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IS CHASTITY A MEDICAL ISSUE?
by
Ross S. Olson MD
News Item: Despite the fact that we are a pluralistic society in the area of smoking cigarettes, a consensus has been reached regarding the message we want to send our kids. Is that message, "Don't inhale?" Or, "Limit your number of cigarettes?" Or, "Use a filter every time?" No, it is, "Never smoke!" But will all kids take this wise advice? No one needs to be delusional about that, because it still clearly serves the vast majority of kids best to be hard nosed and absolute. Is anybody (except the cigarette companies) saying, "Well, we'd like to say don't smoke, but that's not realistic?" Why not just let them learn for themselves? Well, to be young and inexperienced means not knowing when to say, "oops." Long term consequences are a foreign language to someone whose total existence has been short term. But to make a fatal mistake can sort of take the fun out of life. So maybe experience is not the best teacher after all, unless it includes learning from the mistakes of those who have stumbled on before. One who once believed in the benefits of smoking and now knows better, even one who continues the addictive behavior, is certainly better qualified to teach the young than, for instance, an unrecovered alcoholic. "Wait a minute," you are probably saying, "If you mean to apply this concept to sexuality, there isn't enough room in all the nunneries and monasteries of the world for billions of celibates! Besides, it just won't sell." Are we supposed to say "no" to everything? For those unschooled in ancient concepts, what is this "chastity" thing after all? Not "never," it rather means basically, ONE PARTNER FOR LIFE. That works out to no sex prior to a lifetime commitment, and then faithfulness to that commitment. This sometimes goes by the quaint name of "marriage." This concept is not new, although in today's ferment it has a novel sound to it. It is self control for a purpose. It also happens to be the preserved wisdom of the ages for basically all human cultures that have survived. For the loyal opposition, at this point, a thousand points of debate come to mind and the intake valve shuts off. Before losing radio contact, may I say one more thing? Emotional revulsion at an idea does not make it wrong. It does not make it right either, of course, but rather, it should alert the experienced idea-cruncher that something extra-logical may be going on. Ignaz Semmelweis, one and a half centuries ago, was not greeted with raves when he proposed that washing hands between the morgue and the delivery room could save lives. He was not even asked for his data. Rather, his idea was rejected without the benefit of logic, on the basis of a few unacknowledged presuppositions that may have sounded like, "If I don't see it, it isn't real." Or, "What I don't know can't hurt you." Or maybe, "If I didn't think of it, it can't be important." Or worse yet, "If I admit to this, I accept responsibility for untold preventable suffering." Our own past decisions prejudice our ability to evaluate the present. Great breakthroughs in science may not be limited to the brilliant. They are shared by the honest and courageous who study the spectral analyses of the emperor's new clothes and regard truth as more important than another grant. Is this area greeted by illogic and emotion? Consider what the Health Coordinator for a large metropolitan school district said recently. When the statement was made at a public meeting, "You cannot deny that if every person had only one sexual partner for life, they would not get sexually transmitted diseases." She responded, "Well, that's your opinion." (In case you were not paying attention, note that it is NOT an opinion. It is a fact. There are such things as facts!) Sex is not equivalent to smoke. I admit it. Tobacco could have been easily avoided by all if the weed had never appeared on the face of the earth. But sex is an innate part of life. Permanent abstinence is unusual and perhaps difficult. But we have other appetites that require control. And limits may make very good sense for both the individual and society. The presence of an appetite is not license for its unrestrained expression. Let me propose an ideal. Then I will answer a few objections and give examples. ONE PARTNER FOR LIFE IS THE IDEAL FOR SEXUAL HEALTH. How can this be? What is the basis? Isn't it just morality disguised as science? Reasons first, then objections. Please stay tuned. 1. There would be essentially no sexually transmitted diseases. Except for unusual scenarios, like blood borne infection from medical sources, a disease-free faithful couple, who also avoid injecting street drugs, will remain disease free. Compare the treatment of this subject in the July 1991 American College of Gynecology Pamphlet "How to Prevent Sexually Transmitted Diseases." There it is said, "A relationship in which neither partner has sex with anyone else lowers the risk of STD's." (This statement perfectly parallels the subsequent instruction, "condoms may not offer perfect protection, but they can lower the chances of infection if used properly.") Why would someone deliberately blur the boundaries between the "truly safe" and the merely "less risky?" Do they really believe what they say? Do they think their readers won't catch on? Is there possibly any kind of an ulterior motive? At a curriculum committee meeting of the fore-mentioned school district, it was said that some regard marriage as an instrument of male domination, so that it cannot be promoted in the schools. Yet the facts say that most of the suffering from impermanent relationships falls on women, trying to raise children. Does that mean that a woman must stay in the house with a chemically dependent abusive man? Of course not! But ideally, that is a commitment that would never have been made if the brain were in gear at the start of the relationship. Also, by the way, if someone is going to decry the double standard, it doesn't make sense to demand the lower standard for all. That would be as idiotic as the "You've come a long way, baby" ads which equate women's liberation with nicotine addiction. Flaky ideas abound in this crazy world, and many of them do achieve widespread acceptance with less merit than that. 2. There would be fewer "unwanted" pregnancies. With the presence, support and encouragement of a faithful partner, the father of the baby, the difficulties of life are much easier to face. I will not argue that this would eliminate all the feelings of "I can't handle this." But the rate would go way down and the feelings would have to be more transient. And, incidentally, do you ever remember hearing your mother say, "I just can't handle you kids anymore!" What if there were instant post-natal choice options available for the mental health of the mother? How many of us might have been prematurely terminated? 3. It is psychologically healthier. Is divorce an easy thing? How would you react if your partner is having a sexual relationship with someone else? Why is this phenomenon called, "cheating?" When you first fell "in love," didn't you feel, "I want to be with this person forever?" (Even though you may have fallen in love weekly for years.) Is it easy to see someone you care about walk away? All the intuitive indications are that the sexual relationship is meant to be permanent. Sex is a powerful bonding force. Because of the habituating nature of orgiastic activity, there is a natural tendency to anticipate repetition. Intense intimacy of the interpersonal aspects of the sex act tends to draw people together. Thus, in a relationship of prior commitment, sex can be an important element in its ongoing development. Yet, if sex comes before commitment, bonding can take place before it is clear that the choice is a wise one. (Witness the "bonding with a jerk" phenomenon common with otherwise intelligent women.) A doomed or damaging relationship may result. Or psychological devastation can occur when the object of affection takes a hike. A study of the use of birth control by teens (DiCemente, Pediatrics February 1992) found that use of condoms with the third through fifth partners was down to 27.4% from 49.6% for the first. Why might this be? You would expect them to become more sophisticated and prepared. They certainly know where to buy the things. I suggest that self esteem goes down and protective reflexes are replaced by an "I don't care" attitude. Some girls at that point really want a baby (who will stick around and love them since the guys apparently will not.) Newsweek put it this way in an article on teens with AIDS. (August 3, 1992) Teens do not insist on condoms if the partner resists, "because the desire for love and acceptance overcomes the fear of getting sick." Isn't that heartbreaking? They are talking about kids who want love and acceptance, not sex. There is a difference, remember. Their desires are not fulfilled by what they are doing, and they begin to feel cheap and used. They may even become self destructive. But doesn't the seasoned swinger learn to deal with these feelings? Yes, but the solutions are not very pretty. Prostitutes stop feeling. The ritually abused develop multiple personalities because "this cannot be happening to me." And being a sociopath means never having to say, "I'm sorry." 4. It removes the cause of a great deal of poverty and economic difficulty. After divorce, the average standard of living of the man tends to go up. That of the woman goes down. Women and children are the new poor. Pooling resources can only help in the making of a home and especially the raising of children. Maybe it is not just an accident that two parents are necessary to produce a child? Male irresponsibility is not really good for women and children. 5. Many other social problems are reduced. It is no secret that the child in a stable two parent home does better psychologically and academically as well as being at decreased risk for abuse. The promotion of the family is not some failed Republican plot devised by Dan Quayle, rather it is good sense and good science, good ethics and good economics. After the 1992 political football season was over, the idea actually got mulled over, as noted by David Broder in his column carried by the Star Tribune on March 25, 1993. In the Aspen Institute Quarterly, David Gergen pointed out that "the best anti-poverty program for children is a stable, intact family." In the same publication, William Galston of Maryland University stated, "The two most important forces affecting children for the worse in the past generation have been declining economic prospects for young, poorly educated male workers and the accelerated movement toward single-parent households." Atlantic magazine's April 1993 issue stated on its cover, "DAN QUAYLE WAS RIGHT. After decades of public dispute about so-called family diversity, the evidence from social-science research is coming in: The dissolution of two-parent families, though it may [seem to] benefit the adults involved, is harmful to many children, and dramatically undermines our society." Journalist Mark Patinkin of the Providence Journal confessed that he knew it all along but was afraid to say. 6. Sex is ultimately more enjoyable when it is exclusive. Anything casual loses significance. The mystery and the desirability of sex increase if it is saved for one partner to whom I can say, "You are worth waiting for, therefore I will wait until we have made a permanent commitment." Then, I can also say, "This I share only with you." Variety is not spice, it is slow poison. OBJECTIONS Is it possible to object to this clear and logical approach? Of course! It's a free country and I will defend to the death the right of good people to make bad arguments. I will warn, however, that many of these objections look feeble on paper, not because I paraphrased them poorly, but because they work better as unexamined assumptions. I hope that many of those good people will thus separate themselves from the bad arguments. A. Medicine cannot promote morality. What does that mean? Is it unethical for a doctor to tell an alcoholic that he is killing himself? Is it improper imposition of personal values to tell a teenaged boy that drunk driving is a major threat to his life? These are issues of health! In fact, it could be argued that morality is about health, not to mention happiness. B. This approach implies that sex is bad. Almost every good thing can be misused. Claiming that something needs to be exercised within boundaries is not the same as calling it innately bad. Eating is good, but it can be overdone. Eating certain items, like for instance other people, is frowned on by all but the most hard line situational ethicists. C. Sexual impulses cannot be repressed. This one really looks pale in the sunlight and may sit there unclaimed. Yet it does underlie a great deal of current thinking on the subject. It seems to be confirmed by some disturbing phenomena such as sexual abuse perpetrated by some Catholic priests. It influences decisions like passing out condoms in the schools. Yet, the implications of this thinking need to be rationally examined. Reason cannot be conveniently disregarded when it leads to uncomfortable conclusions. Think about it for a minute. Unless we have complete anarchy and victimization of the weak and gullible by the strong and clever, there must be some sort of restraint. All the people have to control themselves some of the time, and some of the people have to control themselves all of the time. All of us, if honest and responsible, will admit that we periodically have impulses that should not be acted on. Some people, because of various developmental tragedies, may not be able to act on any of their sexual impulses without crossing generally accepted lines. Think of those who are only attracted to children (more on this later) or who can only receive pleasure from causing the death of someone else -- the Jeffrey Dahmers of the world. If it is really true that once a guy gets steamed up to a certain degree, it is impossible to stop the train, then we have the perfect defense for date rape. And if "that's the way I am, I have to act on it," is a reasonable explanation for any one type of behavior, it must be logically extended to all, including that of pedophiles and rapists. As a people, the Chinese have shown that it is possible to delay sexual expression and live. It's not just propaganda. Bill Holm in Coming Home Crazy wondered at the repressive sexual morality that made 25 year olds seem like Americans on the naive side of junior high, although he also noted the mystique of controlled sexuality. If someone wants to argue that Chinese are undersexed, try explaining the numbers. D. "Everybody just needs to be responsible and caring?" If we were creatures of logic and altruism, we might be trustworthy in this area. But think for a minute of the way nearly all people justify their own behavior with rationalizations. Mike Tyson says there was consent. Jon Clarke Donahue, even after his "rehabilitation," said that he had sexual relationships with adolescent actors under his teaching because, "they were seductive." The North American Man-Boy Love Association claims that all boys need oral sex and it would be unloving to withhold it from them. Does anybody caught in a wrong admit it and say, "I did a terrible thing?" It happens, but not often. Therefore, some opinions are not as good as others, Some are tainted. The area of sexuality is rife with evidence of this dark side to human nature. Take, for example, the thought that all relationships are sexual and it is only repression and dishonesty that denies it. This is another idea from the twilight zone. In that topsy turvy world view, those with restraint wear the black hats and only those who act out are the good guys. In a former era, this might have been instantly identified as decadence. Now, in our kinder, gentler age, the implications are missed. Maybe this has something to do with the fact that so many psychologists have messed up personal lives. E. This is an old idea. So is "two plus two equals four!" Despite its antiquity, we tend to require adherence to this concept, even from Savings and Loan executives and elected representatives who might prefer a more liberal standard. Change is not always progress. When there are right and wrong answers, any change from the right is bound to be wrong. And, by the way, the idea that there are no universally right and wrong answers ("it's true for you but not for me") is absolute nonsense. It is, of course, a very comfortable approach that allows us to avoid confronting anybody. What about the trial of a man accused of kidnapping, raping and murdering a little girl? He denies it. Therefore in his own frame of reference, he is innocent. It would be politically incorrect to continue the prosecution. Or perhaps in a fit of frankness, he admits that, even in his own scheme of things, he did do what the prosecution alleges, yet he considered it to be right and good at the time. Who are the jury and judge to impose their reality on him? Would you smell a rat if someone says, "Maybe incest would be wrong for you, but it works for me and my family?" All that means is that the speaker is still having a wonderful time and has not seen, felt or faced the consequences in himself or his victim. Tolerance is the worst of all responses to that sort of person. Or would you accept at face value an assertion, by the surgeon about to tackle the removal of a berry aneurysm from deep within your brain, "Most people would be unable to function well under the influence of LSD, but I find it enhances my surgical creativity?" F. Kids will be kids. Maybe so, but is it not the responsibility of the older generation to prevent youthful self destruction? Those of you with children, do you really want your teenagers sleeping around? Those who have been through divorce, do you recommend it? Is a series of temporary relationships something you would like to see as the norm? Even if some will not follow good advice, does the ideal suddenly change? Some have espoused the theory that after a series of temporary "relationships," young adults are ideally equipped to settle down. In actuality, they have been trained for non-commitment. "As long as we both shall love," becomes the vow. If there is any problem, or even just a better offer, the established pattern is now to say "goodbye," perhaps without a tear. G. This approach offends single parents and divorced people. It is possible to do and say anything poorly, but I have found that even those for whom the ideal has not worked out actually want something better for their children. A single mother who has gotten out of her own adolescence, will often volunteer, "I did not plan on it being this way," or, "I was out of my head at the time." I can say to a kid, "Your Mom is doing a great job with you, but it is a lot harder than it would have been if your Dad had stuck around." I will sometimes say, after mentioning that one partner for life is the ideal, "It doesn't always turn out that way, but it still is true." Sometimes I will turn to the single parent and say, "I'm sure mom would tell you that divorce is no fun," The lesson to be learned is that erotic attraction is not enough of a basis for a long term relationship. A lot of those single parents were victims of the "love is blind" phenomenon. It also might be said that sexual attraction is sometimes stupid. If sex enters the picture before commitment, it is nearly impossible to make wise choices about the future. By the way, has anybody thought about the way it offends married as well as single parents when school and clinic professionals cut parents out of the information and decision loop on matters of sexuality and abortion? They do this by saying such things as, "We'd better not tell your parents about this, they might not let you have it." Isn't it rather arrogant to assume that they know better and care more for the kids than the parents, who gave years and tears to them and will continue to be their parents long after the "helpers" (and many of their trendy theories) are only a memory? H. We cannot change behavior, but we can prevent negative consequences. If a crowd of teenagers were jumping off a cliff, is it right to give little pushes to the ones nearest us? If you have only one option, would it be passing out parachutes or trying to stop them? If you can't save them all, would you decline the opportunity to help any of them? Some sex education programs actually increase the rates of sexual activity. This is what was found in the data of the 1986 Harris Poll on Sex Education. ("American Teens Speak: Sex, Myths, TV and Birth Control" Louis Harris and Associates, especially chapter 5.) Although not pointed out by the authors, it showed that some sex education actually increases the likelihood of students becoming "sexually active." "Comprehensive Sex Education" was defined as including four or more of the following: a) biological facts about reproduction, b) talk about coping with your sexual development, c) information about preventing sexual abuse, d) information about different kinds of birth control, e) facts about abortion and f) facts about where to get contraceptives. Among a representative sample of 1000 teenagers, there was a 44% increased likelihood of a student having intercourse if he or she had been through comprehensive sex education as opposed to no sex education at all. There was a 53% increased likelihood of intercourse if the student had comprehensive sex education as opposed to basic reproductive sex education. This was a finding of astounding importance. Yet it was not even noted in the text and had to be found by readers. Why was there no call for a moratorium on the present sex education programs? Probably because it was contrary to the policy of the sponsor of the study, Planned Parenthood. This finding was not isolated. Marsiglio and Mott in 1986 (Family Planning Perspectives July/Aug. 1986, p. 151) also found an increase in sexual activity by 15 and 16 year old girls who had been through sex education in school. Kilmann et al (Archives of Sexual Behavior, Vol. 10 # 2, p. 177ff.) in 1981 showed few follow up studies on sex education curricula, but the most consistent effect for those studied was liberalization of sexual attitudes. How can that be? Knowledge is supposed to be good, isn't it? There are at least three possible explanations for what is happening: 1) Some Sex Education material is sexually stimulating. (Why does pornography sell?) Someone who says graphic material is not a "turn on" is either very repressed or very jaded. 2) All options are portrayed to be safe if you use the right technology, giving a false sense of security. 3) The expectation by the professionals is that adolescents will be sexually active no matter what and they convey this expectation to the kids. Here is a concrete example. At Washburn High School in Minneapolis recently (with a parent present observing) a teacher of a mixed ninth grade health class first stated that condoms were 97% effective, then had several boys and girls stand up in front of the class and take cards on the steps of condom use. They were to compare them with their classmates' cards, arrange themselves in the proper order and then read them aloud to the entire class. "Talk about having sex; buy the condom; have a romantic evening; get in the mood." Then there were explicit descriptions of each step in opening the package and unrolling the condom on the erect penis. Finally, the student she had picked to take the last card, a big football player, read (with feeling), "Ready for intercourse." Think of yourself as 15 or 16 years old and you have just arrived at a summer camp. The director speaks to the group and says, "We do not think that campers should be having sex with each other, but there are condoms in the restrooms and charts on safe sexual practices. Private rooms with locks are available and we won't tell your parents." Are you more or less likely to experiment? I. The directive approach does not work with teenagers. That is simplistic nonsense. It would lead to not telling kids anything in fear that they would do the opposite. Advertisers know that behavior can be changed. All of education is based on the assumption that we should be directive. If we fear that teenagers will insist that St. Paul is not the capital of Minnesota because we were too dogmatic about the whole thing, what should we tell them instead? Or do we need to give up the whole idea of even having state capitals since kids can't learn geography anyway? Interestingly, the Tobacco Institute, not known for altruism, gives out, free of charge to schools and parents, educational material for teens called, "Helping Youth Decide." Its main thesis? Don't preach to your kids! They will only rebel against it. Does this commercial organization have a real interest in keeping teens off the weed? Maybe something wonderful has happened to them while we weren't watching, but there is no other real evidence of a heart of gold anywhere else in the industry. Their endorsement of this concept ought to be the kiss of death for those skilled in critical thinking. J. It will not help to promote a "just say no" approach. This is a classic straw man argument. Nobody real is under the illusion that a single sentence, however many times it is repeated, will make a difference. Nor is anyone saying that it is easy. Rather look at the way we are striving for a smoke free generation. In addition to information, there is motivation, preparation for various scenarios and the turning of positive peer pressure on those who depart from the wise course. Combined with this is the cleaning up of false images in mass media and restraint of victimization by advertisers. It can be workable if honest people agree to make it work. It is definitely not easy. Perhaps this gets closer than anything else to the real objection to promoting this concept. There is a need for genuine individualized communication, laced with personal vulnerability. There may be misunderstanding by adolescents who confuse information on bad choices with personal rejection if they have made those choices. There may be opposition by colleagues whose own practices are essentially unexamined, but still vigorously defended. It requires an output of emotional energy that can be draining. The far easier course is to gently float down the stream, wherever it is flowing. K. But "the studies are inconclusive." As scientists, we are supposed to spout p values and chi squares and meta-analyses and call for further research and collegial debate. Ever more accurate refinements of truth will supposedly emerge from this exercise. But what of common sense and responsibility? OK, let's do a study of playing in the street and see if it really correlates with sudden death. Preliminary results indicate that playing closer to the curb may reduce risk. The confounding variables, however, such as drivers stopping or turning, make it difficult to achieve statistical significance. Also, there seems to be a problem getting subjects. The solution may be to put school based clinics in the grade schools and declare the kids emancipated. Most homes are dysfunctional anyway. The cutoff for safe sexual behavior is not being "over age 18," or having "less than 3 partners," or "waiting 2 years" from the time you first thought of having sex. The mathematical and scientific boundary of risk is more than one partner for life. Zero or one partners, assuming that the one partner has also had no others, means no risk. More than one, the risk is real, not only for disease, but for psychological repercussions. Is it logical or honest to pretend that the ideal is to use condoms every time, or to wait "until you are ready" or to "know your partner?" Those statements can be made, but should be couched in the terms of second choice "if you will not follow the truly safe course." (I was told by one school official that we can not use the term "best.") The purity of public thinking on this topic is deliberately confounded by some who have concealed motives. Then again, the motives of others are as apparent as an exhibitionist's anatomy. Take the writings of Ira Reiss...please. In An End To Shame: Shaping Our Next Sexual Revolution, he envisions a guilt-free society in which no sexual expression is prohibited and everybody feels wonderful. Isn't that just great? Maybe he will entitle his next book, Psychopaths in Wonderland L. We cannot impose our values on others. How about imposing a little reality on someone living in the twilight zone? That has always been an integral part of the practice of medicine and social responsibility. People noted for years that most auto accidents were alcohol related before somebody decided that it was OK to think that thought out loud. It took courage and determination to overcome societal inertia and individual rationalizations as they began to do something about it. Imparting of values also used to be an unquestioned part of child rearing. At least it was prior to the rise of the non-directive therapeutic model of parenthood. Now it is often considered non-democratic and pathological for adults to assume that they actually know more than their children about life. It is considered by some to border on the abusive to convey that knowledge to them any more strongly than with "I statements," as in "it makes Mommy sad when you smear feces on the wall." "Gee," says baby to himself, "Mom seems to have a real hangup about excretory art. Maybe she needs therapy?" M. If people are mutually consenting, leave them alone. Should the word "adult" be fitted into that sentence? That would, of course bring instant quarreling from the advocates of adult-child sex. And others would debate the definition of "adult," whether by age or maturity or situational criteria that will, of course, be immediately appreciated by a person of the proper proclivity at the appropriate moment. "Consent" is the big problem since these things tend to occur without the presence of attorneys and seasoned judges. Different people bring different motivations to a relationship and may say or do things that obscure their real feelings. Children, or even adults, who have been victimized or manipulated, often do not realize what is happening at the time. Only perspective and distance may clarify what was really going on. The guy says, "If you love me, prove it," and she understands this to be a bargain for permanent commitment. He only meant "As long as we both shall love." The pleasure is followed by longstanding pain? Was it actually abuse? Was there true consent? She said, "Are you really a man?" And he felt he had to demonstrate, although she only wanted to be able to brag about having seduced a desirable guy. She felt in her heart that after having his baby, he would love her forever and become the ideal Prince Charming she really wanted. He was angry that she seemed to be trying to trap him. And, in addition, what is the permissible blood alcohol level for making an informed decision about sex? The confusion over what constitutes consent is nearly endless. N. Condoms are a simpler more salable solution. The cry for condom competence is a wail of despair. It says, "All we can do is blunt the epidemic among these witless animals." Perhaps some of the latex peddlers actually believe their own pitch, like the snake oil salesmen of old. But the facts are far from the front page facade. And real experts actually know this. On June 19, 1987, Dr. Theresa Crenshaw asked 800 sexologists at an international conference, "If you had available the partner of your dreams and knew that person carried the HIV virus, would you have sex, depending on a condom for protection?" After a long delay, only one hand was raised. (Testimony before the US House Select Committee on Children, Youth and Families, June 18, 1987, published in "Will 'Safe Sex' Education Effectively Combat AIDS?" by US Department of Education, January 22, 1988.) A study of contraceptive failure (Family Planning Perspectives, vol. 18 No. 5, September/October 1986, pp. 200 - 209) by different age groups found that condoms used by teenagers failed to prevent pregnancy in 18.4% over a year. This compared to 62.9% who became pregnant with no birth control. Thus condoms reduced the rate to about 29% of what it would have been. For disease prevention, the results are no better. Margaret Fischl (in the 1987 International Conference on AIDS, Abstracts Volume p. 178) reported that in couples with one partner positive and one negative for HIV, over one year 82% of those using no protection and 17% of those using condoms "every time" converted to positive. That is a reduction, but not safe by any stretch of the imagination. It is also cumulative. After 2 years the number will go up as about 17% of the remaining negative partners convert, and on it goes. Is it any wonder that the experts felt the way they did? The only wonder is that they continue to recommend a deadly game of roulette to their clients.O. Society has changed. Is it really better for women to raise children in poverty, without the support, or even the presence, of the father of the baby? The solution is not to create some half-baked new society or simply to define what is as OK. What we actually need is a return to literal keeping of traditional marriage vows, each partner loving and cherishing the other, until death. P. If the physician strongly promotes abstinence, the teens will not come back for help when they do become sexually active. There may be something to that, but we risk it in the case of tobacco, hard drugs and perhaps alcohol by taking a strong stand. But in addition, this approach focuses only on the kids who are making bad choices, and fails to give encouragement to the ones who are choosing well and especially the ones on the fence, who could stay on the right path with some guidance. It is like leaving the barn door open so that even though the cows will get out, they at least have the opportunity of coming back. A HUMBLE PROPOSAL May I propose a new working definition of abuse? SEX NOT WITHIN A CONTEXT OF LIFETIME COMMITMENT IS ABUSE.The concept does this for sure: it clarifies the boundaries. Some will still cross the line, but they know they are doing it. It is one thing to have "succumbed to a temptation." It is quite another to have "taken advantage of an opportunity." Which philosophy do you like in your daughter's prom date? I would even propose that in the case of 13 and 14 year old adolescents engaged in "consensual" sex, BOTH are victims. The perpetrator is society. The combination of self-justification by travelers on wrong roads, and wild-eyed utopian visions of a guiltless society by the sadly mistaken intellectual elite, make up the proactive side of the tragedy. They are enabled by an equally reprehensible gutlessness on the part of the masses, who would rather avoid conflict than confront error. The victims are a generation denied the wisdom of their elders. EXAMPLES For those who do not see how this all fleshes out in real life, let me describe a few cases. Abstraction of the issue that forgets real people, is a real problem for many, so this may be more important than the logic. For instance, usually conservative columnist George Will, alarmed about the rising birth rate in Baltimore, comes down on the side of the "Teenagerproof" contraceptive, Norplant. This is because the clientele "cannot remember to hang up their bath towels" much less use more complicated contraceptives. He is apparently proud of his lack of racial prejudice (the example he uses is a white girl) to the point of forgetting the human cost. It may be a cost-effective policy viewed from the Ivory Tower, but from the viewpoint of individual kids, this is a counsel of despair. The psychological devastation of impermanent relationships is enough -- essentially selling one's body, not for money but for a momentary pleasurable oasis in the desert of a life without hope. Beyond this, AIDS is going to steal their very lives. Even if they did use condoms correctly, the 17% per year failure rate is going to allow alarming epidemics. And with pregnancy "taken care of" the rates of condom use will probably sink even lower than the present levels. Many professionals have very different expectations for their patients or clients than they do for their own children. There is a tendency to see adolescents in general as hormones with legs, but their own children as complex individuals with hopes, fears and a future. People's desire for their own children is probably a better measure of what they really believe than their own experience or professional opinions. The ex-swinger may thus be particularly suspicious of his daughter's boyfriend. Of course, some good soldiers of the brave new world, recognizing this inconsistency, have dutifully lowered the standards for their own children. AT A SEX RELATED VISIT The above example, although it requires courage to go against the prevailing paradigms, is essentially easy because it is for the most part preventative. The kids, when responding to this talk, have usually not already made personal commitments to the destructive behaviors. More difficult are the visits for sex related problems, or when it comes up in the context of an already accomplished fact. Then, the commitment of the physician will be tested most directly. It much easier to follow "standard practice." A HIGH SCHOOL GIRL In the course of an evaluation of a high school girl, I asked her if she had ever had sex with anyone. She responded, "Yes." (Standard practice would have assumed that she was now irrevocably "sexually active" and proceeded with teaching about pills and condoms. I was even told by one expert that it would be malpractice to let such a girl leave without birth control, regardless of what she said.) Instead, I asked her what she thought of the experience now. She told me that it was disappointing. (Standard explanations would tell her that the first few times are often such for young women and that she should expect it to get better with experience.) I said, "Does the guy still see you?" "No," she replied, "He doesn't even talk to me." I told her that she had wanted and expected a relationship, but only got an act. She intuitively wanted it to be permanent. That was her ideal. But she felt cheap and used. We proceeded to talk about the fact that she could either go from here to more of the same or back off and reconsider. If a guy really loved her, he should be willing to wait for permanent commitment. If not, forget him. She was worth waiting for. I think she turned around at that point. A handful of condoms and package of pills would have convinced her that there was no more in life than a few moments of pretending to be cherished. I shared this experience at a conference with a prominent expert in teen sexuality. He was instantly livid in his opposition. He told me I was foolish to think that a teen would turn back from being sexually active. He stressed that it was the moral duty of the physician in that situation to prescribe birth control. It almost seemed that he hated to lose a sexually active teen. On another occasion, when I suggested using some of the arguments given in this paper for the teaching of teens, he responded that he was personally and professionally disgusted with my intolerance. A HIGH SCHOOL GUY A 15 year old guy, who looked much older, came in for a genital herpes lesion. I asked him how many partners he had ever had. He said, "Only one." He thought it was a monogamous relationship between two virgins when he discovered the lesion. His girlfriend admitted to having had sex with one other guy during their relationship. "How do you feel?" I asked him. He replied, "Cheated." He went on to tell how the girl had gotten drunk and had sex with an older guy. He could forgive her, but he still had this consequence, and so did she. I talked about the reason for feeling cheated being the intuitive knowledge that this relationship is supposed to be permanent and exclusive. This could be the turning point in his life, for good or for bad. Taking a page from the life of the swinger who infected his girlfriend, he could become a seeker of pleasure who said and did what he needed to meet his own needs and to hell with the rest of the world. Or, learning painfully from the situation, he could carefully choose someone willing to accept him despite this infection, most logically the present girlfriend, and then make very sure of commitment as a partner for life. I suggested that a decision like this is best made after agreeing to cease having sex until the commitment is made. Of course he would have to live with the consequences of this mistake. We hoped it did not also include HIV, and the tests confirmed that it did not. A GIRL WHO ACCEPTED BUT LATER REJECTED THE ADVICE A high school girl came for abdominal pain, she admitted to many sex partners. She also refused a pelvic exam by a male doctor and at the time I saw her, it was late in the day and all the female doctors had left. I said I was concerned about Chlamydia and felt she needed treatment. We agreed that she could start medication and come back for further examination by another doctor on the next clinic day. Then I told her that what I had to say next was much harder than just prescribing medicine. I felt very sad at the thought of what was happening to her. "Are you saying I am a slut?" she responded indignantly, "I know what I am doing. And I use two forms of birth control." "No," I replied, " I think you are a victim. If not of the guys who don't really stick around, at least of a society that has failed to tell the truth about sex." We talked about what her heart wanted. She did not have an available father and was hungering for someone who would say, "I love you." Yet each time she expected to be cherished and wasn't, her self esteem sunk lower making her an easier mark for the next guy. As we talked, her eyes began to moisten. The hard edge gave way to a look of vulnerability. She was hearing and responding to the insight. We parted on good terms. I told her that I really wanted her to have the best possible life. The next day, she returned to see the Gynecologist, accompanied by an adult woman, who was not her mother. They also went to visit the patient service representative at the clinic, complaining that I had been patronizing and paternalistic. This is a risk when trying to truly help someone. She had apparently run the story by her adult friend, who either had strong ideas on female sexual freedom, or some other motive for wanting to turn a confused young girl back onto the road to disaster. Some practitioners might be scared off by that one experience and say, "Well, that just goes to show you that you can't meddle with morals." I say, "If I am going to try to really help people, this is bound to happen once in a while. I can try to learn from it, but a complaint is no automatic indication I have done wrong." I am not willing to abandon the other teens who have been helped, because one came back to complain. DOES IT REALLY WORK? But isn't this just a mirage and an uncontrolled diversion? No, there is real scientific evidence that teaching chastity to teenagers has a positive effect. The evidence is suppressed, however, by those who betray in that suppression that they march to a different beat. Sex Respect, a successful curriculum emphasizing marriage is being attacked by the SIECUS and Planned Parenthood (who claim that they also want sexual abstinence for teens). They do not question its effectiveness, but state that it works by promoting fear. Think of all the terrible things people have been doing to children's psyches for years, warning them about playing in the street, thereby promoting fear of being hit by a car. Planned Parenthood and the ACLU have complained in various forums that sexual abstinence before marriage is a religious concept and does not belong in the public schools. (Of course, so is teaching against theft and murder. Are we to stop that too? And, on the other side of the issue, promiscuity is a doctrine of the religion of Satanism. But it is not nearly as fashionable to persecute them.) These groups have also claimed that the chastity programs promote a stereotypical view of the family as mother, father and children. (Sounds like the complainers need a good sex education course, folks. That IS where babies come from, remember?) Most of the thought questions in Facing Reality, a high school sex, drugs and alcohol curriculum, were ruled illegal in Shreveport, Louisiana, in 1993 by Judge Thaxton, because of a statute that prohibit quizzing students on subjective personal views. (There, for all time, goes the essay test!) Why such trumped up and abstract charges? This is especially puzzling when looking at the data showing an marked improvement in attitudes towards sexual abstinence for unmarried teens. The change was most marked, amazingly, with those who had previously been sexually active and those considered high risk. The short term return to abstinence was about 60% - 70% and longer term studies are underway. (See "Facing Reality: Abstinence Curriculum Evaluation Report, 1994-95," and "Choosing the Best: Abstinence Curriculum Evaluation Report 1994-95" by John Vessey, PhD, Mental Health Services & Evaluation Program, Northwestern University Medical School. Copies available from Project Reality, PO Box 97, Golf IL 60029-0097.) One suspects that the opponents may actually be unhappy about the results Project Respect is having. Their opposition makes no sense as a scientific objection by those who desire above all to solve the problems of teen pregnancy and sexually transmitted diseases, especially when compared with the opposite results of the programs they favor. Open-minded scientists should not too quickly deny consideration of this point of view just "because it does not appear in the refereed journals" or "is not endorsed by acknowledged experts in the field." Remember that those who control the academic channels are also fallible human beings. Teen-Aid, another abstinence program has shown in its 1991 report that there was significant change in attitudes and intentions as a result of the course. ("The Teen-Aid Family Life Education Project: Year End 1991 Report, Teen-Aid, Inc., 1330 Calispel, Spokane WA 99201.) They also showed a great teacher variability with poor results by teachers who did not really believe in the program. That makes sense. If the teacher essentially says, "Well, I'm supposed to tell you to not do it, but what you really need is condoms," the kids will get that message loud and clear. A GIRL WHO THINKS SHE GOT GOOD CARE. I testified at the Minnesota House and Senate in 2004 supporting a bill putting parents back in the loop when their teens receive care for birth control, STD treatment or abortion. And, by the way, the whole time I was speaking, the chair of the committee was talking to a colleague and most of the Democrats had walked out. Near the end of the testimony period, a girl now 18 or 19 got up and said, "When I was 15, I would not have gotten help if the new law were passed because my mother would not have let me. But I went to Planned Parenthood in Duluth and the put me on birth control and checked me every 3 months for diseases." The next statement broke my heart as she said, "And when I became positive for HIV, they were very compassionate. Then they told my mother and they got me on treatment. I am so glad that it was caught right away so I can be on treatment for my HIV." I ask you, did this girl get good care? She thinks so. Where to teenaged girls get HIV? From older guys! This was undoubtedly a predatory or abusive relationship. OPPOSITION TO CHASTITY Unfortunately, some of the opponents of chastity education are actually opposed to chastity. They see their utopian vision of a world without guilt or restraint being obstructed by "outmoded" morality and religion. Margaret Sanger, Founder of Planned Parenthood wrote this: "Through sex, mankind may attain the great spiritual illumination which will transform the world, which will light up the only path to an earthly paradise." (The Pivot of Civilization, NY Brentano's, 1922, p.270) Mary Calderone, Founder of SIECUS (Sex Information and Education Council of the US) wrote: "Change is the new reality... The unchanging... is unreal, constraining, a false goal." "(Children) must become familiar with change, feel comfortable with it, understand it, master it, control it." "If man as he is, is obsolescent, then what kind do we want to produce in his place and how do we design the production line? -- that is the real question facing ... sex education." ("Sex Education and the Roles of School and Church," The Annals of the American Academy of Political and Social Sciences 376, March 1968, p. 57). There are indeed plotters and schemers, who want to change society, beginning strategically with the area of sexual behavior. Yet, many of the proponents of faulty sex education today are just plain deceived. They believe the lies and do not suspect the cover ups. They are doing what they think is right or are swayed by professional peer pressure. Yet the results are already producing disasters in the lives of our young people. MEANING There is an unspoken presupposition underlying this entire presentation. It is that life is not an automatic disaster and there is indeed some sort of meaning to it. In an absurd universe or a life of pointless suffering, perhaps a few moments of pleasure and the illusion of importance are all that can be expected. For despair to set in, usually the props of family and friends have been knocked out or there is an inborn susceptibility to depression. But for many who then reach down to find a foundation of ultimate significance to their life, they find nothing. This is why it should be no surprise that, contrary to accepted mythology in the medical and mental health professions, most religious belief and practice is overwhelmingly correlated with physical and mental health as well as a positive outlook on life. (David Larson MD and Susan Larson MAT, The Forgotten Factor in Physical and Mental Health: What Does the Research Show? National Institute for Healthcare Research, 2111 Wilson Boulevard Suite 1130, Arlington VA 22201, now called ICISH or International Center for the Integration of Health and Spirituality.) It stands to reason that there would be a difference in the outlook. One believes, "I am an elaborate accident, programmed and operating by chance processes with no ultimate meaning or choices." Another is convinced, "I was lovingly created by a wise and powerful God who has a plan for my life that may include difficulty, but emerges on the other side even better." CONCLUSION Is there anything to be done? I propose, as Semmelweis did, that professionals wash their hands. I ask that everyone look rationally and carefully at the factors that hinder proper response to the issue. People need to be willing to stand up for the truth and point out the inconsistencies of style leaders whose actions betray a possible ulterior motive. To really make a difference, we must be willing to do the hard thing and stick our necks out. If we really love kids, it is foolishness to nurture them for 12 -15 years and then allow them to shipwreck on the shoals of sexuality. How much better to repair the old lighthouse! Revision 9/24/05 Publicizes that pornography, nude dancing and escort services are all part of it. Send comments to me at ross{at}rossolson.org The URL for this document is |