In 2010, the Fifa World Cup year, Dr Tlaleng Mofokeng realised she wanted to devote her medical career to the sexual health of women. She was doing her mandatory year of community service after graduating from the University of KwaZulu-Natal in 2007 and interning for two years at Charlotte Maxeke Hospital.
She was based on the West Rand and had to visit a different clinic every day, in mining towns and townships, where she began to realise how closely health was connected to other factors such as housing, sanitation and social issues.
"That was where I got my first sense of women doing sex work," says Mofokeng, 36, better known as Dr T to readers of her Sunday Times Lifestyle sex-advice column. "I saw that they were not receiving adequate health care, also that the issues surrounding them were not actually about sex."
Her internship at an academic hospital had exposed her to all the major medical disciplines but no single area drew her as a speciality. "Most of my peers knew where they wanted to specialise but I found that none of the specialities could give me the connections I was forming with communities and with NGOs that worked with women. I wanted to be a clinician and also be involved in the politics of health, so I decided rather than specialising I would investigate the area of sexual health politics and reproductive justice and see how that turned out."
Mofokeng could not have predicted that within three years she would be sharing a stage with Bill Gates and speaking to global audiences about what women need to be whole, healthy humans. Even back then, however, she knew sex was a big part of what she needed to focus on.
"Young people were always asking me questions about sex," she says.
"I was probably the only doctor there who they could talk to about those things, so when I left, I thought: 'What is going to happen to these people, and what about all the others?' I always had this thing that I needed to reach more young people."
There are many critics of social media and many ways in which it causes harm, but Dr T is living proof that it can also be an enormous force for good. Her one-woman digital crusade to make sex a healthy word has turned this young clinician into a thought leader who addresses the UN and the US Senate, among many others, on how to give the world's women the dignity they deserve.
This all happened, she says, while she was "quietly minding my own business". Except, of course, she wasn't really minding her own business, because Dr T does not sit back and knit a scarf when there is injustice and inhumanity; she speaks out.
When she felt compelled to call the producers of radio shows to tell them there were problems with the information they broadcast on sex programmes, she didn't realise it would lead to her own show, which ran on Kaya FM for three-and-a-half years.
This led to her job at Johannesburg's Disa Clinic, which specialises in women's health issues and where she has worked for the past five years, but at the same time Mofokeng continued to speak out about the issues that matter to her.
"Sometimes when I finished work I'd find people waiting outside wanting to talk about sex. The clinic is not designed for that, you can't really say, 'I'm not sick, I just want to talk about sex with a doctor', and it happened more and more. The media outlets were important because I knew there was a need and that was a way to reach people."
Her TV show, Sex Talk with Dr T, was launched on DStv's Moja Love channel in 2018 and a second season will air this year. Mofokeng was approached to be the host and quickly became associate producer.
"I wouldn't do a show where I couldn't control the content and direction," she says. "It's not just that it's my name - as a medical doctor there are ethical principles and professional considerations. It is fun to be on this show because they understand that and respect what I bring to it."
Everything she says on social media is subject to the same standards. "As a doctor, there are things I can say that others can't. People take me seriously and no matter what I'm tweeting about - sexual pleasure, orgasms, the clitoris - there is a clear thought process behind it. When you use social media as a tool for advocacy, nothing is random."
Mofokeng's parallel career as a global advocate for women's health was partly moulded by her communications skills. In 2013 she and fellow activists formed the Sexual Reproductive Justice Coalition, which has about 200 members and of which she is vice-chair. Shortly afterwards, she was contacted by the Bill and Melinda Gates Foundation, which had launched the 120 under 40 awards to find the next generation of family planning leaders. Mofokeng won the media category and was one of 10 winners invited to the US.
"It was interesting," she says, "because it wasn't about my formal work as a doctor; it was for the tweeting stuff, the TV and radio stuff, for getting information out there and getting people to talk. All that happened organically, there wasn't a master plan. You often wonder why you're doing things and whether they really matter. The award was affirmation that I'd made the right choice; that my work was having an impact."
She has since given keynote addresses at events around the world and worked with advocacy groups such as Global Health Strategies, Global Doctors for Choice, the International Women's Health Coalition and the UN Human Rights Council. She is also a board member of the Soul City Institute for Social Justice, the Sex Worker Education and Advocacy Taskforce and the Safe Abortion Action Fund.
In 2017 she was invited to the Human Rights Council in Geneva to deliver the first-ever statement by a member of civil society about human rights as a basis for abortion access, and was made a member of the Global Advisory Board for Sexual Health and Wellbeing. In 2018 she gave the keynote address to the Population Action Fund on Capitol Hill in Washington DC. Last year she was made an Aspen New Voices Fellow and named a global Goalkeeper by the Gates Foundation, giving addresses in New York City and Berlin.
But for Mofokeng, social media can be just as powerful an education tool as standing on any physical stage. The mild shock she sometimes causes in SA is not a drawback, she says.
"If you are a black woman in SA going on Twitter to talk about vaginas and sex and pleasure, you kind of stand out," she laughs. "At first, people were like, 'What? You are so brave, oh my gosh, how can you talk about these things?' They'd phone my mother and say, 'We heard Tlaleng on the radio!' And she'd laugh and ask what I was saying, but they wouldn't tell her, they'd say: 'Oh no, we just heard her'."
Mofokeng says she has seen a seismic shift in attitudes and a growing willingness, particularly among young people, to talk openly about sex. "But still some people are shy to say they like what you say because then it means they like sex. Still, this is the biggest stigma. How did we get to a place where normal sexual pleasure is stigmatised? It's the weirdest thing."
Another thing that remains stigmatised is abortion. "Even the outspoken doctors who speak about everything won't speak about that," says Mofokeng. "But people want to know, they need to know about access to safe abortion, and that's how my focus shifted towards that. There are already enough doctors online talking about medicine but no one will talk about abortion. Women have a right, this is part of health care, it's not a favour and the constitution supports them, but so many women still think it's illegal, and nurses and doctors treat them badly.
"The idea that you can tell women what to do and what not to do with their bodies manifests itself in many other areas of our lives. The issue of access to safe abortion represents so many other things - autonomy, dignity, quality care, the fact that you should have timeous medical care, not long delays. It represents so many other battles."
One of these battles is not dividing sex into artificial, walled-off categories, she says. Mofokeng's position on the global advisory board for sexual health and wellbeing requires her to travel twice a year to London, where she and fellow board members, from dozens of countries and in many different disciplines, have decided to "bring the issue of sexual pleasure back where it belongs - with health and wellbeing".
"We have this concept of the sexual triangle, where the three points are pleasure, health and rights. We are being really deliberative about changing the narrative around sexuality and bodies."..