Adolescent Sexuality by Dr. Karen Rayne

My long-time, very dear friend Alice Fielding kindly agreed to share her experience around sexuality education and her evolving thoughts on pre-marital sex. She’ll be following the comments on this post, so feel free to engage her in conversation though your comments.

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The only sex talk I ever got from my parents took place at Pizza Hut one rainy afternoon when I was twelve. My dad set his ham sandwich on his plate, leaned forward, looked me square in the face, and said, “SEX IS ONLY FOR MAKING BABIES.” After pausing for effect, he sat back, picked up his sandwich, and resumed eating.

He definitely made his position clear, although I already knew that my parents believed premarital sex was wrong, having picked up this idea from context. I was routinely shocked by what I read on the bathroom walls at my middle school. In elementary school, I had been shocked when a substitute teacher told us she had gotten married the previous month, but had a daughter who was a year old. In high school, I would be shocked when the girl who wore revealing clothes, the girl everyone whispered about, actually did get pregnant and have a baby. Even in college, when asked by a resident adviser what I believed about premarital sex, I wasn’t able to answer.

My parents weren’t religious fundamentalists. My father was a committed Unitarian Universalist; my mother attended a Presbyterian church wearing a lapel button which read, AGAINST ABORTION? DON’T HAVE ONE! I was even less dogmatic than my parents, and in my late teens felt confused about the fact that I didn’t know anyone else my age who was against pre-marital sex but not for religious reasons.

As soon as I graduated from college at age twenty, I got into a committed relationship with a family friend I’d known for several years. He wanted to have sex with me, and I felt silly saying “I can’t have sex with you because my parents think it’s immoral.” So I said yes. When the relationship turned abusive, I felt lost and alone. I didn’t think anyone else would ever want to be with me; I felt like the dirty toothbrush or licked Junior Mint from an abstinence-only sex ed curriculum. Worse, I was afraid to tell the trusted older adults in my life what was happening to me, for fear that they would stop loving me once they found out I was immoral. The only reason I ever told any of them was that months after I finally ended the relationship, I started experiencing symptoms of post-traumatic stress disorder that were too severe for me to deal with alone.

My mentors and friends were loving and supportive from the moment I told them about the abuse all the way through the nine years it took me to recover from the PTSD. I wouldn’t have gotten through it without them. The tragedy here is that if I had told them much earlier, the abuse would not have escalated, and it might not have occurred in the first place. The trusted older adults in my life would have perceived what was happening and helped me, if only I hadn’t been afraid to tell them.

I’m not opposed to premarital abstinence. In fact, I think abstinence is the healthiest choice for most teenagers and many young adults, and I think anyone of any age who makes that choice should be fully supported in it. I am, however, utterly opposed to abstinence-only sex ed, and not just because it’s unrealistic or has been proven ineffective. I’m opposed to it because it closes the doors of conversation between older and younger adults, and that can be incredibly damaging to young people who want to live their own lives but still need guidance from folks who have more experience than they do.

So, go on. Take your daughter or son, or nephew or niece, or younger sibling or cousin or friend’s child out to a pizza restaurant. And don’t be afraid to bring up the topic of sex. But make it a two-way conversation. If you are the younger person in this situation, remember that prior generations grew up with different sexual norms that may be difficult to see past. Regardless of whether you are the older person or the younger, listen. Don’t shame or judge, but try to understand.

Have you ever had an honest, trusting conversation about sexual ethics or decision-making with someone much older or younger than you? If so, how did it go?

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.

Gender is such a malleable concept.  And it can be difficult for people who are entrenched in the general understanding of gender to understand the variances.

I spoke with  my friend Sarah Dopp here some months ago, but I’m not sure I mentioned her website Genderfork, which explores androgyny and gender variance through artistic photography.

I was recently teaching a sex ed class for middle schoolers, and one of the boys was looking at two pictures of an effeminate man from the book Naked New York by Greg Friedler.  In the first picture the man is fully clothed, and the second one he is fully naked.  The boy was grappling with gender and sexual orientation, and confused by the difference between the two.

He said something along these lines: “I can see from this first picture that he is a transsexual, but then I’m confused by this second picture.  He’s clearly gay from the waist up, but then straight from the waist down.  Can you explain this to me?”

Happily, the explanation was much easier to explain than the boy’s erratic guess. (The pictured man was somewhat androgynous, and that we could make no guesses or assumptions about his sexual orientation.)

I have just started a session of my class for parents, and one of the topics that the parents said they wanted to be sure and cover was the difference between transgender and transsexual and how those two topics relate to the gay-straight continuum.

So I’ve been thinking about gender here and there over the past several months.

Then I ran across an article in the New York Times published today called Albanian Custom Fades -  Woman as Family Man.  In extremely patriarchal Albania, if the patriarch of the family died with no male heirs, a virgin woman in the family could take a vow of virginity, give up marriage, sex, and children, and become culturally a man.  Wow!

However, as women have gained rights in Albania, it is no longer problematic for a household to be without a patriarch, and so the custom has died out.  The women quoted in the article seemed basically happy with their lives as men, which they had both sworn to around age 20.  They felt they had more options, more freedom when they were young women living as men, and they had more respect now that they are old women living as men.  One woman said she might not have made the choice she did if women had had more options when she was young.

The article is sure to state that this tradition had nothing to do with being a lesbian.   But I wonder what it has to do with gender.  How much of young, virgin, Albanian women changing genders was based in need of the family, and how much was based in gender identity?  In any event, the Times article is highly interesting and has some great pictures.  It is well worth a read.

(Oh, and we’ll be talking about gender and homosexuality in the third parent class, by the way.)

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 I filmed all day long with two delightful French documentary makers. We filmed at three locations: an interview at an office at UT, a local sex store where I introduced vibrators to an older teenager, and a local Unitarian Universalist church where I led a sex class for middle school students about sexual anatomy and masturbation. It was exhausting.

Probably the most fun was introducing the middle school students to the vibrators and the vulva puppets. We had lots of great laughs and silliness - as all human sexuality classes should.

And today I am resting.

Because tomorrow I head to Dallas to be trained in Our Whole Lives, the Unitarian Universalist human sexuality curriculum. The curriculum covers Kindergarten through High School, plus as two adult curricula. I will be in the training to present the 7th - 9th grade and 10th - 12th grade curricula. Much fun! But much exhaustion as well.

So today I am resting.

Today I am working with a film production company from France. They will be interviewing me about the beginnings of sexuality (remember our conversations about masturbation from last week?) for an up-coming international documentary. They will also be filming a (staged) sex ed class for middle school students. Here is one of the activities we’ll be doing:

Masturbation Fish Bowl - The leaders (me and my friend Patty) will write two lists of questions about masturbation: one for boys and one for girls. The boys will sit in a circle facing inward, and the girls will sit in a circle around them, also facing inwards. The boys will answer the questions directed at boys. The girls will remain silent. Then the boys and the girls will switch.

This activity is designed to increase understanding of the other gender and pleasure
while remaining in a safe environment. When there is more time, the girls write questions for the boys to answer and the boys write questions for the girls to answer. Any topic will do, but it is often useful to help focus the conversation with a general topic.

The story of how we learn about sex and our bodies varies dramatically by culture and by era. There are so many places to learn about sex and bodies: parents, siblings, aunts and uncles, friends, boyfriends and girlfriends, school teachers, churches, movies, music, advertisements, porn, and the Internet. And, of course, many more. The messages we get also span a wide range: are we sexual beings, is sexuality essentially positive or negative, is sexuality strength or weakness, are bodies inherently beautiful or do they need to be made beautiful?

Where did you learn about sex and your body? What message do you think you were supposed to get? What message did you take away?

To honor these differences and paths, I am gathering people’s stories of how they learned answers to these questions and more. I hope to gather stories from different cultures, genders, orientations, religions, and ages around the world. Each and every story is special and has something interesting to say, so I hope you’ll consider telling me yours. You may remain anonymous.

You can approach telling your story in whatever way works best for you. I can send you a list of questions to answer if you want to work in an interview format. Here are a variety of other ways you can contribute your story:

• personal essay
• painting
• line drawing
• photograph
• song
• poem

As long as it’s true and it tells the story of your education about your body and how it relates to other itself and other people’s bodies, I hope you’ll submit it.

I may publish some of what I receive on this blog, but these stories will primarily be made into a book.

Please pass on this request to anyone you feel might be interested in engaging with the topic.

This afternoon a mother asked me this question:

“When do I teach my 13-year-old son about birth control?”

Regrettably, the answer is much more complicated than the question. Because really, it depends. And on pressing her, it was clear that the boy knows how babies are made, and probably knows that there are ways preventing pregnancy. He also knows that you can catch diseases from sexual intercourse, and so probably knows that there are ways of preventing that too.

So this mother’s question wasn’t so much about when to tell her son about birth control, it was about when she should start providing higher levels of knowledge - like how to use a condom and where to get them.

And when a teenager needs to know these things is just a very individual situation. But here’s what I said she should tell her son sometime before he starts high school in the fall:

“There are lots of ways of experiencing your love for someone sexually besides sexual intercourse. These other ways do not include a risk of pregnancy and they generally have reduced risk of STD transmission. Right now, you should probably stick to those. At some point you’ll decide you are ready to experience intercourse with your partner. At that point I expect you to come and ask me for condoms, which I will happily provide for you. If you prefer, you are welcome to leave me a note asking for them rather than asking me in person.”

Sex ed by text message. Of course it happened first in San Francisco, where they’re serious about getting sex education messages out, in any medium possible.

The moral of this story is: Want to talk to your teenager? Do it in the medium she or he uses most. For many teenagers that’s text message.

But maybe it’s not text message. Maybe it’s the cell phone, or Internet-based chat, or e-mail.

Or maybe the medium isn’t as important to your teenager as the primary content of the conversation. In that case, talk about whatever interests your teenager - movies, video games, books, horses, football, anime, whatever!

The point is that in order to reach and effectively interact with your teen on any subject, you have to do it on his or her turf. Trust me.

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.