Sabina Dosani explains Sexpression, a project in which medical students go into schools and teach pupils about sex and relationships

Who told you about sex, when you were at school? Was it a biology teacher, a parent, or a friend? It probably wasn't a medical student. You might be surprised that up and down the country medical students are learning how to teach about sex and relationships.

Sexpression is an international organisation of medical students committed to interactively educating young people in schools about sex and relationships. The organisation has branches in Edinburgh, Cardiff, Nottingham, London, Manchester, Denmark, and the former Yugoslavia.

"Peer education" is a Sexpression buzzword. Ella Tillett, a medical student in Leeds, explains, "Peer education is education by someone who shares your views, role models, or profession. Peer education could be a group of surgeons at an educational meeting. People think of teenagers, but it doesn't have to be. When we go into schools we are role models. But because we are students we are still within reach, in touch, and accessible in a way that teachers might not be."

Dropping the balls

Dan Bernstein, a third year medical student at St George's Hospital Medical School and national coordinator of Sexpression in the United Kingdom, allowed me to attend a peer education workshop. Expecting to be a mere voyeur, I was surprised by two men throwing balls at me. The men, Momir Pantelic and Predrag Stojicic, are medical students from Belgrade, Yugoslavia. Momir is programme officer and Predrag is president of the Youth of Jazas, the Yugoslav Youth Association Against AIDS. Both work extensively in peer education.

We stand in a circle throwing a paper ball and naming the person we have chosen to throw to. More balls are introduced. It is difficult to learn new names quickly while throwing and catching accurately. Momir changes the rules: "Ten throws without dropping the balls." Surprisingly, no one drops them. The balls, apparently, are metaphors for sex education: "A message to deliver," says Momir, "all too often, sex education is preach, threaten, scare. We need new ways. When the group was given a task to focus on, he says referring to our ten consecutive throws, "you improved and didn't drop the ball."

What sort of messages do they deliver? "Information like every five minutes, someone dies of AIDS," Momir explains," Sometimes we bring in someone who has AIDS to share their story. A real life story has a lot of impact."

"Eight years ago in Yugoslavia, you couldn't show a condom on television. We had a lot of opposition; teachers said, 'You'll corrupt our kids.'" As it turns out, someone in the group has a condom, leading to an impromptu demonstration: "Squeeze the little teat; that's for your population paste."

Blushing teachers

The nagging question, "Why should it be left to medical students to go into schools to teach sex and relationships education?" Aren't the nation's educators up to the job? "We're better than teachers at dispelling myths," says Amanda Barclay, medical student from Leeds, "Because we are less embarrassed, and we are willing to answer questions."

"Teachers have reservations about sex education," says Dilys Went, an Independent Consultant and Trainer in Sex and Relationship Education. Over thirty years experience in teacher training as a Lecturer and Associate Fellow of the University of Warwick have taught her that, "'Just say no,' doesn't always work. 'Sex is dirty: save it for the one you love,' is a mixed message."

While Went's research suggests "young people want to learn from their parents," she believes Sexpression has a place when young people are afraid of their parents' reactions. She suggests medical students talk to childrens' parents about sex: "Give them names of parts so they've got something to work with." She thinks Sexpression could help prevent young girls feeling coerced into sex: "It gives them empowerment and a sense of control over their own lives. Girls with high self esteem are less likely to say yes when they mean no."

Ella Tillett agrees, "Teenagers believe they are invincible. We make sex education relevant to them. Pregnancy is commoner than AIDS in the United Kingdom, so we talk more about pregnancy." Sexpression is like an evangelical religion, with all the missionary zeal, smugness, and conviction, except that they preach condoms and safe sex.

Periods, pills, and gay men

When he was at school, Phil Williams couldn't confide in his teachers or parents. He describes his school as "very upper class, with no coherent sex education." Although he attended personal and social development classes, he found them "too girl oriented. A school nurse told us about periods and pills." Although the nurse also told his class about condoms, none of the boys knew how to use them. Phil has another criticism of his school's sex education, "It was biased towards heterosexuals. It was no use to me." Sexpression was different. "As soon as we met our facilitator, my class had a good impression of him. He was there because he wanted to be and that impressed me."

"'At least one of you is gay,' he told my class. He told a class of public schoolboys that he'd had anal sex. I'd never met anyone so direct. I realised I wasn't the only gay man in the world: he gave me hope." Three years on, Phil is a medical student and Sexpression member.

Not just extracurricula

Chris Twine, a Cardiff medical student has developed a Sexpression special study module. "Wales has the highest teenage pregnancy rates in Britain," he says, "and one way to tackle that is through peer education." Unlike Momir and Predrag, Chris sees medical students as "quasi-peers: halfway between peers and health professionals." To find out if their interventions were effecive, students at Cardiff sent schoolchildren questionnaires before and after their Sexpression session. "We found that for 75% of them, school lessons were the major source of sex education," says Chris, "Although their knowledge of contraception was generally good, children's knowledge and attitudes towards services were limited and that's where Sexpression can help." Chris's questionnaire included a free text section. One in five respondents chose to use it. A common response was, "We want to know more about same sex relationships."

How could Sexpression be improved? "We need to learn how to communicate with young children," says Momir, "They may not know what words like vagina or fellatio mean." Isn't this a bit much? Do young children need to know things like that? Dilys Went advocates sex education in primary school, as part of a 10 year government campaign to lower teenage pregnancy rates. "Childhood ends at eight," she says.

Blunders

But the welcome from the school isn't always warm, and when things go wrong it gets ugly. Momir was once ejected from a school: "Teachers said, 'Not in my school,' and threw me out." It didn't put him off: "These things happen," he says, and with a hint of self righteousness he adds, "Teachers don't always realise we have something to offer."

Few Sexpressioners share their blunders as readily as Momir. Sexpression's founder James Jobanputra, now a senior house officer in emergency medicine in Scotland, tells me, "I haven't had enough experience to have been in classes when it goes really wrong." But a few have heard horror stories. A male medical student was "confronted by a roomful of girls wearing burkas. The whole session was silent, awful." Momir remembers "a friend teaching a topic he didn't know the first thing about. It was a complete mess." He didn't seem worried about the consequences: "Just something that happens," he shrugged, "because we're so young." Several peer education group members can recall "the power trip that happens the first time you teach." Predrag suggests humility and honesty as antedotes to power trips, "As peer educators, we don't know everything and shouldn't be afraid to say so."

Emily Spry introduced Sexpression to St George's, where she is now a third year medical student. "It gives us transferable skills. We learn how to facilitate a school class. The dean of Manchester's medical school said people like us give him hope for the future of medicine."

Dilys Went thinks Sexpression is "a wonderful source of help. They are glamorous; young people listen to them: they respect them." She acknowledges "some schools are a bit hesitant" but hopes medical students can collaborate with teachers "so no young person ever has to say, 'If only I'd known.'"