Adolescent Sexuality by Dr. Karen Rayne

Is it awkward to whip out a banana or a cucumber (or even better, a penis model) and tell your teenager you’re going to show her the steps on how to put on a condom? Yep, no doubt. But there’s really no other good place for your teenager to learn how - except for trial-and-error, which really no one wants.

So here are the steps:

1. Check the expiration date on the condom package. Even brand new condoms can be expired.
2. Open the package with your fingers. Teeth or scissors can tear the latex and you won’t necessarily realize it.
3. Figure out which way the condom rolls down. Put it on the head of the penis correctly.
4. Pinch the reservoir tip to squeeze the air out. This ensures that there’s space for the sperm to go in.
5. Roll the condom all the way down the penis.

And here’s the second half of the lesson that regrettably sometimes gets missed:

1. After the male orgasms, he needs to hold the condom on to the base of his penis and withdraw his penis before it becomes flaccid.  This makes sure that the condom doesn’t slip off when the penis becomes smaller.
2. Slip the condom off the penis while still holding it at the base so that the sperm isn’t spilled.
3. Tie off the open end of the condom.
4. Throw the condom in the trash.  (Not in the toilet or on the ground.  That’s just gross.)

These few moments spent together may have the effect of horribly embarrassing both the parent and the teenager.  But it may also have the effect of improving the teenager’s effective use of a condom.  And as a parent, it’s completely worth it.  Because you never want to hear the words “Ummm…because we didn’t know where the condom was when we were…you know…finished.”
And if you just can’t make yourself do it, here’s your out: YouTube, Planned Parenthood, or Our Whole Lives sexuality classes all also teach teenagers how to properly use condoms. So you’ve covered your bases if you’ve made sure that your teenager got the information from somewhere.

I’m getting more interested in talking with doctors and their staff about how to talk with teenagers about sex and safe sex.

It seems that many of the stories I hear about doctors is that they just don’t talk with teenagers about sex. My brother, for example, has never had a doctor ask him about any sexual activity - even though he is engaged in sexual behavior. What’s up with that? And the real kicker is that my dad had expected the doctor to talk with my brother about sex - and was quite taken aback that he never had.

So I’m wondering if doctors are concerned that parents don’t want the doctors talking with the kids about sex? Or maybe the teenagers never see the doctor alone - and so the doctor feels awkward talking about in front of the parents? Or maybe the insurance-based-cattle-call-doctor-offices just don’t allow enough time for the conversation to happen?

What it comes down to is that I’m just not sure what’s holding doctors back from talking with their pre-teen and teenage patients about reproduction and safe sex. What do you think?

Yesterday’s big news was the new Guttmacher Institute study that suggests teenagers are not using oral sex as a way to stay “technically still a virgin.” Rather, it says that teenagers who are engaging in oral sex are by-and-large also engaging in vaginal intercourse.

I must admit - I am rather surprised by this finding.  But I am, if nothing else, swayed and enraptured by good research.  Here’s what the Guttmacher Institute has to say about the numbers:

“Some teens may first experience oral sex immediately prior to vaginal intercourse, while others may initiate vaginal intercourse shortly before having oral sex. While only one in four teen virgins (26%) have engaged in oral sex, once teens have had vaginal intercourse, the proportion increases incrementally. By six months after first vaginal sex, more than four out of five adolescents (81%) have also engaged in oral sex, and by three years after first intercourse, nine in 10 (92%) have done so”

And here are the results that the Guttmacher Instutite draws from this data:

 “There is a widespread belief that teens engage in nonvaginal forms of sex, especially oral sex, as a way to be sexually active while still claiming that technically, they are virgins,” says study author Laura Lindberg. “However, our research shows that this supposed substitution of oral sex for vaginal sex is largely a myth. There is no good evidence that teens who have not had intercourse engage in oral sex with a series of partners.”

But I’m not so sure that I agree with Dr. Lindberg’s conclusions.  Please note that I have not read the actual research paper or analyzed the data myself!  But based on what I have read, here are my problems with her conclusions:

1. I was not able to find anywhere in the information on the study data-gathering about what the teenagers were claiming about their reasons behind their sexual decisions.  We can, with relative clarity given the breadth of this survey, know what the teenagers are doing, but we can’t know why.  So I think it’s jumping the gun to say that teenagers are not claiming to be virgins when they have had oral but not anal sex.  There is other research that does go into a bit more detail of teenagers’ understandings of the meanings of these various activities that suggests differently.
2. What about the 12 to 14 year olds?  I’m unclear on whether this study asked the 15-to-19 year old participants to think back on their sexual experience time-line (which is, of course, problematic in it’s own right) or asked about their current sexual activities over time (much better, in terms of creating quality research but presents it’s own problems in terms of funding).  But I’m concerned that younger teenagers were left out of the equation - it seems to me that many of these younger teens may be the ones who are claiming that one can have oral sex and still be a virgin.
3. What does it mean when you say “1 in 4 teen virgins”?  Did they ask “Are you a virgin?”  And then follow that up with questions about actual sexual activities?  The term virgin just needs to be tossed.  It confuses conversation - as it did the Guttmacher Institute’s press release.  So I hope for more linguistic clarity in Dr. Lindberg’s final paper.
4. The other point that is not fully addressed here is the sexual progression that teenagers go through.  Perhaps it’s common for a teenage couple to get comfortable with oral sex (in order to maintain virginity) and then quickly move on to vaginal intercourse.  In other words, perhaps oral sex is a “gateway sexual activity” to vaginal intercourse.  That’s not really addressed here at all.
5. Okay, one more point and then I’m (hopefully!) done.  I take great offense at Dr. Lindberg’s sentence: “There is no good evidence that teens who have not had intercourse engage in oral sex with a series of partners.”  There is, in fact, no conversation at all until this point about a series of partners.  I am worried that this sentence belies Dr. Lindberg’s unconscious assumption that a teenager who is engaging in oral sex is something of a “slut” and more likely to engage a “series of partners.”

I am fully aware that one research project cannot answer all of these questions.  Gaining a really well-rounded and informed understanding of adolescents’ sexuality will take far more time and money.   Nevertheless, I was disappointed to see that the Guttmacher Institute, as a highly respected research facility, did not temper their statement of results with a nuanced approach to what kind and scope of information this data analysis is really able to provide us.

However, one of the results of the study that I am really, really delighted to see was: Teenagers are having anal sex. (The Guttmacher Institute suggests about 1 in 10 teenagers between the ages of 15 and 19 has had anal sex.) The sex-ed implications are very, very clear. Anal sex carries higher risk than either vaginal or oral sex because of increased likelihood of STD transmission and the physical problems that can be brought on by moving too quickly, not using enough lubrication, and other problems that might induce tearing and serious internal injury - all of which compound the STD transmission risk). So we have to talk with teenagers about anal sex. They or someone they know is probably trying it out, or has tried it out, and the likelihood is that they have never had any information presented to them about how to engage in anal sex safely.

I’ve been disappointed by much of what I’ve read about this study - it primarily just repeats what the Guttmacher press release said with little or no analysis.  But if you’re looking for additional commentary, here is a good place to start.

Planned Parenthood has a new education campaign for teenagers called Take Care Down There. At least one blog has questioned whether the site is cheesy - or more to the point whether it is too cheesy for teenagers. And yes, it’s highly cheesy. Here are two cheesy things I noticed about the site:

1. The lines are clean and the colors bright and the whole site is somewhat reminiscent of that penguin game the kiddies like so much.
2. The characters in the videos are wearing gender-color-coded t-shirts and are somewhat reminiscent of the Apple/PC Apple ads with their white backdrops and amusing banter.

In other words, Planned Parenthood has made this campaign fun rather that stressful. But I think that’s good. There are links to more in-depth, useful information. And through the videos, teenagers are getting exposed some good, basic information about safe sex. It’s not a sex-ed class, and it’s not comprehensive. But imitating a classroom environment is not how the Internet works, and teenagers know that.

Basically, I’m delighted that Planned Parenthood has gone out and gotten people who know what they’re doing on-line and in advertising to create a funny and engaging site to work as a portal to greater information. I think teenagers will be much more likely to visit this site and to recommend it to their friends than something like this one, and it will stick in their minds so they’ll know where to come back when they have pressing questions. Then they’ll be ready to make their way through Teenwire’s denser, more informative body of information.

So go take a look, and report back: What do you think of the Take Care Down There campaign?

May blog

This post is written by guest blogger JustAnotherTeen

The transition from high school to college can be a difficult one for both parents and teenagers. Although my transition will not be nearly the same since I have essentially lived in a supervised college setting for the last three years, I can understand the transition and the anxieties it may cause. Moving away from home to college is often the first chance that a teenager gets to live outside of their parents’ house and of course has many more freedoms than life at home. With these freedoms come freedom in sexuality, whether parents are ready for it or not.

Teenagers may suddenly discover that they can bring anyone back to their room, no questions asked. They can sleep with anyone they want whenever they want however they want. Their sexual outlook on life can change dramatically or only slightly, depending on how they were raised. I believe that if they are allowed the freedom to make their own sexual decisions while still in high school, they will be likely to remember to use a condom every time and less likely to make decisions they will regret. If they have not been allowed to make their own decisions when in high school, they will be less knowledgeable about the risks of unsafe sex and will be more likely to try it with the first person possible just because they can. I realize this is a vast over generalization and does not apply to lots of people. But I didn’t say this is how it would be, I just said it is more likely to be this way. And would you prefer that your teenager make mistakes at home or at college several hours away? Would you rather them be able to ask you about sexuality as they are experiencing it or just get their information from their peers in college. Obviously they are not always going to ask you even if you give them freedom in high school, but they are a lot more likely to then than later. That is my take on most people’s sexual transition from high school to college. Now for how mine will likely turn out.

Since I am already in a serious relationship, I doubt I will have the typical college sexual experience (as if there is such a thing). My relationship probably will not change much other than the fact that we will see each other all day long and we will be able to sleep together more often than we have been able to this past year. It will be nice because our relationship can be pretty rocky as a long distance situation. It is hard for us to both talk on the phone around busy schedules and homework, but when we can just be in the same room working together, we have no problems.

As always, feel free to email me at justanotherteen@gmail.com

How do you think relationships and a teens outlook on sex changes between high school and college?

The Dinah Project recently had a post about how to carry a condom, and ended the post with a good argument for why girls should carry their own condoms. It’s a good post. Straightforward, interesting, and educational. You should forward it on to the teenagers you know, so they’ll be one step closer to using condoms correctly.

Here’s a few excerpts from the post:

To this day, carrying condoms in wallets and back pockets are common choices for men. It needs to be said that fantasies aside, your luck with shine through so much better when your contraceptive is intact. There is something to be said for not having to fumble around for a condom when the time comes, but pulling out a shabby, old prophylactic isn’t going to impress a soul.

…

Besides all this logic and practicality, sharing the condom load between the sexes inspires other creative benefits. For example, it can be the ultimately cool way to overcome the awkwardness of covering the bill in these times when having him pay up just doesn’t always feel right. Dinner is on him, condoms are on you. Well, sort of.

So go read the whole post! You might learn something, and you can pass that knowledge on to so many people in so many places!

Yesterday I wrote the introduction to this series. Today I am writing about how talking with teenagers about sex as a privilege can lead to a discussion of responsibility to the physical aspects of a sexual relationship.

Once a teenager acknowledges that sexual activities are inherently different from non-sexual activities, the most obvious way to talk about these differences is the actual physicalness inherent in sexuality: sexual activities are inherently physically different from non-sexual activities and carry certain physical risks.

The question to ask:

“What responsibility does one have towards the physical well-being of one’s sexual partner(s)?”

Not many teenagers get asked this question, but I suspect that safe sex would be much more common if they were. This question could prove to be particularly revolutionary if teenagers responded by truly pondering the implications. While I generally suggest that adults keep their questioning to a bare minimum of one question, if the situation allows, I might try to slip in this second question into the conversation:

“What responsibility does one have towards the physical well-being of one’s own body, sexually speaking?”

I am sure that I never considered my responsibility towards my own physical, sexual health as a teenager, and I don’t think I ever overtly considered my responsibility towards my partner’s physical well-being.  What about you?  How did you conceptualize these issues as a teenager, or how have you guided your teenager in conceptualizing them?

On Friday I wrote about the importance of talking with teenagers about privilege vs. responsibility in sexual decision making. Here’s the first concrete step a parent or a teacher could ask a teenager to begin a conversation around this topic:

“How is hooking up with someone different from, say, playing a computer game with someone?”

This will, of course, lead to many different answers. Here are some:

• “I’m much more picky about who I hook up with than who I play computer games with.”
• “Hooking up can get you an STD.”
• “Hooking up can get you (or someone else) pregnant.”
• “Hooking up is more fun.”
• “You can play computer games with more than one person but you don’t usually hook up with more than one person at a time.”
• “Hooking up feels better than playing computer games.”

(If you’ve got other answers to that question, feel free to share them in the comments section!)

The parent or teacher can take almost any answer that the teenager gives and turn it into a supporting point for the deeper nature that being sexual with someone implies over non-sexual activities.

By acknowledging that sexuality is inherently different from the majority of activities that a teenager could potentially engage in, the doorway has been opened to talk about the inherently different responsibilities that come with it.

There are three areas of sexuality that stand out as needing bringing particular responsibilities with them: physical, relational, and social. We’ll talk about these three areas of responsibility and how to talk about them with teenagers over the rest of the week.

(Written by Guest Blogger JustAnotherTeen.)

Let’s face it, my girlfriend and I are far from the poster children of safer sex practices. Sure, we are not that bad, and try to use two forms of birth control, but no one could argue that they are the safest ways to go. When we first had sex, she had already been on the pill for awhile to regulate her cycle after she lost an ovary. That was at least one line of defense, but I was adamant that we have two. So at first we used condoms. But, unfortunately, no matter how thin the condom, there is still a difference. Sure, not enough that it should have stopped us. So instead we switched to pulling out as the second line of contraception. And yes, I know, horrible is it not? Pre-cum has semen, it is hard to pull out in time, sometimes you lose the will to, etc etc. But it was just the second line of defense so I did not worry about it too much. Fortunately, we got lucky and never even had a scare. Now she is off the pill for a bit and we have started using condoms with spermicide. Not as much protection as I would like, but definitely better than just pulling out! And lets face it, condoms are some of the most accessible and most effective forms of birth control.

That said, I don’t think teens know enough about them. Can they become less effective if kept in your pocket or a warm car? Do the cheap ones in bathrooms work as well as any off the shelf in your local drug store? Honestly I do not know for certain the answers to these two questions (if I had to guess I would be pretty confident saying yes and no, respectively.) But some teenagers know far less than I do about them, and that is just sad. Furthermore, some teens probably don’t have access to condoms, and that is even more sad.

What forms of birth control do you/have you used in the past? Had any failures or scares? Comment back and let me know. Oh yeah, and feel free to berate my bad second line of defense!

With every privilege should come increased responsibility.

For example, my 6-year-old daughter has increased freedom at every birthday.  She is able to stay up later or walk alone to our neighbor’s house.  But her responsibilities also increase at every birthday.  Last year she started getting ready for bed without our prompting or help.  Maybe this year she’ll start putting her own clothes away or rinsing her dishes.

Teenagers too often have an imbalance of privilege and responsibility.  What I mean by this is that parents are too often willing to provide their teenager with a cell phone or a car (a privilege) without requiring the teenager showing an equivalent increase in responsibility (like paying for a portion of the on-going costs or running household errands).

Sexuality is too often talked about with teenagers in terms that have everything to do with privilege and very little to do with responsibility.  In sex education classes, either at home or in schools, adults are far too likely to assume responsibility for teenagers’ sexuality decisions without putting the onus of safe sexuality squarely where it belongs: on the shoulders of the individuals availing themselves of the privilege of engaging in sex.

Next week I’ll write about what it looks like in concrete terms to ask teenagers to fully step up to the responsibility of safe sex if they are choosing to engage in the privileged activity of sex.