Sex and stigma (part I)

I recently had a discussion with a friend regarding the stigma surrounding sexually transmitted infections and around sex in general. Given the puritanical foundation of our largely paternalistic Judeo-Christian country it is understandable that rigid sexist ideals and social taboos prevail. However, it is also important to note that just below this whitewashed facade lies an occult but rich and gooey truth: humans love sex and few live up to the standards that society attempts to impose. Just look at all the fallen poster boys and girls of the so-called “Moral Majority” (Ted Haggard, Mark Sanford and Iris Robinson to name a recent few). I’ve done a little digging to bring some of that goo to the surface and with the rest of this blog I intend to demonstrate the hypocrisy of the current moral code.

According to George Michael:

Sex is natural, sex is good
Not everybody does it
But everybody should
Sex is natural, sex is fun
Sex is best when it’s
One on one


Britney Spears disagrees:

1, 2, 3
Not only you and me
Got one eighty degrees
And I’m caught in between
1, 2, 3
Peter, Paul & Mary
Gettin’ down with 3P
Everybody loves ***


But Salt-N-Pepa hits the nail on the head:

Let’s talk about sex, baby
Let’s talk about you and me
Let’s talk about all the good things
And the bad things that may be
Let’s talk about sex
Let’s talk about sex
Let’s talk about sex
Let’s talk about sex

Consider Abstinence Only education. A 2008 comparison study of 3440 nationally representative middle and high school students aged >15 years who, when surveyed in 1995, had never had sex or taken a virginity pledge found the following: (Rosenbaum JE. Patient teenagers? A comparison of the sexual behavior of virginity pledgers and matched nonpledgers. Pediatrics. 123(1):e110-20, 2009 Jan.)

  • The US government spends more than $200 million annually on abstinence promotion programs, including virginity pledges
  • >90% of abstinence funding does not require scientific accuracy
  • 81.9% of pledgers denied taking the pledge 5 years later
  • Pledgers did not differ in the average lifetime sexual partners (3) nor in the age of first sex (21)
  • 73% of pledgers and 76% of nonpledgers had had sex at the 5 year mark
  • Fewer pledgers than matched nonpledgers used birth control and condoms in the past year and birth control at last sex

A 2007 prospective study of 240 heterosexual 18–20-year-old male university students in Tucson, AZ found the following: (Partridge JM. Hughes JP. Feng Q. Winer RL. Weaver BA. Xi LF. Stern ME. Lee SK. O’Reilly SF. Hawes SE. Kiviat NB. Koutsky LA. Genital human papillomavirus infection in men: incidence and risk factors in a cohort of university students. Journal of Infectious Diseases. 196(8):1128-36, 2007 Oct 15.)

  • Only 25% of men reported 4 or fewer lifetime sex partners
  • 25% reported >16 lifetime sex partners
  • Only 20.7% of men reported consistent use of condoms during sexual intercourse
  • 41.0% reported never having used condoms

So what happened with all that unplanned, unprotected sex?

The fact of the matter is that while abstinence may be a lofty ideal for some people it is clearly not a viable option for the vast majority of humans. The insistence on abstinence education only is not only ludicrous but clearly dangerous. It has been nothing more than a complete and utter failure to American youth and a waste of tax payer money.

So just what are our real sexual habits anyway? When do people actually become sexually active? According to the 2002 NSFG data as presented by the CDC (MMWR: Sexual and Reproductive Health of Persons Aged 10–24 Years—United States, 2002–2007)

  • % of teens reporting having had sex:
    • Females aged <15 years: 13.1%
    • Females aged 15-17 years: 30.0%
    • Females aged 18-19 years: 70.6%
    • Males aged <15 years: 14.8%
    • Males aged 15-17 years: 31.6%
    • Males aged 18-19 years: 64.7%
  • Females aged 18-24 years who have experienced involuntary intercourse in the past: 9.6%
  • Females who have experienced forced intercourse in the past:
    • Females aged 18-19 years: 14.3%
    • Females aged 20-24 years: 19.1%
  • 3 in 10 adolescents aged 15-19 years reported having had 2+ sexual partners
  • Among never-married sexually active adolescents aged 15-19 years, 75.2% of females and 82.3% of males reported using a method of contraception at first intercourse
  • Among adolescents aged 18-19 years, 49.8% of females and 35.1% of males had talked with a parent before reaching age 18 years about methods of birth control
  • Among females aged 15-17 years, 88.0% of births were from unintended pregnancies

Yes, virgins do exist but they are few in number. A 2009 case-control study of 210 college-aged men aged 18–23 years in Baltimore, MD found the following: (D’Souza G. Agrawal Y. Halpern J. Bodison S. Gillison ML. Oral sexual behaviors associated with prevalent oral human papillomavirus infection. Journal of Infectious Diseases. 199(9):1263-9, 2009 May 1.)

  • Among college-aged men
    • 9% never engaged in open-mouthed kissing
    • 28% never performed oral sex
    • 30% never had vaginal sex
  • Among the control patients
    • 24% never performed oral sex
    • 2.6% never had vaginal sex

For the rest of us, surprise, surprise! Humans LOVE to fornicate and few of us are virgins on our wedding/commitment days. A 2007 study of the four most recent cycles of the National Survey of Family Growth (NSFG) of men and women aged 15-44 found the following: (Finer LB. Trends in premarital sex in the United States, 1954-2003. Public Health Reports. 122(1):73-8, 2007 Jan-Feb.)

  • By age 20, 77% of respondents had had sex, 75% had had premarital sex, and 12% had married
  • By age 44, 95% of respondents had had premarital sex
  • Among those who abstained until at least age 20, 81% had had premarital sex by age 44

Screw procreation. Straight couples like oral and anal sex almost as much as their gay and lesbian counterparts and are just as neglectful with condom use. A 2007 survey of 12,571 heterosexual men and women aged 15–44 years found the following: (Leichliter JS. Chandra A. Liddon N. Fenton KA. Aral SO. Prevalence and correlates of heterosexual anal and oral sex in adolescents and adults in the United States. Journal of Infectious Diseases. 196(12):1852-9, 2007 Dec 15.)

  • 3/4 of heterosexual men and women have had oral sex
  • 1/3 of heterosexual men and women have had anal sex
  • Condom use during last oral or anal sex was relatively uncommon

Likewise, a 2009 study of heterosexual anal intercourse in 1348 adolescents and young adults aged 15 to 21 years in 3 US cities found: (Lescano CM. Houck CD. Brown LK. Doherty G. DiClemente RJ. Fernandez MI. Pugatch D. Schlenger WE. Silver BJ. Project SHIELD Study Group. Correlates of heterosexual anal intercourse among at-risk adolescents and young adults. American Journal of Public Health. 99(6):1131-6, 2009 Jun.)

  • 8% of boys and 6% of girls aged 15-17 years have had anal sex
  • And 33% of men and 30% of women aged 20-24 years have had anal sex

Finally, it is important to recognize the work of Alfred C Kinsey in bringing the discussion of actual sex experience into the open. His 1948 landmark study on sexual behavior in the human male revealed the following: (Kinsey AC. Pomeroy WR. Martin CE. Sexual behavior in the human male. 1948. American Journal of Public Health. 93(6):894-8, 2003 Jun.)

  • About 60% of pre-adolescent boys engage in homosexual activities
  • At least 37% of the male population has some homosexual experience (physical contact between other males who were brought to orgasm as a result of such contact) between the beginning of adolescence and old age

So in conclusion to part I of Sex and Stigma, humans are social, sensual and sexual beings. We are not very good at abstaining from sex even though socially conservative political forces continue to try to keep sex education in the Dark Ages. If we are truly going to make a difference in decreasing our shameful number of unintended pregnancies (we have the highest rate in the entire industrialized world) and at least slow the transmission of sexually transmitted infections we need to foster an environment where we can be at least honest with ourselves and our kids and have educated discussions about sex. Our middle school and high school students deserve better than abstinence only education. We cannot continue to allow our youthful generations to suffer the consequences of heavy handed pious ideology. Advocate for youth and oppose federal funding of abstinence-only education!

One thought on “Sex and stigma (part I)”

  1. Well said Dr. Pate. We are social, sexual and sensual beings.

    Even more so when every child’s genital integrity is protected; when every growing child is allowed access to the best information available to understand the exquisite workings of their own blossoming bodies, we will certainly be evolving to a fuller human potential.

    If humanity is able to become far less religious there is no doubt we’ll see more human happiness, creativity and intelligence.


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