Good morning everybody! I thought I would launch right in on a “sensitive subject” that really shouldn’t be that sensitive. Teen sex. Just hearing those two words together sends tons of people straight to the sand to bury their heads or at least running to the other room to avoid the conversation. Stop avoiding it! It’s not doing any good…for us parents or for our kids.
The thing I hear the most from parents is ” I just know that she is not sexually active, but we are just here for a check up, “just to be safe.” These words often signify some glaring truths. The communication and trust lines are not fully open between the parent and child. The parent has suspicions and just cannot get them verified, but is hoping that I can. The parent already knows and is hoping that I can somehow shame the adolescent into stopping their behavior since they have been unsuccessful. Last, but not least, the parent truly does have his or her head in the proverbial sand and truly has no idea what their child is up to. Let me be clear. These statements are postulations that do not apply to everybody and every parent child relationship. I am just speaking from 27 years of experience and some things I have seen.
Reality check time. A lot of teens are having sex and it is essential that we at least attempt to communicate with them and at least try to give them the tools and opportunities to value themselves and be safe. The Centers for Disease Control and Prevention release the Youth Risk Behavior Survey every other year. This survey is conducted among high school students across the nation. Let’s take a peak at the most recent results. 39.5% of high school students said that they were having sex( 41% male and 38% female. 30% of these students had sex in the three months just prior to the survey. 46% of these students were not using condoms!. Just to drive these statistics home further, another CDC report showed that about 50% of the 20 million new sexually transmitted infections reported each year were in the 15 to 24 year old age group. Whaaat?! Now add to these statistics the emerging teen sex trends, the gender fluidity of sexual behaviors and the increasing rates of bisexual, pansexual, transsexual and polyamorous behaviors among teens. Currently, 48% of teens currently identify themselves as bisexual and 28 percent report that they are uncertain about their sexual identity. My head spins on the daily with all of the new terminology that I hear from my daughters’ friends and I have been told directly by teen patients that “being straight just isn’t cool anymore.” In the interest of further head spinning, I have had patients tell me that they have had 30+ partners between the ages of 15 and 18 without batting an eye.
Being a physician and seeing teens on a daily basis in the office( and being a general counsellor to my daughters’ friends) these statistics do not surprise me, but they are sobering and sometimes confusing to say the least. However, I have to keep these feelings in check somewhat if I want to be able to communicate freely with teens and encourage them to do the same. I still persist that open communication is the key to opening the door to attempting to help these adolescents value themselves and stay safe! I consider myself to be intelligent and I know that sometimes my teen patients tell me things just to see if they can shock me. What they don’t realize is that what they say doesn’t really shock me per say, but it merely strengthens my resolve to try to communicate with them and educate them. I guess you could say it is kind of an unintended reverse psychology situation…lol I also realize as I say this, that my openness is not for everyone. I am fully aware that I will never be invited to participate in sex education classes or lectures at my local schools because I cannot bring myself to go along with the abstinence only discussion. I am too practical for that. I bring slides, present non-judgemental facts, tell anecdotes, point out the pros and the cons, and provide them with the tools and information to keep them safe. This to me is far more preferable that to stand in front of them, thumping on a religious reference and watch all of their eyes close and their proverbial lights go out within seconds. Oh well, I will save my counselling for the office then I guess.
Speaking of the office, let me take you through one of my typical teen office visits. Every teen that I see in the office gets one on one time with just me in the room….with their clothes still on! There is no communication buzzkill quite like having to be naked in a flimsy drape while discussing personal details. So, with clothes on, and phones off( I insist on no distractions) we begin our discussion. If the teen is sexually active and/or is interested in having sex, we begin a dialogue. The first thing that I do is ask them what I call “the big question.” It is something that I ask with hope, but no expectations. I ask them point blank how they knew that they were ready to have sex. In 27 years I have only gotten a handful of thoughtful answers. Most of the time I just hear ” I don’t know” or “It just happened.” or ” if I didn’t I was going to lose (insert partner name) What I am really after with this question is finding out if any kind of thought process went into making that huge decision to have sex. I realize that most of the time the answer is no. I use this question as the lead in to our discussion about sex and its pros and cons. Usually it is a good ice breaker. After the question is let out into the open, I explain to the teen why I was asking in the first place. I explain to them that I am hopeful that when they make huge decisions for themselves that they stop and think about it first. I tell them about my observations over the last 20+ years with my teen patients and we talk about self worth and their own sense of value. I emphasize to them that their own self worth is not just measured by their body parts or their sexual activity. I point out to them that they are incredibly important and they are really masters of their own destiny and every decision that they make affects their future. I also let them know that if they are already worried that their bodies are the only thing left to give, we have much bigger things to talk about. Then we gently transition into a discussion about the pros and cons of having sex as a teenager. I set aside my temptation to soapbox and just discuss some facts. I point out the great disparity in social maturity between men and women at that age. I discuss the potential permanence of relationships at that age. I talk about the reality of how long the act itself might last despite the promises and bragging of most teenage men. I discuss with them the fact that the first several acts of penetrative intercourse may be painful. We talk about the risks of getting pregnant. We talk about proper use of condoms and birth control. I often get some squeamish faces at this point and reluctance to talk about male body parts or even call them by name. It is at this point that I am able to point out that being unable to even say the word penis or be comfortable with “dressing it appropriately” PROBABLY means that it does not belong inside their vagina. This often gets a laugh…..and then an abrupt serious and thoughtful look. I am not sure what that means, but I am hopeful that it means that the patient is at least considering what I said for a minute. We then also talk about the possibility of getting a “reputation” and the consequences of that. Then, we wrap it up together by stacking the facts up against their perception of what the pros might be( these depend on the patient), and give them the chance to evaluate. If the teen decides that no behaviors will be changing that day, we then start talking about how to keep them safe and without early unplanned pregnancies and I arm them with as much info, tools, and options After that discussion is over, we then talk about the best way to keep them healthy and whether or not an exam would be warranted and then that would be scheduled a different day. We will get to the discussion of teens and exams in another blog.
The bottom line is, we have got to be willing to at least attempt to be open with our teens about the realities of sex and keep our eyes on the prize goal: Keep them safe and healthy both mentally and physically. That is all we are really talking about. It is not always easy by any means, but it is definitely important. Have a fantastic day!
Dr. Katz
