American Academy of Pediatricians’ new report is the clearest denouncement of the failures of not talking about STIs and pregnancy prevention
By Molly Redden
The country’s largest organization of pediatricians entered fraught political territory on Monday, with a call for doctors to use their time with patients to combat the potential health consequences of abstinence-centric sex education.
In a new report, the American Academy of Pediatricians (AAP) issued its clearest denunciation yet of sex education programs that fail to offer comprehensive information on topics such as sexually transmitted infections (STIs) and pregnancy prevention.
“This is the mothership telling pediatricians that talking about sex is part of your charge to keep children and adolescents safe,” said Dr Cora Breuner, a professor and pediatrician at Seattle Children’s research hospital and the report’s lead author.
“These guidelines give pediatricians in communities where people might say, ‘We don’t want you talking to our kids about this stuff,’ permission to say, ‘No, I can talk about this, I should talk about this, I need to talk about this.’”
The report is broadly a call for pediatricians to help fill in the gaps left by the country’s patchwork sex education programs. It urges pediatricians to teach not only contraception and the benefits of delaying sexual activity, but to cover topics such as sexual consent, sexual orientation and gender identity with school-aged children who may not receive any information in the classroom and involve their parents.
But the authors single out abstinence-heavy education, which sometimes excludes information about contraceptives, as a key concern for doctors looking to help adolescent patients avoid sexually transmitted infections and unintended pregnancy. As a result, it is likely to fuel an already contentious debate.
Groups that have advocated for sex education to emphasize abstinence instantly found fault with the new guidelines.
“A health organization like the AAP should not be affirming a behavior that can compromise the health of youth,” said Valerie Huber, the president of Ascend, a group that promotes abstinence-centric sex education and advocates for federal funding. The group was formerly known as the formerly the National Abstinence Education Association.
“They recommend ‘responsible sex’ for young adolescents. Exactly what is responsible sexual activity for adolescents? … The science is clear that teens are healthier when they avoid all sexual activity.”
Moreover, Huber said, programs that “normalize teen sex” are unpopular with many parents.
“Most communities do not support the type of sex education they recommend,” she said.
Still, others embraced the report as bringing the AAP’s recommendations more in line with the reality.
“This is a fantastic move,” said Chitra Panjabi, the president of the Sexuality Information and Education Council of the United States (SIECUS), a research group that supports comprehensive sex education. “It’s really important that our medical providers are standing up and saying, hey, the youth in our communities are coming to us because they’re not getting the information they need. And so we need to step in.”
The US does not enforce national standards for sex education and schools in many states are not required to teach it. Across the country, SIECUS estimates, only 50% of high school students receive sex education that meets the recommendations of the federal Centers for Disease Control and Prevention. The other half of students receive anything from an incomplete sex education, to education that emphasizes abstinence, to abstinence-only education, with a focus on delaying sex until heterosexual marriage.
In February, Barack Obama proposed a budget for 2017 that eliminated the $10m the department of health and human services spends on abstinence-only programs every year. But funding continues to flow to those programs from other sources. Title V, an abstinence-only program, allocates $75m a year to abstinence-only programs, money that states match by 75%.
In the last quarter-century, programs emphasizing abstinence as the optimal way to avoid pregnancy and STIs have received more than $2bn in funding from the federal government. Comprehensive sex education, by contrast, has no dedicated federal funding stream.
“It’s a political climate where people don’t want to talk about these issues,” said Breuner. “But it makes our job so much harder when we cannot coordinate our efforts with the schools. It takes time away from the other safety issues we need to be discussing. Don’t smoke weed. Don’t text and drive.”
Recently, two major surveys of existing research on sex education concluded that there was no evidence or inconclusive evidence to show that abstinence-centric programs succeeded in delaying sexual activity. One of the surveys found that comprehensive sex education was actually more effective than abstinence education at delaying sexual activity in teens. (Ascend points to select studies which show the opposite.)
A long-term study found that teens receiving abstinence-only programs were less likely to use contraceptives or be screened for STIs, although rates of infections were not elevated.
The studies helped compel the AAP to issue its first major guidance on sex education since 2001.
“It’s important for pediatricians to have the backing to say, ‘Look, I can’t support telling this stuff to children,’” Breuner said. “I have to deal with the aftermath, which is a 15-year-old who’s pregnant, or a 16-year-old who has a sexually transmitted infection he’s going to have for the rest of his life.”
Breuner said a number of her patients have suffered consequences from abstinence-only education. Many of them are pregnant teenagers and girls who, in the absence of accurate information, came to believe in common myths about pregnancy prevention.
“They’ll say, ‘I thought you couldn’t get pregnant when you were having your period,’ or, ‘I thought it took two or three years after you get your period to be able get pregnant.’ It’s heartbreaking, because I know with education, this could have been prevented.”
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In the interest of honesty, I’m going to be discussing these issues from the perspective of a straight woman, because I am one. I hope that there will be a non-straight woman out there to follow this article up with thoughts about what pleases them, but I just can’t speak for them. So let’s do this.
It often feels like women are expected to give some extremely technical answer when it comes to what we like — that we have a body that’s more like a piece of software, and it’s all about entering the right code and getting the right result. But the truth is, as different as we all are, the answer is very general. Like anyone else, women like to have orgasms. Women like to feel wanted and cared for and paid attention to. On a more technical level, women like a man who knows how to use his hands, tongue, and penis (often in combinations) to the point of orgasm.
But women don’t always need to have an orgasm. While there are a lot of women who can achieve orgasm, and do it multiple times in one sexual encounter, that doesn’t mean that every woman needs to have one to enjoy sex. There are a lot of girls who feel the pressure to “perform” in relationships because the guy will get weird and down on himself if she doesn’t come screaming. There are many times that I personally have not reached orgasm during sex, but still totally enjoyed the experience. I know that I’m not exceptional in that regard, and it doesn’t mean that the guy isn’t talented.
Now, I know that this shouldn’t be politically incorrect, but somehow it’s become a taboo thing to say because we’re all supposed to be “liberated” women who can engage in just as much casual sex as a guy, and don’t need to attach strings to them emotionally to make them worth it. This is bullshit. I can only go off the girls I know and the sex I’ve had, but I have found in my experience that 90 percent of the time, women need some kind of emotional connection with the guy in order to really enjoy sex. It’s not that the act of sex doesn’t feel good, it’s a combination of a) not knowing someone well enough to feel comfortable explaining what you actually need to get off and b) wanting more out of a sexual encounter than just “put the penis in the vagina, say thank you, leave, perhaps send a muffin basket.” There is a lot of media directed at women that emphasizes the idea that we should and even COULD embrace being “sluts” or have sex “like a guy,” but most girls I know can’t relate to this. For a lot of us, a real connection is synonymous with a decent sexual experience.
But even when you are with someone you know, trust, and are very attracted to, that doesn’t mean that the orgasms are just going to start flying fast and loose. First of all, men need to get over their fear of toys. There are some girls who will always need a vibrator during sex if they want to orgasm, and there’s nothing “wrong” with them. There are other women who enjoy using one from time to time because it makes for a face-melting, unlike-anything-else-you’ve-experienced-in-your-life orgasm when combined with the right guy and the right moves, and they should not feel weird about it. There are women who like using any range of toys that involve the butt, and they are no less wife-able. Guys have this weird paranoia that any toy that comes into the bedroom is going to question their masculinity or “replace” him, but this is absurd. The toy is not in place of him, it’s not a supplement because he inherently isn’t good enough. It has nothing to do with him, and we should let go of the idea that everything regarding a woman’s sexuality does. You have to embrace whatever things enhance sex for you, otherwise you’ll always end up frustrated and not enjoying yourself.
Another thing that has become strangely incorrect to say, even though we all know it’s true, is that a lot of women really like rough sex. It doesn’t mean that they are having rape fantasies every time they close their eyes, but the “no means no” talk definitely doesn’t always apply in the confines of a lot of relationships. We’ve become absolutist about what it means to have consenting or even “feminist” sex (ugh), but a lot of women I know could not be more turned off by the idea of a guy asking politely before doing everything. Obviously this is something that a couple has to establish beforehand, but you are naive if you say that people don’t give off body signals that say more than their words do in the bedroom. A lot of women have said “no” to their boyfriends but leaned into him slightly because they want to be “taken,” and that doesn’t mean he did anything wrong. For many people, politics in the bedroom just aren’t sexy. It’s not how their sexual encounters function on a regular basis. If you’re really that worried about it, get a safe word like an adult.
But the biggest problem generally stems from the fact that guys think they know about women, but most of the time, they really don’t. It’s no secret that porn has ruined men’s vision of what women enjoy during sex, but the problem is that, when they finally get around to having sex, girls are often really bad about telling them what they need to do. (We are betraying each other when we don’t educate men, let’s not do this anymore.) I have been with men who had all the swagger of a true casanova, because they were packing an above-average unit and were pretty good looking — and they were TERRIBLE. They thought that their looks and their dick were enough to get them an A+ in the sex department, as long as they just went really hard and slapped your ass every once in a while. In my experience, uncircumcised dudes have been better off the bat because they are more naturally sensitive and relate to the sometimes-unpleasant intensity that a clit can experience. They know that harder does not always equal better, and that soft, rhythmic motions can often be the key to a mind-blowing orgasm. But there are cut dudes who get it, too. They’ve just been taught right.
The best thing you can teach a guy, if you only impart one piece of advice before passing him off, is that if something is working — DON’T STOP IT. There is nothing worse than guys who get the perfect stroke going and then suddenly change paces or decide to start doing something crazy in an effort to show off. You can craft the perfect man in bed, and will have the kind of sex that makes monogamy seem like something to look forward to and not something that will bore you to tears, but it takes work.
If we can remember these things, and learn to laugh at ourselves (weird things will happen during sex, and there’s nothing worse than feeling like you can’t just roll with the punches), we can have some good sex. But first we really need to know what ‘good sex’ means for women, and it’s something that takes a while to learn. But don’t worry, I believe in you!
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I have been married for 13 years. We have had a pretty healthy, fulfilling sex life. My husband does not like to admit to his insecurities but i think he has some insecurity about his penis size and lately, his problem with not lasting very long. He has developed an obsession with stretching my vagina and pulling my labia. He knows I don’t like it. The other night, he introduces a dildo he has secretly purchased. I have enjoyed dildos, even larger ones, in the past, but this one was ridiculously too big. It was over 12″ long and the circumference was as big as a baseball bat. I told him that it was hurting and that it was impossible. He forced it in me. I was crying in pain and he tells me later that he hasn’t been that aroused in years. I am hurt. It hurt me physically, I bled a little, but it hurts more emotionally. What do you think is wrong with him? He has never hit me or been abusive with me, in the past.
Jeez darlin’, that’s fucked up…big time.
Here’s the thing about men who have sexual insecurities. They can and often do project their perceived inadequacies outside of themselves and then act out. And almost always this projection and acting out is aggressive and abusive.
I suppose you know that what we’re talkin’ about here, Lola is sexual assault, right? I mean let’s not mince words. Your husband assaulted you. It was premeditated and worst of all he took pleasure in it. This is extremely disturbing, because, despite his non-aggressive past, he has just upped the ante exponentially. You know what they say about domesticated animals that inexplicably develop an aggressive steak. Once they get a taste for blood there’s no trusting them ever again.
I think your old man has severe anger issues. Issues that if left untreated will…not maybe, but absolutely will…escalate into more aggressive and abusive behavior. Your guy needs help. He needs to know that he stands on a precipice. That he is making a cognitive and affective connection between violence and pleasure and this is very dangerous for all involved, especially you, Lola.
You don’t mention that he had any remorse about this assault. This too is disturbing. Because you can’t precisely pinpoint the cause of his acting out, you’ll never really know when you’re safe and when you’re not. I encourage you not to treat this lightly. Confront him about this. Make it clear to him that he has violated the bond of trust between the two of you. He may try and shift the blame for this incident to you. But remember, you’re not at fault. Insist that he seek professional help immediately. Anything short of him doing that will nullify your relationship.
No waffling on this, Lola! You do not want him to get the message that this incident can be winked at or overlooked. Your wellbeing hangs in the balance.
All unwanted, forced, manipulated, or coerced sexual contact or activity is sexual assault. Sexual assault is not about sex, eroticism or desire; it is about power, control and abuse.