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Sex Files is a bi-weekly column by Dr. Owens in the C-VILLE Weekly, Charlottesville's News and Arts Weekly,

C-Ville.com

This article is this week's cover story

Playing around with sex ed

One girl in four has an STI. Something has to change.

 

 

 

 
 
 
 
On March 11, the U.S. Centers for Disease Control and Prevention (CDC) released the news that one in four girls between the ages of 14 and 19 have at least one sexually transmitted infection (STI). If their study, which is based on a nationally representative sample of over 800 teen girls, speaks for the entire country, it is estimated that 3.2 million teenage girls in the United States are infected.

 


 

More feature articles:

Grading the presidential candidates on sex ed
Planned Parenthood's Becky Reid on McCain, Clinton and Obama

These girls are not having sex alone. You can do the math yourself. If this many girls are infected, imagine how many boys (their sexual partners) have the same diseases—many of them without even knowing it. And then imagine the total number of parents who are clueless about all this, let alone about the fact that their children are already having sex. Let’s be clear: “Having sex” means any type of sexual contact. Ever since the Monica Lewinsky ordeal, some people seem to think that only vaginal intercourse counts as sex.

Here’s a summary of the key findings of the CDC study:

• The CDC study was carried out between 2003 and 2004 and involved 838 teen girls who participated in the National Health and Nutrition Examination Survey (NHANES).

• Study participants were tested for the following STIs: human papilloma virus (HPV), chlamydia, genital herpes, and trichomoniasis.

• 48 percent of black, 20 percent of white, and 20 percent of Mexican-American teenage girls have at least one STI.

• Most common are HPV (18 percent) and chlamydia (4 percent), followed by trichomoniasis (3 percent) and genital herpes (2 percent).

• Overall, approximately half of the teens reported having had sex. Of these, 40 percent had at least one STI.

If you missed this news release, you are not alone. The media, instead of launching a wake-up call to protect teen health, was occupied with covering the Eliot Spitzer prostitution scandal. After all, a juicy sex scandal is so much more captivating than dry public health statistics, as shocking as they are.

The study results were met with mixed reactions. My teenage daughter summed it up in two words: “That sucks.” Countless parents, I am sure, found these statistics eye-opening. Others, including myself, were really not that surprised. How could it be any different? After all, for years most U.S. teenagers have not been getting the necessary information and resources they need to make informed and healthy choices for themselves.

What is going on? How is it possible that this many teens are infected with STIs? How come they are not waiting to have sex?  And how come those who do have sex don’t protect themselves against STIs—and pregnancy, for that matter?
 
Let me tell you what I think about these problems and what I believe we can do about them. I look at the situation from several different angles: one, as a sexual health professional who provides sexuality education to fourth, fifth and sixth graders (and their parents) in one of our local, private schools; two, as a parent myself; and three, as someone who spent the first three decades of my life in Europe, where teen pregnancy and STI rates are drastically lower than in America.

In fact, let’s start by taking a quick look at how European teenagers compare to U.S. teens when it comes to STI and pregnancy rates:

In the U.S., the teen pregnancy rate is:

9 times higher than in the Netherlands
4 times higher than in France
5 times higher than in Germany

In the U.S., the teen birth rate is:

11 times higher than in the Netherlands
5 times higher than in France
4 times higher than in Germany

In the U.S., the teen abortion rate is:

8 times higher than in Germany
7 times higher than in the Netherlands
3 times higher than in France

In the U.S., the teen chlamydia rate is:

20 times higher than in France
(Data are not available for Germany and the Netherlands)

In the U.S., the teen gonorrhea rate is:

74 times higher than in the Netherlands and France
66 times higher than in the former West Germany
38 times higher than in the former East Germany

In the U.S., the teen syphilis rate is:

6 times higher than in the Netherlands
5 times higher than in the former West Germany
3 times higher than in the former East Germany
Source: Advocates for Youth

Why these differences, you might wonder? For one, European teens receive comprehensive sex education at school. “Comprehensive” means that their programs teach them about various methods to protect themselves against pregnancy and STIs. Abstinence from sex is one of the methods taught, but it is not the only one. European teens also learn about condoms and other types of birth control. Armed with this knowledge, they are able to make the right choice to use safer sex methods once they decide to become sexually active.

In comparison, for more than a decade, the U.S. government has focused its efforts on promoting abstinence-only-until-marriage (AOUM) programs, investing more than $1 billion so far [see sidebar, page 23]. There is no federal government funding for comprehensive sex education in the U.S. To date, 17 states have rejected federal government money for AOUM sex education programs. Instead, these states are now teaching or planning to teach comprehensive sex education in which abstinence is not the only option. Virginia was the 14th state to opt out, when last November Governor Tim Kaine submitted plans to eliminate a $275,000 federal grant for Title V abstinence-only education programs from the state budget. So we are heading in the right direction here in Virginia. Let’s hope that other states will follow suit.

According to a recent New York Times article, various student-led abstinence groups have popped up on four college campuses in recent years. Princeton University and the Massachusetts Institute of Technology are home to the Anscombe Society, named for Catholic philosopher Elizabeth Anscombe. Harvard University undergraduates created True Love Revolution and at Arizona State University, there’s a group that calls itself New Sexual Revolution. What mature students choose doesn’t bother me. But we should press upon adolescents and teens more than the virtues of virginity. 

We already know from various studies that AOUM programs are ineffective. Hence my lack of surprise when I learned about the recent CDC statistics. This news merely confirms that too many teens are already paying the price for not having essential information. And for many of these kids, that price is not just an infection that eventually goes away (in the case of viral infections like genital herpes, it never does). If left untreated, many of these STIs can have serious consequences, such as cervical cancer and infertility.

And the number of affected teens is unacceptable. As you can see from the above summary of the CDC study, almost every other black teenage girl was infected. Have we not failed these teens completely? Isn’t it about time that we wake up and do something about it?
 

The three Rs: right, respect, responsibility

Teens are smart. Let’s not leave them in the dark any longer. U.S. teens, just like their European peers, have the right to correct and complete information about how to protect themselves against STIs and pregnancy. We need to treat them with respect and provide them with tools to help them make responsible choices for themselves. According to Advocates for Youth, it is the “Three R Approach” that is so successful in Europe. Give me one good reason why we cannot use the same approach on this side of the Atlantic.

European teens have easy access to correct and complete sexual health information based on solid public health research, and not political or moral agendas. There are also mass media campaigns that send out the consistent message: Safer sex or no sex! I will never forget when nearly all the city buses in Copenhagen, Denmark—and there are lots of them—had a condom painted along their entire length. A public health condom campaign can’t get more obvious than that.

By the way, just because they learn about condoms and other ways of protecting themselves against pregnancy and STIs, teens don’t go out and start having sex. European youth on average start having sex a little later than U.S. teens. The average age of first sexual intercourse in the U.S. is 15.8 years, 17.7 in the Netherlands, 16.2 in Germany and 16.8 in France.
 

Mixed messages—and a word to parents and caretakers

But what about the mixed messages today’s U.S. (and European) youth get about sex? Popular music lyrics and videos often have “explicit” content, and so do magazines, films and advertising. Unless you live on a farm way out in the country without Internet access or TV, your teen will get bombarded with messages about how cool sex is. Look at it this way: what a great opportunity to find “teachable moments” to convey your own values and opinions to your kids! Talk to them about what they see and hear and let them know what you think.

What are “teachable moments”? Forget about “the one sex talk” to enlighten your adolescent child about how humans reproduce. It is much easier to start as early as possible to open up the door to brief conversations about sex. Kids prefer to get this type of information in small, age-appropriate doses.

 


Teachable moments, coined by Debra Haffner [see a list of her books here], start in the bath tub when your boy toddler gets an erection. Tell him the correct term and that it is normal. No big deal. Tell your daughter the correct terms for her various body parts: “ear, nose, vulva.” No big deal. Once you start paying attention to teachable moments, you will find that it is not that hard to inform your child about sexuality. And the best part is that you get to tell them the information you will want them to know—and not let your child hear it from some obscure and questionable source, like a friend on the playground.

On the other hand, if you are a parent who has never spoken to your kid about sex, it is never too late to start. Believe it or not, your teen actually wants to hear from you. Tell him or her what your expectations are. When do you think that it is appropriate to start having sex? Don’t be afraid of sending mixed messages: You can tell them that you want them to postpone sex at the same time you tell them about the various options to protect themselves against STIs and pregnancy.

I am as alarmed as everyone else by the declining average age at which kids have sexual intercourse these days. But we need to realize that the only impact we can have on this trend is by engaging our youth in an open and honest dialogue—not by preaching a singular, moralistic message, which they are likely to ignore at some point. And besides that, AOUM is a message that gay and lesbian teens have no way of relating to, unless they live in Massachusetts, which is the only state that recognizes same-sex marriage.

In order to start reducing the numbers of infected teens, we need parents, as well as our public health and educational systems, to start providing adolescents and teens with the information they need to one day make healthy decisions for themselves. They will act responsibly if they are treated as responsible individuals. They do not want to be lied to. In 2004, a federally commissioned review of 13 AOUM curricula used by two-thirds of federally funded AOUM programs found that 80 percent of the curricula material contained “false, misleading, or distorted information about sexual health.” Isn’t it about time that we start telling kids the full truth?
 

What else can we do?

You can read about the symptoms of the most common STIs here. Too often, these infections have no major symptoms, and can be unwittingly passed on if the person does not use safer sex methods. The only way to catch these infections is through routine screening. If left untreated, the infections can lead to infertility, and some types of HPV are known to cause cervical cancer.

The CDC recommends annual chlamydia screening for sexually active women under the age of 25. They also recommend that girls and women between the ages of 11 and 26 who have not been vaccinated or who have not completed the full series of shots be fully vaccinated against HPV. The vaccine Gardasil was approved by the FDA in 2006. Washington, D.C., and Virginia, have recently passed laws mandating HPV vaccination for school admission, and over 20 other states are currently considering mandating this vaccine.

In order to aggressively address the unacceptable rate of teen STIs before the situation gets any worse, here’s what we have to do: We need to talk openly to adolescents and teens about sexuality, while sharing our values and expectations; launch a public health education campaign geared toward teens as well as parents and caregivers; and focus on providing comprehensive sexuality education, confidential STI screening, access to treatment, as well as vaccination. How hard can that be? It’s not like putting a man on the moon—and we accomplished that almost 40 years ago.


******************************

 

Facts about and symptoms of common STIs
HPV, Chlamydia, Genital herpes and Trichomoniasis

 

HPV

Most people infected with HPV will not have any symptoms. HPV infection is caused by human papillomavirus. There are many different types of this particular virus and some of them are called “high-risk” types and may cause abnormal Pap tests in women. They may also lead to cancer of the cervix, vagina, anus or penis.

Others are called “low-risk” types and may cause mild Pap test abnormalities or genital warts. Genital warts typically appear as soft, moist, pink, or flesh-colored swellings, usually in the genital area. They can be raised or flat, single or multiple, small or large, and are sometimes cauliflower shaped. The warts can appear on the vulva, in and around the vagina, in and around the anus, on the cervix, and on the penis, scrotum, groin or thigh.

The FDA approved vaccine, Gardasil protects against HPV.
 

Chlamydia

Symptoms, if present, generally appear in men and women in about two weeks after infection. However, most individuals (both men and women) show no symptoms. If present, symptoms of chlamydia for both males and females include a discharge, and discomfort urinating (urethritis). Females may experience lower abdominal pain, fever, nausea, pain during intercourse, bleeding between menstrual periods and general malaise.

Chlamydia is easily curable, but if left untreated, chlamydia in women can cause Pelvic Inflammatory Disease.  This in turn may cause chronic pelvic pain, ectopic pregnancies, infertility, permanent damage to the fallopian tubes and surrounding tissue and the possible need for hysterectomies.
 

Genital herpes

There are two types of Herpes simplex virus (HSV-1 and HSV-2). Oral herpes (commonly called fever blisters or cold sores) is caused by HSV-1 and typically appears as lesions or sores on or near the mouth. HSV-2 generally causes lesions or sores in the genital area (genital herpes). Although they are two different viruses, oral-genital transmission may occur. HSV-1 can be transmitted from the mouth to the genital area, and HSV-2 can be transmitted from the genitals to the mouth. Herpes is most contagious when sores are present.

Some individuals do not experience any symptoms of herpes, but are still infectious to their partners. If symptoms are present, this is called a herpes outbreak. The symptoms usually appear in the genital area as one or more small, red, painful bumps, called papules. The labia are the most commonly affected area` in women. The papules develop into tiny painful blisters that contain a clear fluid. Once the blisters rupture, they form wet, painful open sores surrounded by a red ring. Infected individuals are highly contagious during this time. About 10 days after the papules appear; the open sore forms a crust and begins to heal, taking about 10 days or more.

Other symptoms of HSV include swollen lymph nodes in the groin area, fever, muscle aches and headaches. Women may experience vaginal discharge and sometimes painful urination, especially if the urine contacts the open sores. Sores can recur after healing. The herpes virus remains in a person’s nerve endings and flare-ups may be triggered by stress, poor nutrition, depression, extended exposure to sunlight, menstruation in women or other genital infections.
 

Trichomoniasis (also known as Trich)

This common and curable STI is caused by the single-cell protozoan parasite, Trichomoniasis vaginalis.

Women may experience a frothy, yellow-green vaginal discharge with a strong odor. This may cause discomfort during intercourse, as well as itching of the female genital area. Rarely, abdominal pain may occur. Symptoms in women usually occur within 5–28 days after infection. Symptoms in men are often absent. However, some men may have an irritation inside the penis, mild discharge, or slight burning after urination or ejaculation.

 

 

 

Organizations and articles on the Web

Advocates for Youth
(advocatesforyouth.org)

European Approaches to Adolescent Sexual Behavior & Responsibility
(advocatesforyouth.org/
european.htm)

Tips for Talking with Sexually Active Teens about Contraception
(advocatesforyouth.org/parents/contraception.htm)

Parents and Teens Talking Together About Contraception
(advocatesforyouth.org/parents/experts/huberman2.htm)

Sexuality Information and Education Council of the United States (SIECUS)
(siecus.org)

Information Link For Teens
(siecus.org/links/links.html#TEEN)

Information Link For Parents
(siecus.org/links/links.html#PARE)

The Sexual Health Network
(sexualhealth.com)
 

Books

By Debra Haffner (all Newmarket Press):

From Diapers to Dating: A Parent’s Guide to Raising Sexually Healthy Children From Infancy to Middle School

Beyond the Big Talk: Every Parent’s Guide to Raising Sexually Healthy Teens From Middle School to High School

What Every 21st-Century Parent Needs to Know: Facing Today’s Challenges with Wisdom and Heart

By Robie H. Harris and Michael Emberley (Candlewick Press):

It’s so Amazing! A Book about Eggs, Sperm, Birth, Babies, and Families
(for ages 5 and up; these authors also have a book for younger children, but I recommend starting with this one right away)

It’s Perfectly Normal: Changing Bodies, Growing Up, Sex and Sexual Health
(for ages 10 and up)

By Lynda and Area Madaras (Newmarket Press):

The “What’s Happening to My Body?” Book for Girls
; with a companion workbook, My Body, My Self for Girls

The “What’s Happening to My Body?” Book for Boys; with a companion workbook, My Body, My Self for Boys
 

DVD

“The Talk.” With a healthy dose of humor, this series of skits by today’s teens for today’s teens and their parents is the best sex education DVD I have ever seen. Available from Youth Performance Co. (youthperformanceco.com); (612) 623-9180. It comes with a discussion guide.

04/29/2008 - 05/05/2008

Reprinted from C-Ville Weekly

www.C-VILLE.com

 

 
bulletWhere's the desire?                  
bulletChoosing a gynecologist
bulletKnow your anatomy
bulletThe hard truth
bulletIt's how you play the game
bulletJust push "Play"
bulletO God!
bulletTurn to face the strange changes
bulletSex and aging
bulletPut on your party hats
bulletButt seriously
bulletGo with the flow
bulletReading the signs
bulletIn control panel - arousal
bulletIt's a woman's cyber world
bulletSystem overload
bulletFemale condom
bulletHealth benefits of sex, women
bulletHealth benefits of sex, men
bulletSexual abuse
 

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This site was last updated 04/29/08