Sex education: how to really do it

31 August 2017

Children are growing up in a confusing world of online sex and modern gender norms, says Anna Scott. They require relevant, up-to-date sex education to keep them safe from harm and able to form healthy relationships.

Rising numbers of girls under the age of 18 – some as young as nine – want plastic surgery on their vagina because they are distressed by its appearance (BBC, 2017). 

This has sparked concerns that access to online pornography and social media images has led to children having unrealistic perceptions of how they should look (read more about children’s body issues on page 12). It has also shown the need for better education – labiaplasty isn’t needed under the age of 18 because genitals are still growing.

‘Ignorance allows negative, useless and erroneous beliefs to spread,’ says Anita Abrams, a chartered clinical and educational psychologist. ‘If children don’t have access to the facts, they will almost certainly pick those beliefs up. This is misinformation with a big emotional dressing, which means guilt and fear.’

It is not surprising, therefore, that 70% of children in England surveyed by young people’s charity Barnardo’s said they thought the government should ensure all children have school lessons on sex and relationships (Barnardo’s, 2017). 

Carron Fox, the charity’s research and policy officer, says it is important to make the subject of sex less taboo – as in the case of worrying about genital appearance – so that children are willing to talk about it. ‘You would hope that they would be able to have a regular, normalised conversation with a school nurse who could examine them and say: “No, you’re fine”.’

Ignorance isn’t the only issue. Almost three-quarters (74%) of the 11- to 15-year-olds surveyed said they would feel safer if sex and relationships lessons were provided, and 94% agreed that understanding the risks and dangers of being online was important for them to stay safe (Barnardo’s, 2017).

Devolved government approaches to sex education 

Northern Ireland

RSE is covered within the Personal Development and Mutual Understanding area of learning in primary schools and the Learning for Life and Work area in post-primary schools. Schools and teachers can decide which topics to teach in class and which resources to use to help deliver the curriculum. Each school must have its own written policy on addressing the delivery of RSE, which parents can consult upon.


There is no statutory curriculum for relationships, sexual health and parenthood education, but local authorities and schools can decide how to deliver the curriculum based on local needs and circumstances.


Primary schools must have a sex education policy in place which is accessible by parents and carers. Secondary schools can determine the approach they take to delivering sex education.

Legislation push

The government’s announcement in March that relationships and sex education (RSE) will be compulsory in all secondary schools in England has been welcomed by Barnardo’s and a number of other organisations, including sexual health charity the Terrence Higgins Trust.

Children in free schools and academies, which represent around two-thirds of secondary schools in England, were also guaranteed RSE under amendments to the Children and Social Work Bill. The government renamed the subject RSE – previously ‘sex and relationships education’ (SRE) – to emphasise the importance of healthy relationships. In future, personal, social, health and economic education will be taught in all schools in England – primary and secondary, maintained and academy (Department for Education, 2017).

‘We have no objection to the government changing it to RSE if that means it thinks in terms of being age-appropriate, focusing more on relationships in primary schools, with a greater focus on sex and sexual identity in secondary schools,’ says Ian Green, chief executive of the Terrence Higgins Trust.

‘But it does need to be a really dynamic part of the curriculum and not just an afterthought, which it too often is. The fact that it is now going to be a legislative requirement will go a long way to help with that. It’s a massive step forward.’

As is the case in local authority schools, where sex education is already mandatory, all schools will have flexibility over how subjects are taught to reflect the sensitivities of different communities and faiths. Parents will have the right to withdraw their children from sex education, and schools must publish a clear statement of their RSE policy (Department for Education, 2017).

Mandatory requirements differ across the devolved nations, and there are currently no plans to change legislation in line with schools in England (see panel, right). 

‘Welsh Government guidance currently states that schools’ SRE programmes should be relevant to learners and sensitive to their needs,’ says a spokesman for the Welsh Government, which has formed an expert panel to advise on the future curriculum and support for the teaching profession (Cardiff University, 2017).

The Scottish Government will also undertake a national review of personal and social education, and the role of guidance in local authority schools, with a report expected to be published in 2018 (The Scottish Parliament, 2017).

‘We want our children and young people to build positive relationships as they grow older, which is why relationships, sexual health and parenthood education is an integral part of the health and wellbeing area of the curriculum,’ a Scottish Government spokesperson says. 

In Northern Ireland, the Department of Education updated its guidance for primary and post-primary schools in August 2015 (Council for the Curriculum, Examinations and Assessments, 2015). ‘RSE must be delivered in a sensitive manner which is appropriate to the age and understanding of the pupils and in keeping with the ethos of the school,’ says a spokesperson.


Out of date

Yet the major problem has been the Westminster Department for Education’s SRE statutory guidance, introduced in 2000. The department will consult on the new curriculum across England and publish regulations and statutory guidance for consultation later in 2017, with a view to the new curriculum being taught in schools from September 2019.

Current SRE guidance for professionals working with children is completely out of date, according to Carron Fox. ‘Anything about the digital world is just not there,’ she says. ‘Many children’s relationships are online now, and we talk to them about stranger danger, but no one is seen particularly as a stranger online, especially if children feel like they have got a connection.’

The new curriculum should cover issues such as healthy and safe relationships of all kinds, understanding when a relationship isn’t quite right, online safety, and issues such as puberty, sexual health and pregnancy, according to Barnardo’s. Crucially, the charity says, it must also address gender roles, gender identity and LGBT issues. 

‘Young people say their sex education is all about heterosexual sex and nothing about LGBT relationships,’ Carron says. ‘At a young age this might be about someone at school with two mums or two dads. You don’t have to talk about sex, just different relationships and how one isn’t better than the other. There are so many different topics.’

Consent and safeguarding are also vital. ‘It’s really important that the curriculum is robust and age-appropriate, focusing on the needs of young people and enabling them to chart the sometimes challenging world of relationships and sex in a way that is empowering for them,’ Ian Green says.


School nurse support

School nurses encounter many of these kinds of relationship and sex issues. ‘Recently we have seen more young people requesting information relating to gender issues and sexuality,’ says Lindsey Franks, lead practice teacher for school nursing at Leicestershire Partnership NHS Trust. She supports schools in delivering RSE across the region, providing guidance and advice to parents and children through drop-in centres and one-to-ones.

Nicola Boyle, service manager for children, family, health and wellbeing at Central London Community Healthcare Trust, who has been a school nurse working with schools to plan and deliver SRE talks, says that social media and mobile phone use have been a catalyst for many issues related to SRE.

‘There are increasing challenges in how we keep young people safe online,’ she says. ‘So this should definitely be a key focus for RSE education. Also, continued education on sexual health and sexually transmitted infections (STIs), and where young people can access help so that they can stay healthy are important.’

It’s not just new issues relating to RSE that are prevalent, however. ‘In some areas there appears to be a rise in teenage pregnancy, suggesting a lack of knowledge around delaying sexual relationships and the use of contraception,’ says Paula Lawrenson, school nurse practice teacher for Lancashire Care NHS Foundation Trust. 

‘Child sexual exploitation, healthy relationships and STIs are also areas that have been identified for discussion with other agencies.’

How school nurses can help

Give lessons

  • Have a member of school staff present in the classroom to deal with any disruptive behaviour  
  • Use a range of teaching styles: group work, whiteboard teaching and demonstrations 
  • Distribute leaflets or handouts 
  • Have fun with the class but set ground rules at the start 
  • Allow students to write down any questions they are too scared to ask, put them in a box and at the end of the session read them out 
  • Stick to the syllabus.

Have a visible presence

  • Ensure you are accessible to children and parents online and face-to-face  
  • Publicise what school nurses offer children and how they can be contacted– and emphasise confidentiality
  • Hold drop-in clinics in schools.

Use appropriate language and technology 

  • Be open and honest and have the correct and up-to-date information in language that they use and understand and via mediums – such as webchats and text messaging services – that they use 
  • Ensure there are opportunities for them to discuss concerns and ask questions.

In the classroom

Experts agree that as well as including an appropriate wide range of topics, the new curriculum must also be delivered effectively to have an impact.

The Terrence Higgins Trust also wants to see the curriculum treated the same as any other within education, in which teachers are properly resourced and trained to deliver it. ‘Proper time needs to be built into the school week to make sure appropriate time is given to RSE, and it shouldn’t just be an add-on to somebody else’s role,’ Ian Green says.

‘There will also be times when the school wants to bring in other people from outside to deliver parts of the curriculum where appropriate. Teachers need flexibility to deliver the curriculum in the most appropriate, sensitive, inspiring and passionate way that isn’t just focusing on the nuts and bolts of reproductive health, which is the way SRE was often taught in the past.’ 

This doesn’t mean RSE should be treated the same way as any other school subject, however. In the 1950s, an authoritarian approach towards children was taken, from the way newborn babies were treated to the way children were taught about sex, if they were taught about it at all, according to Anita Abrams.  

‘If we’re dealing with geography or maths, adults can be authoritarian – set the rules, set the homework and have consequences for not doing it,’ she says. ‘The attitude has to be completely different for something so personal, so much to do with privacy and emotions [as RSE]. You have to earn the right to talk [to children] about private issues. Either individually or in a group you have to be hugely aware of the fact that there are walls of shyness, self-protection and guilt – really tough feelings that you can’t barge into.’

This is why school nurses play a vital role in delivering RSE. ‘Children ask us all sorts of things,’ says Natalie Jewell, a school nurse who has given puberty talks in primary schools and SRE talks in secondary schools.

‘Every time I think I have been asked everything I ever could be, someone asks me something new. We still come across really old-fashioned ideas and playground myths. Our role is essentially as a friendly face who can give the real facts. And it helps to have a good profile in schools with the students.’

The nature of the content and delivery of RSE by school nurses depends on the NHS region and the resources available. ‘School nurses have the skills but the main problem is that our resources are out of date,’ Natalie says.

Not all trusts expect school nurses to deliver RSE and instead schools pay private organisations to give talks to students. But school nurses are often ‘best-placed to deliver this education, reinforced on a daily basis by confidence and informed school staff’, Paula Lawrenson says. 

‘I hope that schools will request support with this. I do not see school nurses being responsible for the delivery of all RSE, but there is an abundance of research identifying that young people prefer “outside speakers” to deliver what are commonly seen as embarrassing subjects.’


Parent Power

School nurses can also advise parents, who have a crucial role in RSE. ‘Empowering parents to speak to their children about puberty, sex and relationships is a really important area of RSE that can be missed,’ says Lindsey Franks. ‘For schools where we have provided support with delivering sessions for parents, the feedback has been that this was really valuable.’

Parents have a crucial role in RSE and in ensuring their children remain confident and competent about relationships and sex, but ‘many need support themselves’, says Ian Green. ‘RSE in schools, with school nurses playing a distinct and vital role, can provide parents with support they might need to further develop conversations with their children at home.’

There are roles for many different people in the successful education of children in relationships and sex. If the new curriculum reflects this, and covers the expanding range of topic areas, it could have a genuinely transformative impact on the sexual and mental health of a future generation of young people. 


Barnardo’s. (2017) Sex and relationships education will be compulsory in England, government announces. See: barnardos.org.uk/news/Sex-and-relationships-education-will-be-compulsory-in-England-Government-announces-/press_releases.htm?ref=122116&topic=0&region=
(accessed 7 July 2017). 

BBC. (2017) Vagina surgery ‘sought by girls as young as nine’. See: bbc.co.uk/news/health-40410459 (accessed 6 July 2017). 

Cardiff University. (2017) New expert healthy relationships groups to advise on curriculum. See: cardiff.ac.uk/news/view/592589-new-expert-healthy-relationships-group-to-advise-on-curriculum (accessed 10 July 2017).

Council for the Curriculum, Examinations and Assessments. (2015) Relationships and sexuality education: primary revised guidance. See: ccea.org.uk/curriculum/rse_primary (accessed 18 July 2017).

Department for Education. (2017) Schools to teach 21st century relationships and sex education. See: gov.uk/government/news/schools-to-teach-21st-century-relationships-and-sex-education (accessed 6 July 2017).

The Scottish Parliament. (2017) Let’s talk about personal and social education. See: parliament.scot/parliamentarybusiness/CurrentCommittees/103227.aspx (accessed 18 July 2017).


Image credit: Shutterstock

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