8 Jorge Sanchez, Pablo Campos, Barry Courtois, Lourdes Gutierrez, Carlos Carrillo, et al, “Prevention of sexually transmitted diseases in female sex workers: prospective evaluation of condom promotion and strengthened STD services,” Sexually Transmitted Diseases 30, no.4 (April 2003): 273–79; Richard Crosby, Ralph DiClemente, Gina Wingood, Delia Lang, and Kathy Harrington, “Value of Consistent Condom Use: a study of sexually transmitted disease prevention among African American adolescent females,” American Journal of Public Health 93, no.6 (June 2003): 901–2.
9 The study only examined three STDs and therefore does not reflect the possible acquisition of other STDs including HIV, herpes, syphilis and the human papillomavirus (HPV); see Richard Crosby et al, “Value of Consistent Condom Use,” American Journal of Public Health 93, no.6 (June 2003): 901–902.
10 Judith Shlay, Melissa McClung, Jennifer Patnaik, and John Douglas, Jr., “Comparison of sexually transmitted disease prevalence by reported level of condom use among patients attending an urban sexually transmitted disease clinic,” Sexually Transmitted Diseases 31, no.3 (March 2004): 154-160; Anna Wald, Andria G.M. Langenberg, Elizabeth Krantz, John M. Douglas Jr., H. Hunter Handsfield, Richard P. DiCarlo, Adaora A. Adimora, Allen E. Izu, Rhoda Ashley Morrow, and Lawrence Corey, “The relationship between condom use and herpes simplex virus acquisition,” Annals of Internal Medicine 143, no.10 (15 November 2005):707–13.
11 When the public is informed about condom effectiveness by the CDC and other authorities, terms such as “highly effective,” “very good,” and “significant” are used. While there is no doubt that proper use of condoms prevents some infections to some degree, it would be ethical to remind people this refers only to vaginal intercourse and to provide the actual statistics so they can make informed decisions about their behavior. From what I could gather, “significant” sometimes refers to “statistically significant,” a level of protection many people would consider unacceptable.
12 Ruth M. Jacobs, MD, letter to The Gazette, March 28, 2005.
13 She teamed up with Citizens for Responsible Curriculum (CRC) to challenge the video. CRC was also concerned about the lack of warning about the risks of multiple partners, oral sex; the partial protection against herpes, HPV, and other organisms; and subsequently about transgenderism and issues related to homosexuality.
14 Pertaining to HIV, for the receptive individual, compared to receptive vaginal intercourse.
15 Barbara G. Silverman and Thomas P. Gross, “Use and Effectiveness of Condoms During Anal Intercourse: A Review,” Sexually Transmitted Diseases 24, no.1 (January 1997):11–17.
16 In Holland, concern about condom failure during anal sex was so serious that a new type was designed and marketed specific to this use. It appears that the FDA considered the possibility but was concerned about ethical issues involved in testing a new device.
17 Ruth M. Jacobs, MD, letter to The Gazette, March 28, 2005.
18 Jami S. Leichliter, Anjani Chandra, Nicole Lidden, Kevin A. Fenton, and Sevgi O. Aral, “Prevalence and Correlates of Heterosexual Anal and Oral Sex in Adolescents and Adults in the United States,” The Journal of Infectious Diseases 196, no.12 (15 December 2007): 1852–59.
19 Bradley O. Boekeloo and Donna E. Howard, “Oral Sexual Experience Among Young Adolescents Receiving General Health Examinations,” American Journal of Health Behavior 26, no.4 (August 2002): 306–14.
20 Stephanie A. Sanders and June Machover Reinisch, “Would You Say You ‘Had Sex’ If . . . ?” JAMA 281, no.3 (20 January 1999): 275-277; M. Keith Rawlings, Robert J. Graff, Rodrigo Calderon, Shelisa Casey-Bailey, and Mary V. Palsey, “Differences in Perceptions of What Constitutes Having ‘Had Sex’ in a Population of People Living with HIV/AIDS,” JAMA 98, no.6 (June 2006): 845–50.
21 The legal action was based on the curriculum’s exclusion of ex-gays and its discriminatory religious references. The judge found that it violated the establishment clause.
22 And PFOX (Parents and Friends of Ex-Gays).
23 Getting two minutes before the MCPS Board was not easy. The Board office only accepts calls from interested parties on the Monday before they meet, and only for two, thirty-minute periods—one for speakers who wish to address issues relating to the day’s agenda, and the other for speakers wishing to address other issues. At the time Jacobs was trying to present, the number was usually busy. She succeeded in getting through by using the redial button on two separate phones. See Montgomery County Public Schools, “Public Participation,” http://www.montgomeryschoolsmd.org/boe/community/participation.shtm.
24 Usually males are asymptomatic and may only learn of their infection when symptoms develop in a female partner and she is diagnosed.
25 “HIV Services for a New Generation,” January 1, 2001; available at: http://www.marketingpower.com/ResourceLibrary/MarketingHealthServices/Pages/2001/21/4/6131134.aspx?sq=hiv 1 aids 1 epidemic.
26 Discussed as a variation of sexual behavior on GoAskAlice and other sites for teens.
27 This is the email my assistant got when she wrote MCPS to ask if their current (as of March 2009) curriculum specifies that:1. Anal sex is the most dangerous type of intercourse and
2. Condoms may be more likely to fail during non-vaginal use:
Date: Mon, Mar 30, 2009 at 2:49 PM
Subject: sex ed curricula question
Dear Ms. ****:
Thank you for your March 16, 2009, e-mail message to Dr.——, superintendent of schools, in which you request information regarding the Montgomery County Public Schools Health Curriculum, specifically: “does the current sex ed curricula specify that anal sex is the most dangerous type of intercourse, i.e., the easiest way to transmit infection?” and, “does the curricula provide the same or a similar warning to that on condom wrappers (regarding the possible breakage of a condom for non-vaginal use)?”
A 45-minute condom use demonstration lesson for Grade 10 health education students is designed to address the following concept and objectives:
Abstinence is the only 100 percent effective way to prevent unwanted pregnancy and sexually transmitted infections. Individuals who engage in sexual activity are responsible for protecting themselves and their partners from unwanted pregnancy and sexually transmitted infections.
Describe how a condom works to help prevent contracting a sexually transmitted disease.
List in order the proper steps for correctly examining a condom, putting on a condom, and removing/disposing of a condom.
Anal sex and condom use warnings are not the focus of the condom demonstration lesson or the Montgomery County Public Schools Curriculum Framework for Pre-K-12 Health Education.
[name redacted], Associate Superintendent for Curriculum and Instructional Programs Montgomery County Public Schools
28 Mark Jacobs, “Due warning in a ‘risky’ world,” The Washington Times, May 8, 2005.
29 Citizens for Community Values, “Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention.”
30 U.S. Food and Drug Administration, “Condoms and Sexually Transmitted Diseases, Brochure” (December 1990), http://www.fda.gov/oashi/aids/condom.html#strong.
31 Ibid.
32 Surgeon General C. Everett Koop, “To MCPS Board of Education and Superintendent Weast,” available at: http://www.mcpscurriculum.com/pdf/Ruthanalsexpetition.pdf.
33 HPV-related anal cancer is on the rise and has striking similarities to cervical cancer. It most commonly occurs in the anal transition zone, an area of immature cells very like the cervical transformation zone. Having receptive anal sex causes trauma and repair of the anal transition zone, a process that accelerates the turnover of cells and makes the area more vulnerable to malignant change. Teresa M. Darragh, “Anal Cytology for Anal Cancer Screening: Is It Time Yet?” Diagnostic Cytopathology 30, no.6 (May 2004): 371–73. This is the reason some physicians are performing anal Pap tests on men who have sex with men. Also, a 2008 Robinson article ind
icates that the sexual revolution is a major contributor to HPV-related cancers. See D. Robinson, et al, “An analysis of temporal and generational trends in the incidence of anal and other HPV-related cancers in Southeast England,” British Journal of Cancer 100, no.3 (January 2009): 527–31.
34 SIECUS, “Prevalence of Unprotected Anal Sex Among Teens Requires New Education Strategies,” http://www.siecus.org/index.cfm?fuseaction=feature.showFeature&FeatureID=1036&varuniqueuserid=20986960210.
35 Martha Kempner and Monica Rodriguez, “Talk About Sex” (SIECUS, 2005), 46, 68, 76, 79. Accessed at http://siecus.org/_data/global/images/TalkAboutSex.pdf .
36 Stephen Joseph, MD, personal communication, December 1, 2005.
37 American Lung Association, www.lungusa.org.
38 “Anal Sex Basic Facts,” http://www.gURL.com/findout/fastfacts/articles/0,,605386_671456-5,00.html.
39 Remember, Planned Parenthood says, “Parents know that the best foundation for their children’s success is a good education. When it comes to sexual health, Planned Parenthood provides what parents want for their children—medically accurate, comprehensive, and age-appropriate information to guide them through a lifetime of choices.” From Planned Parenthood, “About Us,” http://www.plannedparenthood.org/about-us/about-us-90.htm. Also, “Planned Parenthood is proud of its vital role in providing young people with honest sexuality and relationship information in classrooms and online.”
40 Planned Parenthood, “Vaginal, Oral & Anal Sex,” http://www.plannedparenthood.org/teen-talk/ask/sex-masturbation/vaginal-oral-anal-sex-26056.htm.
41 Answer, “Medical Advisory Board,” http://answer.rutgers.edu/page/medical_advisory_board/.
42 Sex, Etc., “The Truth About Anal Sex,” http://www.sexetc.org/story/sex/2226.
43 Heather Corinna, S.E.X: The All-You-Need-to-Know progressive sexuality guide to get you through High School and College (New York: Marlowe and Co., 2007), 156.
44 Ibid., 159.
45 “Why is anal sex so wrong?” http://www.scarleteen.com/article/advice/why_is_anal_sex_so_wrong.
46 “Receiving anal sex: What does it mean?” http://www.goaskalice.columbia.edu/0847.html.
47 Norman Sohn, Michael Weinstein, and Joel Gonchar, “Social Injuries of the Rectum,” American Journal of Surgery 134, no.5 (November 1977): 611–12.
48 Go Ask Alice! “What’s fisting?” http://www.goaskalice.columbia.edu/1429.html.
49 Heather Corinna, S.E.X., 147.
50 Miriam Grossman, Unprotected: A Campus Psychiatrist Reveals How Political Correctness Endangers Every Student (New York: Sentinel, 2006), 68–70.
51 Merck Manual, available at: www.merckmanual.com.
52 Ibid.
53 Luis Carlos Junqueira and Jose Carneiro, Basic Histology: Text and Atlas, 10th ed. (New York: McGraw-Hill, 2003).
54 Peter Greenhead, Peter Hayes, Patricia S. Watts, Ken G. Laing, George E. Griffin, and Robin J. Shattock, “Parameters of Human Immunodeficiency Virus Infection of Human Cervical Tissue and Inhibition by Vaginal Virucides,” Journal of Virology 74, no.12 (June 2000): 5577–86.
55 B. Voeller and D. J. Anderson, letter to the Journal of the American Medical Association 267 (October 2003): 1917–18. (from Brody, Sex at Risk, 216)
56 A. Moriyama, K. Shimoya, I. Ogata, T. Kimura, T. Nakamura, H. Wada, K. Ohashi, C. Azuma, F. Saji and Y. Murata, “Secretory leukocyte protease inhibitor (SLPI) concentrations in cervical mucus of women with normal menstrual cycle,” Molecular Human Reproduction 5, no.7 (July 1999): 656–61.
57 Lot de Witte, Alexey Nabatov, Marjorie Pion, et al, “Langerin is a natural barrier to HIV-1 transmission by Langerhans cells,” Nature Medicine, 13, no. 3 (2007): 367-371.
58 S. J. Robboy, M. Prade and G. Cunha, in Steven S. Sternberg, ed., Histology for Pathologists, (North Holland, New York: Raven Press, 1992), 881–92.
59 Peter Greenhead et al, “Parameters of Human Immunodeficiency,” Journal of Virology 74, no.12 (June 2000): 5577–86. The cervix may be more vulnerable, especially the transformation zone.
60 Reuters, “HIV infects women through healthy tissue: U.S. Study,” 18 December 2008, http://www.reuters.com/article/newsOne/idUS-TRE4BF7FF20081216.
61 M cells were actually first identified by Dr. Kenzaburo Kumagai of Osaka Tuberculosis Institute in 1922. See Robert L. Owen, “Uptake and transport of intestinal macromolecules and microorganisms by M cells in Peyer’s patches—a personal and historical perspective,” Seminars in Immunology 11, no.3 (June 1999): 157–63.
62 A. D. O’Leary and E. C. Sweeney, “Lymphoglandular Complexes of the Colon: Structure and Distribution,” Histopathology 10 (1986): 267–83.
63 Marian R. Neutra, Nicholas J. Mantis, Andreas Frey, and Paul J. Giannasca, “The composition and function of M cell apical membranes: Implications for microbial pathogenesis,” Seminars in Immunology 11, no.3 (June 1999): 171–81; Harvey Miller, Jianbing Zhang, Rhonda KuoLee, Girishchandra B. Patel, and Wangxue Chen, “Intestinal M Cells: The fallible sentinels?” World Journal of Gastroenterology 13, no.10 (14 March 2007):1477–86.
64 Robert L. Owen, “Uptake and transport,” Seminars in Immunology.
65 J. P. Kraehenbuhl and M. R. Neutra, “Mollecular and cellular basis of immune protection of mucosal surfaces,” Physiological Review 72, no.4 (1 October 1992): 853–79.
66 This has been demonstrated in vitro but not in vivo.
67 William B. Whitman, David C. Coleman, and William J. Wiebe, “Prokaryotes: The unseen majority,” Proceedings of the National Academy of Sciences USA 95, no.12 (9 June 1998): 6578–83.
68 Harvey Miller et al “Intestinal M cells: The fallible sentinels?” World Journal of Gastroenterology.
69 Sinead C. Corr, Cormac C.G.M. Gahan, and Colin Hill, “M-Cells: origin, morphology and role in mucosal immunity and microbial pathogenesis,” FEMS Immunology and Medical Microbiology 52, no.1 (January 2008): 2–12.
70 See Malcom Gladwell, The Tipping Point (New York: Little, Brown & Company, 2002).
71 John Potterat, personal communication with author, May 29, 2008.
Chapter 5
1 Herpes Homepage Discussion Forum, http://racoon.com/cgi-bin/dcforum/dcboard.cgi.
2 Cynthia A. Taylor, Mary L. Keller, Judith J. Egan (1997), “Advice from Affected Persons about Living with Human Papillomavirus Infection,” Image: Journal of Nursing Scholarship 29, no. 1 (1997):27–32; J. Waller, L. A. V. Marlow, J. Wardle, “The association between knowledge of HPV and feelings of stigma, shame and anxiety,” Sexually Transmitted Infections 83 (2007): 155–59.
3 Michael Reitano, “Counseling Patients with Genital Warts,” American Journal of Medicine 102, 5A (1997): 38–43
4 H. M. Conaglen, R. Hughes, J. V. Conaglen, J. Morgan, “A prospective study of the psychological impact on patients of first diagnosis of human papillomavirus,” International Journal of STD&AIDS, 12 (2001): 651–58.
5 The frequency of outbreaks may eventually diminish after several years.
6 R. Patel et al, “Patients’ perspectives on the burden of recurrent genital herpes,” International Journal of STD & AIDS 12 (2001): 640–45.
7 “HPV and You,” Teen Talk, Planned Parenthood, http://www.plannedparenthood.org/teen-talk/watch/hpv-you-26817.htm.
8 “Teaching about Sexually Transmitted Infections,” http://www.etr.org/recapp/freebies/freebie200008.htm; http://www.teenwire.com/education/activity-019.pdf.
9 www.ashastd.org: “Just remember that almost everyone gets HPV at some time... the virus is so common that having only a single lifetime partner does not assure protection... anyone who has ever had sexual relations has a high chance of being exposed to this virus”; www.GoAskAlice.com: “As you probably realize, the only way to be 100% percent certain you don’t get any infections is to not have any oral, vaginal, or anal sex. Most people eventually decide to take the plunge and explore the joys of sex.” www.scarleteen.com: “What’s the answer? There isn’t an easy one. In most cases, if you simply chose to abstain from all
sexual activities, forever, you could like avoid HPV and HSV-2. But very few people are going to do that. . . . ”
10 Margaret R. H. Nusbaum et al, “Sexually Transmitted Infections and Increased Risk of Co-Infection with Human Immunodeficiency Virus,” Journal of the American Osteopathic Association 104, no.12 (2004): 527.
11 Kate Pavao, “Gay Couples Say “I DO!” available at: www.teenwire.com.
12 “Take Action,” http://www.sexetc.org/page/take_action/.
13 Susan Rosenthal et al, “Heterosexual Romantic Relationships and Sexual Behaviors of Young Adolescent Girls,” Journal of Adolescent Health 21 (1997):238–43.
14 “The Sex Mission: Accomplished,” Comment on comic by Martina Fugazzotto. http://gurl.typepad.com/gurl_comix/2007/11/the-sex-missi-3.html.
15 “Survey Indicates Nearly 1 in 10 US Adolescents Had Major Depressive Episode in 2004,” CNS Spectrum 11, no.2 (February 2006): 83; “Suicide Rates Increasing in Girls,” Psychiatric Annals 37, no.10 (2007): 663.
16 Diana Mahoney, “Educate Patients about Asymptomatic Herpes,” Clinical Psychiatry News, May 22, 2008, 54.
17 Graph: “Fifty-Five Percent of Teens Aged 15-17 Say Depression Is a Big Concern,” source: The Henry J Kaiser Foundation; from Clinical Psychiatry News, February 2004, 61.
18 Darron R. Brown, “A Longitudinal Study of Genital Human Papillomavirus Infection in a Cohort of Closely Followed Adolescent Women,” Journal of Infectious Diseases 191 (2005): 182–92.
19 Rachel L. Winer et al, “Genital Human Papillomavirus Infection: Incidence and Risk Factors in a Cohort of Female University Students,” American Journal of Epidemiology 157 (2003): 218–26; Rachel L. Winer, Qinghua Feng, James P. Hughes, Sandra O’Reilly, Nancy B. Kiviat, and Laura A. Koutsky, “Risk of female human papillomavirus acquisition associated with first male sex partner,” Journal of Infectious Diseases 197, no.2 (2008): 279–82.
20 Fact Sheet. “Human Papillomavirus and Genital Warts,” National Institute of Allergy and Infectious Diseases. Available at: www.niaid.nih.gov/factsheets/stdhpv.htm.
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