Hesperian Health Guides

Teaching and learning about sexuality

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HealthWiki > Health Actions for Women > Chapter 4: Sexuality and Sexual Health > Teaching and learning about sexuality


It can take a long time for a group to become comfortable talking openly about sexuality and sexual health. Doctor Aruna Uprety wrote this story about her experience using activities from this chapter with women in Nepal.

It takes time to learn to speak freely

For 20 years, I have traveled with community health workers to remote villages in Nepal to help women who have almost no access to health care. When I first started doing this, village women would only speak in private about their reproductive health. They were too shy to discuss anything in a group.

Over the years, both the health workers and the village women have become more comfortable with reproductive health topics, and it is easier for us to talk about pregnancy and childbirth together. So, I thought it would be easy to talk with them now about sexuality and sexual health. But I was mistaken.

I gathered a small group and began by talking with them about the hardship of their daily lives, about their pregnancies and their health problems, including sexually transmitted infections. But when I started talking about sexuality and sexual health, the women were very shy and laughed a lot. They would not talk openly with me about it.

3 women speaking in a group.
We know what sex is. Sex is how men and women make babies.
Sex is part of our duties as wives. We have been trained not to think about our pleasure.
Sex between two men or two women? We don’t believe you. What a disgusting idea!


The community health workers, however, are very interested to learn more. The doctors and nurses who trained them did not include information about sexuality or ways to speak about it. They want this knowledge, and want to share it with the villagers. They plan to start by talking one on one as they have done in the past. After some time, they believe they will be able to hold meetings on sexuality and sexual health with separate groups of women and men.

Sex has the potential to be one of the most physically and emotionally satisfying experiences of a woman’s life. Unfortunately, for many women, sex is rarely pleasant or satisfying. Sex is especially harmful when it is forced or violent. A woman may want to refuse sex if she is sick or tired, or if she is worried about HIV, other STIs or about getting pregnant, or if she just doesn’t feel like it. Women and their partners need to be able to talk about sex. They need to be able to talk about their sexual feelings, what gives them pleasure, and different ways to have sex that may or may not produce a baby.

Young people need to understand all the ways sex and health are connected before they start having sexual relationships. Some people think that if young people are given too much information about sex, they will have sex too soon. But this is not true. Adolescents who learn about sex and sexuality are usually more responsible and respectful toward each other when they start having sexual relationships.

a woman speaking to a girl.
No one told me about this when I was your age, but I want you to know. Sex is not just about making babies. It is also supposed to feel good.

Start with reproduction

It can be easier to start talking about sex by talking first about reproduction — how pregnancy happens and babies are born. Using medical or scientific words to name the sexual and reproductive parts and explain their functions may help put aside taboos associated with local terms. For example, if the only words people have to name "penis" or "vagina" are considered offensive, they will probably be embarrassed to say them in a discussion about health. Learning a new word can help people in the group take new information seriously and think about sexual health in a more respectful way.

male reproductive parts.
penis
scrotum
female reproductive parts.
fallopian tube
ovary
uterus
vagina
Use drawings like these to explain how women’s and men’s bodies function sexually. Then do the activity on the next page so the group can practice talking about what they have learned.


ActivityReproductive aprons

  1. Form small groups of 3 to 4 people and give each group 2 aprons made out of white cloth, a few pieces of colored cloth, scissors or another tool to cut the cloth, and a pen or marker. You can also use paper to make the aprons.
  2. illustration of the below: a woman and man wearing aprons with drawings on them.
    A man's reproductive
    organs
    A woman's reproductive
    organs

  3. Ask the groups to draw the female reproductive organs on one apron and the male reproductive organs on the other apron.
  4. Next, ask them to cut small pieces of colored cloth to represent menstrual blood, sperm and egg, and tape these onto the aprons so you can use the aprons for this activity again.
  5. When they have finished, bring the small groups together and have 2 people in each group put on the aprons and explain what they show.
  6. If the group is feeling comfortable, ask them to point out which parts are most important for pleasure, and which for reproduction.
  7. To conclude, ask them to talk about what they learned about sex and reproduction. Discuss any other questions they might have.

    Young men and women may enjoy doing this activity together. To make it more fun in a mixed group, have the men and women exchange aprons.


HAW Ch4 Page 78-2.png
Not everyone falls neatly into a category. About 1 of every 100 babies born have body parts that are not standard male or female. These people are called intersex, hermaphrodites, or third sex. The person may be understood to be a boy, for example, but may not have fully developed male body parts and may feel more like a girl inside, or vice versa. If you do this activity, be sensitive to the possibility that some of your participants may not fit perfectly into either category.

This activity may raise questions about problems with monthly bleeding, sex, or having children. If people are interested, you may want to invite a health worker to talk with the group, and see Chapters 4, 6, and 12 of Where Women Have No Doctor.

Don’t leave out sexuality!

There is much more to sexuality than sex or intercourse — a man inserting his penis in the woman’s vagina and releasing sperm. Sexuality is an important part of every person’s life. It is part of the way a person is all the time, even when not doing something sexual or thinking about sex.

Sensuality refers to the physical feelings of sex using all our senses: touch, sight, hearing, smell, and taste. It also includes our fantasies about sexual feelings and experiences — things we can imagine even if we don’t do them.

Intimacy and relationships include all the ways we feel close and loving with a sexual partner. Trust is important for intimacy. Deeply loving relationships usually develop as partners learn over time to trust each other emotionally and physically.

Sexual identity is a combination of 4 things: biological sex (having a male or female body), gender identity (feeling and acting male or female or some mix of both), gender roles (doing what is expected of a male or female), and sexual orientation (being attracted to males or females, or both).

ActivityFind yourself in the spectrum

Sexual and gender identity can change over time. This activity is for your own reflection. You don’t have to share your answers with others. Put a mark (or a few marks) to show where you are in each spectrum below:


Biological sex (having a male or female body):
Male Female
HAW Ch4 Page 79-1.png
Gender identity (feeling or acting male or female):
Male Female
HAW Ch4 Page 79-1.png
Gender roles (doing what is expected of a male or female):
Male Female
HAW Ch4 Page 79-1.png
Sexual orientation (being attracted to males or females or both):
Male Female
HAW Ch4 Page 79-1.png


Gender identity and sexual orientation

Different sexual orientations have different names: homosexual means a person is attracted to persons of the same sex, heterosexual means a person is attracted to persons of the other sex, and bisexual means a person is attracted to both women and men. Sometimes people use the word gay to mean homosexual men, and lesbian to mean a woman who is attracted to other women.

"Transgender," "transsexual", or "third sex" refer to people whose gender identity is different from their biological sex — for example, a person with a male body who feels female, or a person with a female body who feels male. These feelings usually begin when children are very young and begin to see themselves as one gender or the other, or when they develop sexually in adolescence. Some people feel neither strictly male nor female, but both, or sometimes more one than the other.

There are lesbian, gay, bisexual, and transgender (LGBT) people of every race and ethnicity all over the world. In some places they have always been accepted and treated with dignity. But in many places, religious leaders, politicians, and other powerful people actively work to stigmatize homosexuality and transgender identities. Many LGBT people hide their sexual orientation because of anti-gay laws and prejudices. The fear and shame that comes from social rejection can cause physical and mental health problems. LGBT people can be driven into isolation, which could lead to depression and other health problems. They may not seek even basic health care out of fear that their sexual orientation will be found out.

Human rights organizations all over the world are fighting to educate communities, end discrimination, and promote understanding and acceptance of different types of relationships and families.

a young woman speaking.
Sexual orientation and gender identity can be the most difficult parts of sexuality to discuss. In my group, some people did not want to discuss homosexuality at all, so we started by talking about shame and stigma. Everyone was able to agree that stigmatizing anyone is unfair and unhealthy. Perhaps over time people will be ready to talk about different sexual orientations.
Ending discrimination is part of promoting health

Guyana, a small country in South America, has a constitution that declares that women and men have equal rights, and that all citizens have equal access to education, employment, and health care. The constitution prohibits discrimination based on race, skin color, political opinions, or religious beliefs. But these rights have not been respected for lesbians, gays, bisexual, and transgender (LGBT) people who are open about their sexual orientation. Women and men "cross-dressers," who do not wear the clothing society considers correct for their gender, are especially targeted for harassment and find it hard to get jobs.


The Society Against Sexual Orientation Discrimination (SASOD) formed in 2003 with a campaign to include sexual orientation as one of the fundamental rights protected in Guyana’s constitution. Since then they have been working to end harassment and discrimination against LGBT people. They have called for repealing laws that criminalize same-sex sexual relationships and cross-dressing.


SASOD uses the media in creative ways. They host a yearly "Painting the Spectrum" film festival, showing movies from LGBT communities around the world. The films illustrate the challenges and ways of surviving as an LGBT person in communities with few social freedoms, and highlight sexual and gender diversity as an important aspect of humanity.


In 2007, the Ministry of Health, the National AIDS Program, and the teachers’ union sponsored a debate: "Teachers who are homosexual or lesbian should not be allowed to teach." SASOD wrote a letter to Guyana’s main newspaper denouncing the government and union for ignoring the teachers’ right to work, protected by the constitution. Their letter broadened public debate and enabled SASOD to educate more people about sexual diversity and LGBT rights.


More recently, SASOD has partnered with the Ministry of Health and other organizations to launch the Spectrum Health Project, which provides sexual health information, including resources specifically for LGBT people.

a group of men and women holding a banner that reads: "Human RIghts for All.

Preparing to lead discussions about sex and sexuality

To help groups learn about sexual health, you need to be aware of how your own thoughts, feelings, and attitudes influence the way you speak about these topics. For example, you may not be comfortable at first saying words like vagina, penis, or anus with a community group. Practicing first with others can help you prepare to use such words with a group and help others learn to use them with ease.

People will not talk openly unless they feel comfortable and respected. A leader’s comfort — including comfort with discomfort! — is essential for the group. A leader needs to help people feel that it is OK to make mistakes, to be embarrassed, to laugh, to be silent, and to ask questions. A leader should listen more than talk.

a young woman speaking to another while a third woman encourages her.
Mastur... mastur... Oh, I just can't get it out!
It’s OK to laugh. Go ahead! Take as much time as you need.
Work with a partner for support.

Before facilitating a discussion about sexual health, tell a partner about the activities you want to do with a group. Share your ideas and thoughts about each topic, and how you hope people will act and talk. After someone has listened to you, you will be more prepared to listen to others.

Here are some questions to think about and discuss with your partner:

  • What are my own sexual attitudes and behaviors?
  • What attitudes or behaviors of others make me uncomfortable? Upset?
  • How do my own feelings, experiences, and beliefs about sex affect my ability to facilitate a discussion without judging others?
  • What can I do to keep from imposing my attitudes about sexual behaviors on others?
  • What can I do to encourage others to think for themselves?


Reflect and get feedback from your partner. Leading discussions on sexuality and sexual health gives you a chance to learn as well. Take advantage of it! After the discussion is over, sit down with your partner and take turns listening to each other. If you feel embarrassed or confused, this is a safe place to show it. If you want specific feedback, ask for it.

2 women speaking to each other.
Let’s work as a team when we talk with groups about sexuality. We can help each other prepare, and we can support each other if the discussion gets difficult.
It will be so good to know we can check in afterwards. I’m sure I will have a lot of thoughts and questions when we are done.

Starting conversations about sexuality

People may be too embarrassed to participate in a group if they have been taught that speaking about sex is shameful or rude. In some communities, there are social rules that forbid women and men from talking about sex with each other. It is often OK for men to talk about sex and to use strong language, but women are not supposed to hear such talk or use the same words. It is important that women and men get the same information, but they may need to meet in separate groups to discuss their ideas.

HAW Ch4 Page 83-2.png

Sex and relationships are important in every person’s life. If a group of women is comfortable with each other, they usually have a lot to say about their experiences!

Create trust with agreements for group discussions

People will be more willing to share their thoughts and feelings about sex and sexuality if they trust others in the group will listen and respond respectfully to what they say. They also need to trust that no one in the group will gossip about them to people outside the group. To create trust in the group, ask the participants to make a set of agreements at the beginning of the meeting. You can write a list of people’s ideas and keep it posted on the wall to refer to when needed. After the meeting, ask if they feel the agreements were helpful and if anything could be added.

Make sure everyone has a voice, especially those who might feel shy — those who are disabled, cannot read, or feel different than others in the group. Agreements help make sure that everyone feels included and respected.

a group of women making a list of agreements; 1 woman speaks.
We should promise not to repeat what we hear in this group.

Hotlines and radio shows answer private questions

In some places, telephone hotlines provide sexual health information to callers, using either paid staff or volunteers. This is often done as part of HIV prevention work. Radio call-in shows can also invite questions and reach a large audience with accurate information and discussions about health and sexual relationships.

Dear Auntie Stella
a letter that reads: "Dear Auntie Stella, I have a new girlfriend. Must I tell her about my infection?"

Advice letters are very popular in newspapers and magazines. You feel less alone with a problem when you read about someone else in the same situation. And when a kind and thoughtful person responds, you feel understood and may have a better idea what to do. Or, you may know someone with a similar problem and you can use the advice to help that person. You may not want to tell anyone about your problem, but you can use an advice letter about someone else to talk about the problem with your friends.

The Training and Research Support Centre (TARSC) in Zimbabwe started the Auntie Stella project based on advice letters that help young people talk about their feelings, relationships, and sexual health in a relaxed way. The materials are designed to use in small groups of either women or men because young people will talk most freely that way. Rather than telling young people what they should and should not do, the Auntie Stella material helps them think critically about the problems they are facing. It also suggests ways they can work together and become more involved in community decisions that affect them.

Auntie Stella includes 40 letters and replies, with questions like these:

a woman asking the question below.
"Should I sleep with him?" "I was raped. What should I do?"
a woman asking the question above.
a man asking the question below.
"I’m HIV positive. Am I going to die?" "I’m gay. Will anyone love me?"
a man asking the question above.

The material is available as a pack of printed cards with a facilitator’s guide, and can also be used on the Auntie Stella website, www.auntiestella.org.

Words to talk about sexual health

Taboos against saying certain words can be very strong, such as words for sexual parts of the body and for sexual activities. Here is a game to help people practice saying sexual words that are useful when talking about sex. This activity may be easier to do with separate groups of women or men. It can also be a good game to play at the start of meetings to warm people up.

ActivitySexy bingo

To prepare:

illustration of the below: a word card.
Masturbate:
When you touch yourself in a sexual way and it feels good.

Make word cards. Think of about 15 common words that people might use to talk about sex and sexual health. Write each word and its definition on a small card.


Make bingo cards. Make a bingo card for each person with 9 squares (3 rows of 3 squares each). Write 1 word in each square. Each card should include some different words with most of the words placed in different orders.

2 different bingo cards with words including "penis," "kiss," "orgasm," and "nipple."


To mark a square you can use a leaf, a bean, or a stone.


a young woman speaking.
In my women's group, we prepared for this game by deciding together which words to use. We decided to use scientific words. But your group may be more comfortable with slang words.

To play:

  1. Hand out a bingo card to each participant. Explain that you will read the definition of a word. If they have that word on their bingo card, they should mark it. Once they mark all the squares on their card, they should yell "Bingo!"
  2. Shuffle the word cards. Pick one and read the definition. People should call out which word is being described. If people are shy, it helps to have everyone speak all at once. In some groups, it might be better to ask people to raise their hands to give answers. Say the correct word, and ask everyone who has that word on his or her card to mark that square.
  3. in a large group of women, one of them reads from a card while 2 others shout the answer.
    This word means to use the tongue or mouth on the man’s penis or the woman’s clitoris to give pleasure.
    Oral sex!
    Oral sex!

  4. The first person who marks all the squares on his or her card and calls out "Bingo!" is the winner. You can give a small prize to the winner.


a woman speaking.
My women’s group would not enjoy a game like this. But they were willing to discuss the words people use about sex. So I said a word, like "vagina" or "penis," and asked them to name all the other words they have heard people use to describe the same thing. Some of them would only whisper the words they knew.