Many young men will approach RSE warily at the beginning, because you are asking them to consider aspects of masculinity that they are usually strongly encouraged not to consider in public.

The ‘Masculinity Donut’

As you can see from these accompanying images which I made for #InternationalMensDay for BISH.

Also their previous experience of RSE may have been very off-putting. Very risk focused RSE can paint young men as dangerous and careless. Also if young men haven’t had the opportunity to talk about things such as #MeToo or the idea of ‘toxic masculinity’ then their barriers may already be up.

If you’re already an RSE practitioner, you might want to come on my new Advanced RSE Training course.

As you can see in the images above (and in this article I wrote for BISH) the learned rules of masculinity form as a protective layer of dough around the fragile jam (feelings) which must never never spill. In order for us to be doing effective work with young men around relationships and sex education we need to be able to work with their jam as well as their dough.

So we need to understand that the kinds of ethics and values that we want people to think about in RSE are often antithetical to what men are ‘supposed’ to be like. Things like; being caring, kind, careful, responsible, thoughtful, and consensual are often not encouraged in young masculinities. The jam must remain inside the doughnut (at first).

Article continues after this ad for my resources (why not buy some?!) They’re also available at the BISH Patreon Shop.

Group Agreement / Ground Rules

Always do the ground rules or group agreement. I’ve always regretted it when I’ve not done one in RSE and young men really appreciate it when I do. This helps with being able to immediately challenge anything that young men might say that is offensive/oppressive to others. But it also helps to relieve some of the pressure, to acknowledge some of the awkwardness, and for young men to get a sense of the vibe of the lesson.

There’s an example of the kind of thing I’ve been saying lately in this article about making it easier to talk about sex.

In the group agreement try to make it clear that you aren’t going to put anyone on the spot. That you will try to treat everyone consensually and that you will encourage people to get involved but not force them to. In short, you try to model the kinds of behaviours that we are talking about in RSE.

Don’t put people on the spot

The use of distanced learning can help young men learn without being put on the spot and without having to interact with the facilitator. This means that young men can learn without having to admit that they have learnt anything (because obviously men know all there is to know about sex!).

Throughout DO… many of the activities allow young people to self-facilitate in groups where they know each other. Also by not asking personal questions and making it clear you aren’t going to put anyone on the spot then it makes all students feel safer. It also means jam remains safely inside the dough until they feel safe enough to talk about it.

Because of the way that many young men are socialised, from an early age, they are supposed to be interested in sex and thus are supposed to know everything about it. So it can often be difficult for them to accept that there may be stuff for them to learn. So try different learning methods that allow them to learn without admitting they are learning.

Gender includes masculinities

Make sure that your programmes are inclusive from the get go and are inclusive of sexualities, disabilities, races and genders. This also means that young men should also be given the opportunity to think critically about what masculinity might mean for them.

We all have a relationship to gender and that’s true of masculinity just as it is with the many other genders out there. Check out Gender Stories podcast and How to Understand Your Gender are both superb on this.

Many of these tips are about working with young men’s understanding of masculinity where it is, but in doing this we also need to make sure that there is plenty of scope for everyone in the class explore the rules of masculinity and femininity.

Men (like everyone else) are unique

Remember (as lesson 2 of DO… points out) there is not one single form of masculinity to which everyone adheres to. The masculinities of a young white atheist trans man in a London school are likely to be very different from a BME Muslim young man in a Derby school. However, what these two young men have in common are that the rules of how you are supposed to be a man are pretty similar and it’s the rigid nature of these rules and how they are enforced by toxic masculinity that is the problem.

Talking about these potential cross-overs of identities can be an extremely useful way of opening up the topic of being a man in general.

So don’t be afraid of asking young men to reflect on their own relationship to masculinity. On where it gives them power but also how they might be individually trapped by the rules of being a man.

Coalition and solidarity

One thing which is immediately off-putting to many young men is the idea of privilege. It’s important that we bring a critique of structural oppression into RSE. If we don’t then our RSE is both crap and inaccurate. It’s a fact that society gives some people more agency (power) than others. However, we have to be very careful not to fix these power relations in place. If we do, then (eg) we run the risk of fixing men as perpetrators and women as victims.

Power for individuals is contingent on the circumstances and of course it’s intersectional. ‘The power to do what’ is a useful question to have in mind here. We might see the privilege of young men but not see their disprivileges of (eg) queerness, or poverty, or being a carer, or having experienced violence themselves.

What RSE should be doing for young men

RSE should be a tool for the possibilities of transformation. Quite frankly, if our RSE is telling boys to feel bad about (eg) the violence that they haven’t yet committed then it’s not going to do anything. We need to be able to ask people to make use of their agency, not to feel bad about it. So this means shifting from talking about privilege and allyship, to coalition building and solidarity. This also means talking about the possibilities of solidarity for young men. How would their lives be better if they weren’t violently coerced into upholding the rules of hegemonic masculinity?

I wrote about this for young people at BISH in my article on solidarity. Also What White People Can Do Next by Emma Dabiri is excellent as is this really interesting article by Jeremy Gilbert.

Engagement

If you’re finding it difficult to engage with young men at first, be aware of the messages which contradict what it is that men are supposed to be interested in. For example, if the messages of your programme are about risks of sex rather than pleasure then they may just not engage.

Men are often given the impression that their role in sex is to be very mechanical and to just do it. They pre-occupied with performance and size (this comes from porn, film, magazines, most sex advice and sex education). If the conditions are right, young men like talking about feelings too relationships, feelings, sensuality and pleasure too.

A simple semantic one, but I’ve found that putting people in teams, rather than small groups can work well. Also use lots of different learning methods. Keep it challenging and moving along and try to avoid didactic ‘standing at the front’ teaching. This is good for people of all genders I think.

Read more about different learning materials

Ask young men for help

The fact that men don’t like seeking help can be an overused stereotype but it can certainly be the case that they’d rather give it than receive it. Using this to your advantage in RSE can be done through asking young men to go to a sexual health service to check out how young men friendly it is rather than go there for help. You could also frame the real life scenarios lesson in DO… (lesson 6) in this way. How would you help another person

Try to put a framing on topics like consent and abusive relationships which acknowledges where young men have power and thus a *responsibility* to be good on this stuff. If young men accept that being active is an essential part of masculinity (which it maybe shouldn’t be and certainly those things are not just for men) then being good at opening up consent conversations, making sure sex is safer, and healthy relationships chat can be part of that framing too.

Check out my relationships and sex education resources. None of them are just for young men, but I’ve been delivering these activities in workshops with thousands of young men since 1999. They are all also inclusive and have activities around gender, power, and consent.

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It is important to reflect on our practice and offer a service which meets the needs of young men as much as young women. When we have achieved this (or taken steps to do this) we need to promote what we are doing effectively, as well as be very, very patient…

When we successfully deliver projects that meet young men’s needs they become popular through word of mouth – so why spend any time thinking about publicity? The right publicity is part of the cumulative affect of providing a service which meets the needs of young men. I give most of my publicity to my existing clients because I know that they are going to tell their friends and that their friends are going to need convincing.

You can have everything in place, great condoms, perfect opening times, highly trained and motivated staff, amazing promotional material, excellent outreach: but still have to wait months for clients.

The most important factor in creating successful services for young men is to wait and to be patient. Keep doing the same things every week and soon the word of mouth will build.

After around a year you should reach a point where the service will start to see regular numbers of young men.

If the extent of a project worker’s graphic design skills are word art then it is a good idea to get someone else to do a design. A word art poster for a service sends out a message that ‘we don’t really want young men here’ or ‘we have to make it look like we want more young men in but really we don’t want them here’. If you want to have a play around yourself there are some excellent free programs you can use, for example inkscape, gimp and openoffice: you can also get some cool free fonts from dafont. Or you could always pay me to do it.

Printers are often able to provide artwork and in many ways this is the easiest and most cost effective way of getting your images right. You could ask some of your prospective clients ideas for a logo and images but remember that they are not experts either. You may get some good ideas from some young men in a logo design competition but this can be time consuming and can sometimes not get you great results. Speak informally with clients about what images they think work. Their favourite record covers, trainers and adverts can give you an idea.

If you shop around you can get 2000 flyers printed for £300 including artwork. However it is important that you work well with the designer giving them a detailed brief and an understanding of what you are trying to do. Don’t be afraid of asking for changes – it’s probably the most interesting job in their in-tray. UK Flyers are good, tell Jim I sent you: but other printers are available.

Here are a couple of examples of logos and designs from some of my projects

Some services don’t have a catchy name for their service, however most specialist services choose a name and this is not just for specialist young male provision but also for young people’s sexual health services ‘brands’.

I have developed two branded male sexual health services ‘The Space Man’ and ‘BAM’. ‘The Space Man’ was a service firstly held at a young people’s one stop shop (sexual health, drugs, careers, housing, education, benefits etc) called ‘The Space’. This was very popular in Derby so we piggy-backed onto that for our Friday afternoon session. It was catchy, sounded masculine and everyone knew where it was (it was also a popular song in a Levis advert years ago which unaccountably young men still remember).

‘BAM’ stands for Brook and Men. It’s short, catchy and looks cool. It also gives the impression that there is no messing about at the service and that it’s dynamic and manly. Same goes for Bish, but you can’t have that one.

It can take months to get the right name as it has to sound masculine but not aggressive. It needs to have a very broad appeal without being naff and it needs to be timeless. Keep it short and snappy and no rubbish acronyms like ‘TACT’ (try a condom today, sorry Diane) ‘SHAG’ or ‘SHARE’. Perhaps take the number of the building where the clinic is such as the ‘374 Clinic’ by Brook Brixton.

When striving for designs that have a high impact it’s important that the appeal is broad and attractive to all young men. Many young men do not like football and may feel excluded by reference to it for example. It’s also important of course not to produce anything that has any heterosexual connotations.

Even if there are no heterosexual references in publicity sometimes masculine designs can be off-putting and exclusive to young gay men. Traditional masculinity is strongly associated with heterosexuality so it is important to be inclusive. However a leaflet aimed at young men with the word ‘gay’ prominently featured may be off-putting to straight young men. Possible ways around this are by using expressions such as ‘for all young men up to 19’ and or including a small gay pride flag.

When we work in sexual health services we develop our own language to indicate what we offer such as ‘family planning’ or ‘sexual health services’; but these are meaningless terms for young men so we need to be specific about what we offer.

If our services work well with young men then they will tell their friends to come to the service. What would they say to their friends?

“They give you really good condoms for free”

“They don’t want to know your business”

“They don’t keep you hanging around”

“They explain things properly”

“The people there are alright and don’t lecture you”

It’s important to sell our services so instead of just saying ‘free condoms’ how about ‘top quality free condoms’ or ‘accurate information and honest advice from top professionals’. Counselling or offering relationship help is a service that many young men would want if it was called something else – ‘life coaching’, ‘we listen hard’, ‘sort your head out’ or even ‘come and talk to our life coaches’.

Back to part one

all images and text © Bish Training 2010 bishtraining.com

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Young men can attend our services full of anxiety which can be accompanied by an exhibition of macho behaviours. The way that we communicate with young men in services needs to demonstrate that we value them, that we understand what they want from the service, that attending such services is a big deal for them and, that with all this in mind, we need them to behave in a certain way and to follow certain procedures.

Working with young men in clinics mostly involves explaining procedures, asking them to do things and sometimes asking them not to do things. Below are some tips on how to communicate with male clients in clinics

Young men tend to respond to brief and clear communication so try to avoid waffling about procedures or policies. Think about what the client needs to know and try to say it in one or two clear sentences.

For example when explaining about confidentiality to male clients “this is our confidentiality policy, it basically means that if I tell anyone I’ve seen you without asking you first I can get sacked”.

It’s important to use clear straightforward language with young men. This means avoiding euphemisms and saying things as they are (eg penis or dick rather than ‘private parts’ or ‘tackle’). Also young people don’t see a distinction between family planning clinics and GUM services – they see them all as ‘sexual health service’. Client rather than ‘patient’ (they aren’t ill), also check-up rather than screening.

Young men often do not understand clinical language or have no connection with it (for example “piss/pee hole” rather than “urethra”). To make it relevant it needs to be in a language that they understand.

Young men use slang but it doesn’t mean that you should in order to make yourself understood. This is because a) you may not be totally clear what the slang means to that young man, b) they might not be very clear what it means, c) it makes you try to look ‘street’ and part of their gang – this can be embarrassing and the point of slang amongst young people is to make them sound different to people like you! Also they are coming to us because we are the highly trained professionals: who are also friendly, warm and clear.

A useful icebreaker can be to ask them what something means or even to say that you know what it means but not use it yourself.

Young male clients deserve a warm welcome to services and deserve to be valued and treated with respect. However this does not mean appearing over-friendly. Remember that to make young men feel comfortable they need to accept that attending your clinic is a masculine thing to do. Being touchy feely in approach at first can be off-putting. There is a great example of this in this research from Steve Pearson here where young men are wary of workers with bean bags being too friendly.

For an initial welcome try ‘alright?’ rather than ‘HI! How are you?’ Also although eye contact is important it is a good idea to use this sparingly at first as it can be quite intimidating.

Large groups of young men can be intimidating – even for experienced workers. They can also be a rarity in some clinics. It’s important in both cases to appear cool and confident and show that it is not a big thing. The more they feel that it is normal for young men to come in, and that you see groups of young men all the time, the better.

Being ready for groups of young men by having a ritual that you always follow can help this. Groups of young men often come in on recommendation from their friends who will have informed their friends about the rituals that happen – where they sit, who is on reception, how long to wait etc.

When first seeing male clients if you are unsure how to come across take clues from their body language. For example

• If they don’t like eye contact don’t try to establish it;
• if they have a closed body posture make sure that you give them space;
• if they are speaking quietly speak at the same volume;
• if they are making jokes to feel more comfortable laugh along;
• if they want to shake hands and call you mate do the same.

Usually you will sense when the client is more comfortable and you’ll be able to be increasingly open and friendly.

Understanding the difference between external (dough) and internal (jam) masculinities is vital when we a offering a clinical service for young men. In the waiting room young men are still in external mode, knowing that, at some stage, they are going to be asked very personal questions, be examined and be treated: a potentially very non masculine experience. This can lead to some inappropriate behaviour from clients or a less productive consultation.

Doctors, nurses and health advisors working with young men must have a good idea on how to help facilitate this process; much of it is down to basic client care and having the basic rituals each time a client visits. Not being a clinician I’m not an expert in how this is done but I suspect that the following are important:

• Having the same ritual each time a client is seen; the way clients are called from the waiting room, the body language and eye contact used and the way their role is introduced.
• That clients having some knowledge about the process and what is going to happen (particularly with regard to tests) before they happen.
• That confidentiality is consistently assured throughout the visit.
• There is a clear space for the client in the consultation room and they are allowed to feel comfortable.
• Giving clients excellent care but making sure that they get the impression that examining clients and taking sexual histories is standard practice that clinics do all the time (proformas of questions may help with this)

Most challenging behaviour from young men in clinics is not problematic at all – just different. Young men can be energetic, loud, funny, use up a lot of space, need lots of stimulus, sociable and curious. When taking a view on behaviour of young men in a waiting room ask yourself whether there is a real problem or whether they are merely behaving like young men. Are the following really problems?

• Loud conversations
• Walking around the waiting area looking at posters or coming in and out of the waiting area
• Talking on phones or even playing music from them
• Low level play fighting whilst sitting next to their mates
• Talking to other people waiting

It is important not to have to challenge lots of behaviour. Some of the above might be problematic in some clinics but should be handled with a softer touch such as a discrete finger on lips, playful but stern look for example.

If there is a genuine problem such as

• Inappropriate advances on other clients
• Inappropriate comments to staff
• Roaming around corridors
• Intimidating posturing

Avoid shouting

Shouting can create immediate irresolvable conflict. Young men are used to being shouted at and will shout back upsetting you, themselves and the whole clinic. Even calling loudly across a clinic can have a seriously fractious affect – no matter how polite or justified you are.

Make a point of being strong but fair.

Young men have a strong respect for rules if they are enforced fairly. Make sure that everyone is treated the same way – regardless of gender or age. Don’t be scared of being assertive but avoid escalating any tension.

Be polite, quiet, on their level and use humour.

If you have to have a word with clients ensure that you sit with them and are quiet so that they aren’t told off in front of the clinic waiting area. Use of humour is good if possible “are you chatting someone up in my clinic? Is there nowhere else that you can go to do that?”

Have a good reason and get your facts straight

It is vital that you have a good reason for challenging behaviour and it is important (in the interests of fairness) to explain the reason. It is also important to make sure that you clarify with them what they have done. For example

“Were you wondering up and down the corridor? I know it’s boring waiting but you can’t do that because we need to make sure that the service is confidential and safe. Are you ok with that?”

Or “I’m sorry but it’s not really an appropriate place to chat people up because people can be very upset coming here and that can make it much worse”.

Remember that you are in control and have quite a lot of power. Many clients will not understand what is expected of them in a clinic as it the only place where young people are where we expect them to sit quietly and not talk to each other. This can be very confusing. They are waiting for a service from you and they are probably anxious and uncomfortable.

Until recently I thought that having ground rules on the wall would make the service feel less young people friendly. After having discussed this with clients I now realise that I was completely wrong! Rules give everyone a clear boundary of behaviour and are for potential ‘perpetrators and victims’ – so that clients who are offended by bad behaviour can feel confident in reporting it to a member of staff.

When working in clinics we professionals are reasonably clear about the kind of behaviours that we do not want to see (see above): but why should young people share our view? Young men have a strong respect for very clear rules, which are fairly and strictly adhered to; and, even if we still have to tell them off they at least understand that they have broken a rule and are out of order.

The best way to develop a set of rules, is to start by discussing it with colleagues and then circulate a draft to clients. Ask clients about the wording, whether there is anything they want to include or take out. In my experience this has opened up a useful dialogue about why some behaviours are out of order.

When you have some rules make sure that they are clear and specific rather than euphemistic and theoretical (eg please do not make fun of people for being here, rather than, please respect other people using this service). Also ensure that everyone sees them and be prepared to explain why you have the rule.

Here’s an example of the one I did for our clinic

Part Five

all images and text © Bish Training 2010, bishtraining.com

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Young men are reluctant users of sexual health and contraceptive services, particularly for preventive reasons. If young men have symptoms of a STI then they will probably end up at a GUM service eventually but it is important for all services to send out positive signals to young men so that they attend our services earlier.

In order to offer a service that is relevant to the needs of young men we need to actually deliver what men want and need.

Where possible we should buy condoms from a brand, which are advertised and can be bought in shops. Although in clinical terms there may be no difference between condoms it makes a huge difference for two reasons

1. Trust. If we want young men to change behaviours and use condoms every time then they need to trust the product.
2. In order to get young men into our clinics in the first place we need to show that we value them. If we give a young man 10 condoms, that could be bought in shops, they feel like we are giving them £6.

Additionally the popular condoms have more bells and whistles that make them more attractive to young men. As well as the variation in size etc (see below) the popular brands are ‘easy on’ or have odour masking to prevent them from smelling like condoms. We may think that these are unnecessary gimmicks but they have a cumulative affect in making young men believe that using condoms are easy, more beneficial and feel just as good (maybe even better) as not using them at all.

The popular brands may cost two or three pence more per condom (though you should speak to your local sales rep, because they often provide great discounts) but it is much more likely that they will be accessed and used confidently. Our clients would prefer 15 popular condoms than 20 (or even 30) unpopular ones.

How much information do we give to young men about the condoms we give them? It is important that once we have the young men in the clinic that we ‘sell’ the condoms that we are giving to them, even if they aren’t available in shops or have ‘bells and whistles’ (see below).

For example “These condoms have a flared shape at the end making them easier to get on and more comfortable. They also act as a second foreskin because the glans (bell end) moves around inside the condom during sex which can feel very pleasurable”.

Or “these are tight fitting condoms which can help you stay harder and last longer as they restrict the blood flow”, which is always better than saying “these are small size”.

Reading the literature that comes with the box can tell us more about each condom we are offering. The condom manufacturers are selling the condoms to us so we should be selling the condoms to our clients. So looking at your condom stock; how wide are they? do they have an odour mask? are they straight sided or flared or contoured? how long are they? do they have lots of lubricant on or ‘gentle’ lubricant (not as much)? how thick are they?

Most condom companies have a range of publicity leaflets about their condoms; for example Durex have leaflets about how their condoms are tested. Get hold of these and read them, and make them available to clients. If you demonstrate to male clients that you know about the condoms that you are giving to them, then it demonstrates that you value the client, making it more likely that they will value your service.

Or you can read my post about condom types here

We know that a broad range of condoms impresses men. Young women are able to access many different forms of contraception and are often given the choice of many different brands. Having different types of condoms is a common factor for projects that attract more young men. It shows that we value them and also demonstrates that we know that young men would like a choice.

Condoms of different sizes and shapes are important so that clients can find the right fit for them. A recent study suggests that incorrectly fitting condoms can have an effect on slippage, breakage, erections and pleasure. The abstract is here and a really interesting podcast about it is here. Most companies offer a flared, straight fitting and narrow ‘trim’ size condom as well as those with a range of thicknesses. Flavoured condoms decrease the risks associated with oral sex, which young men are increasingly concerned about, and also demonstrate the condom use can be fun.

There are also condoms that increase pleasure with ribs, studs and even spiralled contours. Some such as the Durex Performa can delay ejaculation and others can make people ‘tingle’. These may be gimmicks and may not have a huge physical effect but that isn’t the point. They work because they encourage people who wouldn’t normally wear condoms to have a go because they associate sexual pleasure and success with the products. (Although for male clients new to sex, or having sex with new partners, I would always advise using the most regular condoms at first.)

Lubricant is also important because some clients enjoy having anal sex and they can also help make vaginal sex and mutual and solo masturbation more pleasurable – many younger clients refer to this as ‘bashing cream’ and can help many boys with tight or no foreskin. Additionally informing clients of the benefits of putting a very small dab of lube on the end of the penis before putting the condom on is a good idea, so long as they are also told about making sure the condoms don’t slip off.

Once we have a variety of condoms it’s important to offer a choice of condoms rather than a mixed bag, which they could take very quickly. This might seem obvious but spending a little more time with clients to get them to choose the condoms means that we have more opportunity to establish a dialogue and a relationship with them so that they feel more comfortable asking questions and also that they feel more comfortable receiving relevant information.

It is essential to build working relationships with young men in order that they ask questions about their own problems or find out more about sexual health generally. Young men invariably do not really begin to trust our services until they have visited at least a couple of times.

Young men have low levels of knowledge around sexual health and have few safe opportunities to explore their feelings about relationships and sexuality. Parents are often reluctant to talk to their sons about sex (particularly dads) and schools often are unable to offer more than very basic biologically focussed SRE.

Young men are very good at pretending to know something when they don’t and if they are not feeling comfortable enough in our services then they will do everything they can to prove that they know everything about sex, and that maybe they could teach us something about it (and maybe they can!). This might lead us to believe that young men don’t want to have these opportunities to learn and thus we do not need to waste our time thinking about how to offer this.

However sexual health services which are geared up to work with young men give them a great deal of information and advice, simply because they are not getting it from anywhere else, and also because they have created the right environment and used the right language to make this ok. For example it is always good practice to demonstrate condom use for first time clients, even if the client is sure that they know how to use them. I do this by saying that I have to do this because it’s part of the policy and by being very matter of fact about it.

In my opinion many Condom Distribution Schemes do not really meet the needs of young men if they do not offer this opportunity for them to ask questions and to learn more. Just giving young men condoms may meet their expressed needs but it doesn’t meet their unexpressed needs that may be found in the ‘jam’ of the donut.

When we first see first time clients there is a lot to get through. It can be overwhelming for the client if we try to give them all of the information that we think they will need because we are not sure if we will ever see them again – as well as trying to establish Fraser competency and whether they are sexually active. We need to achieve the right balance between giving enough information to clients without damaging the voluntary relationship they have with us.

The key is to say as little as possible in each visit, to pare down any information to the very basics and to offer this information verbally and in written bite size chunks. If we try to cover condoms, STIs, relationships, the law, consent, non-penetrative sex, testicular cancer, puberty, genital health and sexual anatomy in one visit;

• Our clients are unlikely to take everything in
• They won’t get chance to speak or ask their own questions

We need to be confident that our clients will come back (usually with their friends). To enable this to happen in my services I give out smaller amounts of condoms and encourage clients to return, often increasing the number of condoms once they have attended a few times.

If we are giving out condoms for the first time we need to ensure that our clients can use them properly and that they know what to do if it goes wrong.

A typical first time visit to my service might include the following

1. Introduction to the service, my name, what we offer.
2. Confidentiality and what this means (see below)
3. Registration
4. The condoms and a brief description as I put a selection of each different kind into their bag
5. Handing condoms over with an instruction leaflet and a leaflet about the different condoms (in a bag closed with a sticker).
6. Demonstration of using condoms “I do this with all clients for the first time – it doesn’t take long” including information about emergency contraception
7. Any questions? (there are often questions)
8. Remember that just because you have condoms doesn’t mean you have to have sex (if not sexually active).
9. Have you considered talking to your parents about coming here? (if under 16)
10. Where and when the next clinic is for them to get more.

Even this is quite a lot so I always explain that for their next visit they can choose their condoms and go (though in reality that doesn’t usually happen).

For follow-up visits, if clients do not ask questions an issue is raised by either asking open questions or by giving them a written piece of information.

Information needs to be given both verbally and written down as this has the greatest impact on client knowledge levels. Having written information also means that we can be more succinct verbally. It also means that for occasions when clients aren’t feeling comfortable chatting we can pop a leaflet into a condoms bag with a quick description of what it is. For example ‘this is a leaflet about how you can check your testicles for cancer, it’s important that you check them once a month, if you have any questions come back and see us’.

The Bite Size SRE leaflets have been developed, by me, over 10 years of working with young men in sexual health projects. They are a way of delivering an informal programme of SRE to young men and they also help to answer the most commonly asked questions. They really do work and young men are often disappointed when I have run out of leaflets!

Once the relationships with clients begins to build over a couple of visits clients then ask questions specific to their own problems or sex lives.

Much of this resource is about establishing a preventative model of sexual health for young men. This would encourage young men to come in sooner, preferably before they start having sex or before they start having unsafe sex.

I currently run this kind of project alongside a GUM clinic and it acts as a referral pathway for many young men that wouldn’t usually have accessed a service or would only have accessed a service when they were desperate (when they were symptomatic or given a PN slip). They get check-ups while they are there because they are easy (they are already in the building), because they think it’s a useful service, with lovely staff and also because we have addressed their fears.

When young people attend a sexual health service for the first time, it is probably the first time they have ever attending any health service without a parent before. We need to remember that this is a big deal for them, even when they are macho, swaggering, be-hooded young men! There are a number of things that services can do to give clients more confidence in this area. They could produce a welcome leaflet or poster which explains what happens and who does what. They can also be told that all the tests will be explained to them by the practitioner and that they can refuse any test.

Young men worry about confidentiality in the same way that all young people worry about confidentiality, just because they may not seem worried about it doesn’t mean they aren’t. The ‘You’re Welcome’ guidance has a section on this. Reminding young men through the publicity, through posters, through welcome leaflets and verbally can help them to feel more at ease about their security.

Young men have deep-seated anxieties about whether a swab will be taken from their urethra. It is very important to address this with clients, whether you do this or not, at the earliest opportunity: preferably in the promotional materials for the clinic. Services offering pee in a pot or self swabbing or rapid HIV testing should be very upfront about this. If a service does take swabs, for instance for symptomatic GC, then they should say what it involves and should explain how uncomfortable it may feel.

Also many young men feel very uncomfortable at the idea of having a male practitioner examining them (in fact some young men prefer female workers generally, even those delivering non-clinical services). We might perceive this as a trivial concern, and perhaps even homophobic, but I think that it’s an important fear which needs to be taken seriously. I’ve spoken to young men who have happily been examined by male and female doctors. In fact young men have reported to me that, in the days of urethral swabs, the male doctors were much more gentle! If they feel assured that they are in capable hands and they know what is happening before it happens then they feel much more comfortable.

Young men do not want to be in a clinical setting for a long time; so it makes sense to try to speed up how long it takes to see them. However we need to ensure that we are still able to offer a thorough service. Seeing young men quickly is not the answer in itself; they deserve a high quality thorough service too, we just need to be able to deliver it in a way that can meet their needs.

Many Condom Distribution Schemes sacrifice the amount of time that a young male client can spend with a sexual health professional, in order that they get their condoms quickly. In my experience most young men are desperate to access the correct information and advice once they have built a relationship with the service; this takes some time to do in order to build trusting relationships.

Furthermore it is tempting to make sexual health screening easier and quicker in order to make it easier for the client; however, a thorough examination can reveal many more issues and problems. Often clients believe that they are asymptomatic when they are not, for example, or; young men may not be aware of other penis related conditions such as phimosis or balanitis. If young men have taken the time to wait for a service then they feel good in the knowledge that they are getting the 5* treatment, the full works, a proper MOT!

Again this is something which, in my view, is a weakness of many Chlamydia Screening Programmes, particularly those which do not work in close partnership with local sexual health services. We may think that this ‘arms length’ service is something which young men want, but if we only work with young men on an external and superficial level then we are not working with them around issues which are truly going to improve their sexual health and that of their partners.

Part Three

all images and text © Bish Training 2010 bishtraining.com

The post Working With Young Men in Sexual Health Settings 2 appeared first on Bish Training - Sex & Relationships Education.

Over the last 14 years I’ve run projects which have aimed to increase access to sexual health services, condoms, information and advice for young men – as well as challenging the problematic values and attitudes they sometimes have.  This manual draws on best practice and research as well as my own personal experiences of effective methods of working with young men in sexual health services.

“Clinics were judged to be ‘woman’s domain’, and were only seen as relevant to men when they had to visit a clinic when they’d caught an STI. They would certainly not seek advice there – like the young women, they felt these clinics were staffed by people who were far too old to understand them. Whilst they would have welcomed free ‘stylish’ condoms (ribbed, flavoured, branded), they had a very poor opinion of the condoms which they had heard could be obtained via clinics.”

Young People’s Perceptions of Contraception and Seeking Contraceptive AdviceA Report on the Key Findings from a Qualitative Research Study Prepared for: Department of Health Prepared by: Counterpoint Research

“[Y]oung men approach most services and agencies with some reluctance… men will use services under certain conditions: when they are desperate; when agencies have a strong positive view of them; and when projects do not stigmatise them. There also appears to be an unfortunate combination of young men thinking that illness, vulnerability and asking for help are inappropriate, and agencies (generally) not having the experience or the inclination to target young men specifically.”

Boys’ and Young Men’s Health: What works? Trefor Lloyd, Working With Men for the Health Development Agency.

Despite improvements in the last decade, young men are still very much minority attenders of sexual health services. The implications for us not working with young men in clinics is clear, with rising rates of infection and still high rates of teenage pregnancy. It is clear that we need to adapt our practice to encourage young men to overcome their barriers around asking for help.

However it is often not recognised how difficult it is to work with young men in sexual health services and many clinicians are frustrated at not having the answers to the following

• How can we work with young men if they are not coming into the clinic?
• The only time we see young men is when they are in groups, which we find are intimidating and difficult to work with. How can we deal with this?
• How can we deal with inappropriate behaviour from the boys?
• What do young men want from us?

This resource gathers what we know about working with young men around sexual health in clinics and gives a step by step practical guide to offering a service that young men will want to come to in order to prevent sexual ill-health rather than only attending services when they are desperate.

The key to working more effectively with young men and to avoid many of the challenges that we encounter is to make attending such services seem, to young men, as men friendly as possible. To do this, it’s important that we demonstrate that we value them as equally as we do all other clients. However as well as valuing them we also need to be able to challenge them and some of the problematic values and attitudes which come with being a man – this isn’t easy.

Work with young men can be very difficult if we do not value them. These posts have practical ideas, which have come out of years of practice with young men – however without really understanding how masculinities are constructed we may never really value young men or understand the way they behave at all.

Many workers in this field will positively dislike working with young men. I have delivered and participated in training where participants (both men and women) have conceded that they feel very negative about men in general. Staff in sexual health clinics will have worked with many people who have been victims of male oppression; rape victims, victims of homophobic attacks, young mothers left to fend for themselves.

High quality participatory and experiential training is important in this respect. Participants need to feel able to explore their own values and where they come from, without the feeling that they are being blamed, in order to be able to see how young masculinities work. Services that work towards understanding this will be infinitely better equipped to come up with their own strategies for working with young men. Even if we don’t like some young men we can learn how to value them.

Being a man is more than just biology. Men are given messages about ‘how to be men’ from an early age until they die. These messages are very powerful because they come from so many different sources; parents/carers, friends, school, men and women, social class, religion, different ethnic cultures, TV, sport, magazines, films, pornography, magazines …..

They are also very powerful because these messages always end up saying the same thing. This is known as hegemonic masculinities, which basically means that there is a rulebook on how men should behave. They should be

Hard, strong or physical

Not open with emotions, appearing emotionally strong by not revealing emotions.

Troublesome, cheeky or rebellious

Focussed on performance, goals and success. Provider. Not needing any help.

Cool, have the right labels, fit in

Into sport

Straight and not be like women

This rule book on how young men should behave is problematic because it offers a very narrow template on how men should be and what roles they should adopt. If men don’t want to adopt these roles they can be excluded and become subject to bullying or ridicule. Many young men want desperately to be a man but find it difficult due to race, class, disability, sexuality, their body, their economic status – for many only way they can assert their treasured masculinity is by being homophobic or sexist or oppressive in some other respect. Some are more able to pick and choose which aspects of masculinity they value and which they don’t.

The messages that young men receive about being a man contradict with attending a sexual health service. Men are meant to be self-sufficient, know everything about sex and not need any help. Furthermore sexual health services seem, whilst not explicitly excluding young men, to be focussed on the needs of young women.

So when young men do come to clinics they have the usual feelings of vulnerability, fear, embarrassment, stigma which they are reluctant to address but they also have further fears about their masculinity and moreover their perceived masculinity. This can be expressed in the masculinity donut.

This demonstrates the difference between internal and external masculinities. Men need to be able to be in control of when they can present their internal masculinities and will present their external masculinities in public until they feel safe to do otherwise.

So young men attending a sexual health service for the first time will be feeling vulnerable, lost, embarrassed, stigmatised. As attending sexual health services is also seen as unmanly there is also a threat that the young man may not be seen as behaving in a masculine way.

Additionally they will be aware that part of their visit will involve revealing their internal masculinities (for example if they are having a check-up) and they are anxious that they do not reveal this until they are ready. Thus what may happen is that they behave in such a way to assert their masculinity. They will create more dough in order to protect their jam!

In a clinical environment young men’s opportunities to create more dough are limited so we may see more young men in groups, or may chat up other people, or talk about needing extra large condoms or hear sexist or homophobic remarks. This can be a major problem for us even if we understand why it is happening. It can create tremendous barriers and can make work with young men feel unpleasant and undesirable. Sometimes when we are working with young men all we see is dough.

The trick is to make attending sexual health services feel like a masculine thing to do. We can’t do this by reconstructing society to enable young men to re-think their masculinities but we can do it by making our services more masculine (or doughy) places to visit. If we do this then the very act of attending our services will be an acceptable expression of masculinity. Then once we are working with them we can start to effect real change.

Part Two

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The post Working With Young Men In Sexual Health Services Part One appeared first on Bish Training - Sex & Relationships Education.