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Social Issues: Letters

To: All GHI Providers From: Ross S. Olson MD
Re: Adolescent Sexuality

On October 18, 1990, Dr. Sylvia Hacker spoke to over 200 GHI providers on the subject of adolescent sexuality. She was both interesting and persuasive. Her ideas, however, must be considered highly controversial. I made comments from the floor and have corresponded with her since. She has been very kind in responding to my letters but I continue to be convinced that she is, with all good intention, promoting ideas that are dangerous. As caregivers for other peoples' children, we have a high degree of responsibility to give guidance that is appropriate and not just popular, true and not just trendy.
I will very briefly summarize her main points and my concerns. Those who are interested in examining the more complete debate may send me the tear-off at the bottom of the back page and I will return all of the ongoing correspondence plus a copy of Dr. Hacker's article in Siecus Report which is a written form of her October address. I welcome any comments and discussion in person, in writing or on the phone. As I understand it, the Education Committee is planning a seminar on adolescent health for the fall of 1991 at which this issue will be considered.

Dr. Hacker stated that the old norm must be rejected because we have learned too much and come too far to accept it any longer. "The norm of denial, which operated quite successfully before World War II, and in many respects still lingers, can be summarized as: SEX IS BAD, except in marriage, and then you should not enjoy it too much, especially if you are a woman, BUT PARENTHOOD IS GOOD." Under this norm she placed three premises: 1. Sex = intercourse only. 2. Children and older people are asexual. 3. Sexual thoughts are as evil as sexual deeds.

This approach worked, she said, in a subsistence society but will not appeal to those who want to "actualize themselves" and fulfill their higher needs. Our culture has only come part of the way towards true, liberating, guilt-free permissiveness and is still fixated on intercourse, which is now a health hazard (Dr. Hacker here implicitly recognizes the unreliability of condoms). The answer is to give adolescents permission to express their sexuality in other ways, like mutual masturbation and properly protected oral sex. In answer to a question, Dr. Hacker stated that after a time of doing this with a series of partners, a young person would "learn commitment." What is needed in the mean time is creative educational innovations like anatomically correct penis models with condoms on them.

I respond that Dr. Hacker has caricatured the traditional norm in an attempt to make it appear untenable. She apparently knows nothing or chooses to reveal nothing about a marriage relationship in which each partner tries to be sensitive to all the needs, including sexual, of the other and is committed to work through the difficulties. Even so, she has freely admitted that for the majority, the old system worked.

Rejection of the old on the basis of social change comes from an unreasonable faith in progress, the idea that "new is improved." Yet logically speaking, if the truth has been spoken, any change will be a lie. It cannot be denied that for the prevention of sexually transmitted diseases, the ideal is one partner for life. If two people each wait with genital sexual activity until making a wise choice of a life partner and then remain faithful to that partner, the chance of getting sexually transmitted diseases is essentially zero. That choice or celibacy, no partners for life, are the only truly "safe sex" options. Call it unrealistic if you wish but no one can argue with the mathematics.

Appeal to Maslow's heirarchy of need is interesting because Maslow lamented in his later years the misuse of his concepts. He said that only a small portion of adults are capable of self actualization and it was never meant to apply to children or adolescents. There is also no reason to believe that adolescents experimenting with every other form of sexual expression will really avoid intercourse. This concept would need to be tested before it is unleashed as a second sexual revolution. I suggest that it would end up as disastrously as the first. Regardless, it is clear that all forms of sexual activity are very powerful as habituating and bonding agents and that the psychological consequences of sexual promiscuity are considerable, even if the physical consequences could be avoided with certainty.

In addition, there is good evidence that sex education as it is being done actually increases sexual activity among adolescents. This can be seen in the data of a large 1986 Harris Poll which indicated that those having "comprehensive sex education" were 44% more likely to be sexually active than those who had no sex education at all. The conclusion was not noted, perhaps because the sponsor of the poll was Planned Parenthood, but it is clearly there in the data and confirmed by other studies.

"How can this be?" many ask. There are four reasons I can think of: the material in some courses is sexually stimulating, natural inhibitions are broken down in presenting the material to mixed groups, all options are said to be OK and the expectation of the professionals comes across, namely that this is what kids are inevitably going to do. By the way, anyone who claims that pictures and words about sex are not sexually stimulating is either very repressed or very jaded. Pornography does not sell because of a good marketing department; it creates its own market.

What kids need is not graphic descriptions but wise advice by adults who understand their own sexuality with its power for good and evil. Down through history and across cultures, although there have been abuses and aberrations, there is a strong tendency to put safeguards on the powerful sex drive. Margaret Mead's work in Samoa has been shown recently to reveal not the institutionalized promiscuity she reported, but the gullibility of an anthropologist, believing the wild stories of a playful group of teenaged girls who noted her appetite for the spicy. It is cultural arrogance of the highest degree to assume that what we just came up with is automatically superior to the preserved wisdom of the ages.

Kids need advice on how to say "no" and how to avoid situations where the temptation may be too strong. They need to understand the incredible benefits of waiting until they have carefully chosen a partner for life and made a genuine and permanent commitment. Then they can enjoy a sexual relationship free of fears. They need not fear disease or betrayal and can find the highest degree of pleasure in a relationship created by an act of the will.

Dr. Hacker claimed that men like virgin wives because "they cannot compare." Yet, I submit that it is no advantage to be able to compare. Rather it is a curse to have to compare. What a privilege to be able to say to a mate, "This relationship I have shared only with you." Of course some will not follow our advice, but why take the failures and define them as normal, pushing borderline kids in that direction. It is true that just over half of high school seniors have had at least one sexual experience, but that means that nearly half have not. In addition, many of those classified as "sexually active" have either stopped or are ready to consider stopping. Do any parents want their own kids involved in a series of temporary sexual relationships? Even single parents -- especially single parents that I talk to -- want something better for their kids. They know how hard it is the other way. Should we as professionals treat other people's children like dogs in heat? No, even though it may take more of our time and energy, even though we may risk placing ourselves in the category of "old fogies," let us offer the best to our young patients. Science is on our side. Physical and mental health go with it. It can be done.

To: Ross Olson MD, Bloomington Pediatrics

Dear Dr. Hacker,
I was the dissonant voice at your lecture to Group Health professionals in Minneapolis on 10/18. I thank you for allowing me to respond repeatedly during your talk. Most speakers would not have done so.

Still, there are many questions that remain. I have asked permission of Dr. Norris to write to the conference attendees. He suggested, fairly, that your reply also be included. I would classify you as a spellbinding speaker -- a truly gifted communicator. That, of course, increases your level of responsibility regarding the truth and fairness of what you say. In talking to people afterwards, I found that several said they agreed with the (excuse the expression) "thrust" of your talk. Yet, when I discussed the points one by one, they found themselves lining up with "the opposition".
There are several key points that need to be dragged out again and examined by light of day. Firstly, you spoke of the "old system" of sex only within marriage (also only intercourse, basically only for procreation, done "in ignorance", and women not supposed to enjoy it.) You admitted that overall this approach did keep down diseases and extramarital pregnancies. Then you claimed that "we all agree," except for a few Neanderthals, that we cannot and should not go back to it.

You are correct that the reason for our problem is related to change. It is more than that, however, it is the American addiction to change. We believe that "new" is "improved" and that change is for the better. This has allowed us to progress technologically (only to later discover pollution of the environment and destruction of resources). But it has made us forget that if truth has been spoken, any change is wrong. It is historical and cultural arrogance to believe that what we just happened to think up is superior to the wisdom preserved and distilled through the ages.

What we need is not just a return to the imperfect application of the model, but what it ought to have been like. You cannot argue with the fact that if every person had only one partner for life (or no partners for life), there would be essentially zero chance of sexually transmitted diseases. Anything more produces risk. The mathematical cutting edge defines promiscuity, not as "just someone I picked up," or "someone I did not really care about," but as anything more than one partner for life. You may argue about the practicality of it ever happening universally, but you cannot argue with the mathematics.

I agree that no matter what, there will be some who do not follow this high road. Yet I maintain that it is irresponsible to not hold this up as the ideal. There is a clear body of evidence that this exclusive and permanent sort of arrangement is also the most healthy psychologically.

Still there is more. Included in this ideal should be male sensitivity to the total needs of his wife, including the sexual. Those who understand the Biblical tradition know that sex was created by God for mutual enjoyment within the bounds of marriage. They also are familiar with the the commands that a husband love his wife as he loves his own flesh and also as Christ loved the church, which means he must be willing to die for her. Even people who do not accept that record as authoritative can see the great advantage to such a commitment. There must be knowledge of the partner for such love to be genuine and meaningful.

You spoke of Maslow and his hierarchy of need. Are you aware that in his later years he lamented the misuse of his concepts? He based the idea of self actualization on the study of two of the most outstanding people he had ever known. Among their characteristics was the submergence of their own interests in some greater cause. He said that only a very small percentage of adults were capable of self actualization and the idea was never intended for children. Yet it became the rallying cry for those who feel that they have to "do their own thing" to be fulfilled. Hedonism replaced altruism.

Your basic point, as I understood it, is that sexuality is all pervasive and its energizing effects can be redirected if a new conceptual framework is developed. That idea, in its simplest terms, is one with which many will agree. Your application of it, however, has several problems.

The most serious difficulty is your assuming that sexual energy must be expressed in a genitally stimulating, essentially orgiastic manner but that if diseases and pregnancy are avoided, everything will be fine. Because intercourse is a health hazard, you stated, we must teach kids to do everything else. Thus you mentioned mutual masturbation, oral sex (in response to a question you added "with proper safeguards") and other mutually pleasurable activities that might lead to orgasm.

First of all, is it indeed "fine?" I maintain that sexual activity leading to orgasm is a powerfully habit-forming activity and can be a potent bonding agent between two people who engage in it together. It is not casual because it involves an intimate sharing and potential vulnerability. This is why it is so hard to lose someone. It is hard enough if two people are just "in love" but never acted on it in any way. It is infinitely more difficult if there has been a sharing of sexual intimacy. Divorces are harder than moves. Breakups are worse than class changes. There is no reason to believe that the emotional consequences of "intercourse-free" orgiastic activity would be any less likely to produce these emotional consequences than intercourse.

In addition, there is no good reason to believe that adolescents would even go along with the program. Having been told they can play with fire, it is much more likely that they would regularly pass the point of no return and go ahead to include the "forbidden fruit." Therefore, the "practical" application of this approach would still have to include oral contraceptives and condoms, which would produce the same false sense of security we see today. Because the "experts" believe that kids cannot make sensible decisions, safety nets must be in place. Because everybody expects me to fall, why not jump?

If you truly want to show the utility of what you propose, why not design and run a careful study? Measure the rates of diseases and pregnancies. Carefully study the psychological outcome. How much better a contribution that would be than to simply preach a utopian concept and expect everybody to intuitively endorse it. If your concepts are enthusiastically accepted and acted upon, and if they lead to as dismal a failure as the sexual revolution of the 60's and 70's did, will you be around to accept responsibility? Would it not be better to get a bit of preliminary data first? Of course, that has not been the pattern over the past 30 years. We have been experimenting on the whole country.

You might ask me to run a study of traditional morality. To begin with, you agreed that it worked before, even though in an imperfect application. Also, there are studies on curricula using this concept in high schools that show an immediate decrease in sexual activity and improvement in school performance. (See the Project Respect material.) As to "comprehensive sex education", the Harris Poll commissioned by Planned Parenthood in 1984 revealed the unexpected result that those who were subjected to such curricula were about 44% more likely to become sexually active while in High School. This information is in the data but unreported by the pollsters who preferred to crow about the increased use of contraceptives by sexually active youth who went through a program. I see a lack of honesty in all this.

You mentioned the St Paul data on school based clinics as evidence that programs that recognize the reality of adolescent sexual activity succeed. That data is faulty. The school population was dropping about the time the number of births dropped. Apparently no mention of the denominator was made by the school based clinic people. Others later found figures for the general time period to be dropping at about the same rate as the drop in births. In addition, the data on births and abortions was not comprehensive but based only on the clinic records. (See the chapter in Dinah Richard's book.) The organizations whose interpretation of these events has gotten the widest circulation have ulterior motives.

You promised me, in response to one of my early questions about commitment, that you would get back to that. You stated, in the end, that after their experiments in sexual gratification with everyone who rang their bell, kids would "learn" commitment and responsible behavior. Thus they would be able to get married and stick with their mate. They would be able, after their far ranging experience, to say "no" not only to continued coupling when "in Limerence" but also all forms of sexual exploitation including incest. I doubt it and the burden of proof is with you.

Couples who live together before marriage are more likely to be divorced than those who do not. It makes sense. The training has been in having all the "benefits" without the commitment. If down the line, another deal comes along, why not? Conversely, someone who says, "for better or for worse, I am committed to you" (interesting how familiar those words sound), will not just move on at the first difficulty but will do everything possible to make it work with the ultimate good of the partner in mind.

I have a quarrel also with your conceptualization of touch as part of sexuality. The need to be touched is very pervasive but it does not always lead to orgiastic expressions. Yes, I understand that you are broadening the definition of sexuality by doing this to include those matters. The problem is that our culture has already given sexuality a virtual monopoly on touch, to the point that some people are afraid to touch. You may be coming at it from the other direction, pointing out that if people are not afraid to touch, they should not be afraid to go "further". I am afraid that some will stop hugging their kids for fear of sexual abuse. Potentially, a reception line could be considered a form of orgy.

I am convinced that many young people enter sexual relationships because they really want intimacy and warmth, often feeling a lack of this from parents. Adults hold babies and hug little kids. There is a tendency to do it less for older kids and and especially by dads. Yet this may be an important deficiency in the adolescent's development. The hugging must be pure and proper (especially if you plan to run for governor some day) but I am convinced that it is essential. I have heard many homosexual young men describe an intense longing to be close to a father figure that was never fulfilled and eventually became sexualized.

I think it is better to consider touch to be another basic drive, one which relates to sexuality but is distinct and separate. This fits the data and makes it easier to avoid the illusion that a touch must inevitably lead down a certain path. Were you tactically using this approach to blur the distinctions between various levels of relationship? That would make the "it's just like shaking hands" approach to sexual relationships believable, but I think it is a sneaky way to do it.

Regarding masturbation, it is certainly true that resort to self stimulation is better than sexual exploitation or some dangerous activity. Calling it self love is misguided because it distorts the concept of love which includes sacrifice. However, the desire to explode old stereotypes and relieve fears may have lead some to become over-enthusiastic promoters.

Studies of persons afflicted with paraphilias indicate that they are usually accidentally conditioned in early adolescence by masturbating to deviant fantasies. (See the letter by Dr. Cline with references). Not everyone is necessarily susceptible to these problems but some are. Teaching young teens how to masturbate is not necessarily a wise thing to do. Fantasy is much less dangerous than reality, but it seems best to avoid dwelling on fantasies that should not ever become reality. It may also be better to let it be an outlet at need and not an activity to be sought out.

This brings us to the final point of knowledge. Those who promote chastity (sexual abstinence before marriage and faithfulness in marriage) are often accused of being in favor of ignorance. Those who oppose condoms are caricatured as wanting to prevent the dissemination of knowledge about condoms. I am not in favor of ignorance. Rather, the truth about condoms should be told, for instance, the 10 to 15 % failure rate in preventing pregnancy, the similar failure rate over 1 year in preventing the spread of AIDS from one heterosexual spouse to another and the over 30% breakage and slippage rate among male homosexuals using them for anal intercourse.

The place of "knowledge" is even more than this, however. The sort of things that are being told and the way they are being told is crucial. We are given the impression that knowledge is the answer to sexual problems, but this is misleading. If the "knowledge" conveyed is that everything is safe with condoms, and that teens should be choosing whether or not to be sexually active, the resultant choices by the students will probabably reflect that point of view.

Why were students given comprehensive sex education found by the Harris Poll to be 44% more likely to initiate sexual activity? I suspect that in addition to conveying a false sense of security and using a non-directive approach, the material itself is sexually stimulating. This, of course, immediately identifies me as a prude who is unable, among other things, to appreciate the graceful arcs of Mapplethorpe's photos. But I challenge every intellectually honest person to ask themselves, "Is sexually explicit material erotic?"

After all, why is pornography such a big business? Do they just have the best ad agencies? Does their sales force work harder? Of course not. Like drugs, the product creates its own market. Therefore it should not be a big surprise that certain ways of teaching about sexuality may prime the pump. It is this intuitive embarrassment and fear that makes it difficult for some parents to talk to their kids.

The concept of a "latency" period has given academic support to the uneasiness that many feel about giving explicit material to grade school aged children. According to psychoanalytic theory, they are suppressing their sexual drives at that time and can be harmed by upsetting the balance. Yet some methods of teaching seem determined to break down that reticence and modesty. Some teachers have asked first graders to stand in a mixed classroom, pointing out and naming their body parts including the genitals.

Materials used for teens can also have the "side effect" of breaking down inhibitions and stimulating interest in acting out some of the topics. I say "side effect" because some utopian thinkers believe and state that the breakdown of inhibitions is a worthy goal on their way to a society free of guilt and shame. Margaret Sanger, founder of Planned Parenthood wrote, "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 p. 271) suspect that the path may lead more to a nation of psychopaths.

Would a sculpture of an erect penis with a condom on it do any more than remind those who are intending to engage in intercourse to use the appliance? Those who say "no" are either even more repressed than the archetypical fundamentalist they claim to have uncovered at the bottom of the abstinence "plot", or they are so jaded that they have no reaction to anything short of hard core.

You mentioned the boy who fainted at the description of anal intercourse. That would be an extreme manifestation of what is, however, a common type of reaction -- namely disgust. It would serve to form a barrier against experimentation in that direction, unless there were an effort at desensitization. Indeed, the reaction might be derided by some as "homophobic" and therefore despicable.

Let me say that, whatever a person may want to think about male homosexuality, it is essentially a death sentence to turn a young person loose into that lifestyle. There is a normal ambivalent stage to the development of sexual orientation. When sexual awakening begins, peer groups are same sex and early experimentation may be same sex. Orgiastic activity is itself habit forming. I am convinced, as I stated above, that homosexuality is a complex developmental problem and that there are many teenagers for whom the final outcome is in doubt. If they are told that all choices are equal, those choices are described in X rated (excuse me, NC 17) detail and natural barriers to certain choices are removed, there is a good chance that some will turn that way. Then the lie becomes apparent. All choices are not equal, but some groups want to swell their numbers because in the mind of the 20th Century American, whatever is, in significant numbers, is right.

What kids need is not graphic descriptions but wise advice by adults who understand their own sexuality with its power for good and evil. Kids need advice on how to say "no" and how to avoid situations where the temptation is too strong. They need to understand the incredible benefits to waiting until they have carefully chosen a partner for life and made that commitment. Then they can enjoy a sexual relationship free of fears. They need not fear disease and need not fear betrayal.

You claimed that men like virgin wives because "they cannot compare." Yet, I submit that it is no advantage to be able to compare. Rather it is a curse to have to compare. What a privilege to be able to say to a mate, "This relationship I have shared only with you."

Ross 5. Olson MD
Minneapolis MN 55417

Send comments to me at ross{at}

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