The pleasure gap: How a new program is revolutionizing sexual health education for young women

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At 9:30 a.m. on a mild Saturday morning last December, a dozen teenage girls form a circle in a drab classroom at the University of Windsor. Some stretch, others snack on Nutella and breadsticks and sip ice tea. Some have on eyeliner, others look as if they just rolled out of bed, huddled in sweatshirts and ripped jeans, their ankles bare over white sneakers.

The 16- and 17-year-olds have given up their weekend to sit in this room and think about their intimate relationships – past, present and future.

They are some of the first high-school students in the country testing out a leading-edge sexual assault prevention program that has shown remarkable promise. Among university-age women who took the voluntary, Canadian-designed course, the rates of reported rape one year later were 46 per cent lower than those among women who did not take the program, according to a 2015 study in the New England Journal of Medicine. Rates of attempted rape were 63 per cent lower; attempted coercion 36 per cent lower.

Now, researchers at the University of Windsor are working to deliver the intensive, 12-hour “Flip The Script” program to women when they need it most – in high school, before they set off for frosh week. The researchers received five years of federal funding from the Public Health Agency of Canada to adapt their university-level program for younger girls. Separately, in Vancouver, a small number of young women in Grade 11 and 12 have taken the existing, opt-in program, thanks to a women’s shelter initiative.

In Windsor, the girls spend two days delving into frank conversations teenagers seldom have with their parents. They dissect how high schoolers talk about sex, from jokey slang such as “Disney Plus and Thrust,” to the more worrisome “How many kills do you have?” – which is how some boys boast about their sexual conquests, as if in a violent video game. They explore why it’s so hard to negotiate manipulation in close, coveted, long-term relationships with men they care about. And they zero in on the red flags of sexually coercive behaviour: how to spot it, extricate themselves or fight back (Day 2 involves a Wen Do self-defence class).

But it’s the final hours that prove the most pivotal for many of these Grade 11 and 12 students. Here, the conversation moves beyond consent to sex – pleasurable sex, at that. The young women talk about female sexual anatomy, masturbation, desire and a persistent phenomenon known as the “orgasm gap”: Time and again, researchers find women are significantly less likely to masturbate to orgasm or climax during partnered sex than men.

Students are asked to think through what they might want in romantic relationships, and how to assert it. One exercise involves crafting “bottom-line messaging” that’s meant to help young women firmly convey where they stand on sexual intercourse. “The more comfortable we are with being able to talk about sex, the more assertive we will be in communicating what we want, as well as what we don’t want,” the exercise reads.

“Part of this is, if I know what my own sexual desires and values are, then I can know that when someone is pressuring me, they are wrong to do so,” said Charlene Senn, a University of Windsor psychology professor who originally designed Flip the Script for women in first-year university.

“For the youngest women, the least experienced women, this is the beginning that plants that seed,” said Prof. Senn, who holds the Canada Research Chair in Sexual Violence.

Most Canadian sexual health education still focuses on reducing disease, pregnancy and risky sexual behaviours. Absent from many lessons is open, meaningful discussion about what happy, mutually fulfilling sexual relationships actually entail. Amid this vacuum, adolescents are growing up with ready access to online pornography dominated by coercive, misogynistic depictions of sex.

Flip the Script is one program in a growing educational movement offering high-school students a cultural reset button.

“This is the worst world, where we have high rates of sexual assault and really low knowledge about sex that isn’t coming from a commercial source or from something that is harmful,” Prof. Senn said. “We need to provide more knowledge – not less.”

The pleasure principle

Talking about pleasure in school remains a deeply uncomfortable proposition for many parents and educators, who believe such conversations aren’t meant for adolescents. Pleasure remains largely off-limits in curricula, even as young people say guidance on good romantic relationships is what they want most, according to a large-scale 2018 report titled The Talk, part of the Making Caring Common Project from Harvard University’s Graduate School of Education.

“Adults want to protect the young from sexual violence and violations of consent. But young people want to know how to have sex and relationships. There’s such a vast gap there, we’re ships passing in the night,” said Frédérique Chabot, who is the Ottawa-based director of health promotion at Action Canada for Sexual Health and Rights, a national organization that advocates for more investment in sex ed.

Slowly, sexual health educators are beginning to embrace teaching that goes beyond disaster prevention to encompass healthy, positive sex lives. The new teaching model is in line with the World Health Organization’s definition of sexual health: “pleasurable and safe sexual experiences, free of coercion, discrimination and violence.”

The thinking emerging among sexual health experts is that pleasure, consent and coercion are inextricably linked: When you know what you want, you also know what you don’t want, and are better poised to react and assert yourself.

Arguably the most eye-opening exercise of the Windsor weekend is dubbed “With Whom Would You Do It?” The young women are given worksheets to fill out in private. They are asked to contemplate the various types of people that fill a life – strangers, acquaintances, casual partners, boyfriends and life partners – and which intimate experiences they’d feel comfortable sharing with them, if any. The list of theoretical options is long, from spooning and skinny dipping, to watching porn and sending nudes, to nipple kissing, fellatio and anal sex.

These decisions are different for every woman, the facilitators explain, and can vary based on her personal or religious values, her stage in life or her past experiences with trauma. The girls fill out their forms quietly, pensively.

It’s a startling exercise, not only for its explicitness but for its novelty. Most women never stop and contemplate their sexual wants and boundaries this purposefully – to consider whether the sex they’re having aligns with the rest of their lives. More typically, these decisions happen in real time, sometimes inebriated, sometimes unsure. As a host of emerging research is finding, many young women’s sexual decision-making still revolves around pleasing partners and maintaining harmony in relationships – this as their own thoughts remain unconsidered.

The exercise proved to be “the big moment” for Sian Kilpatrick, a Vancouver high-school student who took a physically distanced version of the program at a yoga studio this summer.

“We aren’t really given the chances to think about this kind of thing,” said Ms. Kilpatrick, 17. “It’s about setting your boundaries for yourself and not doing it for anybody else.”

From her vantage point as a Grade 12 student, Ms. Kilpatrick sees troubling gender divides pulsating through high-school culture. Female pleasure is not really on the radar, and men are the focal point of sex. At house parties, making out frequently turns into oral sex – for him. “It would never be the other way around,” Ms. Kilpatrick said. Young men are watching lots of online porn. Young women privately worry about pain during early sexual encounters, she observed.

“For boys, sex is pleasurable. For girls, it’s a thing to worry about: You don’t want to get diseases and you don’t want to get pregnant and you don’t want to get raped. ... It’s not, ‘Was it even good?’ It’s more like, ‘Were you okay?’”

Ms. Kilpatrick said the course helped her envision the kind of relationship she’d want in the future. She thinks all girls should take the seminar before they head off to university, including her little sister, who is 13.

“We want to have healthy relationships.”

Modern love

The lingering cultural hesitation to discuss healthy, pleasurable relationships in sex ed poses particular risks to girls, experts say. A growing body of research reveals that pleasure is frequently missing from young women’s sexual interactions. Experts urge parents to take that point to heart, saying it holds real ramifications for their daughters’ mental health and the quality of their intimate relationships now and into adulthood.

University of New Brunswick psychology professor Lucia O’Sullivan has been sounding the alarm over strikingly high rates of sexual problems among young people for more than a decade.

Nearly 85 per cent of young women aged 16 to 21 experienced a sexual problem, with 47 per cent reporting pain during sex, 48 per cent low sexual satisfaction and 60 per cent an inability to orgasm, according to a 2016 study from Prof. O’Sullivan and her colleagues that followed 405 students over two years and was published in The Journal of Adolescent Health.

When Prof. O’Sullivan and her colleagues later interviewed 53 people aged 18 to 21 for a 2018 Journal of Sex Research study, the young women described having little to no interest in sex but doing it anyway for the sake of the relationship. While several of the men talked about struggling to overcome behaviours they had picked up from porn, some women complained about partners thrusting too hard. One woman talked about her sex life being “not bad,” despite having to stop midway through intercourse 75 per cent of the time because the pain felt like “a ripping.”

In Toronto, sex educator Nadine Thornhill noticed a disquieting pattern whenever she raised the issue of pleasure with high-school-age women.

“What I often find with young women – and the younger they are the more I find this – is that a lot of their understanding of what makes good sex is centred around the guy’s experience,” said Ms. Thornhill, who held voluntary workshops after school at community centres at the request of student councils or community groups.

“I’ll hear things like, ‘My boyfriend wants to have anal sex. How do I do that? Is it going to hurt? How do I give him a blowjob? How do I know if I’m doing it right?’ What I try to introduce is the question of, ‘Do you want to do these things?’ Some girls have never thought about it before. Their eyes get big and the conversation will suddenly perk up.”

For some of the teens, this is a eureka moment. But for others, it’s overwhelming: “In a way, it is easier to think, ‘All I have to do is make this other person happy,’” Ms. Thornhill said.

Karen B. K. Chan, a Toronto educator who focuses on sex and emotional literacy, gets similar reactions when she leads consent training session at universities across Canada during frosh week.

“We’re trying to foster a consent culture and we’re asking everyone to ask,” she said. “But for many people, when the question comes it’s scary because then you have to answer it. Many answer, ‘I don’t know. We’ll just do whatever you want. I’m fine.’”

Perhaps the bleakest portrait of neglected female desire comes from journalist Peggy Orenstein, who interviewed more than 70 young women aged 15 to 20 about their experiences, attitudes and expectations of intimacy for her 2016 book Girls & Sex: Navigating the Complicated New Landscape.

Ms. Orenstein observed that most of the young women had come to view sex as a performance, not a “felt experience.”

“The concern with pleasing as opposed to pleasure was pervasive … especially among the high schoolers who were just starting sexual experimentation,” she wrote.

Half of the young women had never masturbated and few had ever had an orgasm with a partner, although most had faked one. In casual relationships, they were expected to give oral sex but rarely received it. Young women described oral sex as both a chore and a skill to master, “one on which they expected to be evaluated, possibly publicly,” Ms. Orenstein wrote.

Asked to define sexual satisfaction, young men said it means pleasure and orgasm. Many of the young women said it means satisfying partners, getting emotionally closer and not experiencing pain.

Alarmingly, half the girls reported experiencing “something along a spectrum of coercion to rape,” Ms. Orenstein wrote.

Rates of sexual abuse, dating violence and sexual harassment have all risen since 2013, with those who watched porn more likely to have been in a violent dating relationship, according to a 2018 BC Adolescent Health Survey of 38,015 students aged 12 to 19. The older the students got, the more likely they were to believe that they would be unable to say “no” to unwanted sex.

There are worrying signs about how these realities play out in adulthood. A 2019 BBC poll of more than 2,000 women aged 18 to 39 found that nearly 40 per cent had experienced unwanted slapping, choking, gagging or spitting during consensual sex. And nearly half of women experienced poor sexual health, according to the large-scale National Survey of Sexual Attitudes and Lifestyles, which involved interviews with thousands of British adults in 2018. Women struggled with low desire and a lack of emotional closeness in their relationships, as well as serious difficulties talking about sex.

Reconditioning women

In Windsor, a large diagram of a legal scale gets beamed up on the wall. On one side of it are the words: “be nice,” “be good,” “maintain relationships” and “don’t hurt anyone’s feelings.” On the other side are the words: “personal integrity,” “personal safety” and “sexual rights.”

The diagram is part of a running theme in Flip the Script: to recondition young women away from the old social expectations that they be people-pleasers, and get them prioritizing self-preservation instead.

“When they’re in a situation with a coercive person who they might like, where they might want to preserve that relationship, if we’re not turning [social norms] on their head and helping girls and women see value in themselves and see themselves as worthy of protection – this undermines their ability and confidence to prioritize their own safety, well-being and values in this situation,” explained Sara Crann, who recently completed a postdoctoral research fellowship at the University of Windsor, and is working to adapt the university-level program for high-school girls.

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Throughout the course’s final unit on relationships, which is sourced from existing sexuality-education curricula called Our Whole Lives, the Windsor facilitators make clear to the young women that consent is the lowest bar anyone should expect in a relationship. They ask them to consider their rights in sexual relationships: the right to trust, privacy, independence and the right to end it. But also: the right to have fun, to be happy.

“We don’t have much practice being assertive in sexual situations – even as we can be assertive in other ways in our lives,” the Windsor facilitators, Lorraine Oloya and Jessica Fontaine, tell the young women.

Ms. Oloya and Ms. Fontaine are both social workers who’ve been rigorously trained to deliver this sensitive material. But they also look and sound like they could be the girls’ cool older sisters: They’re stylish, bubbly and occasionally swear.

“We’re a hot mess this morning,” Ms. Fontaine announces on the first day of the seminar. Wearing a slouchy sweater and velvet leggings, her hair pulled into a haphazard bun, Ms. Fontaine teases herself for being old (she’s 28). “Promposals: Is that still a thing?” she quizzes the girls. “Oh god! So much pressure.”

This is all by design: The facilitators captivate the girls precisely because they don’t resemble their parents or teachers.

“We want to be seen as relatable,” Ms. Fontaine said. “In terms of the slang that’s used, the sexual acts that are talked about, the pop culture references, the technology … we try to keep it pretty young.”

Throughout her sessions in Vancouver last August, Ms. Kilpatrick felt safe talking to facilitators who reminded her of herself. “They went through the same things you’re going through 10 years ago or five years ago,” she said.

Increasingly, the new breed of sex ed is being taught by charismatic educators who look and sound nothing like the phys-ed teachers who typically got saddled with delivering “the talk” in gym class.

Toronto’s Ms. Chan is philosophical about sex, but also funny, speaking frankly with young people about deciphering what they find pleasurable. She likes to point out that pleasure isn’t one universal experience – some people love hot showers or massages that hurt, and others don’t. The key thing for women to keep in mind is that their own desires sit separate from being desired by their partner: “Our socialization conflates being desirable as being the desire,” she explains.

Ms. Thornhill, too, is engaging with her young charges. She uses thought-provoking analogies about pleasure and shares her reading list, including Emily Nagoski’s groundbreaking 2015 book Come As You Are; Literotica, a compilation of diverse erotic short stories; and the classic 1970s tome Our Bodies, Ourselves on women’s health and sexuality. “It’s the book that I was given when I was a teenager,” she says. “It’s where I learned that the clitoris is a thing.”

Ultimately, for these teachers, sex ed should venture beyond consent to what happens after a yes.

“It’s actually figuring out, is your partner enjoying this thing that we’re doing?” Ms. Thornhill said. “This really has to be the central goal of consent.”

The men in the equation

Ms. Crann is often asked why Flip the Script is only on offer to women, when perpetrators of sexual violence remain men, by and large.

“The gut reaction is, ‘Why are we asking women to give up their weekend? Why is our focus not on perpetrators?’ It’s a valid and important question,” she said.

While a number of boys-only prevention programs exist in Canada, Ms. Crann argues that interventions targeting sexual and dating violence perpetration have not proven effective in the long-term. And although bystander programs are showing increasing promise, the majority of sexual assaults happen in private.

In the meantime, she insists there is value in a women-only sexual assault prevention program. The point isn’t to place the burden of prevention on their shoulders, but to give young women a host of practical options for when they find themselves in coercive situations.

The ideal, Ms. Crann argued, would be a combination of effective, mandatory first-year university programs targeting perpetration, bystander intervention, resistance education for girls and women, as well as “broad cultural change that renders violence unacceptable, which the #MeToo movement is a good example of.”

Speaking with young, heterosexual men, Ms. Thornhill and Ms. Chan find they are struggling, too.

With honest conversations about pleasure absent from their lives, some are taking their sexual cues from hardcore porn. When they find out that many of these techniques aren’t actually pleasurable for their female partners, the men can get upset: Have they been doing it wrong the whole time, and why didn’t their girlfriends speak up? The educators try to shift men’s thinking about sex away from pressure, positions and performance, toward reading cues and mutual pleasure, in the moment.

Often, these young men aren’t having satisfying sex, either.

“Men grow up around hypersexualized porn that’s violent, this locker room culture version of what sex is,” Windsor’s Ms. Fontaine said. “I feel sad for young men. They’re missing out on the pleasure and connection that can come from really understanding another person’s sexual preferences and sexuality.”

Flip The Script

In Windsor, researchers have been careful to meet girls where they are. Aside from their test-run last December, there have also been focus groups with high-school students in Kingston, London and Simcoe, Ont. Teens told the researchers they want more information about LGBTQ relationships, cannabis and what to do when a partner demands nudes.

Next, the team will recruit 900 high-school-age women to test the adapted sessions. The goal is to roll out a program through schools, community groups and sexual assault centres in Ontario beginning in 2024, and nationally and internationally after that. The opt-in course will be offered after classes and on weekends and open to all girls aged 14 to 18, whether they are in school or not.

Separately, Vancouver’s Lorie Barton is working with the non-profit North Shore Women’s Centre to bring the existing Flip the Script university program to female Grade 11 and 12 students in British Columbia. (Once the high-school program is created, they will switch.)

“This is a real lightbulb moment for a lot of girls,” said Ms. Barton, a technical writer at a software company.

“A lot of the girls, it might be the first time they realize they have a right to want something. Here, they practice having their voice listened to. ... What it’s actually doing is giving you peer approval to stand up for yourself.”

Meighan Sherman, a unit guider with Girl Guides of Canada in British Columbia, has informally encouraged Rangers – young women aged 15 and up – and their families to consider the program. As with any other adult life skill, young women should know how to advocate for themselves in their relationships, she said.

“We promote all kinds of training for our girls, whether it’s first aid or self-defence. Why not this?” said Ms. Sherman, who wants her two daughters, 16 and 12, and a son, 14, to enroll in a course such as Flip the Script.

To Ms. Sherman, 39, this new era of sex ed is light years away from “the talk” she and her classmates received in Grade 6, when the girls and boys were separated in two classrooms.

“Somebody was brought in for the girls and we were talking about all the technical things: These are the ovaries, here’s a diagram, here’s a puppet,” Ms. Sherman recalled. “On the other side of the door, we heard this loud cheer. The boys were watching hockey.”

She believes more open and honest dialogue about sex, consent, mutual trust and “loving connection” in relationships could have been a lifeline for many women who are adults now.

“Our generation just tended to struggle through it. So many of us have experienced things that, looking back, if there was some way we could prevent our girls from ever going through that, learn how to speak up, find coping mechanisms and this level of support, it would have been a huge difference to us.”

Feedback from young women in high school is promising.

Nour Bitar was in Grade 12 when she volunteered for the Flip the Script workshop in Windsor last December. She thought it would help equip her before she moved to Ottawa to live in residence at Carleton University. While her Grade 9 sex ed class had covered STIs, pregnancy, contraception, abstinence and bullying – “all the fear,” as she put it – there was scant mention of happy, healthy relationships.

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Ms. Bitar, now 18, found the discussions in Windsor enlightening, especially the idea that girls and women are taught to put the needs of others before their own, and that this thinking can hinder them in relationships where a partner proves to be abusive.

She left the session feeling more confident.

“We need to know what our values are before we get into a relationship, or else it will be determined for us,” Ms. Bitar said. “If you know your boundaries, your wants, your needs, that will level things out.”

In the spring, Ms. Bitar had her first relationship. She described it as unhealthy: The young man made disrespectful remarks that left her feeling uncomfortable about her body image. She spoke up, and after a month, the two ended things.

“I was not being respected and I want to be respected,” she said.

Throughout the experience, Ms. Bitar remembered one of the exercises the girls had done in Windsor. They’d been asked to consider characteristics that make a healthy, long-lasting relationship and jot them down on colourful sticky notes. She had written down “compassion,” “caring” and “understanding.”

Without those two days of conversation, the teenager suspects she might have stuck with her ex longer.

“Had I not taken that workshop, I probably would have thought to myself, this is what a relationship’s supposed to look like.”