-da-da-da-da-da-da. This is why I would never trust you with my intimate life. I mean, I kind of hard relate because I'm one of those people that I've never been like a playlist kind of person. I literally just like, let's just put on the whatever was on there and let's go and we might get a bit of a bit of a weird interlude.

You might get you can call me out. Wait, did the Paul Simon. Did you call me out while they were having sex? They've, yeah, yeah. What happened? Yeah. They found it very funny. They were like, I could explain. This is my friend's doing.

That's upset. I mean, the best sex you're having, you're laughing, right? Yeah, you are laughing, but preferably, like, if you're listening to DiAngelo and, you know, you can have a bit of laugh within that context. And then suddenly, da, da, da, da, da, heads are raised. things stop happening. I would, they'd laugh, but maybe you laugh in too much. Anyway, anyway, great question. This friend should have known that I have a prankster spirit.

Okay, question two. Yeah. What is the sexiest item of clothing? And I'm going to clarify, it must be an item of clothing that is still sexy if it is the only thing that someone is wearing. So, you know, a t-shirt might be sexy, but if someone's only wearing the t-shirt, it's become a bit Winnie the Pooh. I was not saying.

I was not saying. so do you mean that i i like on someone else or like on on my person you you may answer however you see fit i mean i i mean no clothes is probably the way to go right like i mean that's the sexiest thing like for me a bit of let's just get right down to nudity um No playlist, no clothes. I'm straight shooter. Let's just get to it. What's all this lingerie about?

Why boxes? Just take it off. Let's see whether the substance is, you know. I have to say, like, you know, if somebody, a nice pair of like boxes can be kind of, kind of you know cute but like no i'm just like just wrap it all up just get to the nakedness actually that is the true efficiency of a doctor yeah just that's that is a medical professional let's get let's get to the real the real meat of the matter just get the underwear off get to the

get to the substance ashes what's yours what's your sex of his clothing oh what's my what's the sex statum of clothing um i i would answer this in a gendered way in a gendered way i think if you are you know, someone who identifies as a woman, naked, apart from a pair of shoes, I mean, that's hot. And it kind of doesn't matter what the shoes are. It's always, always sexy. So you could be wearing, for the sake of argument,

you know, like Monsters Inc slippers, right? She's still going to be sexy. Naked but for a pair of shoes. Very sexy. For a gentleman, or anyone who defines themselves as a gentleman, naked but for a pair of boxes, obviously. That's an obvious one, but I do find something endearing also about a man who is naked apart from a pair of socks. There's a sort of inherent silliness there, which I find, I then find sexy.

Can't explain that. Socks. Do they have to be matching? Yes, yes. I mean. Okay, okay. So if they're not matching that might be a bit of a turn off. And there can't be gross socks.

They can't be socks where like, you know, there's a, there's a, there's a, yes. there's a toe poking through the hole, obscenely. I think mine's just pants, genderless. Just pants. Just pants. Whatever pants you're wearing, I think that's the one thing where I'm like, if that's still on, that's still kind of, that's really hot to me. That's really hot.

Granny pants. Any pants, holy boxes. Honestly, any pants, because it's the tantalizing last thing. That's between, it's the last frontier. It's the last frontier. It's erotica. It's the last thing separating full nudity. But when you become just a fleshbag, it's erotic.

to me when someone still has pants on. I love having pants on. What I would say about granny pants, so, you know, the granny pants are obviously sort of like very full coverage and they're designed to have structural benefits is that I actually think granny pants look quite hot. Like, I don't know what it is.

I don't know if it's just like, I think I look hot in them, but granny pants. The idea that you could push pants to one side to get what you want, oh. Oh! No, I have to say there is a bit of something about that. Yeah. I mean, as we've established, briefly lived in my case, because let's get to get to it. But I have a final question. Yeah. Final question. In terms of the departments in a

hospital, which is the one that tends to have the sexiest staff? Oh, I love that. Oh, this is actually very fascinating. I have actually dated colleagues. I'm not, I'm not married to a medic now. congratulations you know that is a feat for a lot of doctors because they don't do anything else but oh you know what it's so

it's actually a real cliche do you know what there's something about okay and people will understand if they know what I mean if they are in any way know much about medicine there's something about radiologists

right okay and I tell you why radiosid is like some of the most feared in the like in the in the hospital because you put in your imaging requests and they call you up and they are basically telling you off about like why you don't need this expensive imaging that you've requested right and there's something about a radiologist telling you no right they're literally like telling you off basically they're like you yeah they're like you can't have that and you have to explain and justify

your medical knowledge to them before they like willingly submit to your request and there's something about a radiologist that knows what they're talking about essentially but they're also in dark rooms and often look like they might be vitamin D deficient as well. Do you think like a lot of doctors have a thing about

being told no that's actually quite sexy because you're often in a position where you're the one handing out advice and you're the one in the position of power and then when you're being told no and explain yourself to me without blind faith, maybe that's a bit of a turn on because the tables have turned.

You know, maybe what I will say, though, is that most doctors throughout their medical training have actually been subject to quite a lot of humiliation by senior other doctors, right? Like medical school is just a humiliation ritual. So by the time you've finished, I think you've probably actually had a bit of, bit of enough because your whole training people were just like bullying you basically in telling

you you lack any kind of intellect so um actually by the time you've got got to the end um or you're like a consultant like i am i think actually you're just like you're done you're done oh my god no there's there's a lot to unpack there get so mash there's a lot to unpack with like the logic and psyche of even people that decide to go to to medical school at like 18 years old which is what happens in this country oh my god like it's a bag of like neuroses right there right noted for my dating life okay yeah oh god we have a big middle segment though some of our middle segments it's like we could discuss them with anyone anytime any place we are so glad to have you on the show because

I really want to talk about this but I have absolutely no expertise and I'd be completely out of my depth so we really we really need you like you're a very valued guest for this so thank you this is the middle segment and it is a question I've been thinking about quite a lot which is how or are right-word political swings affecting our sexual health and I will explain a bit further so you as we know are a senior your consultant you're a sexual health clinician and it's funny because we talk about sex on if I quite a lot but we don't really talk about sexual health um and the everything that's wrapped up in sexual health um and i've when i thought about this as well as i don't really discuss this

for my mates like it comes up occasionally if there's a real crisis or someone might want to go get treatment they're just like mentioned it casually but it's not like we're not talking about like we talk about having sex um which we talk about a lot so even we're not having it a lot so so something I've been thinking about is how our current political moment is affecting our sexual health and well-being. Because we know that politics impact sexual health. We know that moments of repression lead to worse sexual health outcomes, as do economic downturns. You know, the AIDS crisis became a crisis because there was government denial and action. Siphilis in the pre-20th century was an epidemic, partly due to lack of medical knowledge,

but partly because the state blamed sex workers, there's these like fallen women who broke the morals of the time, and they just locked them up rather than taking preventative measures that would have maybe targeted the iterant male population of soldiers, sailors, etc. that were actually most responsible for the spread of it. And we have been,

in dragging us into the now, we've been in a dramatic right-to-political swing for quite a while. I would say certainly it's come to the mainstream since 2016. You can always argue, oh, we've always been swinging to the right, but it has come to the mainstream for me in a way that's very obvious since 2016. And

We've talked about on, if I speak, how that right-wood swing can affect everything from, you know, interacting with our fellow human socially, so it's the atomization, it's convenience culture, it's like pure capitalism, it's like individualism, transactional dating. We've talked about how it affects things like the clothes we wear. But what about our sexual health and habits? So what I want to know from you to start off with is if you've noticed a change in sexual health trends and patterns in recent years that you think a little. link to the swing to the right, whether that's, you know, the way that people are getting masturbation injuries or the type of things you're seeing with contraception, with STIs, etc. So yeah, let's start out there. Have you noticed any changes that you think are linked to the right? Giant questions. I love this. But let me just say I love this anyway because I'm passionate about talking about

all of the things that we started off talking about. Like I ran pleasure workshops for a bit and I love talking about, you know, the sexy bit as well, but then I do also have this thing where I call it sexy sexual health, which is basically like people try to depoliticise sexual health, which is probably, I would say, one of the most politicised areas of medicine, hence why that's where I went. And it essentially is, some of these issues have always been, you know, at the fore, but clearly the trend. in our times, the rise the far right, fascism, yes, we're getting huge changes. So I think one area that's kind of been growing slowly is very much when we think about kind of what previously was called family planning, now contraception area, access to abortion. So that is probably much more obvious. To the general public, some of these trends, especially in the UK, have probably been not as over as in the US. But there's an academic at Aston University, Dr. Pam Lowe,

who's done loads of work, has been lots of times, about funding to this sector in the UK and the essential Americanisation of this space, right? So we've been getting funding, they've been getting funding from, you know, evangelical, far-right Christian nationalist organisation, to kind of transform the movement.

And what we've seen outside kind of abortion clinics and in family planning spaces is things like vigils outside clinics. And that's why some areas have introduced buffer zones and things like that. And some of these things people have seen news stories about because, you know, when buffer zones were introduced, there were some debates around that.

But it's only really now that, you know, Nigel Farange is starting to kind of get into bed with anti-abortion activists that people were like, hold on a minute. but it's been like over a 10 year period we've seen like a really clear Americanization of this space where we thought that was kind of very much wrapped up in this country 90% of people surveyed generally are pro-choice and that was that was kind of that but then we've seen

you know the Crown Prosecution Service go after people before decrim happened earlier this year and all of this has been because we feel like there are clearly external players that weren't really, didn't have skin in the game before. So there's that going on. Then we've got social media doing its own thing, you know, where we've seen the far right used social media really, really successfully, right, in so many ways.

But particularly among young people, right, we thought, oh, we're just going to get young people getting more and more kind of like liberal and lefty forever. And actually, what we found is actually we've got this like kind of movement of conservatism. And also, you know, we've got health wife influences and, you know, and that has had a really kind of big impact on Gen Z's psyche and response to relationships, we think, right? So in this country, we get a lot of understanding about sex and lifestyles from Natsal survey. And the most recent one's not coming out until next year. So the data from that is actually a bit old. But, you know, we've seen these different surveys done by, you know,

different public health organizations. And Genzi generally seem like they're getting more conservative. So they're having fewer sexual partners. They're more interested in kind of marriage. And also natural life. styles less contraception use um you know and i'm not saying these things are inherently bad things but i'm just like we also need to have a think about why some of these things are kind of happening um yeah i know i've given you a lot there and i know you have a lot more questions so i was going to um

ask you something because you mentioned uh running pleasure workshops and one of the things that was really missing from my sex education because i'm a uh child of the 90s and 2000s. So that's when condoms are getting chucked at you from the school assembly, you know, like it really is. I remember the glow in the dark ones. Endless fun. And also my mom is now retired, but she worked in child protection. So there were very frank conversations about sex in the house, but they were all framed around various forms of risk, whether that was the risk of sexual violence or thinking about pregnancy or thinking about STIs. And what was entirely missing from all of it is, well, where is pleasure? So I had a long list of things

that sex shouldn't be and nothing at all on a sheet of paper which had the, you know, what sex should be heading. So how do you open up that conversation in your work? And what's the political value of it? Yeah, so pleasure is often, you know, very much excluded from the conversation for so many people I think particularly young women are kind of told you know

there's that clip in I think sex education or Netflix where there's a sex lesson everyone's scared basically you're scared, you're told that you have you know a set of choices and that's how sexual health and reproductive health is very much

set up kind of devoid of thinking about kind of the social, political context in which lots of individuals are making these choices and having sex. And I think if you're from a demographic or you're particularly, you know, a young person, then sometimes what's happening is that people are just focusing on the risk that your choices may negatively have on society, right? So if you have an unplanned pregnancy, what's going to happen to that pregnancy, how much it's going to cost people, is that progeny that you have going to be beneficial and so forth.

And then pleasure just kind of just is not, has never been focused upon because what is the kind of supposedly the economic benefit or value beyond the individual to pleasure. Like pleasure is an indulgent thing that only some people get to have when all the other things are taken care of. So I think pleasure, you know, lots of people have written about it. Adrienne Marie Brown, like about how pleasure is essentially revolutionary, right?

For lots of people, particularly people live. mean, with a lot of marginalisation because it allows them to kind of take back some autonomy and actually get some joy in circumstances that are otherwise very deplete and depressing. So that is why myself and a friend actually Guyathri, who I want to give a shout out to you because actually has a play on at the moment at Soho Theatre for period party about navigating a period party. young Tamil queer person so um we started doing pleasure workshops together and one of the reasons we chose to do that is we had appreciated similarly from our own experiences that we hadn't had access to that information or that conversation and that small act of saying to people oh you know like

you've been told you can't go into kind of a sex shop our first one was in shush which has closed down now but used to be a sex shop off um of old street and just saying look you can come into these spaces, you can explore, you don't even, lots of the people that came to workshops, maybe not even sexually active yet, but they were doing it preemptively because they had lots of questions. And I think that's really what it's about. It's about telling people that actually is a really, I think, defiant act, particularly when your life is so miserable, right? And the system is just not set up for you to prosper to say, actually, I'm going to take this little slice of time for me and focus on me and actually that can have real world ramifications for people

they can feel more confident they can feel more bold they can know more about themselves and sorry really long answer but just to say that in terms of how it comes into my practice um people work really differently within sexual health and for me especially with young people when they come in with their first sexual experience or even you know people when they're slightly older I always ask them you know did you enjoy that experience right not just about trauma because that's something different if you didn't consent right and those questions are else as well but like you know was it a good experience you know you don't always have to orgasm but you know do you know what that is and some people are taken aback even young people might feel awkward but I always let it be known

that actually that's actually you know quite a key part of sex also right and just to let them know to start to consider those things early. So yeah, I think it's an integral part of the conversation and it is getting better, but I guess in this current climate, it's probably getting worse again. I wanna talk about that. I do wanna go back to talking about like

the changes and attitude to contraception and how it's linked to politics and what you're actually seeing on the ground. But in terms of pleasure, something that I've also been thinking about a lot because we've talked about pornography on here and how that's also linked to the changing moment. And I wonder in the,

the people that you work with, have you noticed a shift from when you started practicing to now in the ways that they consider what pleasure is, in the ways that they consider talking to other people about pleasure? Because I'm trying at the moment. So in the last episode that was coming up before this one, we're talking about like numbing and the numbing effects that going on your phone all the time, on the internet on devices has and how it disconnects your brain from your body. And I've noticed that when I, I'm having a section to action, my body will be physiologically, like, physiologically, is that the right word? Reacting, yeah, physically reacting. And there's signs, like, when I'm not

turned on, there's clear signs, but sometimes I can, I know I'm really turned on, and I'll be reacting that way, but there won't, I can't connect it. And I'm going to, I'm going to have to reprogram my body to, like, understand sensation. So it's things, I'm starting simple in the morning, like, I'm having to drink a coffee without any phone and just try and, like, I'm, like, like think about the sensations or like feel the sensations to try and reconnect it. It's like if I masturbate, I'm going to have to put the, put the fucking vibrator down and masturbate with my hands to try and reconnect those sensations and reconnect my body to the pleasure I'm feeling. And I'm wondering with young people, you know, the rise of

pornography, but also just the idea that they're on the phones all the time and they're disconnected. Are you seeing that in these conversations you're having about pleasure in the way they consider pleasure? I think more so what we're seeing I think the how our phones and you know screen time is impacting us you know obviously this is

a new thing nobody really knows we don't have that time span of data to say this is how it's going to impact us overall and things like that and there's things that we're just discovering but one of the things I mentioned at the beginning that we are seeing younger generations actually having less sex

actually overall and some of the this is because of what you mentioned in terms of kind of screen time and engagement. People are, we know, quote unquote, people talk about like a loneliness kind of epidemic because people are not getting out as much. Pups are closing down, right? And people are not interacting in that way. And this is an extension of that really as well, that ultimately people are not connecting with people physically as often as they were previously. and they're seeing kind of their phone as a substitute.

So I definitely have seen it within clinical practice in terms of, and we also have to remember the huge impact that COVID had, right? So there are some studies that have shown in terms of compared to the generation or a few years beforehand, there is that age of people who would have been making, you know, the phrase that we use is sexual debut. And they didn't make a sexual debut due to COVID, right? and or it was delayed and now there's an awkwardness

they spent that time on their phones on their computers and you know then they had to go meet people in practice and how does that translate and they can't really maybe connect physically in the way that people slightly older than them that went to university

or didn't go to university but had those spaces filled with young people where a lot of people get there you know a lot of their kind of first sexual interactions and they didn't have those moments or they went to those spaces, they went to college, but all of their courses were online, right?

So I'm definitely seeing that aspect. And, you know, I'm sure you've seen clips as well of people, you know, jokingly laugh about interactions with Gen Z because I think we're all probably millennials, right? Where you go to a coffee and you get a Gen Z server and they kind of just like stare you out, right? the Gen Z stare, right?

And or they talk to you a little bit like you're online. And I see that sometimes in my interactions, right? I'm having a consultation with them, but the conversation doesn't really flow in the way that I would expect it to flow. There's a lot of a stunted interaction. I do think it's a problem. I think it's a problem and it's translating to their relationships and their sex lives.

and I think we're only really just trying to understand the impact some of these things have had on people, honestly. What about, wait, Ash, do you have anything you want to say? Because I have another question, but if not, go ahead. Follow on. I'll do a little hand signal when I want to go ahead. What about in terms of millennials? Because something I know that me and my friends discuss quite a lot is this,

and I think it's, again, linked to the fear of being vulnerable and how worried we are about losing like social capital and that I also think is linked to the idea that it was being surveilled or was being watched or is being assessed to see if you're behaving in a like a cool slash normal fashion, whatever that exactly means. But there's this, you know, this fear of being vulnerable and voicing,

like I'm actually a bit nervous or like I haven't done this in a while. Like I just, and I always say that if I'm having sex and it really helps calm me down. and also makes them, I don't know, there's more trust that I feel is built and then the experience tends to be better for me and I didn't used to, but I have friends who they won't do certain things

because they're just worried about getting it wrong and they're always like, oh, I just get worried about getting that wrong or that I won't be good at it. It's that you can't be good at if you don't try it because then you don't have the confidence that you're good at it. And I was having this discussion in the day.

So I was wondering, like, in terms of pleasure and having sex, are you seeing that with millennials? Like, what's going on? So I think, yeah, no, I think, think, you know, I think it's a hard thing to gauge, but I think you're right in terms of essentially what it is is there's a, there's this greater like self-awareness. And basically sex is one of the most vulnerable acts, right? You are often, you know, partially or completely unclothed. Do you have to be scrutinized by somebody that you might not particularly know?

It's very vulnerable act. And there's also, you know, you'll open yourself up to, yeah, criticism but it's also supposed to be as we talked about at the beginning it can be really silly and funny and but you it's messy right there's nothing messier than sex like there's bodily fluids everywhere and like it can look a real state and it's not instagramable really well you know we have oaf and only fans and things like but it's not picturesque like it should be a bit messy and just a bit chaotic, right? And in order to get to that point, you probably need to be a bit of a mess. It's not going to look picturesque. You're not going to look picturesque, right? And I think that letting yourself go, right, is definitely something that increasingly I think people are struggling with,

with all of the things that you mentioned, right? Like, you need to be able to kind of free yourself and let yourself go. And I would say that. So lots of people don't know, but lots of sexual health services have them. They might sit in Guine departments, but psychosexual health services, right? And there are really long wait lists

for psychosexual health services in a lot of areas because I do think there are a lot of issues around this that are just kind of people don't know where to go when they finally find somewhere to go. There's this like really long wait list. people are struggling to essentially explore and have the kind of sexual interactions that they that they wish they wish to have yeah and I think that is a key part of it you know I think I'm quite fortunate that I grew up at the start of social media and screens but everything I did during my teenage years wasn't recorded and put online right it wasn't I did a whole bunch of stuff, right, that looked really messy and I'm so lucky that it's not just there forever to, you know, haunt me. Well, I was thinking about this as you were speaking and I was

thinking about one of the defining features of, you know, my sexual debut during my teenage years was curiosity. I was curious that there was this world of experiences and I wanted to know what it was about. And I actually had this friend where we made a decision. Like it wasn't within the context of dating each other and things. We sort of made this decision to be like, hey, do you want to like do stuff? Because we both just want to know what it's like. And we want to know what it's like and we want to, you know, when we meet someone that we do want to date, we want to be good at it. And when I think about what changed and, you know, you know, you trigger warning for a discussion of sexual violence which is coming up it was when there was an

experience of sexual violence and what replaced that feeling of curiosity was a sense of well i was punished for my curiosity um you know i i put my hand too close to the fire and i got burned and it took a really long time and i think i'm still working this out took a really long time to stop associating sex with punishment and I think that lots of people have that experience and it can be in a variety of ways so obviously sexual violence and the internalization of victim blaming is one way in which people think about punishment for sex the language around unplanned pregnancy and STIs again is another way in which there can be a narrative of well you've been punished for your sexual curiosity, shaming, public shaming for being perceived as sexually curious or sexually

motivated. Again, it's another way in which the language of punishment and the sense that there's punishment out there permeates people's sexual experience. So we've talked about pleasure, but I suppose what I'm really interested in is what's the role of dealing with and managing shame in your work. Yeah, thank you. And I think I was really hoping we'll get to shame and stigma. And ultimately, you know, even for myself, right, and you touched upon at this beginning, you know,

immigrant family and they want you to do something secure and they send you off to medical school and you're going to be a doctor and then you choose a discipline. And I say, I'm going to do sexual. reproductive health and they're like you know my parents actually quite chilled but you know people like uh why is she doing that why is she going everywhere talking about sex and you know um abortions and all of these things like oh my goodness you know and um we're still very much

operating under stigma and shame you know it's really common for me to sit in clinic and um even among young people people are coming in they're in their hoods they're sitting in the corner, they don't want anyone to see that they've come there, or older patients that are coming for more contraceptive reasons, they're really loathe that the fact that, you know, family planning used to sit separately to sexual health clinics until about 2012, and they're really low that they have to come to a sex clinic to get their, you know, contraception fitting. So we are still very much operating under the system of stigma and shame. And the reason at the core is exactly what you mentioned,

that ultimately the way that sexual health has been positioned is that if you have poor sexual health or you require sexual health, it's because you have done something wrong, okay? And you therefore, and that's another reason why people also say that you shouldn't fund sexual health interventions because it's a moral failing of the people that require those services that they're there in the first place. You're either having sex too early,

sex before marriage, you're sexually deviant, what did you do to be assaulted that you now need to go and get follow up at a sexual health clinic. And so it is a sector that we're constantly operating under still trying to push back against this narrative of shame and punishment of the population that we're serving and they're not deserving of services, compassion and care. And I think really, this strikes that, you know, much wider arguments, you know, about neoliberalism and choices and the idea, essentially, that basically people will have the same set of choices. And if you create this, you know, even plain field that people will make the right choices and be able to live these, these perfect lives, which is obviously kind of, as I said, devoid of all these other structural things that are going on that are very much diminishing the choices and the decisions that people can make, particularly around their sexual and reproductive health. And that's why I'm really, really passionate. And I'm very passionate about talking about sexy sexual health and all these

other things. But I'm like, this wider context is very, very important to the conversation. Or we're still consistently going to struggle with the fact that people want to decommission our services, tell us our services aren't necessary because the people that, require the services are flawed, um, beings, you know, in some way. I'm not quite sure if I've answered your question or whether I just went on my own personal interest. I've got, I've got a follow-up, which is I guess specifically about STIs. The stigma that's attached to STIs is very different from the stigma or the sort of narrative that's around other forms of infectious disease. So if I were to pass on a cold, that has a very different

social meaning to, if I were to pass on an STI. How do you walk the line between not tipping into stigma and shame, but also instilling a sense of collective responsibility that we all have to look after our health because we also have to look after the health of other people? Yeah, I think firstly, the reason ultimately we know the difference. in terms of why people feel that way, it's because sex already is still taboo, right? And people then also start asking, you know,

very personal questions about, like, who were you having sex with? Was that, you know, was that sex, you know, somebody that you should have been having sex with in terms of, are you in a relationship with that person and all these other things that come with it? And so ultimately, you know, that's a load, a lot of where the stigma and taboo is loaded.

I think in terms of, of pushing back against that narrative, it's really talking about the social, kind of structural determinants of health and why we seem to see differences in why people have STIs anyway. Sometimes, you know, and I've seen it several times, somebody's had sex sometimes with one person and sometimes they've ended up with three STIs. And they've not necessarily done anything different to somebody that considers themselves, you know, good at testing and screening. It's a case sometimes of misfortune and the sexual networks that we keep. And I think people misunderstand sexual health in that way. There are a lot more complexities to it. We know there

are overlays with social deprivation. So I work in an area that is quite socially deprived. I work in South London and there are different pockets of communities like there are in London generally of wealth and huge disparity but we know that certain things like our sexual health services and how they set up we say we have a national health service but we also know from working in our national health service not national right it's not it's it is a postcode lottery if you go to areas of huge wealth um they get better donations they also get doctors that want to work there more because of prestige that's attached to that certain institution. So you also get sometimes a brain drain in parts of the country.

I'm not saying there aren't good doctors in different parts of the country. But what I'm saying is that people that go there sometimes are actively going there, sometimes to counteract the disparities that exist. You're under a lot more work pressure because they're working with lower resources. And then we also have, we're dealing with, you know, wider complexities with patients. in those areas and patients can't get appointments so they don't get testing early so there's a lot of complexities to why some people are getting infections and other people are not getting infections and obviously it suits the system to blame the individual for their their infection or whatever's

happened to them as a result but rather than talk about the fact that and I see this in my community and that I serve in terms of, I see, for example, a lot of patients bringing children to appointments, right? And we have, you know, some changes that have occurred where child care is more, slightly more accessible,

but it's still really expensive in this country. And so they have to make a decision whether they're going to come to clinic with a child, not come at all. And sometimes those consultations are difficult. Some clinics say you can't bring a child. They say, we just can't see you. quantity is difficult, especially if the child is of understanding age, what we're going to discuss

sex in front of the child. They also need to be looked after. So then it's locking out a whole set of people that can't even access care. A lot of our services are walking. People on zero-hour contracts hear that often are like, I can't just come here and wait for hours to be seen. And they come then when they're in the worst possible state because they're like, okay, I really need to come now. I physically can't operate at work. My genitals are on fire, right? Whereas somebody else could have come a bit more preemptively. And I think we have to contextualize what's happening socially.

And that's how I take away the shame because, you know, I talk to patients. I ask them about the wider context of their lives. And sometimes it's very revealing. One of the stories that I tell you and divided is about, a young black man that kept on coming to clinic, um, for gonorrhea. Um, he'd probably had of like, I think about three, maybe four episodes of gonorrhea. And, you know, there was that kind of idea, I think, from maybe the other stuff that saw him of like male bravado. He was getting, he's not using condoms because he can't really be bothered. And I just asked a few more probing

questions. And it actually turned out that he did not have any secure accommodation. And he was essentially doing sex in exchange for a sofa and he didn't feel like he could say he could wear a condom because he was sleeping on a woman's sofa and she don't want to use a condom, right? So I think, and essentially what he was doing was sex work, but, you know, because of how he appeared, people hadn't interrogated that. So I just think the way to destigmatize it is really talking to people about what's going on because usually there's a lot more going on. And I think people outside the sector need to understand that it's a lot

more complex. Sometimes it's people having a good time and really sometimes people having a very bad time. I still have a question I really want to ask. Go for it. I still have a question I really want to ask. Sorry, I went on ages. No, no, we want you to go ages. You are the person who wants to go on ages. It's about contraception. It's about what you said at the start and I'm

fascinated because I see this right with swing and I see kind of contraception being attacked from this. There's an underpinning idea that contraception isn't a natural thing, especially if you're a woman or someone who has like an implant or a coil or something and it's not natural because I guess it isn't natural. But I'm seeing an attack on it from two different sides, which is from the natural thing, which is one that it's not feminist or it's rather because the contraception is like the tool of the patriarchy because men, there's not contraception for men in the same way that there's

contraception for women. And the second one is that it's not natural and it's like we should all be going back to just letting our natural cycles flow and all of that. Are you seeing that impact on the way that young people are using contraception? Yeah, absolutely. And it's been a growing trend for a really long time, particularly because we've had really big apps that, you know, promised to be able to track your cycles and give you a clear idea of your window. Obviously, there's caveats to that.

Not everybody has regular cycles. People ovulate early. Things like, you know, drinking can sometimes change your, your, your, your, your thermal temperature and how accurate measuring certain things are. But we're seeing that massively. And I think to be honest, this speaks to, so I'm also PhD, part-time PhD student at King's. And my research focuses on the experience,

particularly black women, long-acting reversible contraception. And for people that don't know, long-acting reversible contraception are methods that you don't have to think about daily. So an implant, an inter-uterine device, or depot injection, which you have every three months. But ultimately, that then places your consternation. contraception under more, I guess, medical management because we have to insert the device, we have to remove the device. And so then takes away maybe a little bit of the patient

autonomy because it's not like a tablet that you can just stop or a condom that you just stop wearing. And so it's been a long ageo kind of discussion and within a lot of feminist literature around particularly the advent of long acting reversible contraceptions, right? And that ability to misuse or how you coerce populations and how some people don't feel that they have autonomy over their choices, particularly when people feel medicine is particularly paternalistic. So I think some of the backlash that we're having around contraception and choices, some of it is to do with movements towards natural choices. We've had a massive movement in kind of veganism, people not wanting to imbalance their hormones, I'm not sure about the

impacts some of the contraceptions are going to have in terms of the long term. And I think there are valid questions raised in terms of only 2% of all medical funding goes to sexual reproductive health, right? And so our studies are small. There are loads of questions and that speaks to why do issues of sexism and things like that. There isn't enough funding in certain areas, right? And then there's the other issue around this is that people are also becoming more aware of and more hypervigilant of kind of the power that medical establishments have, and particularly around COVID, where we all went into kind of lockdown. And when we went into lockdown, what happened to a lot of people's

contraception is that they couldn't get these things removed. There were people that wanted to get pregnant and couldn't get their implants out. They couldn't get their interuterine devices out because the clinics closed they redistributed staff to hospitals and people lost a lot of autonomy and some people saw some of these things and they were like this is really coercive you know um even people having side effects and it was almost like oh you're bleeding a lot but it's not life threatening we can't risk getting COVID just kind of figure it out you know so there's been a bit of a backlash because you know social media has given people more of a voice to share these to say I went to my provider. I said that I didn't want this anymore and these things

happened. They said actually, you know, what, keep it a bit longer or they said, oh, you've had four kids already. Don't think you should have any more. Do you think you want to go back? I've had people speak to me on panels and say that clinician said to them, do you want to go discuss it with your husband? And they were just a bit like what, you know, these things are still happening. So there were many reasons but it's absolutely a clear trend that there is more kind of hesitancy and distrust I think building around contraception and some of it again links to social media but also things that happened in the last kind of five years as well that I don't think we've really addressed I think I just my life final follow up because I know we have to go

and done I'm a soon but with that I have friends who are like grappling with with all those things you're talking about. And, you know, but what is, what is the safest way through right now? Should they continue using contraception? Should they not? Because I think this is a question that really plagues people. It's like, I know this will mess with my hormones.

I know it's got all these other things attached. But then if I stop, what happens? So from a consultant, what's your view? Yeah, and to say I sympathize with people because I am, you know, of reproductive age, right? And like, I also need contraception. And ultimately, I think I always ask the question, how not pregnant would you like to be, right?

And then I also ask, if you get pregnant, what have you thought about what you're going to do with that pregnancy and also the impact that that has on you, right? Because people are very different. And, you know, there's lots of social stigma around, quote, unquote, using abortion as contraception, right? But ultimately, I see a lot of people contraception fails, people have side effects.

And there are many reasons why actually contraceptive methods can't be used or don't work for people, right? And ultimately, I think that's the question people need to ask, right? Are the side effects or the issues you're experiencing worse than the possible unplanned pregnancy? How likely is that unplanned pregnancy? Because if you have a regular partner and you're having sex regularly, then your risk of pregnancy is higher. If you have sex once every three months, then probably, you know, if you come off a method that is long term, that's subjecting you to side effects because you're taking it every day, probably the benefit is not necessarily outweighing the risk because you're only having sex four or five

times a year but you're having the side effects every day or every week right um so it has to be context specific but i think people need to ask themselves really key questions like if i became pregnant and you know that was unplanned for me is that going to be like a life you know psychologically very damaging event or am i going to know that i'm not continuing the pregnancy and just continue with my life and feel really okay. And I think that helps people answer the questions, really, about what they think is the priority. Speaking of questions where people are asking essential probing truths about their lives,

we must now move on to our dilemmas segment. If you have a dilemma, if you are in problem, If you are in big trouble in the words of Jose Marino, please email us at if I speak at navaramedia.com. That's if I speak at navaramedia.com. Annabelle, are you ready? I'm ready. Okay, so I will read this one out.

Hi, Ashen Moyer, and of course, Annabelle. I'm sure you're not short of content ideas, but having recently scrolled through the dredges of Mumsnet to get an answer to how on earth do I afford to have another, in my case, child. The most common answer seems to be 50-somethings who had kids in the 90s saying, you'll make it work. It got me thinking that this is a phrase I hear daily, too many a problem faced by the everyday millennial slash older Gen Zia. How do I clear my debt? How do I afford to buy a house? How do I pay the bills and afford childcare? It's a stupid phrase. It made me feel

shit and despite doing all the things I was told to do as a young adult, going to uni, working my way up a halting career ladder, budgeting, it hasn't exactly all worked out. Why do people say this? Is it a British thing? And if I do have my second child, I've just found out I'm pregnant and I'm considering all options, will I just make it work? And are we talking make it work where my family remains not exactly thriving but content? Or will the familial relationships be torn to shreds, our finances even worse, and our mental health in the pit. I say all this, knowing that I am in a really extremely lucky and privileged situation. I know many people are in much more dire situations and don't even have a choice,

the basic necessities to live, or safety. Your show is the only one I listen to every week. I tried listening to Mummy podcasts, but find them unbearably unrelatable. I feel more affinity with the two of you, well, three of us now, than the parents at the school gates, so thanks for that. So Annabel, I think this goes exactly to the point that you were making about considering a pregnancy in all of its dimensions. How would it feel to have a non-planned pregnancy? How would it feel to terminate a pregnancy? How would it feel to carry a pregnancy to term? You know, whether or not you would want to be the one being the primary carer for the child,

the material conditions in which you may parent a child. And the special conditions, and the specific context of you've got lots of parents being given advice by people who, quite frankly, grew up in an entirely different set of economic circumstances. So how would you, how would you advise our, our special one, our devoted listener? Yeah, thank you so much for sharing this and this dilemma, actually, because I think it speaks to an issue that I see so much in my practice, but also, you know something that personally is really actually, yeah, relatable for me. I have a 17-month-old and, you know, considering if I have more children and things like that, particularly with this current climate economic circumstances, something I can really relate to.

And just to say, Ash, yeah, what you were speaking to is what commonly lots of people in this space organised under reproductive justice, right? So in terms of that decision-making, process and if you have the resources and trying to make sure people have the resources to raise their children well. So I think in terms of the decision, I think she's already done a lot of the kind of, or they've done a lot of the weighing up in terms of, you know, I think you have to think about materially, unfortunately, what you would like your life to look like. But that being said, as she said, things have not really panned out as she necessarily planned. And your circumstances can change at any point in time. That's the thing, right? So when you make a decision not to have children or you'd make a decision to have children, that is something that ends up being a lifelong decision based on something or a circumstance that could change, like your economic circumstances, right? And I think for me, that's the key, right? If you make a decision that you're not having a child or you're having a child, that's something that you then have to live with for the rest of your life, however long that might be. And that can have really damaging psychological consequences one way or the other on individuals, huge amounts of regret, huge amounts of distress, right? So I think you have to probably process essentially how you're going to feel one way or the other

because your economic circumstances could change, right? And the other thing you also have to think about is that what we consider, you know, secure and a happy environment and material fulfilled for a child, I think your listener particularly they sounded like they're not necessarily living in poverty, right? And obviously that definition has changed to suit different political purposes,

but in terms of, then they sound like they're materially relatively secure, right? And in that way, you then have to decide what is it that you feel that you might not be able to provide for the first child or both of the children economically because ultimately if children are fed watered, have access to education,

feel loved and secure, that's actually a lot more than unfortunately and most children globally are experiencing and actually we know that under those circumstances a lot of children will thrive. So I think also what you, and also what you expect for yourself because I focus quite a lot on, you know,

the needs of the children. But I think as somebody that's a word, working mum also does a lot for my family and things like that. I think you also have to ask stuff, so this is your first time on this planet too, right? And what do you want your world to look like? Because we haven't really gone into this, but it's something that I'm so interesting in terms of like mothering and motherwork and the domestic sphere and things like that and how supportive your partner or your, if you have a village, right? And what does having more children then look like for you and your personal fulfillment and life and what you can do

because ultimately I'm very passionate that it's very difficult to have it all all at the same time and sometimes that's also going to mean compromising probably quite a lot in terms of the other things in your life and whether that's going to bring you more fulfillment or make things more challenging so I think answering some of those questions will help but it's such a person decision and I think, you know, it's very unhelpful speaking sometimes intergenerationally on this issue because our circumstances, even the world environment, I found it very difficult being pregnant 17 months ago because, you know, there's genocide happening, there's all these things and I had to consider and I felt very, very heavy bringing a child into this world

when we weren't valuing lives. So I think, you know, intergeneration. I understand that sometimes these conversations are not necessarily particularly helpful. What is the cost of a child, would you say? Like, just up front, what is the material cost of a child? Well, this is the thing, because in terms of, you know, people run figures, even a bit irritatingly. When you try to make arguments around contraception and investment, there are like tools that decide how much welfare or things children will cost the state and things like that. There are tools like that that can turn out a number. But I think it's very variable because do you go and buy the most expensive buggy or do you go and buy a buggy that just gets you out of the house, right?

But I think up front personally to have a child in terms of making sure you've got, you can get a lot of things secondhand. I got a lot of things second hand. Lots of people do. But you are going to need probably a few thousand pounds up front, you know, to have a child, right? and not everybody has that to spare. And with, you know, child labour laws,

child labour laws being what they are, you can't make them pay for themselves anymore. But yeah, gone are the workhouses. But, yeah, you know, it's, it is really expensive. And I have to be honest, there are loads of hidden costs. And this is something that I, I, I, I, I, I, I, I, I, I, I, I, I, I, I, I, I, I, it is really expensive. spoke about briefly when I had a baby that, you know, even like breast pumps, right? And some of these things, it's like difficult to reuse them because, you know, sterilising someone

else's breast pump, you do, but, you know, people give you things. But there are a lot of hidden costs that until you actually go through the process, you're like, what the hell? Where did this come from? No one prepares you. Yeah, that's something I think about a lot because it's, I remember we discussed previously with a parent about the costs and people writing and being like this was so helpful talking about the costs of children and what that actually means in material terms for my bank account. Oh, can I just say something really quickly in relation to this?

Because I don't think we touched upon it, but I think it is so important, right? And I and others have spoken about it a lot is that we do think that the two child limit on benefits is going to be lifted, right? and the Greens have campaigned quite a lot on this and maybe Labour can do something about it in response but I think this is something that lots of people don't understand that where this policy came from but again we talk about the Americanisation of our politics

but academic Dorothy Roberts wrote quite a lot about two family cap limits from the US that were introduced in the decades ago I think New Jersey had one of the earliest ones and this idea that you can basically, you know, by putting in a cap, it makes people pull up their bootstraps and go to work and we're just essentially, you know, making people idle by ensuring we're lifting children out of poverty.

It's been shown time and time again not to be true. And it's also just ridiculous because we know that the people that are often using universal credits have jobs. They're just not jobs that pay well enough. And I think this kind of speaks to this. this issue as well that we're seeing that you know why should people have to live with a decision not to have another child when they're working you know sometimes in in two-income households and we still can't they still can't afford to have have the families that they want to have that's a reflection I think more of our politics you know what's actually fascinating about that the other day I was talking to someone and they pointed out in Scotland they don't have the cap right and it's an actual case study study right there about the difference it makes because Scotland's child poverty rates are significantly lower than England's because they don't have the cap and they're projected by

2029 to be 21.8% and England's right now are 31% and projected to go up to 31.5%. And the only difference is that cap. The only difference is that cap. And it's purely like if we remove that cap it would lift like 400,000 children out of poverty within five years. Yeah, it's cruel and it's punitive and it's just um and it doesn't stop the children it doesn't stop the children it doesn't stop the kids being born it just emiserates the children so yeah i think that's a really good point to bring in there ash do you have any advice for our writer i don't have that much i don't i don't necessarily have advice but what i have is maybe um special one a different frame for thinking about this because look i think it is true that when you're receiving advice particularly from strangers on the internet um

you know, they're bringing their own set of experiences to it as if it's universal. But I think sometimes that there's a little bit of a risk that we think of our problems as being so unique that there's nothing to learn from others. And I'll give you an example of this. If I were to have a child now, I would be in completely different circumstances from the ones that my mum was in when she had me. So I'd be a little bit older. I'd be in a marriage which wasn't breaking down. I'd be in a house that I can afford and I'd be in a relatively stable job. My mum was not in those situations at all. You know, she'd already had my sister who was very, very unwell. You know, my dad was busy doing what he did best, which was being a prick. And she was

thinking, how do I parent two children who are deeply and profoundly wanted by me when my material circumstances are so insecure, right? Now, there were different circumstances in terms of what the benefit system was like then, what was the labour market like then, what was housing costs like then. So it's not as simple to say everything was harder or everything was easier, but certainly she was dealing with a set of circumstances which for her own sense of what situation do I want to be when I have kids, they weren't ideal. And Ultimately, she said, well, I want this child more than I want a more middle-class life. And that's why she had me, right?

Economically, probably better if she didn't have me. You know, she couldn't send me down the mines like you're good in years past. And, you know, I was a net drain on the household finances. But that was a reflection of what it was she really wanted. I think that it's easy to forget that in every single generation of parents, people have had to make choices in circumstances that were far from ideal. And every single time, there are things which condition and inhibit their agency. And in every generation, there are people who choose to express that agency in some way,

whether that's by not having a child or having a child, or having a child with a different set. of relationships around that child or in a different sort of setting. And I think that one of the pressures that people are under is that there are a whole set of economic and material pressures, but there are also cultural ones too. And I think that one of the things which marks how people of my peer group and social class think about rearing children is that if your child isn't at least as middle class as you, you failed them.

And there are lots of people I know from different social class backgrounds who don't feel that way. So that's not to say have the kid, everything's going to be fine and it's not going to say, you know, yeat the kid to Rosie, right?

I'm not giving advice about the having of the child. I'm saying that there are all sorts of things that shape and condition your sense of what is right and what is the right set of circumstances to bring a child in. and not to repeat the 50-somethings on mum's net

that have been driving you mad in terms of you'll work it out. People do work shit out in non-ideal circumstances. The human race continues despite our best efforts. And I think that's also something that's worth bearing in mind. I think what you've said is so important in terms of the working things out. But I also just really want to emphasise

and I see this so much with my job role that you have to be prepared when you have a child for every eventuality. and I've seen it with lots of friends, right? There's no guarantee how that child's going to be or that circumstance. Lots of my friends have children with special educational needs, right? Some people I know have had to stop working as a result, right?

They're now worse off probably than they anticipated they would. So I just think that having a child anyway is an unknown, right? It's just, you know, you can prepare for every eventuality and being the best economic circumstances and then a spanner gets thrown in the works, right? So that is just the part of the roulette. And I think we're told that we can prepare. You know, that's another thing about this set of choices.

We're told that we can just prepare for everything. And you just can't do that. The one thing I'll say about this dilemma is when people say you'll make it work, what they're saying is, I don't know and you will continue to exist. Which is actually really good, I think quite an emotionally mature response if you phrase it like that. Oh my goodness, I'm going to try that. Should I try that at work? Yeah, I don't know and you will continue to exist.

Imagine hearing that from your doctor. I'm going to get struck off. Yeah, literally. It has been, as Ash was about to say, I'm probably really interrupted with my analysis. It has been such a pleasure. No, really thank you so much for inviting me. This has been really fun.

We're going to have to get you back because I've got so many questions I didn't get to ask. Pick my brain, pick my brain. What is the clitoris? I'm not entirely sure. I saw her a TikTok the other day where a guy was like, maybe we weren't meant to find the clitorist. Maybe the clitorist is meant to find you.

And then he goes, no, it's just woke propaganda. It doesn't exist. Stop it. It does exist. It does exist, guys. I've seen it many times. But so just the sensitive tip of the penis. And everyone thinks it's the bottom.

It's the balls in the top. Anyway, that's another episode. Another episode. This has. been the most sensitive part of the penis if I speak. If I speak. Thank you, Annabelle. We will see you special ones next week. Bye.