Dr. Wes: When discussing sex, I've always said that the fastest way to shut down the neural pathways between your teenager's ears and his brain is to launch into a thoughtful lecture on the dangers of sexually transmitted diseases. If you throw in some icky pictures, you actually can increase the speed of shutdown by a factor of three. Unfortunately, sexually transmitted diseases - especially HPV, herpes and chlamydia - are on an epidemic rise, with about 25 percent of sexually active teens in any given year contracting some form of STD. Why? Because while teenagers have generally conquered birth control - especially oral contraception - they've yet to take seriously the likelihood of infection. If you think about it, this fits pretty well with what we know of the teenage brain. Teens see pregnancy in school with some regularity. They see the difficulties of teen parents and how early pregnancy limits their ability to move out of their families and into the world. Once you realize this, and then accept the probability of pregnancy, it's a short trip to the doctor to get on birth control. That's why the teen pregnancy rate is down by 35 percent over the last 20 years.
Unfortunately all the oral contraception on earth won't protect anyone from contracting STDs. The Centers for Disease Control and Prevention note that chlamydia and gonorrhea remain the most common curable STDs among teens. While both respond to antibiotics, they can be very tricky as they sometimes go undetected, leading to more severe health consequences down the road. The CDC notes that it's not uncommon to see more than 5 percent of teen boys and 5 percent to 10 percent of girls infected with chlamydia at any given moment.
While properly used condoms can limit exposure to chlamydia, HIV and gonorrhea, herpes and HPV have the nasty attributes of being both incurable and fairly easy to get. About 22 percent of young adults have genital herpes (HSV-2), though the severity varies dramatically from unnoticeable to very serious. Interestingly, the prevalence of HSV-2 is increasing most dramatically among young white teens, as the rate for 12- to 19-year-olds is now five times what it was just 20 years ago. Young adults ages 20 to 29 are now twice as likely to have HSV-2 as they were in 1986.
There's great debate between the abstinence movement and those who advocate prevention through sex education. I have expressed my qualms before about early sex, but I'm also aware that about two-thirds of 18-year-olds are sexually active and only 10 percent of the population remain abstinent until marriage. Thus we need more than encouragement to abstain in order to protect most teens. A sensible approach is, in my view, teaching teens to take sex seriously from an emotional, contraceptive and medical standpoint. That's a concept that has been lost in the last few years, but it's one that should unite both sides of the debate. It must be taught early in life, and it's acceptance by teens has a lot more to do with what they see around them than which lecture they are given.
Marissa: It seems that quite a few people my age jump into sex at an early age, and by the time they graduate high school have had more partners than they can count on one hand. We all hear about the good stuff that goes along with sex, but no one ever ends a story with, ": and then I got chlamydia, and that sucked." I wish that they would. The silence that surrounds STDs is what helps keep up the occurrence rates.
While no one wants to talk about their sexual history (at least not all of it), I think teens need to step up and try to be mature about it. If you cannot discuss with your possible partner whether they've had an STD, I think it's safe to say that you should not have sex. It's not only important for you, but for the other person involved as well.
Of course, the best way to stay STD-free is to be abstinent, but I am not naÃive enough to believe that the majority of high school students are. So my next suggestion would be to remain exclusively with one person. If that's not possible, then at the very least, make sure you use industrial strength contraception. If you and your partner have never had sex with anyone else (and you know this for a fact), then birth control pills, if taken religiously, could be enough if that's what you prefer. Make sure to sit down and say exactly what you expect and what things you are OK with. Make an agreement and honor that agreement.
If you sleep with more than one person, then you have to accept the fact that your risks will be higher and this will mean that you need to make sure you go to the doctor and have STD screens done. A lot of STDs don't have really distinct symptoms. So even if you don't notice anything that seems problematic, it never hurts to make sure. STDs are nothing to be shy about. The consequences of letting something go can be too damaging. All the work that goes into getting tested and having contraceptives may seem inconvenient, but that is what comes along with choosing to be sexually active.
Contest: Marissa's job is up for grabs in fall 2006. We're taking essays over the next two weeks in response to a challenge question you can find at www.ftimidwest.com.
- Dr. Wes Crenshaw is a board-certified family psychologist and director of the Family Therapy Institute Midwest. Marissa Ballard is a Lawrence High School senior. Opinions and advice given here are not meant as a substitute for psychological evaluation or therapy services. Send your questions about adolescent issues to firstname.lastname@example.org. All correspondence is strictly confidential.