Adolescent Sexuality by Dr. Karen Rayne

This guest blog written by femmes femmes.

While it may be true that many doctors will not prescribe hormonal birth control without a pap test and/or pelvic exam, the reality is that there is no medical basis for such a restriction. Pap tests are for cancer screening: the result of the pap test doesn’t determine whether the patient can use birth control. Neither the US Food and Drug Administration, the World Health Organization,Planned Parenthood Association, or the American College of Obstetricians and Gynecologists believe that a pelvic exam or pap smear should be required for hormonal birth control. According to WHO, a pelvic exam for contraceptives (including monthly injectables) is a Category C. That is “does not contribute substantially to the safe and effective use of the contraceptive method.” The information that a doctor gets from a pelvic and a pap is not information that is needed to safely prescribe hormonal birth control.

From this article http://www.medscape.com/viewarticle/490153

Over the past decade, questions have been raised regarding the evidence-based need for pelvic exams and Pap smears, especially in regard to the initiation of oral contraceptives. There is consensus among several prominent healthcare organizations that the pelvic exam is not required, at least during the initial visit. These organizations include the US Food and Drug Administration,[1] the World Health Organization,[2] Planned Parenthood Association,[3] and the American College of Obstetricians and Gynecologists.[4]

There are certainly many good reasons to do a pelvic exam and Pap smear, but initiation of birth control, specifically oral contraceptives, is not one of them.

See also this article:

http://www.universityofcalifornia.edu/news/article/3192

Although hormonal contraceptives are not recommended for women with some serious medical conditions, the problems that make their use unwise are effectively identified through medical history and a simple blood pressure measurement. “Hormonal contraceptives can safely be started based on medical history review and a blood pressure check. For most women no further evaluation is needed before making a decision to use them,” said George F. Sawaya, MD, UCSF assistant professor of obstetrics, gynecology and reproductive sciences and research coordinator for the UCSF-Stanford Evidence-based Practice Center.

Furthermore, requiring pelvic exams for birth control prescriptions is both paternalistic and unethical. The decision to have a pelvic exam should be the client’s: she shouldn’t be coerced into it due to a need for contraception.

See also:
http://findarticles.com/p/articles/mi_m0CYD/is_20_37/ai_93531936
http://www.managingcontraception.com/qa/questions.php?questionid=36
http://www.managingcontraception.com/qa/questions.php?questionid=635
Heather S. Dixon, Pelvic Exam Prerequisite To Hormonal …
http://www.google.com/search?client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&channel=s&hl=en&q=http%3A%2F%2Fwww.medscape.com%2Fviewarticle%2F490153&btnG=Google+Search
http://www.fhi.org/en/RH/Pubs/Network/v21_3/NWvol21-3medbarriers.htm#safeuse
http://209.85.165.104/search?q=cache:SKnqAiWZAj8J:www.contraceptiononline.org/contrareport/article01.cfm%3Fart%3D65+Pelvic+exam+is+not+necessary+for+safe+use+of+combined+oral+contraceptives.&hl=en&gl=us&ct=clnk&cd=15&client=firefox-a
http://humupd.oxfordjournals.org/cgi/content/full/10/5/449
http://www.guttmacher.org/pubs/journals/3301301.html

Yesterday I met someone formally who I’ve known for about two years now. It was a delight, really.

Joe works construction. For the past two years he’s been the gate guy for a building under construction at UT. So every day that I’ve gone to UT over the past two years, I’ve passed by Joe. If you’re a regular reader here, you know that I often encourage my readers to say hello and engage with their communities around them. Generally I’m encouraging you to do this with the teenagers in your community, but the principle holds regardless of the age of your friend-in-potentia. So taking my own advice, I’ve said hello and then later good-bye to Joe about three days out of five for the past two years. Joe’s got grown children and six grand-kids. When there’s something official going on at the gate, he’s all business, but when there’s not, he’s delighted to chat for a minute or two. But for whatever reason, even though we always said hello and chatted, Joe and I had never formally introduced ourselves. He knew I had kids because sometimes they came to campus with me, but that was about it.

The building that Joe’s working on will be finished this month. So as my class ended yesterday, I was pretty sure that I wouldn’t see Joe again. As I was leaving campus, I stopped to say a final good-bye to Joe. Here’s how our conversation went:

Me: Well, today’s my last class day! I probably won’t be back until the spring at the earliest.

Joe: I guess that means we won’t see each other again. My name’s Joe.

Me: Hi Joe. I’m Karen.

(we shook hands)

Joe: I’m going to miss seeing you here. It’s been nice saying hi whenever you’re coming in.

Me: Yes, I’ll miss seeing you too, Joe. Here’s one of my cards.

Joe: Oh good! Can I call you sometime to say hi and see how your little girls are doing?

Me: I would love that, Joe.

And then Joe looked at my business card.  And suddenly I wished I hadn’t given it to him.

Because here’s the thing. I love my work. I think it’s important work. Critical, even. But there are people who I don’t talk with about my work. Like my grandparents. Don’t get me wrong, my grandparents know what I do. I tell them when I have parenting classes coming up, and I’ve given them this blog address. But they tend not to read it, and they don’t ask me probing questions about my classes. My grandparents expressed some sadness that they wouldn’t be able to watch the documentary I was interviewed for last month.  (It will come out next March probably - I promise I’ll let you know!)

Back to Joe. He’s a bit younger than my grandparents, and yes, I was jumping to some huge conclusions and making some brass, potentially unfounded, judgments about what he would think of me when he read my business card. (It says “Adolescent Sex Education”.)

So I’m worried that Joe thinks…well, poorly of me because of what I do. My grandparents are proud of me, because that’s just the kind of grandparents they are. If they heard of someone else doing what I do, they would probably say something along the lines of, “Well, I never!” Because I’m doing it, they probably say something more like, “Well, it must be important then! Good for you, for doing something important!” Joe, of course, has no such compunctions about being proud of me.

And this is why I find it hard to state my business outside of business circles. If I meet someone in the context of my work, they’re welcome to disagree with me and argue with or ignore me. But it saddens me deeply when I’m suddenly worried that someone I’ve met in social circles won’t want to continue our friendship because of my work. I’m sad when I realize that in addition to being not-safe-for-work (yes, I know there are plenty of you who consider me that, regardless of my tastefully worded content), I am also sometimes not-safe-for-friendship.

That, in a nutshell, is actually why I do what I do. Sexuality needs to be talked about. It should be a topic appropriate for public spaces. And eventually, it will be. Between now and then, I just hope that Joe and others accept me for who I am: someone whose business is to talk about sex.

I have loved teaching this class at UT. I feel like I’ve learned a lot, and that I’ve been able to guide my students to a deeper understanding of their students’ learning process. Both of these are good things.

But I’m also just exhausted. I’m ready to wake up and stay home. I’m ready to not have hours of reading and grading every night. (Yes, I read everything I assign to the class, the night before we’re due to talk about it. And I assign a lot of reading.)

I’m ready to be back here, focusing on you and your teenagers and supporting their path to healthy sexuality. That will start tomorrow, after I turn in final grades.

Hooray! Freedom!

A father told me yesterday afternoon that he was worried about his pre-teen son’s future break-up habits and how they would effect his son and his son’s future, theoretical dating partners. (Might sound a bit preemptive, but I had asked this dad to tell me his biggest fears around his son’s sexuality, and this is one of the things that he was the most worried about.)

I’m working under the assumption that if one parent has this fear, so do others. So here’s what I told him:

Break-ups suck, regardless of the age. But they are potentially a good long-term learning experience for teenagers. (If there are any teenagers reading this, please forgive me! Keep reading and I hope I’ll win you over.)

It’s good for teenagers to learn how to handle re-grouping after a rejection. And it’s also good for teenagers to learn how to make a considered rejection.

There are lots of times that we get rejected. It can be by a love-interest, by a college, by a publishing agent, by potential job, by a current job (getting fired or “reassigned”). And learning how to hold on to your self-compassion through such an event is critical. Adolescence is a pretty good time to learn - the stakes aren’t as high as with a marriage or a career. It still hurts, it still sucks big time. But it also teaches re-grouping skills in a very effective, hands-on way.

There are also lots of times we need to reject someone else. This can be as simple as saying no to a request for a date to as complicated as firing a friendly co-worker who is the only breadwinner for her family. Again, this can be emotionally draining, but sometimes you’ve got to do it anyway. Not very many people are good at saying no gracefully and then let the other person deal with their own hurt feelings. And learning how to do it as well as possible is better to do as a teenager than as an adult. Because the stakes are lower.

When’s the last time you were rejected or you rejected someone else? Do you feel like you handled it well? Do you feel like the other party handled it well?

Okay, folks, I’ve hit bottom in my ability to write cogently about adolescent sexuality, about parenting, about current events, about all the topics that make this blog fun and interesting. Happily for you and me, I see the way out of this pit. It brightens up particularly well after next Wednesday, when the class I’m teaching at the University of Texas ends. The issue is really that I’m teaching for three hours a day about a topic that is not sex.

So what’s the point, really? I mean, since the topic isn’t sex?

Yesterday I twittered for the first time in some weeks: “Too much talk about education, not enough talk about sex. What can I say? Sex is just more fun than learning.” And I hold by it. I miss writing here every day, I miss my consultations with parents, I miss my parent classes.

Nevertheless, here is a lovely missive from my slightly-punchy students yesterday morning:

Girl (dating, no children): “Steven, I love you. I love your life. I want to marry you.”

Boy (single, no children): “Okay. You can raise my children for me.”

Boy2 (unknown dating status, no children): “Oh, you might want to watch out. He’s got a thing about dumping his kids on his wives and leaving them for grad school.”

Girl: “No, that’s okay. I would totally be pregnant and barefoot in his kitchen.”

Boy: “Thank you for the sentiment, but that’s really unnecessary. I mean, there’s no need for you to be barefoot.”

And the class dissolved into hysterics. Literally, several of them laughed so hard they cried. But maybe you had to be there. Or maybe you have to be exhausted from over-reading and over-analyzing every little, teeny, tiny classroom nuance. Because it really was funny at the time.

And another dialogue event from yesterday morning during a conversation on adolescent cognitive development:

Girl: “But you have to be aware of more than just the cognitive development. I mean, so much else is going on in teenagers. Like you have to know what happens when a boy gets a huge surge of testosterone…”

Now, I will admit under pressure to having made a hand-gesture…maybe more like a finger-gesture…but common…with an opening like that, how could you not. I think only one student saw my little finger-gesture, and he found it highly amusing anyway.

So now, here I am, blathering away, nauseous I’m so tired. And thanking my personal, private deity that there’s only three more full class days before I can sleep in and make waffles with my daughters. Not to mention writing better blog posts.

In the meantime, take a look-read here. I think it holds the test of time. And then come back again next week when we’ll be talking about issues like adolescent relationship abuse and “pregnancy pacts” and other whathaveyous.

Condoms vs. AIDS

Happy Friday (and Happy Weekend) to everyone! I’ve started teaching my class, and am bulking up on my academic reading rather than my condom commercials…but this one jumped out as too fabulous to pass up.I also want to recommend one of Hugo Schwyzer’s recent pieces on how and when it is appropriate to talk to teenagers about breaking up with their boyfriends/girlfriends. Hugo’s blog is really great and it’s high time I recommended it in this space.

See you on Monday!

How to hide an unwanted erection

This is a straightforward list of effective suggestions for those teenage boys who are dealing with extensive testosterone surges and who are in need of some assistance in making themselves socially appropriate for the duration.

Go on now, pass on the video or the information to those most in need!

I love this comic strip!

Another reason to buy your teenager a dildo…

As promised yesterday, another reason to buy your teenager a dildo if she or he is inclined to seek one out.

Please note: While subtle and relevant, this television advertisement does contain sexual connotations.

Another great condom commercial!

The other day I was talking with someone about good video sex education content, and we started talking about the condom commercials I’ve posted here. That conversation got me started looking for good ones again, and I found this one. Hope you like it on this Friday morning!

To see the other condom commercials I’ve posted, use the drop down menu called Categories to the right, and search for Condom Commercial.