Adolescent Sexuality by Dr. Karen Rayne

Being a gay teenager can be really, really hard. Teenagers who commit suicide are more likely to be gay. Teenagers who are homeless are more likely to be gay. (There was an article about homeless gay teenagers in yesterday’s New York Times that prompted me to write about the subject today.)

What all of those articles and others talk about is that many GLBT (gay, lesbian, bisexual, and transgendered) youth are rejected by their families. The Times article quotes a study that found gay teenagers are more likely to experience physical violence from their families than heterosexual teenagers do, which is why more of them are homeless.

Now, I suspect that it is unlikely that anyone reading this article would physically hurt or attack their child if the child was gay. Nevertheless, part the reason that this kind of family-oriented violence against GLBT youth is allowed to continue is that we as a society do not talk about or accept teenagers being gay or transgender. I consider it part of my job as a sex educator of teenagers and their parents to talk about this subject with as many people as I can reach. I encourage each of you to talk with at least one about the experience of GLBT youth today. Think about the teenagers you know, and reach out to one of them who you think might be struggling with the issues of a GLBT youth. Let them know they have your support. You might be the only one to offer them such support.

Dan Savage is my favorite sex columnist. He is smart, concise, and offers up (usually) solid, well thought-out advice. He answers questions on a wide variety of questions, from the seriously kinky (like this) to relatively more pedestrian sexual issues (like this), and includes a good bit of political discussion as well (like this, from just before the 2000 elections). If you’re not ready to be surprised, don’t read through too many of his columns.

But do read this week’s advice which includes a discussion on HPV and oral sex. I like his perspective on it, particularly his discussion of gender and medical attention at the end.

Cancer Sucks

I’m having a problem. Twice when my girlfriend has given me oral sex, I’ve come in her mouth and then a little urine has come out. She’s understandably mad. The first time it happened was in the morning, so I thought it was just me being full of piss, but the second time I just came a lot and she kept sucking and a little bit of urine came out. Her technique involves a lot of sucking, so could she be creating some vacuum pressure? Or is there just something wrong with me?

Pissing By Accident

Swallowing a little piss may be the least of your girlfriend’s worries, PBA. Researchers at the Johns Hopkins Bloomberg School of Public Health announced last week that oral sex—blowjobs and cunnilingus—may cause throat cancer.

First the bad news—and you better sit down, because it’s really, really bad: If you and your girlfriend have had more than five oral-sex partners in your lives, PBA, you are both 250 percent more likely to develop throat cancer than some sad asshole who’s never had oral sex. Researchers are too polite to point this out, but I’m not: Most Americans eat pussy and swallow cock. According to the National Center for Health Statistics, 90 percent of straight men and 88 percent of straight women report engaging in oral sex. Half of all American teenagers have had oral sex; by age 19, the number rises to 70 percent.

“Researchers believe,” reports New Scientist, “[that] oral sex may transmit human papillomavirus (HPV), the virus implicated in the majority of cervical cancers,” and the virus lodges in the throat, where it can cause cancer. Study subjects infected with HPV were 32 times more likely to develop throat cancer; folks who tested positive for one highly aggressive strain of the virus, HPV-16, were 58 times more likely to develop throat cancer. Smoking, previously believed to be the culprit behind most throat cancers, only triples a person’s risk. (A new slogan for the tobacco industry: “Smoke cigs, not pole.”)

But before we panic—it’s just one study—let’s put throat cancer in perspective. Despite the fact that nearly all Americans engage in oral sex, throat cancer accounts for a tiny percentage of the roughly 1.5 million cases of cancer diagnosed every year. According to the Cancer Facts & Figures report released by the American Cancer Society in 2007, we will see 35,000 cases of oral cancer this year—that’s tongue, mouth, pharynx, and “other oral cavity.” That compares to 271,000 cases of digestive-system cancers, 229,000 cases of respiratory cancers, 220,000 cases of prostate cancer, and 180,000 cases of breast cancer.

And let’s put HPV in perspective, too. While most sexually active adults are exposed to HPV at some point, our immune systems usually “clear” the virus on their own. So not every HPV exposure leads to infection, and not every HPV infection is lifelong. Clearly, men and women need to keep an eye on their throats—and researchers are, according to reports, working on a saliva test for HPV—because when it comes to cancer, early detection saves lives.

So while the news is alarming, and the mainstream media will doubtless go into full hysteria mode, last week’s report in the New England Journal of Medicine shouldn’t be read as, “Eat yourself some pussy, get yourself some throat cancer!” Engaging in oral sex puts you at a greater risk—significantly greater, admittedly—of contracting a virus that, if your body doesn’t clear it, has a very small risk of causing throat cancer. It’s not a certainty; it’s a risk. As with any pleasurable activity, sexual or otherwise, we weigh risks against benefits and make decisions. Smart folks minimize their risks—by, say, using condoms for oral sex (har har)—but most sexually active adults are likely to conclude that the real and immediate pleasures of oral sex are worth risking a distant and unlikely case of throat cancer.

And now for the good news: There’s a vaccine that offers 100 percent protection against the strains of HPV that cause cervical cancer in women and, it now appears, throat cancer in men and women. The HPV vaccine has already been approved for women and is currently being tested in men. You may have already heard of this vaccine thanks to the controversy that surrounds it. The HPV vaccine is most effective when administered before a person becomes sexually active; doctors recommend that girls receive the vaccine at age 11 or 12. Religious conservatives believe that the HPV vaccine undermines abstinence education by making sex less risky. Never mind that studies have shown that abstinence education does not work. The right would rather see 4,000 American women die of cervical cancer every year than call off the fraud that is abstinence education.

And up to now the mainstream media have refrained from calling the right’s opposition to the HPV vaccine what it is—delusional, psychotic, homicidal—because up to now only women’s lives were at stake.

That’s about to change.

Here’s the headline from my morning paper: “HPV Factors in Throat Cancer: Study Could Shift Debate About Vaccine.” You bet it will. Up to now the HPV vaccine—which, again, has proven 100 percent effective against the cancer-causing strains of the virus—could merely prevent 10,000 cases of cervical cancer in American women every year, along with 4,000 deaths. But now the debate could shift—it will shift—because it’s no longer “just” the lives of 4,000 American women that are on the line, but the sex lives of 150 million American men.

“If men got pregnant,” goes the bumper sticker, “abortion would be a sacrament.” Now that straight men can get cancer from eating pussy, the HPV vaccine is going to go from controversial to sacramental faster than you can say, “Suck my dick.”

Getting back to your original question, PBA: Maybe researchers will one day discover that piss cures throat cancer. If that day comes, your girlfriend will thank you for those mouthfuls of piss. She’ll be married to someone else by then, and may only contact you through her lawyer, but still. It could happen. Just in case it doesn’t, PBA, discuss your orgasm-induced urinary incontinence with a doctor.

Welcome! There are many new people coming to this blog, and a few who have been reading for a while now. I have lots to say about adolescent sexuality and the issues that surround it, but I am interested in your questions too. Do you have a question you’re just waiting for a post to answer? Are there issues or topics that you’d like to discuss with your child/teenager but don’t know how? Is there something you’ve been wondering about me or my background? Please post your question or topic in the comments section, and I’ll address it. If you would like your question or comment to be annonymous, e-mail it to me (karen.rayne@gmail.com), and I will post on it without mentioning your name.

The Voices of American Sexuality Blog recently included this post:

gone down on more than six people in your life? might as well be smoking two packs a day

Not the sort to provoke any additional moral panic around fellatio and its sista-friend, cunnilingus (that’s Oprah’s corner of the market; school bus episode anyone?) but according to researchers at the Johns Hopkins Kimmel Cancer Center, there is conclusive evidence that human papillomavirus (HPV), transmitted via fellatio, causes some throat cancers in both men and women. Reporting in the May 10 issue of the New England Journal of Medicine, the researchers found that oral HPV infection is the strongest risk factor for oropharyngeal cancer (located in the tonsils, back of the tongue, and throat), even stronger than tobacco and alcohol use. Having multiple oral sex partners (more than six) tops the list of sex practices that boost risk for the HPV-linked cancer, although mouth to mouth transmission remains possible and was not ruled out by the study. Taking into account that approximately 20 million people are currently infected with HPV in the US alone, and about 6.2 million Americans get a new genital HPV infection each year, these new findings might be cause for concern amongst the extra sexually generous.

According to recent statistics from the CDC, by age 50, at least 80 percent of women will have acquired genital HPV infection. Stats for men are less clear; while most women are diagnosed with HPV on the basis of abnormal Pap tests which check for changes in the cervix, the cervixless are less likely to know if they’re carriers unless they develop one of the two (out of 30!) sexually transmitted strains that cause genital warts, the only visible symptom of the virus.

Maintaining its disheartening stance, the study points out that HPV-linked oral cancer has been on the rise since at least 1973, and is expected to beat out those caused by tobacco and alcohol use. Already accounting for 60 percent of oropharyngeal cancers and about a third of all oral cavity and pharynx cancers in the United States, there are more than 11,000 individuals currently kicking themselves for skipping that after sex smoke. Never mind the shot of Jack that got them there in the first place. So bring out your “inconspicuous” flask everyone already knows about and, what the hell, treat yourself to that carton you’ve been eyeing at Walgreen’s. After all, increasing your chances for oral cancer by two and a half or threefold (respectively) is nothing compared to the six plus oral sex partners you met over Spring Break. Yup, the same ones who, in a cruel twist of fate, made you 8.6 times more likely to lose a tongue.

Disappointing, but true, ladies and gentlemen. And it is information like this that adolescents need to be fully aware of as they begin their sexual interactions. Oral sex is becoming increasingly common among teenagers, often taking the place of vaginal sex because teenagers view it as harmless - no chance of pregnancy, no chance of STD contraction. This second assumption is just far too prevalent among teenagers. Check out two of my previous posts to read about what STDs can be contracted through oral sex and the research on the increasing rates of adolescent oral sex.

I regret to say that the links about the side effects of hormonal birth control from Friday’s posting are no good! I am so sorry! I hope everyone will accept this apology, along with some working links with similar information.

Aphrodite Women’s Health website has an article about the side effects of hormonal birth control and is particularly focused on depression. They also have a contraception discussion forum that has lots of good information (along with some bad, so please your judgment appropriately), and this particular thread within that forum has many good sites linked from it.

I have recently heard from a number of parents of adolescent boys interested in the boys taking sex ed classes from me, and I am delighted! Until this recent spate of interest, all of the interested parents had girls. This is not to say that parents of boys were unsupportive or uninterested in what I was doing - they just didn’t think their boys needed such a class. They all would agree, I am sure, that healthy sexuality is a boy’s responsibility just as much as it is a girl’s. They just didn’t think their boy needed more information or could spend the time to acquire more information than they already had. Parents of girls seem, almost across the board, to see the acquiring of additional information about sex and sexuality as an absolute necessity to their girl’s healthy physical development.

I wonder if this parental belief has something to do with boys getting older? The parents I have talked with over the past several days all have middle school boys. The parents of boys I have talked with previously have mostly had high school boys. Whatever the reason, I am so pleased to have the opportunity to reach young men and help ingrain their sense of responsibility and ownership over their sexuality.

The New York Times printed two interesting articles this weekend that I think are important to understanding the changing landscape of adolescent sexuality, here and elsewhere.

The first article is about the HPV vaccine. New Hampshire is offering the HPV vaccine for free to anyone who wants it. Washington and South Dakota have followed suit. New Hampshire isn’t able to keep up with demand, and is having to figure out how to prioritize who gets the vaccine first. Washington and South Dakota have had a strong response to the free vaccine offer, although they have not been running out of it. It seems that the people in these states have responded well to the state offering the vaccine, but not requiring it. There just hasn’t been much debate, because the people who are against the vaccine are simply not giving it to their children. While in general I think the vaccine is a good thing, I think this is a far more intelligent roll-out than the very poor attempts in Texas and Virginia at requiring the vaccine of all young women.

One more point before I move on to the next article. A young woman (15 years old) friend recently asked her doctor mother a very intelligent question: “Why aren’t boys getting vaccinated as well?” It frustrates me that reproductive health and issues around safe sexuality continues to be considered a woman’s responsibility.

The second article is about the changing abortion rate in China. It seems that the majority of the sex/reproductive education in China is directed at married women. The abortion rate among these women has been dropping steadily for some years now (it peaked in China in 1990 with 14 million abortions, and had dropped to 7.1 million in 2005; there are about 1.29 million abortions in the US every year). This drop in abortion rate, however, is among married women. Young, single women have increasing abortion rates - some having as many as two abortions in a 6 month period. The primary and very relevant lesson from this seems to be that a little reproductive education can dramatically reduce abortion rates. I see reducing abortion rates as something everyone should agree on as a national goal, regardless of whether they think abortion should be legal or not.

The links below all work now!

This is from Jan Matney’s Parenting: Living With Your Zen Master about the emotional ramifications of oral birth control (and I’m not just linking to it because she references me!).

From Jan Matney:

I worked for fourteen years as a psychotherapist, and when dealing with women with depression and/or anxiety, I never, in all those years, asked the question “Are you taking birth control pills?” In recent years, I’ve become more concerned about the hormonal imbalance and resultant anxiety and depression that can happen from birth control pills. Statistics indicate only a small minority of women are negatively emotionally impacted, but that’s not the feedback I get from the women in my life.

If you have daughters who are considering birth control medication, you might want to read the discussion below that women, boyfriends and physicians are having. It’s different news than the published stats.

http://www.aphroditewomenshealth.com/forums/ubbthreads.php?ubb=showflat&Number=55642&page=1&fpart=51

http://forums.obgyn.net/womens-health/WHF.0308/2462.html

One young man watched the transformation in his girlfriend after going off birth control medication, and when he was asked about taking the pill for men, he immediately said, “No way.” He’s not sexist, just wary of suffering as she did.
Not taking birth control pills may seem antithetical to the Feminist Movement and certainly, the medical establishment’s view, but sussing out your own answers for your own body is important.

This doesn’t address the issue of adolescent sexuality, and how to advice our children to protect themselves emotionally and sexually as they grow and mature (Check out www.adolescentsexualitytoday.blogspot.com for a conversation with Dr. Karen Rayne on this issue.) It’s just a different cut–Even if children make seemingly healthy choices with their burgeoning sexuality (i.e., “yes!” to birth control pills), that particular choice may not be the best choice for their mental health. It’s important that we, as parents and professionals, pay attention and sometimes let go of “the way it’s done” so we notice the way it is for that particular person.

This issue is so under-discussed, and I understand why. When encouraging teenagers to use birth control, it is hard to make your presentation nuanced enough to adequately discuss the potential ramifications associated with hormone-based contraceptives.

I see this as being particularly problematic in our society which presents oral contraceptives as the basic pregnancy prevention method, which can be supplemented with condoms if STD/STI prevention is also needed. Teenagers have internalized this message, and often say the only reason condoms should be used is in sexual relationships that are not monogamous. In other words, they associate their partner’s request to use a condom with their partner cheating on them.

I prefer to recast the condom as the most basic birth control method, because it doesn’t have the potentially negative hormonal side effects and it very handily protects against STD/STIs as the same time. I do suggest supplementing condoms with hormonally-based birth control for teenagers who don’t experience negative side effects.

Young children are socialized very early on into stereotypical gender roles. But what about the child who goes the other way? Last December there was a fascinating article in the New York Times (still available at that link) about young children who are drawn towards living as the opposite gender. The article introduces a range of professionals who believe, on one side, that children should be strongly encouraged to emulate their own gender regardless of their natural inclinations, and on the other side, that children should be supported in their exploration of gender.

While supporting an exploring child has a clear draw for many of us, that may start to break down when a 4-year-old boy wants to grow his hair long, wear only dresses, play only with girls, and change his name to a girl’s name (as the little boy featured in the story does). I tend to think of myself as very open minded about gender, but I know that would be an uphill battle even for me.

I think this particular issue can highlight the still existing gender prejudices that our society holds. We would not think much of a little girl who wore only pants, kept her hair short, played mostly with boys, and used a boyish sounding nickname. Girls like this have been labeled “tomboys” and been allowed to follow that path fairly easily for some time now.

I have been ruminating about why this particular gender discrepancy exists, and have come up with two possible reasons behind it. Perhaps it is because women have broken the gender barrier more effectively than men, and so girls are allowed a larger range of activities. Or perhaps it is because typically masculine activities are still more valued than are female activities, and so it is seen as more reasonable, more acceptable that girls try to emulate masculine activities than that boys try to emulate feminine activities. Maybe it’s a mix of the two. Maybe it’s something else all together. I’d love for anyone with more ideas on this phenomenon to post them.

Putting a condom on a penis correctly is not a terribly difficult thing to do, compared to the many difficult things people do in this world. But it is one of the only potentially life-saving activities that most people are never explicitly instructed in. Even more oddly, many of the young people who are explicitly instructed in proper condom application practice with a banana rather than a penis or a reasonable facsimile. This is absurd.

Texas law states that selling sex toys is illegal. Okay, fair enough. Stores such as Austin’s Forbidden Fruit, however, may sell educational aids. I will be the last one to suggest that anyone might use one of these educational aids for a sex toy, but I will be the first in line to suggest that they should actually be put to the purpose they are being sold for. That is to say, as educational aids. Let’s gather our gumption and actually teach teenagers how to put a condom on a penis rather than on a banana. Last time I checked, AIDS has not yet mutated to bananas, nor do they have the right genes to get a young woman pregnant.