An Rx For Teen Sex

By Jodie Morse

The slide show was chilling: a cervix with precancerous lesions, shriveled fallopian tubes. But what made Seth Claude and his friends really blanch was a penis covered in sores and distended like an autumn gourd. "Before, I just thought if you got genital warts, maybe you had one or two, but then I saw the person with a bajillion of them and was, like, 'Whoa,'" says Seth, 13. "[The pictures] are enough to make you have nightmares."

But will they keep him from having sex? The images form the backbone of Worth the Wait, a sex-education curriculum taught at Seth's school, Caldwell Middle School in Caldwell, Texas, and in 31 districts across the state. Written by Dr. Patricia Sulak, an obstetrician-gynecologist and professor at Texas A&M University's College of Medicine, the lessons set forth the clinical consequences of teen sex in pictures and eye-popping statistics charting the numbers of young people infected with sexually transmitted diseases. The take-home message: abstain from intercourse or put yourself at grave medical risk.

A bitter battle over sex ed has long raged in this country--and with each year the foes have become more deeply set in their stances. On one side are religious conservatives arguing that sex outside of wedlock is unholy. They have secured millions of federal dollars for abstinence programs that teach about the hazards of contraceptives. The other camp, backed by virtually every major medical organization, contends it is irresponsible to deny kids information about condoms. Now, as Congress is weighing President Bush's proposal to boost abstinence funding by 33% to $135 million, those allegiances are shifting. A small but vocal cohort of doctors has gone to the abstention side. "I used to think all we had to do was dump condoms in the schools and be done with it," says Sulak. "But after reviewing the data, I've had to do a 180 on kids and sex."

The turnabout is proving contagious. Sulak has sold her slide kits to health-care workers in 44 states. More significant, the American College of Obstetricians and Gynecologists, which has long been on the other bank of the sex-ed divide, will honor her with a presidential award next spring. Meanwhile, a group of more than 400 doctors collaborated on an abstinence CD-ROM, Prescriptions for Parents: A Physicians' Guide to Adolescence and Sex, released last month by the National Physicians Center for Family Resources. "Parents and children want medical facts, not a one-sided moralist approach," says Dianna Lightfoot, the center's president.

Abstinence educators also want to put the medical story on the table. From 1999 to 2001, the Medical Institute for Sexual Health in Austin, Texas, which markets materials to abstinence instructors, saw a 150% increase in sales of its products. Even the Centers for Disease Control and Prevention (CDC), whose education programs encouraged condom use, has been quietly recasting its position on abstinence. The agency pulled from its website this summer a feature called Programs that Work, which had touted the success of eight condom-based sex-ed curriculums. Now the agency is focusing on abstinence-only programs. Says Lloyd Kolbe, director of the CDC's division of adolescent and school health and an original author of the condom feature: "It was a very limited approach."

What's different now? The '90s presented a mixed picture of teen sexual health. There was a solid 20% decline in the teen birth rate, and according to a CDC report released last week, sexual activity decreased 15%. But the incidence of certain sexually transmitted diseases rose among adolescents. A quarter of all new HIV cases today occur in those ages 21 and younger. And doctors are reporting more frequent diagnoses of herpes and the human papillomavirus, or HPV, which is linked to cervical cancer and is thought to infect more than 15% of sexually active teens. The last figure is the one gnawing at some doctors. Though the particulars of HPV remain something of a medical mystery, we have learned at least one frightening thing about the disease: HPV is spread through skin-to-skin contact of genitals and their surrounding areas, so condoms do not always protect against it. Which means, as Sulak is fond of saying, there is no such thing as safe sex.

That Sulak should be leading this charge is a little surprising. She is a highly respected contraceptive expert who has devoted the past decade to researching the birth-control pill. She came to her latest cause seven years ago when she was asked to help choose a sex-ed program for her son's middle school. The curriculums she examined were steeped in ideology and medical errors. So she designed one, drawing extensively on data from the National Institutes of Health and the CDC. "All we've done is state facts," she says, "and you can't argue with facts."

But the way those facts are framed is drawing fire from both sides. Some hard-line conservatives, who see sex ed as the one culture war in which they have had consistent successes, contend Sulak doesn't do enough to promote the sanctity of marriage, a condition of receiving federal abstinence funding. Nor are they particularly pleased by the prospect of young children spending part of their school days looking at cervixes. Says Leslee Unruh, president of the National Abstinence Clearinghouse: "I've raised five abstinent children without showing one of them diseased genitals."

For their part, advocates of comprehensive sex ed worry about sins of omission. Worth the Wait is silent on masturbation and homosexuality and, in keeping with federal guidelines, mentions condoms only to point out their myriad imperfections. "Manipulating facts about condoms is using a scare tactic to try and get kids not to be sexually active," says Tamara Kreinin, president of the Sexuality Information and Education Council of the U.S. "And the fact that physicians are now doing this gives it an added level of credibility." Dr. David Kaplan, a professor of pediatrics at the University of Colorado School of Medicine, shares her concern: "It's infuriating not to give kids information so that they can protect themselves."

Yet some of Sulak's most ardent defenders also come from within the medical profession. "I'm a convert to her way of thinking," says Dr. Gerald Joseph Jr., an obstetrician-gynecologist in Springfield, Mo., and district officer at the American College of Obstetricians and Gynecologists. "There's no question her program is 100% medically accurate and responsible." Indeed, doctors have a hand in all aspects of the Worth the Wait curriculum. Not only do they train health educators from participating schools, but either a doctor or medical student also gives a guest lecture to students during the semester. If at any point during the program those students say they won't be abstaining until wedlock, they are promptly referred to a medical professional to talk about contraceptives.

Perhaps the most pressing question about Worth the Wait is the one that has dogged the abstinence movement from the start: Does it work? Though a major federal evaluation of 11 programs is due out early next year, no study has yet confirmed the merits of the just-say-no approach. But there are small signs that Worth the Wait is making a difference. A continuing evaluation that involves Texas A&M University professors found that from 1999 to 2001, frequency of sexual activity among seventh-and eighth-graders in the program dropped 4% and 2% respectively.

Back in Caldwell, Seth Claude and his girlfriend Chaille say they are taking things slowly. "We sit next to each other on the bus and at lunch," he says. And when they get together, they often wind up talking about genital warts. --With reporting by Perry Bacon Jr./Washington and Adam Pitluk/Caldwell

For more on sex education in schools, tune in to MTV on Oct. 3 at 10 p.m. E.T. for "Protect Yourself: Sex in the Classroom," part of the network's FIGHT FOR YOUR RIGHTS: PROTECT YOURSELF campaign, a yearlong initiative dedicated to in-forming the audience on issues of sexual health.

With reporting by Perry Bacon Jr./Washington and Adam Pitluk/Caldwell