Histories of Sexual Health in Britain, 1918–1980

Across the twentieth century Britain experienced several radical transformations of its sexual-health policies and services. These developments brought huge benefits and helped to break down the stigma and inequalities that had impeded access to care. Yet fundamental challenges remain, and history has much to teach us as we face those challenges. Understanding the historical impact of clinical practices, social conditions, cultural attitudes and policy interventions enables us to recognise long-term trends and patterns. And it makes us better equipped to tackle persistent and emerging sexual-health challenges today.

Today, sexual health is defined as the ability to lead a pleasurable and safe sex life and is recognised as a vital component of overall health and wellbeing. Historically, its definition was much narrower. In clinical practice, it meant combating syphilis and gonorrhoea—the principle ‘venereal diseases’ preoccupying health authorities. In the public imagination, it meant remaining morally and eugenically ‘fit’ to ensure the future health of the race and nation. Gradually, sexual health ballooned, becoming its own clinical field and encompassing a variety of other, newly identified diseases like chlamydia as well as diverse provisions for women’s health, maternal welfare and family planning.

Key to these changes was Britain's state-funded sexual-health service. At the end of the First World War, Britain created the Venereal Disease Service, which was universally available and free at the point of use. Integrated into the NHS after 1948, it was a vital part of Britain's shift towards socialised medicine. Millions of patients passed through its nationwide network of clinics. It was among the most important pieces of health infrastructure in Britain in the twentieth century, changing the way that people thought about, talked about and experienced sexual health. The Venereal Disease Service was intended to help overcome the enormous inequalities and stigma that had defined sexual healthcare for the Victorians and Edwardians. Certainly, it went a long way towards correcting a variety of social injustices and endemic health challenges. 

But in practice, within sexual-health clinics and wider society, prejudice and stigma persisted. Women and the working classes continued to be viewed as 'vectors' of contagion, in need of management and surveillance. Structural violence faced by LGBTQ+ communities within healthcare continued to undermine wellbeing and health outcomes. Institutional racism continued to impact the sexual-health experiences of minoritised communities. And many of these problems persist.

These are among the many important issues that the project explores. In mapping the complex interplay of personal, social, cultural and political factors that shaped people’s health experiences, the project aims to fill major gaps in scholarly and public understandings of Britain’s historical sexual health.

Images © Wellcome Images CC BY 4.0

Despite its historical importance, very little is known about almost every aspect of sexual health in the decades before the AIDS crisis. Especially scarce are records of personal stories and memories. Such experiences cannot be inferred from written records and have not been the focus of previous oral-history studies. Yet they constitute an important, unique part of Britain’s past.

Therefore, a key part of this project is the collection of oral histories, which we are conducting with people who accessed and/or staffed sexual-health clinics between 1948 and 1980. Our hope is that this collection will help to fill a major gap in our historical knowledge, making the history of sexual health more diverse and inclusive. 

At the end of the project, the collection will be deposited with the British Library through a formal partnership with National Life Stories. The British Library is the national library of the United Kingdom and its oral history collection is one of the largest in the world. They will preserve the project’s recorded oral histories as a permanent, publicly accessible resource.

If you accessed or staffed a VD clinic at any time before 1980 and would like to contribute your stories to the project, please get in touch with Dr Anne Hanley (a.hanley@bham.ac.uk).

The project team is developing a collaborative forum for researchers, health workers, policymakers and activists working in sexual health across different geographic regions and time periods. Tapping into existing networks and working with project partners, MESH will host a programme of research and policy meetings at Birmingham and strategic UK institutions. Planned events will hosted by the Institute of Applied Health Research and Institute of Advanced Studies. The aim is to initiate cross-disciplinary connections that, long-term, will facilitate the development of collaborative publications and learning resources.

If you work in the broad field of sexual health and would like get involved with MESH, please contact Dr Anne Hanley (a.hanley@bham.ac.uk).

One of the project’s key aims is to improve access to and experiences of sexual health in Britain and we believe that history as a big role to play in achieving those improvements. The project team is working with Sex Education Forum and the Thackray Museum of Medicine to design creative RSE workshops that will introduce students to a range of historical source materials and engage them in participant-led reflections as a way of creating a safe space for discussing difficult topics in RSE. The workshops will be interactive and immersive, helping students to unpick the histories behind sexual-health stigma and inequalities. In so doing, we aim to improve health experiences and outcomes for young adults.

If you work in a secondary school and would like to know more about these workshops, please get in touch with Dr Anne Hanley (a.hanley@bham.ac.uk).

In collaboration with our project partners, we are developing a range of historically informed public workshops hosted by the Thackray Museum of Medicine. As in the project’s RSE workshops, we are using history to build greater awareness of sexual health, promote safe sexual-health practices and achieve improved health and wellbeing. History is driven by stories. They resonate with people, who think about themselves through those histories. But stories about sex and sexual health still carry a lot of stigma. History is important because it also provides a safe distance to discuss difficult subjects affecting people today. For example, STI rates remain high among young adults, who report confusion and shame about discussing their sexual health and going for regular check-ups. Patients from minoritised communities report unconscious bias and testimonial injustice when seeking care. And trans patients often do not feel represented or safe in clinic, fearing discrimination from healthcare professionals. Approaching such difficult and sensitive subjects through history has the potential of offer participants a distancing mechanism—a safe space—to discuss these subjects and explore ways to process personal and potentially traumatic experiences.

In some of our public-engagement workshops, we are encouraging participants to produce postcard art inspired by the information postcards and posters historically distributed by the Venereal Disease Service. The aim is to reclaim the visibility of sexual-health experiences that were historically sidelined. The artwork will be displayed at the Thackray Museum of Medicine.

If you are interested in attending one of our walk-in workshops, please keep an eye on What’s On at the Thackray.

• Hanley, A. (forthcoming) ‘Migration, racism and sexual health in postwar Britain’, History Workshop Journal.
• Hanley, A. (2020) ‘“Sex Prejudice” and Professional Identity: Women Doctors and their Patients in Britain’s Interwar VD Service’, Journal of Social History, 54:2, pp. 569–98.

• Professor Jane Anderson CBE (Consultant Physician and Director of the Centre for the Study of Sexual Health and HIV at Homerton University Hospital NHS Foundation Trust)
• Dr Rageshri Dhairyawan (Consultant in Sexual Health & HIV, Barts Health NHS Trust)
• Professor Matt Houlbrook (Professor of Modern History, Birmingham)
• Professor Simon Szreter (Professor of History and Public Policy, Cambridge; Co-Founder of History & Policy)
• Dr Ingrid Young (Chancellor’s Fellow in Social Science of Health & Medicine, Edinburgh; Co-Chair of IReSH)

• Social Studies in Medicine (SSiM)
• Institute of Applied Health Research
• Institute of Global Innovation Gender Inequality
• Centre for Modern British Studies