Sex education : don't wait for it

It is in the news again. Another round of the fight for sex education and contraception for our children. Sue Axon, from Manchester, fought to establish her right to know if her children under the age of sixteen were being referred for abortions.

For me, it all started with Victoria Gillick in 1983. She is a devout Roman Catholic woman with ten children. She went to court to try to prevent doctors giving contraceptive advice to children under sixteen without parental consent.

A fourteen year old girl comes to see me alone on Monday. Mum and Dad are at work. She has come on the way to school. She has been getting stomach pains for several weeks. It is not appropriate to examine an unaccompanied minor, save in an emergency, so I make her an appointment to come back after school with Mum.

On Tuesday, I see a thirteen year old girl who wants to go on the pill. She says, “I can’t tell me mum, she would kill me.”

On Wednesday, I see a fifteen year old girl. She asks me to arrange an abortion. She is too frightened to tell her parents that she is pregnant.

I have two teenage daughters. Would I want a doctor treating them in this fashion without consulting me?

Is the world upside down? Have we gone mad?

At the end of last year, my daughters’ school started classes on sex-education and STDs for girls over fourteen. Parents who objected could see the headmistress. There was an option to withdraw their girls from the classes. I went to see the headmistress.

Victoria Gillick lost her case in 1983 and Sue Axon has just lost hers. The courts have decided that not only may doctors give contraceptive advice to children under sixteen, they may also arrange abortions for them without consulting the parents. The children have a right to confidentially and the parents must not be told routinely.

Cosmopolitan Magazine is widely read by teenage girls. I found one lying around the other day. It included a primer on how to give good oral sex. And USA Cosmopolitan this week is featuring: Sex position of the week.

“Spice up your sack sessions with a scorching new position every Monday”

The Christian Institute states that sex education and contraception promote promiscuity. I always have trouble with the word promiscuity. What does it mean? The Christian Institute knows, I assume, but I do not.

What should we do as parents? What should we do as doctors? How do we help our children navigate themselves through this minefield? Cosmopolitan oral sex manual from Monday to Saturday and the Christian Institute on Sunday?

Teenagers are sexually mature. They are going to have sex. They are going to have sex with or without our approval. They are going to have lots of it, and they are going to continue having it. It is an odd conundrum that as doctors we decline to examine and treat young girls without a parent present, unless it is a sexual matter and then anything goes.

Odd or not, that is what we must do.

The fact that girls come for contraceptive advice and abortions without their parents is a reflection on the failings of their parents and on the failings of the education that Society (that’s a pompous word for you and me) has not given them.

Sex is an important and enjoyable part of life. This weird believe that it is only going to take place within a meaningful, monogamous, married relationship is a pious platitude. It has nothing to do with the realities of being a modern teenager.

Boys need contraceptive advice even more than girls. Most teenage boys combine a permanent erection with the belief that condoms are something to blow up like balloons at parties.

Teenage boys blow up balloons

And still, staggeringly, there is a background, sexist, Victorian belief that girls do not enjoy sex as much as men, or do not have the same needs and desires. Anyone still adhering to that belief would do well to read "Girl with a one track mind", which is a beautifully written sexual romp from an articulate and intelligent young woman.

Young people have sex. And they enjoy it. What we have to do is prepare them for it and teach them how to deal with it.

There is overwhelming evidence that the better the sex education and the earlier it starts, the fewer problems you have with abortions, early failed marriages and sexually transmitted diseases. Such education needs to start in the home environment and be continued in primary school. It needs to be targeted at both boys and girls.

Looking at Europe and the USA, which country has the lowest abortion rate? Holland. They have the best sex-education in the world. The UK is not too bad.

The USA is not doing well at all. The following is taken from Advocates for Youth:

"WASHINGTON, DC (December 14, 1999) The U.S. has 13 times the teen birth rate of the Netherlands, 25 times the gonorrhea rate of Germany, three times the teen abortion rate of France, and U.S. teens begin having sex earlier than European teens.

Yet, according to a new study released today by the Alan Guttmacher Institute more than 1/3 of all U.S. public school districts with a sex education policy prohibit any discussion of contraception, teaching abstinence until marriage as the only way to prevent HIV and teen pregnancy."

Since that was published, the American courts have made the teaching of so called Intelligent Design legally compulsory. What hope does that give for those wanting to improve sex education? Those who spend so much time fighting against Roe v Wade and abortion might do better to attack the problem from the other end.

The message now from some educators in parts of America is it's "worth waiting for." Sadly, as the nurses in Blount County, Tenessee are finding, most teenagers are off message. They are not waiting.

"The problem with teen sex in Blount County: Is there a problem with teen sex in Blount County? Most definitely, yes.

Blount County healthcare professionals (physicians and nurses) and public-health officials are alarmed at the large number of teens in this county who suffer the consequences of teen sexual behavior each year. Our county’s teens have a very high rate of problems arising from sexual behavior, and this rate is increasing."

Read through this scary document.

Meanwhile, back in the UK Dr Crippen would be horrified if his sixteen year old daughter went to the doctor to get an abortion behind his back. But his horror would relate to his failure as a parent to have the sort of relationship where she could have approached him first.

I did go to see the headmistress of the girls’ school, but not to complain about the sex education lessons. On the contrary. A lot of the girls at this school are patients of mine. I know who is on the pill, who has had abortions and who has had chlamydia. Starting these lessons at fourteen is too late. I know some of the parents who have objected to these lessons (“My daughter does not need this sort of thing yet, she is too young”). Sadly, they could not be more wrong, for it is their daughters who come covertly for advice because they dare not talk to their parents. These parents themselves are in desperate need of education about the realities of life.

The headmistress was in agreement. She would like to start the sex lessons in the first year with the 11 year olds. But she cannot. Why not?

The parents will not let her.

Sex education is too important to be left in the hands of parents. It should be a compulsory part of the school curriculum. You would not let a parent withdraw their children from maths or English lessons. Nor should they be allowed to withdraw them from sex education.



Picture from the city of Fredericksburg which has one of the highest rates of teen pregnancy in the state. Thirteen percent of city girls between 15 and 17 got pregnant and six percent of those gave birth in 2002.