The question and my reply is here. I also had the following feedback to the column that focused on the importance of oral and if it constituted a relationship ‘deal breaker’.

One person pointed out I hadn’t talked about whether her reluctance to give oral sex related to her desire to give it. While the original question didn’t make reference to this, it was a relevant question that could have been posed to the person with the problem. It also highlights one of the ways we generally focus on oral sex – which is the belief often shared in popular culture/advice giving that if you get it you have to give it. This can be particularly problematic if someone is keen on one but not the other, and some advice that suggests you have to do both even if you dislike one. This might be a more nuanced point for those offering advice/education on relationships to think about further. Why do we see oral as something that has to be given in order to be received? What other ways are there of thinking about pleasure that don’t rehearse a narrative that oral sex is only ‘fair’ if you give and get in return.

More feedback stated that I hadn’t focused much on her asking him how important oral sex was. The letter describes a partner who wants to do it but gives no indication of how much of a desire this is. So it would have been more useful to detail how to have a conversation to identify early on if this is something very important to a partner or not.

A colleague (who wishes to be anonymous) gave me some more detailed pointers around the approach I had taken in my reply. They said:

“Every time I go to read something you’re written, I’ve done so with excitement, and I always have a satisfying experience and can say, “She speaks my words better than I can.” I think this article misses something. I think the article pussyfoots around.

Ya see, I think that for most couples, the birthday blowjob with attitude is not what most men like, nor do most women want a guy to go down on them with a close-pin on his nose. ( I know it’s a het assumption.) Quid pro quo sex ain’t never gonna work, and in our culture, in this time, I think it is foolhardy to think that it won’t matter. Yes, I’d equate it with the porn/anti-porn couple, it’s that much of a barometer.”

The problem, my reply and the above responses to it may be useful for those who are questioning about oral sex, or who offer therapy or work in psycho/sexual health. Not least to explore some of the values we have about oral. About its changing importance in relationships and popular (Western) culture, about how this may impact in different relationships (particularly lgb ones), and how therapists and educators may internalise values about oral that in turn affect their practice.

I asked colleagues and friends for feedback on the advice given – including what information was shared and the tone/approach taken. Their thoughts on how I could improve the reply are below:

Ronete Cohen
“The information you give is very good. I think though that, if she’s depressed, for instance, she could find that number of questions at once a bit overwhelming. It might be better to break up such blocks of questions and intersperse them with an illustration of what could possibly be going on, or what you’re trying to get to, or recognition of how difficult things must be for her. All of these things could help make her feel seen and heard and make it easier for her to absorb what you’re writing and act on it. Things are undoubtedly also difficult for her husband, but we don’t know what’s going on there, what the state of the relationship is or whether or not he’s contributing to the situation in a way she’s unable to spot. I personally would find out what was going on with her (i.e. individual therapy) before I went the route of couple therapy.

Also, I suspect that telling you what kind of help she would like and what barriers are in the way would be too difficult a question for her to answer or she wouldn’t be writing to you. I’m not sure though that all this is possible within the limitations of your word count. One more comment: NHS mental health services are being cut so badly, that anyone needing treatment for a serious problem is not very likely to find it. Even when you’ve survived the waiting lists, often the number of sessions available is inadequate to deal with the problem, plus the type of therapy offered can be unsuitable. I hear this all the time from NHS colleagues, and from clients who end up going private (often referred by an NHS therapist).”

Laura Davies
“I might also ask whether she has girlfriends or other outlets to talk about her problems. I would be suspicious of prior sexual or physical abuse, though that would be hard to target in a newspaper column– why is she identifying her husband as the target? And of course I would want to know if there are children witnessing this and then patterning their own relationships after this.”

I hope you’ll consider donating (if you haven’t already) and check out their site to find out all the amazing things they do and how you can support them.

You can keep in touch with Hesperian Health Guides
On twitter @Hesperian
On Facebook
On YouTube
Or via their website

Wishing you a happy, healthy and restful Christmas if you are celebrating. And all the best for a wonderful New Year.

Although this blog’s been celebrating one particular health charity, here’s to everyone who works in healthcare – particularly those who will be working over the holiday period.

To play us out it’s the children of St Paul’s Arts and Media (NZ) and their version of the Christmas Story.

As you celebrate you might want to think about supporting Hesperian Health Guides and here are the ways you can do that.

You can…
* tell people about Hesperian and use their resources in your own community.
* volunteer as a translator of their books
* donate materials for them to use
* help distribute their health guides and dvds
* support their programme of providing materials for people to create their own health/development posters, flyers and books
* join the People’s Health Movement
* support their health guide apps and wikis
* volunteer to research and write health and development guides for them
* volunteer to advise on their digital strategies and programmes
* endorse and assist the Curt Kessler Fund that aims to ‘comprehensively integrate cancer into a primary healthcare manual useful for community health workers all over the world’
* encourage other health, development, aid and community workers worldwide to use Hesperians tools and resources

And of course you can DONATE to ensure their amazing work continues!

To get you in the giving spirit here’s Kate Rusby again, this time with Here We Come A Wassailing.

Tomorrow I’ll give you more details about opportunities for volunteering in open access health publishing, but until then please enjoy this film of The Dualers (Tyber and Si Cranstoun) busking (prior to Si going solo). Great talent!

If you are celebrating the Winter Solstice today, Yuletide Blessings to you. And here is a reindeer on a treadmill. All in the name of medicine, of course.

You might want to share this information with colleagues and communities you work with, or offer materials of your own that can be developed for open access teaching and learning tools for global health work.

To enable projects like this please give generously to Hesperian Health Guides.

On the Advent blog today a bit of Christmas kitsch to get you feeling festive. Make yourself a cocktail, hang up the tinsel and enjoy Eddie Dunstedter’s rendition of Let It Snow/Rudolph The Red Nosed Reindeer.

What’s so important about Primary Care and The People’s Health Movement?
On the Hesperian website they explain “The People’s Health Movement (PHM) had its origins in 1978, at the Alma-Ata Conference,(where) health ministers from 134 countries, in association with the World Health Organization (WHO) and UNICEF, pledged to achieve ‘Health for All by the Year 2000′ and dedicated themselves to implement Primary Health Care as the means to achieve it. Unfortunately, people’s health status has not improved and, in many cases, has deteriorated further. Two decades after Alma-Ata, we are still facing a global health crisis characterized by growing inequalities within and between countries. As people’s living standards decline, new threats to health are emerging and old threats are reasserting themselves. The forces of corporate-led globalization are preventing a more equitable distribution of resources, a necessary condition for the improvement of people’s health. Within the health sector, the failure to implement Primary Health Care has significantly aggravated the global and local health crises. Pressure must be exerted on decision-makers, governments and the private sector to make “Health for All” a priority through the development and support of people-centered initiatives and to oppose the corporate vision of “Health for All Who Can Pay….Alma-Ata called on the world to achieve basic health care for all the world’s population by the year 2000 and recommended comprehensive primary health care as the best means to this end. Unfortunately, after Dr. Mahler’s tenure, WHO pulled back on this recommendation, and with UNICEF, the International Monetary Fund and others, began to concentrate on top-down single-issue campaigns, such as bed nets, micro-nutrients and immunisations”.

So when you are giving to Hesperian you are contributing to a unique and important global venture, where communities are involved in creating, sharing and benefiting from accessible healthcare resources which seeks to empower while subverting the idea that only those who can afford it get care. This is by no means an easy task and in many places it proves exceptionally difficult to implement. However donations from people like you to Hesperian and other People’s Health Movement projects are one step towards greater equality in healthcare and improving people’s quality of life.

Your Advent treat today involves a singing reindeer and a bit of a cliffhanger – if you want to know what happens to poor old Rudolph you’ll have to watch the whole movie (it’s the 1964 TV Special ‘Rudolph The Red Nosed Reindeer’).

To help more people have positive stories to tell you can also get involved by volunteering to write, translate or distribute Hesperian Health Guides – details on how to do this can be found here. Financial donations are equally appreciated!

Your Advent clip today is a holiday light show. I appreciate it’s for an upmarket store so won’t appeal to everyone, but the show itself is stunning.

With thanks to @taniaglyde for finding and sharing this clip.

You might consider helping Hesperian by translating books like this; or writing new texts to offer advice and support to male and Trans sex workers, or to provide critical resources for healthcare and development practitioners who have contact with sex workers. (If you think you can help with writing health advice books on any topic please email Hesperian). Alternatively if you travel for work and could help distribute books your assistance would be very welcome. As might sharing existing leaflets and flyers you have on sex worker rights and health which you can donate to Hesperian’s growing archive. Or you may want to assist with work like this on a variety of health topics by donating.

Your Advent treat today is Lamb’s beautiful song Gabriel.

Lamb – Gabriel by Angkor