Adolescent Sexuality by Dr. Karen Rayne

A mother recently asked me if teenage boys need pornography - whether that visual stimulation is really, really important to them and their sexual development. My answer? No. Teenage boys do not need porn. They may want porn. They may seek out porn. They may be fascinated by porn. All of these things are really, really normal.  But that does not mean that they need it.

Three decades ago the porn that was available to teenage boys was their father’s Playboy stash in his closet.  The current situation is much more problematic, because now the porn that is available to teenage boys is essentially limitless and includes every kink possible (without the cold-shower-effect of suggesting their father is into it as well).

So what to do when you, as a parent, find the paper or electronic trail your teenager leaves that ends in pornography?

Well, first you get really, really clear with yourself about how you feel about pornography. Then you talk with your teenager about it. “It” being porn.

And what to do if you never find that trail? Well, you have to assume it’s just because your teenager is better than others at concealing what they’ve seen. And that includes girls.

Every person, by the time they are 16, has seen some kind of pornography. Most have seen it much, much earlier. So you need not fear that you are introducing something that they have not seen or thought about privately. Rather, you need to fear that they have seen something they don’t know how to talk about.

Conversation about pornography with an adult (parent or non-parent) who is very, very clear about their own perception of pornography and can still talk openly and draw out the teenager’s perception pornography is the most effective route to supporting teenagers in navigating these tricky areas.

Boys need to know that girls often feel insecure around pornography. Girls need to know that boys are often curious about pornography. And everyone needs to know that (a) the bodies shown in pornography are extremely unusual and (b) it’s important to talk about and ask questions about the visual images they find, strewn carelessly about on the Internet.

What do you think?  What kinds of conversations about porn have you had with your children?  What kinds of conversation did you have with your parents?

I have posted before on how to talk with your kids about sex before.  But here’s an additional tip: Practice saying all of those tricky words (penis, vagina, vulva, orgasm, ejaculate, etc.) beforehand.  In fact, practice saying them right now!  Just getting over the embarrassment of hearing your own voice saying “oral sex” can be a big deal.  Then, once you’re use to that, imagine saying it in front of your teenager.  Making sure you neither giggle nor choke over “roll the condom down over the shaft of the penis” will go a long way to giving your words credit in your children’s eyes.

What words have you had trouble saying in front of your children?  What words did your parents have trouble saying in front of you?

So the liberal blog-o-sphere is simply agog with the CDC announcement that the adolescent birth rate has risen for the first time in fourteen years (it had been steadily falling). Bush’s abstinence-only “sex education” policy has been taken to the cleaners with this announcement. Here’s a quote from the CDC announcement that I think sums everything up nicely:

The report shows that between 2005 and 2006, the birth rate for teenagers aged 15 - 19 rose 3 percent, from 40.5 live births per 1,000 females aged 15-19 in 2005 to 41.9 births per 1,000 in 2006. This follows a 14-year downward trend in which the teen birth rate fell by 34 percent from its all-time peak of 61.8 births per 1,000 in 1991.

However, if you read deeper into the announcement, you find (as the Reverend Debra Haffner points out), that births rose among all women - not just teenagers. In fact, the total fertility rate is at the highest point is 1971, and is above replacement rate for the first time since then. The other serious numbers that come out of this announcement is that the Cesarean delivery rate rose again - indicating a 50% increase over the last 10 years. This is coupled with a rise in preterm births and a rise in low birth-weight. These are all much more alarming statistics than a very slight increase in the adolescent birth rate.

Now, I am not one to miss an opportunity to slam abstinence-only “sex education.” In general, I am just color-me-pink when big-time statistics like this come out indicating that the 1990’s had better sex education than the 2000’s. But I don’t agree that these numbers are enough to do that. The rise actually just takes us back to the 2004 adolescent birth rate (and is still lower than the 2003 adolescent birth rate). Many more questions need to be asked here: Did the abortion rate change? How many of these pregnancies were planned? (Yes, teenagers do plan pregnancies, and the biggest increase was among 18 - 19 year olds, who are the most likely teenagers to plan a pregnancy.) Did condom or hormonal birth control usage change among teenagers between 2004 and 2005? What about access for teenagers to abortion, condoms, or hormonal birth control?

I am also suspicious of people who rail against teenage births in general. Teenage parents aren’t all bad, and I’m tired of them being portrayed that way. The real issue for me is unplanned pregnancies, and yes, most teenage pregnancies are unplanned. The real issue is lack of real information, lack of access to reproductive health care, lack of self-efficacy around sexuality, and the highly overblown image of sex that prevails in our culture. None of these failures are exclusively the result of abstinence-only “sex education” (although it certainly hasn’t helped).

All of us - even those who support comprehensive sex education - need to acknowledge the role that we play, every day, in our society’s sex education. Do we talk openly and appropriately with people of all ages about sex and sexuality? Are you comfortable bringing up the topic of birth control when a young person you know gets into a serious relationship? Are you comfortable providing that birth control?

This is an area where you are either part of the solution or part of the problem. Where do you stand?

Thanks so much to Heather Corinna from Scarleteen for this information.

Planned Parenthood is now dispensing the pill without a pelvic exam. You can read more about it.

This is a relatively unusual program. Planned Parenthood’s requirements are that you do not have:

• certain conditions that make it inadvisable to use a hormonal method [of birth control]
• symptoms that must be evaluated with a pelvic exam

Now, there is some argument against getting yearly pap smears, for reasons of cost and the potential of false positive results of pre-cancerous cells. However, Heather suggested to me that Planned Parenthood is providing the pill without a pelvic exam simply in order to reach young women who are scared of their first pelvic exam, and are using that as an excuse to not use birth control. There is no indication on the PP website of why they have decided to stop requiring a pelvic exam.

For tomorrow: much discussion about the new CDC findings that teen pregnancy rates have started rising for the first time since 1991. (Yes, you are free to go into the appropriate tizzy of outrage at this information. While you wait for my comments, there’s lots to read about it: here and here and here are good places to start.)

Recently a young woman wrote me asking this question:

I am 19 and just recently lost my virginity, so my mom and I talked about how I should get on the pill. I’ve never had a pelvic exam (against my mom’s wishes) because I’m really shy and nervous about it, but she said that I can’t get the pill without having a pelvic exam, that makes sense but is it true? And how soon after I start the pill is it safe to have sex without a condom? Is a pelvic exam really as scary as I’ve heard?

And here is my answer to her:

These are all really good questions. Being shy and nervous about a pelvic exam makes a lot of sense. Here is a website that describes what will happen during your first gynecological visit (they describe a pelvic exam, although they do not name it as that specifically): http://www.scarleteen.com/article/pink/your_first_gynecologist_visit

Here is the factual information:
Your mom is right - you will need to get a pelvic exam in order to get on the pill. You can have sex without a condom after you have been on the pill for one complete cycle - from one period to the next.

Here is the emotional information:
It makes sense to be scared of a pelvic exam. It kind of marks a whole new beginning in your gynecological life - the need to be tested for STIs - and that’s not a pleasant thought. However, I can tell you that after you’ve had one or two, they won’t be scary any more. Don’t get me wrong - they can be uncomfortable, and if you don’t find the right person to do them, they can be embarrassing. But they do become a normal part of how you take care of your body.

So take some time and find the right person. Do you have a general doctor who you like and feel comfortable with? They will often do pelvic exams. If you don’t, then take some time and visit with several nurse practitioners or physician’s assistants. They are more likely to be female and not to be as rushed.

If money is a concern, you can go to Planned Parenthood. They are often (although not always) adept at talking young women through their first pelvic exam. They can prescribe the pill for you.

Now, I want to explain myself before the inevitable rush of comments asking why I did not explain the negative side effects of birth control pills to this young woman. First, I did not mention it in my e-mail response because the pill works really well for some women, and second because that’s not the question she asked me. Nevertheless, if this young woman reads my blog (or if her mother does), she’s just gotten access to information about how the pill can be harmful.

Do you have questions you’d like the answer to? Questions about sex, teenagers, parenting teenagers, or teenagers having sex? E-mail them to me, and I’ll post the answers here.

I am hopeful that the new movie Juno will be a good one. It’s about a teenage girl who gets pregnant - but it appears to deal with the subject with humor and at least a touch of realism. Watch the preview - click on “video” on the homepage.

And happy Saint Nicholas Day!

RH Reality Check had a really great post on abortion yesterday. While I highly recommend you read the whole thing, here are several of the points that stood out to me:

“There were many disturbing moments during the Republican presidential debates last week . . . But what had to be one of the more defining moments of the strange night occurred when the question turned to abortion. The graying, gray or bald white men all seemed to nod in agreement on a breathtaking (though unstated) policy initiative for women: the DIY abortion.

The question posed by the “young lady,” as homey Fred Thompson called the gal, was: If abortion is outlawed then who is the criminal: woman, doctor, or both? This has always been the sticky question for the anti-abortion side. Do they intend to start locking up women for murder? Stunningly, Fred Thompson, National Right to Life’s endorsed candidate, said no. He suggested that some people will be able to perform abortions with no fear of prosecution: women on themselves. Thompson explained his (and one figures, National Right to Life’s) bold new plan that would kick in once Roe is overturned. Said Thompson, “The question is who gets penalized and what should be the penalty. I think it should be fashioned along the same lines it is now. Most states have abortion laws that outlaw abortion after viability and [the criminal penalty] goes to the doctor performing the abortion not the girl, the young girl, her parents, or whoever it might be. I think that same pattern needs to be followed.” Under this plan, apparently a woman is free to perform an abortion on herself, possibly with the help of her parents or “whoever it might be” as long as a physician or a health care provider actually skilled to provide safe abortion care isn’t involved.

The last time the United States banned abortion — pre-Roe — doctors faced only minimal penalties for providing safe care. Apparently Thompson, and every GOP candidate except Rudy Giuliani agree, that policy was a mistake. This time around the crime of abortion, if (and apparently only if) performed by a doctor, will be murder and extreme penalties will apply. It seems clear that the environment post-Roe will be harsher than pre-Roe.

Last time around, a clandestine network of safe abortion services sprung up. This time, if the anti-abortion candidates have their way, the risk for physicians would be too great. And so women who can’t reach safe care will be much more likely to take matters into their own hands, which the Republicans apparently don’t mind.”

I won’t include the rest of the post, but it is really worth your read.

For me, reproductive rights are one of the few (maybe the only?) absolute issues in an election decision. The RH Reality Check post goes on to discuss how anti-abortionists are hoping to expand the concept of abortion to include birth control. This slippery slope is simply an untenable situation. It would put women back a hundred years.

I will start posting more information about candidates and their perspectives on things like sex education, reproductive rights, general educational policy, and other issues that affect teenagers and their sexuality as we get closer to the primaries and the election. (Well, I’ll be posting more about the front runners anyway…there’s far too many of them to talk about them all!)

Today, I have no voice. Literally. We’re passing a little cold around our house, and it seems to have hit me the worst. (Hence the late post today - sorry about that!) So yesterday afternoon as I was teaching my second class of the day, my voice disintegrated into nothing. I didn’t realize how much I use my voice at home - I have two children, a puppy, and and older dog. I constantly interact verbally with these four small creatures. Not to mention my husband delighting in my silence - it is a very occasional thing around here that he gets the the last word - and even rarer that he gets the only word!

So what, you’re probably asking, does this have to do with teenagers or sex?

Well, because it reminds me of when I was a teenager. I talked a lot then too, but I wasn’t listened to very often. It hurts not to be listened to - either because of your age or your vocal cords.

My brother, 17 years old, is feeling like teenagers are discriminated against. My stepmother tells me that he voices his distress over this loudly and somewhat belligerently - just like I used to do! She said she was actually surprised and impressed that I still am focused on teenagers. When my teenage self that I would make teenagers my life’s work, she didn’t take me seriously.

Teenager’s voices are overlooked, ignored, and not taken seriously. I’m tired of this trend.  It’s one of the reasons I do the work I do.

Several weeks ago I wrote about using the Socratic method. And while I stand by what I said in that post, I realized through talking with several parents that I need to include a caveat: the Socratic method only works if you are in a completely calm and open place. It only works if you are really, truly open to whatever course of action your teenager decides on. Because even with the best questioning, and even after considering all of the view points and possible courses of action, your teenager may still decide on a different course of action than you had hoped for.

So, if you are not in a very open place, you need to steer clear of the Socratic method. (Be honest with yourself!) In the event that you are not feeling very open, here is a different rule-of-thumb for you: You get one question. So make it a damn good one!

Here are the kinds of situations where this rule of thumb is the most critical:

• You walk in on your child having sex/doing drugs/sneaking out/etc.
• You hear through the grapevine that your child has done one of the above
• The teenagers next door has an all-night, raucous party while their parents are out of town.
• Anything else that just makes you angry
• Anything else where you think that the young person in question needs to be punished, told that they were wrong, or in any way lectured to

In these situations, you get one question. So take your time thinking about it - bounce your question off your therapist, your spouse, your best friend, your mother. Get the wording just right so it will really get to the heart of the issue, and leave very little wiggle room for a non-answer. You have 5 - 7 days, at most, to figure out your question.

Then find a relatively calm time when no one is rushing off, and ask the question. Then stop talking. Do not elaborate. Do not rephrase the question and ask it again. Do not qualify it with something like, “Do you know what I mean?” Just wait. If the silence gets awkward, that’s okay. Let it be an awkward silence that the teenager feels the need to fill.

So, to paraphrase this rather longer-than-I-had-intended post: The Socratic method works very well when you’re feeling centered. Otherwise, use the One Question Rule.