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Calling a vagina a vagina: why cutesy code words are terrible for our sexual health

New Zealand’s rates of sexually transmitted infections like chlamydia are some of the highest in the Western world. That’s the bad news, says Siouxsie Wiles – the good news is that we can begin fixing the problem just by being more frank about our genitalia and what it does.

Lady parts. Bits. Flower. Front bottom. Hoo hoo. Foo foo. Vag. Vajayjay. Chuff. Fanny. Snatch. Pussy.

A few years ago, The Eve Appeal , a UK gynaecological cancer charity, found that two-thirds of young women they surveyed had a problem using the words vagina or vulva, and nearly 40% of 16-25 year olds said they resort to using code names for their genitalia. Even worse, many of the young women couldn’t correctly identify their internal and external genitalia on a simple diagram. Do you know a vagina from a vulva, or where the cervix and labia are? Give it a try.

When I became a mother, I vowed there would be no mention of foo foos and vajayjays in our house. I mean, come on. Foo foo? Where the fuck did that come from? When my daughter was old enough to start learning the names for the parts of her body, she learnt them all. Elbow, vulva, knee. They are all just parts of her. When we use phrases like foo foo and front bottom, we make these essential parts of our body a source of shame. Stigmatised. Like something we need to hide. I’m guessing that’s why we think it’s perfectly ok to admit to having a chest infection, or a pus-filled knee, but not an itchy crotch. How did Hermione Granger put it? “Fear of a name only increases fear of the thing itself”. Well, not on my watch. Or so I thought.

Cupcakes decorated with colourful female genitalia. Photo: Melanie Dawn Harter / Getty Images

Cupcakes decorated with colourful female genitalia. Photo: Melanie Dawn Harter / Getty Images

My daughter is rapidly approaching tweenagehood, and last year her class at primary school started on the first level of the NZ health and physical education curriculum: “describing changes in growth patterns and identifying body parts”. She came home after their first lesson astonished and a little deflated. She was the only one in her class who knew the words vulva and vagina. From what I can gather, her classmates reacted with a mixture of shock, horror and giggling when, without a hint of embarrassment or shame, she spoke up and named both male and female genitals. An even sadder thing happened after that lesson though. She was asked by one of the teachers not to talk about vulvas and vaginas outside of the class. She learnt an awful lesson that day: our genitals are something to be ashamed of, to keep quiet about. This is how it starts.

When we stigmatise parts of our body like this, we do ourselves no favours. Because there are grave dangers lurking – like the bacterium Chlamydia trachomatis. Chlamydia can be transmitted from person to person during vaginal, anal and oral sex. Yes, oral sex too. It can also be passed from an infected mother to her baby during childbirth. And chlamydia is no walk in the park. In babies, infection can lead to blindness and pneumonia. The symptoms of chlamydia in women include abnormal vaginal discharge, bleeding between periods, pain when having sex or peeing, and an itching or burning in or around the vagina. In men, it’s pain when peeing, pain and swelling around the testicles, a clear or cloudy discharge from the tip of the penis, and a burning and itching around the opening of the penis. Are you squirming yet? The good news is chlamydia is still easily treated with antibiotics.

For some reason, chlamydia isn’t a notifiable disease here, so doctors don’t have to report to the Ministry of Health on how many cases they treat, or who has it. The best guestimates put chlamydia rates in New Zealand at about 630 cases per 100,000 population, which is the way public health people describe things. To put that in context, it’s double what the rates are in Australia and the UK. Our rates also vary around the country, from about 330 cases per 100,000 for the West Coast District Health Board (DHB) region, to about 1,140 per 100,000 for the Lakes DHB.

Now for the bad news. Seven out of ten women who have chlamydia, and one out of four men, will have no symptoms at all. Nada. Zilch. Those microscopic chlamydia beasties will be happily living inside those people, who remain blissfully unaware they are infected. Not only will those wee beasties be silently passing from person to person, but without antibiotic treatment about half of asymptomatic women will go on to develop pelvic inflammatory disease (PID). What’s PID you ask? Swelling that can cause serious complications like chronic pelvic pain, ectopic pregnancy and infertility. It’s a similar story for asymptomatic men. If they don’t get treated they can develop painful swelling of the testicles and epididymis (that’s the tube located at the back of the testicles that stores and carries sperm), as well as reactive arthritis and infertility.

So, let’s do some back of the envelope calculations. According to the most recent figures available, in 2014 there were 28,331 cases of lab-confirmed chlamydia in New Zealand. Of those, 19,986 were in women. If they represent the roughly three in ten women with symptoms of infection, that’s a staggering 46,634 women and young girls who could have asymptomatic chlamydia and be at risk of disease and infertility later in life. For the men and young boys, it works out at 24,825 at risk.

So why are our rates of sexually-transmitted infections (STIs) so high? Well, in a recent survey, less than half of sexually active young people reported using condoms. That has to change. If you are sexually active and have never had an STI check, or haven’t had one in the last year, go get one done. Same for your partner(s). And if you aren’t trying to have a baby, then use barrier protection like condoms and oral dams. When properly used, they are very good at stopping the spread of STIs.

But to really beat infections like chlamydia, we need culture change. And that starts by ditching code names like foo foo and front bottom, and talking openly about common symptoms like pain, itching, oozing and bleeding, whichever part of the body they come from.

When it comes to our sexual health, it’s time to stop beating about the bush. At least not without a wearing a condom.

 

Dr Siouxsie Wiles is Deputy Director, Education and Outreach, at Te Pūnaha Matatini, a Centre of Research Excellence. She describes herself as a microbiologist and bioluminescence enthusiast. Head of the Bioluminescent Superbugs Lab at the University of Auckland, Siouxsie combines her twin passions to understand infectious diseases.

All this week Te Pūnaha Matatini are running InfectedNZ, which brings together leading health, social and economic researchers and people with personal stories to write about infectious diseases and what we’re going to do about the looming antimicrobial Armageddon. Follow their blogs here and join the conversation with #infectedNZ. Backing it all up, wherever possible, is data from Figure.NZ. Their charts are based on data sourced from public repositories, government departments, academics and corporations. Check out their #infectedNZ data board and sign-up to create your very own data board on any topic that floats your boat.


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