Monday, June 9, 2008

Oral sex isn't a safe alternative any more

As a pastor, I was often asked by parents to speak with their teenage children about sexual issues.

Usually I told the parents that it would be a waste of time for me to talk to them. First, I wasn't their parent, but an outsider, and one whom they regarded as biased towards a particular view of the problem. (They were quite correct in that, of course.) Second, kids spend much more time with their parents than they do at church, or with church figures. They're going to learn much more, take in much more, from their family experience, than from someone else's preaching or teaching. Third, they're in an environment - school or college or university - with other teenage kids, where they're under peer pressure. Again, that's going to influence their behavior far more than I can. If they haven't received a good grounding in a basic moral life by the time they reach their teens, it's too late to try to instill such an approach at that point.

(Needless to say, parents don't like to hear that . . . but it's true.)

However, I tried to point out to the kids the very real dangers of premature sexual experimentation. They used to laugh at me: but now statistics are bringing home the tragic consequences of loose sexual behavior. According to a recent conference held by the Centers For Disease Control And Prevention:

A new CDC study indicates that one in four (26%) female adolescents in the United States has at least one of the most common sexually transmitted infections (STIs). Led by CDC’s Sara Forhan, the study is the first to examine the combined national prevalence of common STIs among adolescent women in the United States.

Based on the overall STI prevalence of 26 percent, the authors estimate that about 3.2 million adolescent females in the United States are infected with one of these STIs. They note that the total prevalence might be slightly higher than these estimates indicate, because some STIs – including syphilis, HIV and gonorrhea – were not included in the analysis; however, the prevalence of these STIs is low in this age group.

In addition to overall STI prevalence, key findings of the new study include the following:

  • The most common STI was cancer- and genital wart-associated HPV (18.3%), followed by chlamydia (3.9%), trichomoniasis (2.5%), and HSV-2 (1.9%). Among the teenage girls who had an STI, 15 percent had more than one.
  • By race, African American teenage girls had the highest prevalence, with an overall STI prevalence of 48 percent compared to 20 percent among both whites and Mexican Americans. (Other Hispanics and race/ethnic populations were captured in the survey, but there were insufficient numbers in any one group to permit valid prevalence estimates for any group except Mexican Americans.)
  • Overall, approximately half of all the teens in the study reported ever having had sex. Among these girls, the STI prevalence was 40 percent.
  • Even among girls reporting only one lifetime partner, one in five (20.4%) had at least one STI. Girls with three or more partners had a prevalence of over 50 percent. The predominant STI was HPV.

According to the authors, the high prevalence of HPV indicates that teenage girls are at high risk for this infection, even those with few lifetime sexual partners. It is important to realize that most HPV infections clear on their own; however some infections persist over time, placing women at risk for cervical cancer.

Sobering statistics, indeed!

There have been media reports that teens are turning to oral sex as a 'safer' substitute for conventional sexual activity. This doesn't seem to be borne out by the facts. As the Washington Post reported last month:

Contrary to widespread belief, teenagers do not appear to commonly engage in oral sex as a way to preserve their virginity, according to the first study to examine the question nationally.

The analysis of a federal survey of more than 2,200 males and females aged 15 to 19, released yesterday, found that more than half reported having had oral sex. But those who described themselves as virgins were far less likely to say they had tried it than those who had had intercourse.

"There's a popular perception that teens are engaging in serial oral sex as a strategy to avoid vaginal intercourse," said Rachel Jones of the Guttmacher Institute, a private, nonprofit research organization based in New York, who helped do the study. "Our research suggests that's a misperception."

Instead, the study found that teens tend to become sexually active in many ways at about the same time. For example, although only one in four teenage virgins had engaged in oral sex, within six months after their first intercourse more than four out of five adolescents reported having oral sex.

"That suggests that oral and vaginal sex are closely linked," said Jones, whose findings will be published in the July issue of the Journal of Adolescent Health. "Most teens don't have oral sex until they have had vaginal sex."

. . .

Previous research had suggested that oral sex was increasing among teenagers as an alternative to intercourse, but those studies were based on small samples or anecdotal reports. The new study analyzed data collected from a nationally representative sample of 1,150 females and 1,121 males aged 15 to 19 who were questioned in detail in 2002 for the federal government's National Survey of Family Growth.

A majority of the teens -- 55 percent -- said they had engaged in oral sex, which was slightly more than the 50 percent who said they had had vaginal sex. But oral sex was much more common among those who already had had intercourse: Eighty-seven percent of those who reported on a computerized questionaire that they had had vaginal sex said they had engaged in oral sex as well, compared with 23 percent of those who described themselves as virgins.

When the researchers examined the timing of sexual behaviors, they found that among those who said during face-to-face interviews that had had vaginal sex in the past six months, 82 percent said they also had had oral sex, compared with 26 percent of the virgins.

Among those who had initiated vaginal sex more than three years earlier, 92 percent had engaged in oral sex.

Those figures seem to confirm that oral sex isn't being used as a substitute for 'conventional' sex - but they also confirm it's widespread. I've encountered many teens who seem to believe that oral sex doesn't carry the same risk of sexually transmitted diseases as vaginal or anal sex. I'm afraid that's wrong, too. For example, a recent report in the Chicago Tribune attributes a rise in throat cancer to the spread of orally-transmitted HPV infection.

With 6,000 cases per year and an annual increase of up to 10 percent in men younger than 60, some researchers say the HPV-linked throat cancers could overtake cervical cancer in the next decade.

"It's almost a new disease, in a sense," said Dr. Ezra Cohen, an oncologist at the University of Chicago Medical Center. "It's now becoming a dominant sub-type of the disease that we see in our clinic."

The HPV infections likely took root decades ago as the Baby Boomers were reaching adulthood, and only now are spurring a rise in throat cancer cases, mostly among men and women in their 50s.

No one understands the precise reason for the increase, though experts suspect it's linked to changes in sexual practices that emerged in the 1960s and '70s. For example, oral sex is a known risk factor for HPV-related throat cancers, and studies have shown that people who have come of age since the 1950s are more likely to have engaged in oral sex than those who were born earlier.

I try to convey these realities to teens when I speak with them, but it's hard to get them to listen. I hope that readers who have teenage children will share these facts with them, and I hope they listen more to you than they would to me. For the rest of us, let's try to set as good an example as possible to those who look to us for guidance - and let's not minimize the dangers inherent in a promiscuous lifestyle.

They're very real.



phlegmfatale said...

the challenge in speaking with teens about any behaviour-related health issue is that they are going to live forever. Right?

Anonymous said...

So let me get this straight.

They are no longer Sexually Transmitted Diseases (STD) they are now Sexually Transmitted Infections (STI).

I can't believe that changing a name and making it sound like a "cold" is going to changes anybody's mind.

Like I've told all my kids, as you grow up you are going to make decisions on your own. Sometimes they will be good decisions sometimes they won't. However, any decision that will have a lifetime negative effect on you for a few minutes of pleasure, you better you think the whole process through.

MadRocketScientist said...

Ah, the fruits of abstinance only sex ed.

Encourage abstinance, just as we would encourage young people to practice defense driving or to not handle firearms without an adult. But we must also educate young people about the dangers and realities as well as how to properly mitigate those dangers (condoms, seatbelts, the four rules, etc.).

I was in 7th grade when we learned about condoms (and how effective they were), babies, and STDs and how they can be transmitted. No shying away, no holding back.

Maybe we should start having kids take the sex ed course I took in Navy boot camp. One day of slides and to a man everyone in my company seriously considered taking vows of chastity.