You're Teaching My Child What?

by Miriam Grossman

  The Compelling Link Between Oral Sex and Oral Cancer

  In May 2007, a group of surgeons and cancer specialists reported on the increasing incidence of oral cancers in young adults.33 Oral tumors used to be considered diseases of people in their 50s and 60s who smoked and drank heavily; young people were at very low risk.34 But surgeons have been seeing younger patients35 who are neither smokers nor drinkers.

  The risk of oral cancer in these patients was related to their sexual behavior: having more than five oral-sex partners in their lifetime increased their risk a whopping 250 percent. Evidence that the throat cancers—a type found at the base of the tongue and in the tonsils—were caused by HPV was called “compelling.” So here’s one more way this virus does harm—by traveling from genitals to mouth, and quietly causing deadly cancers in the throat.

  This finding is particularly relevant to sex educators, because by ninth grade, that’s age 14 or 15, 20 percent of students have had oral sex.36 Online “sexperts” inundate kids with detailed and graphic information about this activity, portraying it as safe and normal. More than a year after the report, gURL.com’s37 newsletter (delivered right to your daughter’s email account) read: “Martina’s not afraid of a little man juice”38 (“. . . ewww . . . it’s so sticky. . . and a little salty.... ”) But no mention here of HPV-related oral cancer.

  Do teens use protection for oral sex? “Never happened, never will,” says Lisa, 15. The NCHS [National Center for Health Statistics] study found the same—only nine percent of the teens surveyed reported using condoms for oral sex.

  What’s the problem here? Why so much unsafe behavior? It’s due to abstinence education, says Teen Talk. “Since abstinence-only education doesn’t teach about safer sex, many teens may not be aware of how to reduce their risk of infection during oral sex.”39

  What a blunder. I’d say Planned Parenthood, which runs Teen Talk, missed an opportunity here. Instead of trashing the enemy, they need to sound an alarm: Having oral sex with multiple partners is associated with throat cancer. Don’t do it!

  Planned Parenthood is not the only group guilty of ignoring this critical finding: I find no mention of it by SIECUS, on Columbia University’s GoAskAlice, or any other of the dozen websites kids are directed to for “medically accurate” sexual health information.

  Where are the red flags alerting kids that oral sex can be hazardous? Where are Scarleteen’s and Sexetc’s activist campaigns urging them to stop? As of this writing, almost two years after the report, they have yet to be seen.

  The Number 1 Bug Is Worse Than They Say

  Chlamydia is the most common bacterial STD in the United StatesIn 2006, reported infections hit an all-time high—a million new cases, up 5.6 percent from 2005.40 Usually asymptomatic, chlamydia is notorious for the damage it causes to the female reproductive system: pelvic pain, ectopic pregnancy, and infertility. Girls are instructed: If you get an annual check-up, chlamydia can be caught. If you take antibiotics, you’ll be cured.

  My patient Delia was reassured in that way. She was a graduate student whom I saw while working in UCLA’s student counseling center, and I told her story in my 2006 book, Unprotected.41 Delia had chlamydia years before I met her, during her wild freshman year. She and her boyfriend took antibiotics as instructed, and were declared cured. I explained in the book why this was inaccurate and misleading, and I want to explain it again here. Young people, especially women and girls, deserve to know how chlamydia can evade detection and cause persistent problems—even with yearly exams and antibiotic treatment.

  Chlamydia’s mission is to travel all the way up the genital tract: from the vagina, through the narrow cervical opening, to the uterus, and finally, to enter the fallopian tubes. It might succeed in reaching its destination by hitching a ride on some sperm. In the tubes, the bacteria settle in. The immune system responds to the invasion, and there’s probably some swelling and pus. It may cause fever and pain, or it may not.

  But the dangerous part isn’t the tubal infection, it’s what’s left when it heals: a scar. The fallopian tubes, where fertilization occurs, are only about one millimeter in diameter. A tiny scar here can cause infertility, or worse.

  A fertilized egg—which is much larger than sperm—that’s moving toward the uterus can be trapped when its path is narrowed by the scar. Unable to proceed, it will grow in the tube, causing what’s called an ectopic pregnancy. Unless discovered at an early stage, the tube will eventually burst, causing sudden, enormous pain and bleeding: a medical emergency.

  In Unprotected, I wrote:Did Delia’s infection reach her tubes? There’s no way to know now, without doing invasive tests. It’s possible she was treated early, before the bacteria had a chance to travel. That’s the best scenario: the bacteria are gone and her tubes are wide open.

  But what’s “early”? Time is of the essence in treating Chlamydia; we’re in a race to get it before it advances. Once it reaches the tubes, it may be impossible to eradicate.42 Women who show up for their yearly check-ups are routinely screened for Chlamydia, and treated if positive. But what if they were infected months earlier? How long does it take for the bacteria to reach the tubes? We don’t know. In the female pig-tailed macaque monkey, it takes about eight weeks.43

  There’s more we don’t know. We don’t know, for one thing, how well the screening test identifies cases where the infection is dormant. A negative result does not guarantee the absence of infection.44 We’re not sure which antibiotic is best, or how long treatment should last. We don’t know if treatment always wipes out the whole infection. It’s possible that in some cases, medication temporarily stops the bacteria from reproducing, only to be reactivated later.45 And we don’t understand why women with Chlamydia are more likely to get cervical cancer.

  Chlamydia infection is perilous because it can cause serious damage without noticeable symptoms: no appreciable pain, fever, or discharge. A woman may be unaware of the infection until years later, when she tries to conceive. But her delicate fallopian tubes are scarred and narrowed—sometimes completely blocked. The intricate process of transporting the egg at the right time to the right place is now impossible. She’s sterile, the doctor tells her, because of this bug she acquired in her care-free youth.

  The experts say that Delia may hear this some day, because she has some of the risk factors that may lead to Chlamydia infection: intercourse at an early age, many partners, and possibly use of oral contraceptives. Having intercourse at an early age was dangerous because—as explained earlier—her immature cervix had a larger transformation zone, containing cells that are more susceptible to infection. These vulnerable cells form a bright red circle in the center of the cervix. Delia’s teenage cervix provided a larger target area for infection than if she had waited until she was older.46

  With each new man in her life, Delia increased the likelihood of infection because men are not screened unless they have symptoms. As a result, there is a huge pool of infected men unknowingly passing the infection along, especially on college campuses.47 If Delia is like the majority of college students, she’s used condoms inconsistently,48 but even if she had used them correctly and consistently, condoms may not have protected her completely. Finally, there’s the pill. It’s suspected, but not yet proven, that oral contraceptives may facilitate infection by enlarging the transformation zone,49 or by decreasing the amount of menstrual blood, which can act to flush the bacteria down and out.

  There’s more here. Chlamydia infection may lead to fertility problems even when Delia’s tubes are wide open and clean as a whistle. Amazing creatures that they are, when white cells recognize Chlamydia as a foreign invader, they memorize the bug’s structure, especially that of a protein called hsp. Based on the contours of hsp, the white cells produce weapons to combat it: antibodies. White cells are like mobsters who never forget—they store the memory of Chlamydia HSP, adding it to their hit list, should they cross paths again. And the memory is passed down, to all future generations.


  Fast forward ten years: an embryo is growing safely in Delia’s uterus. She’s finally pregnant. Time to celebrate? Not so fast. The embryo makes a protein, one that happens to be a type of HSP. That’s not good. Delia’s white cells are unable to tell the difference between the earlier HSP, and the new one. Her defense system concludes: the enemy—Chlamydia—is back. Antibodies are released, and the “invader,” the embryo, is destroyed... a miscarriage.

  Bottom line: Chlamydia infection is a complex issue, about which there are more questions than answers. Following current guidelines is important, of course, but it’s not a guarantee that one is out of the woods.

  So why tell girls that there’s a certain cure for Chlamydia? I’ve been asking that question ever since I discovered the real dangers of this ravaging bug. I dug up 1994 copies of American Journal of Obstetrics and Gynecology50 and learned how the HSP reaction causes early pregnancy loss and decreased in vitro fertilization success years after antibiotic treatment. In a 1997 volume of the medical journal Human Reproduction51 I learned that even after treatment, Chlamydia DNA can be detected in the fallopian tubes, evidence that an earlier infection may not have been cured.

  But as of this writing, “comprehensive” sex ed reassures our daughters: just come in for testing, take these tablets, and you’ll be fine.

  Well, maybe. Hopefully. But maybe not.

  Fear-based or Truth-based?

  With ten million new STIs every year in young people,52 no wonder they’re fed platitudes: They’re so common. Most people have one at some point. Telling the truth, sharing stories like learn2luv’s or all_alone23’s might shake up students. We certainly wouldn’t want to frighten them into changing their behavior; that would be what SIECUS and Planned Parenthood call fear-based sex education. Scare tactics, of course, have no place in health education.

  Or do they?

  Think about how other health topics are presented, like alcohol, illicit drugs, tanning beds, trans fats, and—of course—smoking. Subtlety is not the preferred mode of communication.

  Consider an ad campaign in New York City called “Nothing Will Ever Be the Same.” “Smoking gave me throat cancer at 39,” says a poster showing a man named Ronaldo Martinez holding a metal device against his neck. “Now I breathe through a hole in my throat and need this machine to speak.”

  The TV ad is more disturbing. Kids swim underwater in slow motion and happily splash about in a pool to the sound of a guitar. Mr. Martinez strolls nearby, fully clothed. An eerie, synthesized voice tells us, “I was born on an island where swimming was a way of life. I never thought that anything could keep me from the water. Then I got cancer from smoking cigarettes and lost my voice and have to speak through a hole in my throat. If water gets inside, it will drown me. I used to love swimming.”

  Scare tactics? You bet. But as a result, says The New York Times, thousands of New Yorkers have quit the habit. The campaign, created in Massachusetts, was praised by public health officials in both states. The implication? The ends justify the means.

  Educators especially love to warn kids about the dangers of lighting up. Just look at Sexetc.org, a site recommended by Advocates for Youth:Is Smoking Killing You?53

  Smoking wrecks your health from drag one—even if you don’t notice it....Did you know, for example, that smoking can cause:• Cavities

  • Headaches

  • High blood pressure (which can lead to strokes or heart attacks)

  • Flu

  • Osteoporosis (a bone disease)

  • Stupidity (it can reduce the blood flow to the brain and muddle your mind)

  • Raging PMS

  • Ulcers

  • Wrinkles

  It’s easy to say I’ll stop when I’m sick. But by that time, it may be too late. Be smart. Stay smokeless.

  It doesn’t appear that Sexetc.org was wary about using scare tactics in this case. Smoking wrecks your health from drag one? Cigarettes cause the flu, PMS, stupidity?

  Don’t get me wrong, I agree that smoking is a nasty habit. But let’s be honest about the double standard. Educators use scare tactics to influence lifestyle decisions all the time, and no one objects—it’s quite the opposite. Whatever it takes to get kids to stop smoking, drinking, or speeding, we say: the ends justify the means. Only in sex education are so many sobering facts deemed “fear-based,” and omitted from the classroom. And these groups call themselves “science-based” and “medically accurate”? Now that’s chutzpah.

  I submit that when we’re dealing with debilitating, lifelong infections, we should tell it like it is—warts and all. But it won’t happen, because ideologues are at the helm, And for them, smoking is a loathsome evil, while teen sex is empowering and fun.

  Planned Childlessness

  With a few subjects, sex educators are comprehensive. One of them is pregnancy prevention. Another is reminding teens that should a pregnancy occur, they have choices.

  Try this: ask an adolescent to either find France on a map, identify the second president of the United States, or name three types of contraception. I’ll bet that to the average kid who’s been through years of comprehensive sex education, the choice is a no-brainer: she’ll launch into a discussion about condoms (his and hers), birth control pills, and Plan B. If she’s listened well, she’ll be able to reel off their side effects, cost, and relevant legal issues. You know, it’s almost a shame this stuff isn’t on the SATs.

  But how many young people, especially young women, realize the limits of their fertility?

  Not all young people look forward to having a family some day, but most do. When freshmen—both women and men—at four-year colleges were asked which life goals were essential or very important, 75 percent said “raising a family.”54 Therefore, one would hope that sex education would include not only instruction about preventing or terminating a pregnancy, but also basic facts about fertility, marriage, and building families.

  You may be thinking, Teens need to know about pregnancy prevention because that’s relevant to their lives now. Starting a family will be something that happens later. Why teach them about having babies now?

  For the same reasons, I’d answer, that we teach them about breast self-exam and osteoporosis. Sites like GoAskAlice and gURL.com provide girls with basic facts about these adult conditions. Since most girls want to be moms, shouldn’t they know when in their lives it’s easiest to conceive and deliver a healthy child?

  Sex ed provides kids with pages and pages of information about contraception and abortion, leading them to believe that in a zillion years, when they do want to get pregnant, all that’s necessary is to stop—stop taking the pill, stop using the diaphragm, and stop wearing a condom. Pull the goalie and let the babies roll. Easy, right?

  Try telling that to the hordes of women seeking treatment at fertility centers all over the country. Many of them can’t conceive because they waited too long.55 They’ve realized a biological truth they wish they’d known earlier: pregnancy doesn’t always happen when you decide you’re ready. There’s a window of opportunity, then the window closes.56

  Young people, especially teen girls, should know about that window, so they can keep it in mind as they make decisions about career and relationships. We’re not doing a good job at that; large numbers of women are misinformed about the limits of their fertility. A 2001 survey showed 89 percent of young, high-achieving women believed they would be able to get pregnant into their forties.57 Another found that women have an excellent understanding of birth control, but they “overestimate the age at which fertility declines.”58 The former director of RESOLVE, a support network for couples coping with infertility, reports: “I can’t tell you how many people we’ve had on our help line, crying and saying they had no idea how much fertility drops as you age.”59

  Here are the facts teens need to know. A woman is born with all the eggs she’ll ever have, so when she turns thirty or forty, her eggs do, too. The easiest time for her to conceive and give
birth to a healthy child is in her twenties. At around thirty, her fertility begins to decline, and at thirty-five, it begins to decline dramatically. By forty, her chance of conceiving each month has decreased by 75 percent compared to a decade earlier.60 But what about all those celebrities in their forties and beyond, you may ask, whose gorgeous babies grace the cover of People magazine? Many of these older moms have no genetic relationship with their child; adoption or surrogacy had to enable them to achieve their dream of parenthood. Not that there’s anything wrong with that, but it’s something to be aware of.

  Teens need to know that using technology to create a child is costly—economically and emotionally—and that some methods are controversial. Many women, troubled by the relentless ticking of their biological clock, pursue extreme measures: spending their nest egg on fertility drugs, using a younger woman’s eggs, freezing their own for future use. Next time you’re in line at the grocery store, check out the tabloids for photos of middle-aged celebrity mothers. It’s unlikely you will come across the following captions: baby on left, born following two years of agonizing treatments costing an arm and a leg; twin girls, right, conceived via in vitro fertilization when three embryos implanted, one, another girl, “reduced” in the womb. People Magazine can omit these details; it doesn’t claim to be medically accurate and comprehensive. Sex education does.

  I searched for the word “motherhood” on some of the most popular teen sex ed sites. On Columbia’s GoAskAlice.com, no matches were found. On gURL.com, I was asked to check my spelling. On SexEtc, a bunch of links about teen mothers came up.

  What about Planned Parenthood? Their mission is to offer “accurate and complete information to make childbearing decisions” and to preserve “reproductive freedom—the fundamental right of every individual to decide freely and responsibly when and whether to have a child.” Sounds great, but a search of their teen section, Teen Talk, brought up no information about the optimal time to start a family, the whole story about the hazards of Chlamydia, or the regrets of women who always put career first.