August 29, 2013

Where Did Billy Ray Go?

When I watched Miley Cyrus slither on stage at the recent MTV awards looking like a cross between a 12 year- old boy and a seasoned pole dancer, I felt as though someone had kicked me in the stomach. Clearly she was coached to act sexually outrageous in order to get attention. But her handlers forgot to tell her that she would embarrass herself and, hopefully, her family. Her performance showed how seriously she has been prostituted by adults wanting to gain one thing: a lot of money. And as she moved on stage I wondered, where is Billy Ray?

I remember an interview that Billy Ray did in 2007 when he described his relationship with his then 14 -year -old daughter. He remarked that he enjoyed teaching her to cook hot dogs and play games with her but when it came to discipline, he wasn’t very keen on it. That was her mother’s territory. Clearly over the past six years, his fatherly influence has waned miserably. I don’t know Billy Ray and before I would indict him as a bad father, it is important to give him the benefit of the doubt. Perhaps Miley and /or her mother cut him out of Miley’s life. What happened on stage several nights ago shows what happens to young girls who have no fatherly influence; for no dad who cherishes his daughter would advocate such sexually ridiculous behavior.

But rather than point fingers, I think that it I important to learn a few things. First, Miley, at 20 years of age, is still cognitively not yet an adult. We know through studies on brain development that the higher brain functions (those that help young people understand behavior and their consequences) aren’t complete. That means that parents must still give strong and clear guidance to 20 -year -old children in order to keep them safe. I wonder if Billy Ray knows this.

Second, we must recognize that the same forces, which seduced Miley to behave as she did, are at work on our kids too. The difference between our kids and Miley are only two things: she has more money and more exposure. But with access to the Internet, many of our young daughters can acquire enormous exposure and let’s not be fools. They know how to get attention, just like Miley does. So we must be relentlessly diligent in keeping tabs on what our girls show to whom and when.

Third, Miley’s behavior shows us how desperately girls crave male attention. That means, dads, you’re on. We can glean from her performance that she didn’t get nearly enough attention from Billy Ray because we know that girls who get attention at home are far less likely to seek it outside the home. And, as I wrote in Strong Fathers, Strong Daughters, the most effective way to boost a girl’s self-esteem is to have her father show her more physical affection. Can changing a girl’s behavior be as simple as having her father hug her, pay attention to her and show her that he loves being with her? Yup.

Finally, this is no time to be a wimpy parent. Every parent needs to learn to be comfortable stonewalling their kids when necessary. Specifically, moms and dads need to learn to say “no” to their daughters more frequently and with more authority. Skip the friendship thing- you have the rest of your life to be friends. Engage your kids in conflict because it shows them you care enough to protect them. When it comes to how girls dress, for instance, we mothers seem to lose our minds. We want our girls to “fit in” with their friends and that means we are too lenient with skanky clothes. We need to listen to our husbands when they tell our daughters that they can’t go to school wearing skirts that are two sizes too small and shirts that dive to their navels.

Parents be warned. The world doesn’t like kids very much. Young girls are seduced into believing that in order to be anyone, they need to look and act promiscuous. If they can do it to Hannah Montana, what young girl is off limits?

You Are the Most Important Man in Her Life

Men, good men: We need you. We—mothers, daughters, and sisters—need your help to raise healthy young women. We need every ounce of masculine courage and wit you own, because fathers, more than anyone else, set the course for a daughter’s life.

Your daughter needs the best of who you are: your strength, your courage, your intelligence, and your fearlessness. She needs your empathy, assertiveness, and self-confidence. She needs you.

Our daughters need the support that only fathers can provide—and if you are willing to guide your daughter, to stand between her and a toxic culture, to take her to a healthier place, your rewards will be unmatched. You will experience the love and adoration that can come only from a daughter. You will feel a pride, satisfaction, and joy that you can know nowhere else.

After more than twenty years of listening to daughters—and doling out antibiotics, anti-depressants, and stimulants to girls who have gone without a father’s love—I know just how important fathers are. I have listened hour after hour to young girls describe how they vomit in junior high bathrooms to keep their weight down. I have listened to fourteen-year-old girls tell me they have to provide fellatio—which disgusts them—in order to keep their boyfriends. I’ve watched girls drop off varsity tennis teams, flunk out of school, and carve initials or tattoo cult figures onto their bodies—all to see if their dads will notice.

And I have watched daughters talk to fathers. When you come in the room, they change. Everything about them changes: their eyes, their mouths, their gestures, their body language. Daughters are never lukewarm in the presence of their fathers. They might take their mothers for granted, but not you. They light up—or they cry. They watch you intensely. They hang on your words. They hope for your attention, and they wait for it in frustration—or in despair. They need a gesture of approval, a nod of encouragement, or even simple eye contact to let them know you care and are willing to help.

When she’s in your company, your daughter tries harder to excel. When you teach her, she learns more rapidly. When you guide her, she gains confidence. If you fully understood just how profoundly you can influence your daughter’s life, you would be terrified, overwhelmed, or both. Boyfriends, brothers, even husbands can’t shape her character the way you do. You will influence her entire life because she gives you an authority she gives no other man.

Many fathers (particularly of teen girls) assume they have little influence over their daughters—certainly less influence than their daughters’ peers or pop culture—and think their daughters need to figure out life on their own. But your daughter faces a world markedly different from the one you did growing up: it’s less friendly, morally unmoored, and even outright dangerous. After age six, “little girl” clothes are hard to find. Many outfits are cut to make her look like a seductive thirteen- or fourteen-year-old girl trying to attract older boys. She will enter puberty earlier than girls did a generation or two ago (and boys will be watching as she grows breasts even as young as age nine). She will see sexual innuendo or scenes of overt sexual behavior in magazines or on television before she is ten years old, whether you approve or not. She will learn about HIV and AIDS in elementary school and will also probably learn why and how it is transmitted.

When my son was in the fourth grade at a small parochial school, the teacher gave his class a science assignment. Each student was to write a report on any one of the infectious diseases from a list she gave them. My son chose to write about HIV and AIDS. (This was a popular choice because it is so widely talked about.) He learned about the virus and about drug injections and medications used to battle it. After I picked him up at school, we stopped by the grocery store. As I pulled into the parking lot, he was telling me about his findings. Then he said, “Mom, I just don’t get it. I know HIV is really dangerous and that people who get AIDS die. And I get, you know, how men and women give it to each other, but what’s this stuff about men giving it to other men? I just don’t see how that can happen.”

I took a deep breath. Now, I am not a squeamish person. I am a doctor. I’m used to talking to patients about sex-related health risks. And I believe strongly in treating all patients the same, whether they are heterosexual or homosexual. But here’s what grieved me: I know from child psychology that it was too soon to detail specific sexual acts (beyond simple intercourse) to my son. It was one thing to teach him how children are conceived. It was quite another to talk about sexual acts that he cannot understand and should not be confronted with at his age. I felt as though his right to innocence had been invaded. I never withhold information, because knowledge is important, but timing is crucial.

Shocking young children breaks their healthy sense of modesty. That modesty serves a protective function. There, in the grocery store parking lot, I spoke as gently as I could, but my son was rightly upset. This knowledge and the mental pictures it drew for him taught him something he didn’t want to know, and was not and could not be prepared to know at his age. In today’s world, we adults do a terrible job of letting kids be kids. Our children are forced prematurely into an adult world that even our own parents or grandparents might have considered pornographic.

When your daughter hits fifth or sixth grade, she will learn what oral sex is. Before too long, she will have a pretty decent chance of seeing someone engaged in it, as the new trend in sexual behavior among adolescents is public display. She will feel comfortable saying the word condom and will know what they look like because she has either seen them on television or at school. Many well-meaning teachers will pride themselves on speaking openly and honestly to her about sex, determined to break the taboo about adults talking to kids about sexual activity. The problem is, many health (sex) educators are woefully behind in the information they use—and this isn’t their fault. Their materials are often outdated. And many celebrities don’t help. Sharon Stone, for instance, recently remarked to the teens of our nation that they should participate in oral sex rather than intercourse because, I guess, she believes it to be safer. Does she understand that any sexually transmitted disease (STD) a kid can get from intercourse, she/he can get from oral sex? I doubt it. Sure, she probably felt that she was on the cutting edge of the new era of sex education, but the problem is, her assumptions are outdated and she hasn’t taken the time to learn the scientific facts. She doesn’t see what we doctors see. Yet she and celebrities like her reach millions of teens with their various messages of “safe sex,” which unfortunately aren’t safe.

Teachers in most schools are no better informed. They know that a high proportion of kids are sexually active, and that many parents don’t know what their kids are up to. But the teachers rely on government-mandated curricula, and government bureaucracies move slower than our knowledge about medicine. Moreover, the government’s standards are not based entirely on science but on principles that many parents might not share.

Sex education curricula generally follow the guidelines of the Sexuality Information and Education Council of the United States. SIECUS is a nonprofit advocacy group that proposes to “assist children in understanding a positive view of sexuality, provide them with information and skills about taking care of their sexual health, and help them acquire skills to make decisions now and in the future.” Let’s review just a few of the guidelines written in the manual so that you can make your own decision about what your daughter is learning at school.

For children ages five to eight (kindergarten through second grade):
• Touching and rubbing one’s own genitals to feel good is called masturbation.
• Some men and women are homosexual, which means that they will be attracted to and fall in love with someone of the same sex. (This is in the manual for the older children.)

For children ages nine to twelve (third through sixth grade):
• Masturbation is often the first way a person experiences sexual pleasure.
• Being sexual with another person usually involves more than sexual intercourse.
• Abortion is legal in the United States up to a certain point in pregnancy.
• Homosexual love relationships can be as fulfilling as heterosexual relationships. (This is in the manual for the older children.)

For children ages twelve to fifteen (seventh through tenth grade):
• Masturbation, either alone or with a partner, is one way people can enjoy and express their sexuality without risking pregnancy or STDs/HIV.
• Being sexual with another person usually involves different sexual behaviors.
• Having a legal abortion rarely interferes with a woman’s ability to become pregnant or give birth in the future.
• People of all genders and sexual orientation can experience sexual dysfunction.
• Some sexual behaviors shared by partners include kissing, touching, caressing, massaging, and oral, vaginal, or anal intercourse.
• Nonprescription methods of contraception include male and female condoms, foam, gels, and suppositories.
• Young people can buy nonprescription contraceptives in a pharmacy, grocery store, market, or convenience store.
• In most states, young people can get prescriptions for contraception without their parents’ permission.
• Both men and women can give and receive sexual pleasure.

For children ages fifteen to eighteen (tenth through twelfth grade):
• Some sexual behaviors shared by partners include kissing, touching, talking, caressing, massaging, sharing erotic literature or art, bathing or showering together, and oral, vaginal, or anal intercourse.
 • Some people use erotic photographs, movies, or literature to enhance sexual fantasies when alone or with a partner.
• Some sexual fantasies involve mysterious or forbidden things.
• People can find creative and sensual ways to integrate contraception into their sexual relationship.

Now let me be very clear here. I don’t care what adults do regarding their sexual behaviors. But I’m a kid advocate and these guidelines bother me, as I hope they do you. First, they are scientifically illiterate. Kids can and do get STDs through mutual masturbation and oral sex. Herpes and human papillomavirus (HPV), for example, are transmitted through touch. Second, these guidelines normalize the bizarre. Sexual fantasies with mysterious things? Are we talking porn-shop stuff here? Third, they lead kids. Note the position of the later statements, which imply that if you want to enjoy pleasure, here’s how to have it. Fourth, they encourage behavior (such as anal sex) that is inherently dangerous. Fifth, whatever one thinks about controversial issues like abortion, it is misleading, to say the least, to downplay the seriousness of the procedure on not only a girl’s body but also on her mind and emotions.

In elementary school your daughter will learn about drugs, the dangers of sniffing glue, why she shouldn’t smoke marijuana, and how bad cigarettes are for her. She will meet her friends’ mothers’ boyfriends. Some will be nice and some won’t be. She will be taught to let someone know—a teacher, a parent, a police officer—if an adult man touches her pubic area or breasts (even if they haven’t developed yet). She will be taught why her friend Sarah has two moms, or two dads, or two moms and one dad, or no mom or dad and only grandparents or foster parents. Most of this she will learn before sixth grade, while you’re at work trying to get through the day and fighting your own battles.

You drive home at the end of the day, walk into your house, and there she is. Twelve years old, chasing her nine-year-old brother, screaming because he took her iPod. Then she sees you and either stops screaming or runs away, because she doesn’t want you to see her ugly behavior.

Or you come home and see her watching television. Chances are, the minute you walk into the room she will grab the channel changer and flip through numerous stations. Why? Because she doesn’t want you to see what she is watching—she’s afraid you will be either angry or disappointed in her. Why? Because the shows aren’t Bewitched or the Cosby Show. They aren’t like the shows you watched growing up. The programs on television have changed right under your nose. Studies show that the amount of sexual content increased from 67 percent in 1998 to 77 percent in 2005. If you grew up in the 1960s or 1970s, the amount of sexual content was, comparatively, virtually nonexistent. We’ll look at this in greater detail later, but imagine: three-fourths of the shows your little girl sees have sexual content (unless she still watches Dora the Explorer at age twelve, which I doubt). In addition to this, the intensity of the sexual content has gotten worse. In the 1960s, sexual content was Barbara Eden showing her navel on I Dream of Jeannie. By the 1980s, prime-time television was up to heavy kissing or allusions to petting. But that’s become boring. Now, prime time offers numerous allusions to intercourse and oral sex.

For young kids—particularly early preadolescents—such sexualized images and talk can be nothing short of traumatizing. Remember, your daughter will most likely begin puberty before her male friends. This means that from about the third grade on, you need to be very careful about what she’s exposed to. While you and I might not even notice a scene of two people heading beneath the sheets, you can be sure that it raises all sorts of questions in her mind. She is forming her impressions about sex and about how teens and adults behave. If she is forced to form these impressions too young, more often than not, they will be overwhelmingly negative.

When Anna was ten and halfway through her fourth-grade year, her mother brought her in for her annual physical. She was an excellent student, played soccer, and was very well adjusted. Her mother said, however, that she had recently been acting very antagonistic toward her dad. Her mother had no clue why. Anna’s father had had long talks with her and went out of his way to be kind and attentive. This didn’t help. Neither her mother nor I could figure out what was going on. Anna just shrugged her shoulders when I asked why she was so angry with her dad. Perhaps she was just having early pubertal “rebellion,” her mother and I concluded. (Be careful when you hear this term, because nine out of ten times, this -isn’t normal. More is brewing beneath the surface of her behavior.)

Two more months went by, and Anna and her mother reappeared in my office. Things had gotten worse at home. Anna didn’t want anything to do with her father and her mother felt crazy. Was she missing something? Was he abusing her? The very thought made her feel guilty and nauseated. But she was so worried about Anna’s behavior that even such terrible possibilities had passed through her mind. After the three of us chatted, I spoke with Anna alone. We retraced recent events in her life to try to pinpoint when the anger had started. School was okay. She had gotten along fine with her dad and brother. She hadn’t gotten into a tangle with anyone at school. I gently probed for evidence of physical or sexual abuse from anyone. Nope, she said. I believed her. Finally she fell forward and her head dropped level with her shoulders. “I saw this show,” she started. My ears perked up. “Well, I didn’t want my parents to know because they would’ve been really mad at me.”

“Anna, what kind of show was it?” I asked.

“I don’t know the name of it or anything. I was just waiting for dinner. I had finished my homework and Mom said that I could watch TV, so I did. While I was flipping through the channels, I just saw this stuff happening. I knew I shouldn’t watch, but I just kind of couldn’t help it.” She stopped, hoping that I would allow her to stop there. Clearly she was upset. She felt guilty, angry, and sick.

I waited. She wasn’t going to talk, so I did. “Anna, who were the people in the show?”

“I don’t know, just this guy and this lady. Yuck. She was kinda, you know, like, naked.”

“I see. What were they doing?”

“Uh. Um. I’m not really sure, but I didn’t like it at all. She had really big boobs showing and this guy was on top of her. But, see, I know all about that stuff ’cause my mom’s told me. But, it was just so weird. I mean, this guy ripped her shirt and he had her pinned down. She wanted to get up and he wouldn’t let her. He was really strong-looking and he was holding her hands down really tight.”

“Anna, I’m so sorry you saw that. That must have made you really upset.”

“I dunno. I guess so. I mean, it’s just a show and all. You’re not gonna tell my mom and dad, are you? They wouldn’t let me watch TV for a long time.”

I changed the subject, knowing that her parents had to know if they were going to help her. “Anna, why did you get so mad at your dad? Does this have anything to do with the show?” I knew, but I wanted her to see the connection.

“Well. I guess I never really thought of it that way. I mean, I know my mom and dad had to have sex once—you know, to have me. Do you think that my dad was like that to my mom? I was just thinking that she had to put up with him being mean and stuff and if she did, it would be my fault. Because if they didn’t have me, then my dad wouldn’t have been mean to my mom. Do you think he hurts her like that?” She looked terribly worried.

“No, absolutely not. Your dad would never do anything like that to your mom. Honey, that’s not normal. That’s television. Sex is really wonderful and is nothing like that at all. I’m sure that your dad would never in a million years hurt anyone that way.” I had to repeat myself to help her believe me.

Anna was having a tough time, but think about her poor dad. For the last two months, in her mind, he had been a sex-crazed, woman-abusing rapist. And he didn’t have a clue what was going on. Does television have an effect on your little girl? You bet it does. But you hold all the power.

Perhaps you come home and notice that she is in her room. You’re exhausted, and even though you assume that she is watching shows you don’t approve of, you feel relieved that she is home and safe, and you’re just too tired to intervene. (A word of advice to make your life easier: don’t let your daughter have a TV, or a computer, in her room. Save TV time for family time when you or your wife can decide what to watch.)

You’re tired a lot. If you’re reading this, you are a motivated, sensitive, and caring father. You are a good man, but you’re probably exhausted. For you, there is great news and bad news.

The great news is that in order to experience a richer life and raise a fabulous daughter, you don’t need to change your character. You need only to indulge what’s best in your character. You have everything you need for a better relationship with your daughter. You don’t need to “find your feminine side,” or stop watching football or drinking beer, or talk about the details of sex, birth control, and condoms with your daughter. Sure, your daughter needs your guidance, attention, and instruction, but talking to her about the serious issues of life is easier than you think.

Here’s the bad news. You need to stop in your tracks, open your eyes wider, and see what your daughter faces today, tomorrow, and in ten years. It’s tough and it’s frightening, but this is the way it is. While you want the world to be cautious and gentle with her, it is cruel beyond imagination—even before she is a teen. Even though she may not participate in ugly stuff, it’s all around her: sexual promiscuity, alcohol abuse, foul language, illegal drugs, and predatory boys and men who want only to take something from her.

I don’t care whether you’re a dentist, a truck driver, a CEO, or a schoolteacher; whether you live in a 10,000-square-foot home in rural Connecticut or a 1,000-square-foot apartment in Pittsburgh—ugliness is everywhere. Once upon a time ugliness was somewhat “contained”—gangs, drug pushers, and “the bad crowd” stayed in defined pockets, in certain neighborhoods and schools. No more. The ugliness is all around.

Believe it or not, I’m not a doom-and-gloom doctor. I always hope that kids have dodged the ugliness or have been “tough enough” to buck the bad stuff. Many times—especially over the last ten years—I’ve had a beautiful thirteen- or fourteen-year-old girl in my office and wondered whether I should ask her about sexual activity. I don’t want to. I know that if I find out she is having sex, my heart will sink. She is too young. The risks are too high.

Finally the wiser, clinical physician part of my brain wins. I ask, “Are your friends sexually active?” (That’s the easiest way to find out if she is.) “Do you have a boyfriend?” “What about sex—have you thought about it? Done it?” Here is where the tricky part comes in. “Sex” to kids means sexual intercourse. So I can’t leave it at that. Sadly, I have to ask very specific questions about her sexual behavior.

Here is my point. Over the last ten years I’ve had hundreds of these interactions, and I can’t tell you how many times a “good kid” looks down at the ground and nods.

As sad as this is, it makes sense, and we will go into detail as to why in a later chapter. But, fathers, you need to know that your daughters are growing up in a culture that is yanking the best right out of them. Am I exaggerating about the world your daughters face? You decide. Let’s look at some national data about girls, and some about boys as well.

Sexual Activity
• One in five Americans over age twelve tests positive for genital herpes.
• Herpes type 2 infections increased 500 percent during the 1980s.
• 11.9 percent of females will experience forced intercourse.
• 40.9 percent of girls fourteen to seventeen years old experience unwanted sex, primarily because they fear that their boyfriends will get angry.
• If a teen girl has had four sexual partners, and her boyfriend has had four partners, and the two have sex, she is exposed to fifteen sexual partners.
• If the above number increases to eight partners each (not unusual, particularly in college), your daughter is exposed to 255 partners.
• 46.7 percent of students (girls and boys) will be sexually active before high school ends.
• There are five to six million new cases of human papillomavirus (HPV) infections annually.
• HPV is spread through sexual contact. Some HPV strains cause cancer, some don’t. HPV is responsible for approximately 99 percent of all cervical cancer cases in women.
• A teen girl is at greater risk for dangerous sexually transmitted diseases because the skin overlying her cervix (epithelium) is immature. While she is a young teen, her cervix is covered with a layer called columnar epithelium. As she matures into her twenties, this is replaced with squamous epithelium, which is more resistant to viruses and bacteria.
• If a girl takes oral contraceptives for more than five years, she is four times more likely to develop cervical cancer. This is most likely due to an increased number of partners and poor condom use.
• As many as 90 percent of people infected with herpes type 2 do not know they are infected.
• Forty-five million people in America are infected with herpes type 2, and one million become infected each year.

• 35.5 percent of all high school girls have had sad, hopeless feelings for longer than two weeks. Many physicians call this clinical depression. 12.4 percent of African American females, 18.6 percent of Caucasian females, and 20.7 percent of Hispanic females have made suicide plans in the last year.
• Engaging in sex puts girls at higher risk for depression.
• 11.5 percent of females attempted suicide last year.

• 27.8 percent of high school students (female and male) drank alcohol before age thirteen.
• Within the last year, 74.9 percent of high school students (female and male) have had one or more drinks each day for several days in a row.
• Within the last month, 44.6 percent of high school girls have had one or more drinks per day.
• 28.3 percent of high school students (female and male) had more than five drinks in a row on more than one day in the last month.

• 8.7 percent of high school students have used cocaine in various forms.
• 12.1 percent of high school students have used inhalants one or more times.

Media Use (TV, computers, DVD, video games, music)
• Kids spend, on average, 6.5 hours per day with media.
• 26 percent of the time, they are using more than one device. This means that 8.5 hours’ worth of media exposure per day is packed into 6.5 hours. (This is equivalent to a full-time job.)
• Kids spend more than three hours a day watching TV.
• They read an average of forty-five minutes a day.
• Kids with TVs in their bedrooms watch, on average, an hour and a half more TV per day than kids who don’t have TVs in their bedrooms.
• 55 percent of homes get premium cable channels like HBO.
• HBO and Showtime had 85 percent (the highest amount) of violent programming.

The disturbing data goes on and on, but some trends do appear to be reversing. Many schools have anti-gang programs, as well as programs that discourage underage drinking and programs against smoking or taking illegal drugs. The number of teen pregnancies—and the rate of teen sexual activity—might be declining. But whatever hints of progress we might have, they’re not nearly enough. Your daughter is still at terrible risk—and fathers are what stand between daughters and this toxic world.

Don’t think you can’t fight her “peers” or the power of pop culture. Exactly the opposite is true. Yes, the four Ms—MTV, music, movies, and magazines—are enormous influences that shape what girls think about themselves, what clothes they wear, and even the grades they get. But their influence doesn’t come close to the influence of a father. A lot of research has been done on this—and fathers always come out on top. The effects of loving, caring fathers on their daughters’ lives can be measured in girls of all ages.

Young Girls
• Toddlers securely attached to fathers are better at solving problems.
• Six-month-old babies score higher on tests of mental development if their dads are involved in their lives.
• With dads present in the home, kids manage school stress better.
• Girls whose fathers provide warmth and control achieve higher academic success.
• Girls who are close to their fathers exhibit less anxiety and withdrawn behaviors.

Older Girls
• Parent connectedness is the number-one factor in preventing girls from engaging in premarital sex and indulging in drugs and alcohol.
• Girls with doting fathers are more assertive.
• Daughters who perceive that their fathers care a lot about them, who feel connected to their fathers, have significantly fewer suicide attempts and fewer instances of body dissatisfaction, depression, low self-esteem, substance use, and unhealthy weight.
• Girls with involved fathers are twice as likely to stay in school.
• A daughter’s self-esteem is best predicted by her father’s physical affection.
• Girls with a father figure feel more protected, have higher self-esteem, are more likely to attempt college, and are less likely to drop out of college.
• Girls with fathers who are involved in their lives have higher quantitative and verbal skills and higher intellectual functioning.
• 21 percent of twelve- to fifteen-year-olds said that their number-one concern was not having enough time with their parents. 8 percent of parents said their number-one concern was not having enough time with their kids.
• Girls whose parents divorce or separate before they turn twenty-one tend to have shorter life spans by four years.
• Girls with good fathers are less likely to flaunt themselves to seek male attention.
• Fathers help daughters become more competent, more achievement-oriented, and more successful.
• Girls defer sexual activity if their parents disapprove of it, and they are less likely to be sexually active if their parents disapprove of birth control.
• Girls with involved fathers wait longer to initiate sex and have lower rates of teen pregnancy. Teen girls who live with both parents are three times less likely to lose their virginity before their sixteenth birthdays.
• 76 percent of teen girls said that fathers influenced their decisions on whether they should become sexually active.
• 97 percent of girls who said they could talk to their parents had lower teen pregnancy rates.
• 93 percent of teen girls who had a loving parent had a lower risk of pregnancy.
• A daughter from a middle-class family has a fivefold lower risk of out-of-wedlock pregnancy if her father lives at home.
• Girls who lived with their mothers and fathers (as opposed to mothers only) have significantly fewer growth and developmental delays, and fewer learning disorders, emotional disabilities, and behavior problems.
• Girls who live with their mothers only have significantly less ability to control impulses, delay gratification, and have a weaker sense of conscience or right and wrong.
• When a father is involved in his kids’ day-to-day activities, they are more likely to confide in him and seek his emotional support.
• Parental control and monitoring are effective deterrents against adolescent misbehavior.
• Kids do better academically if their fathers establish rules and exhibit affection.

Your daughter takes cues from you, her father, on everything from drug use, drinking, delinquency, smoking, and having sex, to self-esteem, moodiness, and seeking attention from teen boys.

When you are with her, whether you eat dinner and do homework together or even when you are present but don’t say much, the quality and stability of her life—and, you’ll find, your own—improves immeasurably. Even if you think the two of you operate on different planes, even if you worry that time spent with her shows no measurable results, even if you doubt you are having a meaningful impact on her, the clinical fact is that you are giving your daughter the greatest of gifts. And you’re helping yourself too—research shows that parenting may increase a man’s emotional growth and increase his feelings of value and significance.

Your daughter will view this time spent with you vastly differently than you do. Over the years, in erratic bursts and in simple ordinary life together, she will absorb your influence. She will watch every move you make. She might not understand why you are happy or angry, dishonest or affectionate, but you will be the most important man in her life, forever.

When she is twenty-five, she will mentally size her boyfriend or husband up against you. When she is thirty-five, the number of children she has will be affected by her life with you. The clothes she wears will reflect something about you. Even when she is seventy-five, how she faces her future will depend on some distant memory of time you spent together. Be it good or painful, the hours and years you spend with her—or don’t spend with her—change who she is.

At age eighteen, Ainsley left her small Midwestern hometown and began life at an Ivy League college. She enjoyed her first year, but during her second year something shifted inside her. Now, at age fifty-one, she still can’t explain why she changed that year.

During her sophomore year, Ainsley began acting wild. She drank too much, and was eventually kicked out of school. She had to call her mother and father to tell them that she was returning home. She packed up her posters, books, and disappointment, and drove home alone.

Ainsley spent the next twenty-four hours behind the wheel of her Jeep, frightened, relieved, and anxious. What would her parents say? Would they cry, scream, or both? In the midst of her wondering, something felt peculiarly good. She didn’t know how or why, but she wanted her parents to help her figure out life for the next six months.

When she finally parked in the driveway of her parents’ house, she saw her dad’s Chevy in the garage. No one met her outside. She walked up the steps and peered like a stranger through the window to see them before they saw her. They were drinking coffee in the kitchen. Somehow this made her feel more in charge.

The door was unlocked. Ainsley said that the next few minutes changed her life forever. As she pushed the door open, she saw her mother first, her face puffy and red from crying. She looked tired, angry, and sad. Ainsley went to her and hugged her.

Then she saw the look on her father’s face. Anticipating anger and disappointment, she was confused by his expression. He looked strangely calm and kind. She hugged him and wanted to cry but she couldn’t.

Her mother shouted that Ainsley had been foolish. She had thrown away her future. She had shamed their family. Ainsley stood quietly and listened. Then, in the middle of her mother’s lecture, her father came toward her and whispered, “Are you all right?” She burst into tears.

Ainsley realized at that moment that her father knew her better than she knew herself. While she felt confused, she understood that he saw right through her; he recognized, as no one else could, that something was broken inside the girl he cherished. Ainsley’s father didn’t make her work the night shift at McDonald’s or at the local gas station. He waited, he listened, and he kept his hurt to himself. He wasn’t concerned with what family and friends would think. He didn’t worry about how the expulsion would change her future. He was worried about her.

“You can’t imagine how that felt,” Ainsley told me. “It was over thirty years ago. The love I felt from him is as fresh and new as it was then. I knew he loved me. Sure, he was proud of me, but that was always on the periphery of our relationship. He didn’t let his disappointment or anger ever supersede his love. In those moments after I walked through the door, I got a glimpse of who I was in his eyes. I knew then that I, not what I accomplished, was what he cherished.” She stopped abruptly and her nose and cheeks turned red. She smiled through a few plump tears and shook her head, still marveling in disbelief at the man she loved and missed so dearly. Her father made the difference in her life. You will make the difference in your daughter’s life.

You have to—because, unfortunately, we have a popular culture that’s not healthy for girls and young women, and there is only one thing that stands between it and your daughter. You.

Fathers inevitably change the course of their daughters’ lives—and can even save them. From the moment you set eyes on her wet-from-the-womb body until she leaves your home, the clock starts ticking. It’s the clock that times your hours with her, your opportunities to influence her, to shape her character, and to help her find herself—and to enjoy living. In the chapters that follow, we’ll look at how fathers can help their daughters: physically, emotionally, intellectually, and spiritually.

August 22, 2013

The Seven Secrets to Raising Healthy Boys

1. Know how to encourage your son. One fault is babying and spoiling him. But another is being so harsh that you lose communication with your son and destroy his sense of self-worth. We’ll look at how to strike the right balance.

2. Understand what your boys need. Guess what? It’s not another computer game; it’s you. We’ll look at how to get the most of your time with your son.

3. Recognize that boys were made for the outdoors. Boys love being outside. A healthy boy needs that sense of adventure—and the reality check that the outdoors gives him.

4. Remember that boys need rules. Boys instinctively have a boy code. If you ­don’t set rules, however, they feel lost.

5. Acknowledge that virtue is not just for girls. Boys should, indeed, be boys—but boys who drink, take drugs, and have sex outside of marriage ­aren’t “normal” teenagers, they have been abnormally socialized by our unfortunately toxic culture. Today, my practice as a pediatrician has to deal with an epidemic of serious, even life-threatening, problems—physical and psychological—that were of comparatively minor concern only forty years ago. A healthy boy strives after virtues like integrity and self-control. In fact, it is virtues like these that make a boy’s transition to manhood possible. They are necessary virtues, and he needs your help to acquire them. I’ll show you how.

6. Learn how to teach your son about the big questions in life. Many parents shy away from this, either because they are uncomfortable with these questions themselves, or want to dismiss them as unimportant or even pernicious, or because they ­don’t want to “impose” their views on their children. But whatever one’s personal view, your son wants to know—and needs to know—why he’s here, what his purpose in life is, why he is important. Boys who ­don’t have a well-grounded understanding on these big questions are the most vulnerable to being led astray into self-destructive behaviors.

7. Remember, always, that the most important person in your son’s life is you. Being a parent can often seem a daunting task. But I’m here to tell you that almost every parent has what it takes to raise healthy sons. You have the intuition, the heart, and, yes, the responsibility to change the life of your son for the better. This book is a step toward showing you how.

August 12, 2013

The Epidemic is Real

THIS BOOK ISN'T JUST ABOUT LORI, Alex, and Holly. It is about an epidemic of sexually transmitted diseases that is invading the lives of all of our teens. It is about our future and the future of our country. It is about the suffering (both physical and emotional) occurring in the kids we love so much today, and the suffering that will occur five, 10, even 20 years from now. It's about how this epidemic will affect our children's ability to have their own, and even whether those children—our grandchildren—will live long, healthy lives or die prematurely.

Consider that this year alone, 19 million Americans will contract a new sexually transmitted disease. More to the point, 2 million to 4 million of those infected will be teenagers. Some will be infected with not just one, but two or three diseases. Overall, 25% of teens—one out of every four adolescents—who are sexually active will contract a sexually transmitted disease (STD) today. Even more outrageous is the fact that although teenagers make up just 10% of the population, they incur 25% of these diseases.

Every day, 21,000 teens will become infected with a new STD. In fact, a British study found that almost half of all girls are likely to become infected with an STD during their very first sexual experience. We have a serious problem on our hands.

While the statistics may shock you, they've become a part of daily life for me. Every day, one-third of the sexually active teenage patients I see have a sexually transmitted disease. Yes, I said one-third. It might be herpes, or human papilloma virus (HPV), or chlamydia. Every once in a while one turns up with gonorrhea or syphilis. More rarely, I have to tell a kid still wexcxcaring braces he has HIV, the virus that causes AIDS.

I and hundreds of doctors like me are on the front lines of this epidemic. We see precancerous conditions in girls as young as 14, infertility in girls barely old enough to get pregnant, babies infected with STDs their mothers didn't know they had, and infants born with herpes-caused encephalitis infections, which cause massive brain swelling. We see our children dying from HIV or cancer caused by HPV—dying before they've barely had a chance to live.

Public health officials call this explosion of STDs among our children a "hidden epidemic." From where I sit, as a practicing adolescent doctor, I couldn't agree more.

This is an epidemic, for sure, but it is a silent epidemic. For this epidemic, there is no public outrage, no television news magazine exposé, no based-on-a-true-story movie about crusading advocates fighting this scourge, no Congressional hearings, and no Race for the Cure. And yet this epidemic is just as serious as any health emergency you can think of. It threatens the very lives of our children and the future health of our country.

It's time this epidemic comes out from the shadows. Only then, when we've begun to understand the magnitude, to comprehend the scope, to shine the light of knowledge and understanding on this terrifying scourge, can we begin talking about solutions.

And the scope is immense. Trying to wrap your mind around it is like trying to comprehend distance in light-years. Consider:
  • This year, 8 to 10 million teens will contract an STD.
  • Nearly one out of four sexually active teens is living with a sexually transmitted disease at this moment.
  • Nearly 50% of African-American teenagers have genital herpes.
  • Although teenagers make up just 10% of the population, they acquire between 20 and 25% of all STDs.
  • Herpes (specifically, herpes simplex virus type 2) has skyrocketed 500% in the past 20 years among white American teenagers.
  • One in five children over age 12 tests positive for herpes type 2.
  • Nearly one out of ten teenage girls has chlamydia, and half of all new chlamydia cases are diagnosed in girls 15 to 19 years old.
  • STDs accounted for 87% of all cases reported of the top-ten most frequently reported diseases in the United States in 1995.
Even more terrifying is that these numbers are only guesstimates. Because most STDs have no symptoms, experts can only estimate the scope of the epidemic. The actual figures, some say, are many times higher. In February 2002, an editorial in the esteemed Journal of the American Medical Association reported that the number of people with asymptomatic STDs (those that have no outward signs, like lesions or warts) probably exceeds those whose diseases have been diagnosed.

Here's another way to look at it: Picture a football stadium filled with teenagers. Start counting. One in five cheering kids has herpes. One in four has some type of STD and one in ten has chlamydia. If we pulled all the healthy kids out of there, leaving just those teens infected with an STD, the stadium would still be nearly full.

An epidemic occurs when, in a particular community, there is an extensive and growing prevalence of a disease that attacks many people simultaneously.

Using that definition, there is no question that our teenagers are experiencing an epidemic of sexually transmitted diseases.

Epidemic is also defined as a disease that does not naturally exist within a certain place. When it comes to STDs, that place is our kids' bodies. Our teens have naturally occurring yeast and bacteria in their bodies that act to enhance their health, aiding in digestion and helping maintain healthy homeostasis. But STDs don't belong in children's bodies. They are foreign invaders. They infect healthy organs and tissues in the reproductive tracts, the bloodstreams, and the mouths of our children.

Furthermore, the STD epidemic is not a single epidemic. The Centers for Disease Control and Prevention (CDC) consider it a multiple epidemic of at least 25 diseases—nearly 50 if you count the various strains of virus groups. The most common STDs are HPV, herpes, chlamydia, hepatitis B, gonorrhea, syphilis, HIV/AIDS, trichomoniasis, and chancroid. And there are a host of others that threaten our kids, most with only clinical names that sound as foreign as another universe. Consider some of them: Mycoplasma hominis; Ureaplasma urealyticum; bacterial vaginosis; granuloma inguinale; shigellosis; Campylobacter; hepatitis A, C, and D; cytomegalovirus; genital molluscum contagiosum; human T-cell lymphotrophic virus types 1 and 2; amebiasis; Giardia; and Candida albicans.

All of these wreak havoc on young bodies in different ways; some work quickly, some take their toll slowly.

It's so hard to grasp the vastness of these infections. Just picture flying 10,000 feet above Yellowstone National Park, looking out the window, and seeing thousands of small fires. Some are blazing and spreading, others crackle and smolder, and still others just spit out some smoke and a few sparks. Although they all have varying degrees of seriousness, when you're flying at 10,000 feet, all those flames merge and the entire park appears engulfed in fire. That's what's happening to the population of our kids.

In the 1960s, a simple shot of penicillin could cure the two known STDs: syphilis and gonorrhea. Today, there are no simple cures and in many cases there are no cures at all.

Take herpes. Currently, more than 45 million Americans are infected with the herpes simplex type 2 virus because there is no way to cure it. A 1997 study published in The New England Journal of Medicine sent shock waves through the medical community when its authors reported that 20% of those 12 and older tested positive for this strain of herpes. Initially, I, like many physicians and parents I speak to, assumed the researchers were testing people in STD clinics. So of course the numbers would be high; these people are going to the clinic because they think they have an STD. But that was not the case. The researchers tested people in the general population, not groups of people with high-risk behavior. When I tell audiences about this, many don't believe me. I had to read the article twice to believe it myself.

Overall, teenagers today are five times more likely to have herpes than they were in the 1970s.

This should terrify you as much as it does me, since herpes spreads only through sexual contact, and can remain hidden with no symptoms for months or years. Herpes is a lifelong disease that can resurface again and again, causing bouts of painful genital ulcers, disrupting lives, putting barriers between its victim and his or her partner, providing a constant reminder of mistakes made 10, 20, 30 years ago. Not something you want your teenager to live with.

Or consider HPV, one of the most prevalent sexually transmitted diseases in this country. HPV is the infection most responsible for my personal crusade to help teenagers avoid sex. It has the dubious distinction of being one of the few causes of cancer we know about, and is responsible for 99.7% of cervical cancer cases and the deaths of nearly 5000 women each year.

Men aren't safe from HPV's devastating effects either. The virus is linked to penile and anal cancer, and troubling new research suggests it may also play a role in some head and neck cancers. Although vaccines are being researched, nothing is available today to the general public. Likewise, there is no medication, no treatment that will eliminate the virus. Just careful watching for the first precancerous cells to appear. Even worse: Most victims have no symptoms (just 1% develop genital warts). Having this virus without knowing it is like living with a ticking time bomb.

Then there's HIV, the virus that causes AIDS. You've no doubt heard of the nearly miraculous new drugs for HIV, medications that significantly improve the quality and duration of life for those infected with the virus. Those medications, however, haven't changed the ultimate truth about AIDS: It is fatal.

And although the majority of HIV cases still occur between men having sex with men, the number of HIV-infected women is rising rapidly. In 2000, nearly half (45%) of all AIDS cases among 13- to 24-year-old women were acquired through heterosexual sex. Here's an even more frightening number: More than half (61%) of young people between 13 and 19 who were infected with HIV that year were women. More young women than young men are getting HIV. Again, the disproportion exists even within HIV: Half of all new infections are in our youth!

Even if your child is "lucky" enough to catch a "curable" STD, such as chlamydia or gonorrhea, there's no guarantee that we, her health care providers, will catch and cure it before it causes significant damage. In young girls, for instance, the bacteria that cause these infections can "escape" from the cervical area (where we can get a culture and identify it) into the uterus and up through the fallopian tubes, causing a secondary infection called pelvic inflammatory disease (PID). As it races through their bodies, PID leaves girls' fallopian tubes and ovaries severely scarred and permanently damaged, perhaps rendering these girls infertile, or subject to a potentially fatal tubal pregnancy. We've seen PID rates skyrocket in the past 15 years. Today, almost a quarter of a million teenagers are diagnosed with PID every year, as a direct result of the spread of STDs—and chlamydia and gonorrhea in particular.

The spread of gonorrhea, one of the oldest STDs, was coming down in numbers until the late 1990s, when the rate of infection began inching up again. If you think this STD isn't worth worrying about because a quick dose of antibiotics can cure it, think again. Today, public health officials are alarmed by rising numbers of antibiotic-resistant strains of gonorrhea. And because gonorrhea, like chlamydia, rarely announces its presence with symptoms, teenagers infected with it are at risk for a host of more serious complications, including PID.

The next time you're at the mall, take a moment to observe that pack of teens you're likely to see roaming the storefronts. Chances are good you'll spot a bright young girl sporting a stomach-baring tank top. Even as she window-shops at American Eagle Outfitters, there's a one in four likelihood that a virus is working its way up through her reproductive tract, changing the cells in her cervix so that in a few months, maybe in a few years, she'll find she has a precancerous condition requiring surgery. You may spot a boy in low-rider jeans and a backwards-turned baseball cap. Chances are one in twenty that he's got a sore on his penis he's too embarrassed to ask anyone about. Even if he did get up the courage to ask, he's not sure whom to confide in. And that group of ten girls moving together like a school of brightly colored tropical fish? At least one has a bacterial infection she doesn't know about, an infection that will leave her infertile.

We're not talking about troubled teens: We're talking about all teens—yours and mine. The teens who belong to the church youth group, work at the local gas station, or hand you ice cream across the counter. They have personalities and faces. Look at their faces and see who you think might be infected. If you look at more than five, chances are you'll see at least one infected with a horrible disease.

Black, white, Asian, Hispanic. Rich kids or poor. Straight-A students or dropouts. It doesn't matter. Sexually transmitted viruses, bacteria, and parasites don't discriminate. They attack all sexually active teens. Consider just one example:

An astonishing 15 to 20% of all young men will be infected with the herpes virus by the time they reach adulthood.

The reasons for the current epidemic among our children are clear. I'll outline just a few of them here; later in the book, I'll go into much more detail.

Birth control and condoms. Public health officials and doctors have been fighting teen pregnancy for decades now with two heavy-duty weapons: oral contraceptives and condoms. The overwhelming goal that we've dealt with has been to reduce teen pregnancy. Congratulations: Teen pregnancy dipped in the late 1990s, and now every year, about 1 million teen girls get pregnant.

I myself worked for nearly a decade prescribing birth control to teens. I believed that oral contraception was the most powerful weapon I had to help teens avoid life-altering dilemmas that can and do cause irreversible physical and psychological harm. But I realize now that what we've been doing has been akin to rearranging the deck chairs on the Titanic. We now face a gargantuan consequence of that sexual freedom: At the same time teen pregnancies declined, the STD epidemic shot through the roof. The sexual freedom that birth control allows teens has done a good deal to promote the rise in disease.

Condoms are no answer either. As you'll see in Chapter 7, condoms do little to prevent many viral infections spread by skin-to-skin contact, especially HPV and herpes. We've talked for decades about "safe sex," and while condoms are somewhat effective at birth control, when it comes to STDs, the best they can do is reduce the risk of infection. And the risk of reduction, as you'll see, is far too inadequate and in some cases nonexistent.

What they don't know can hurt them. If you figured the sex education classes your teenager takes in middle and high school would include information about STDs, think again. One study found that most teens fail a simple test on their knowledge of STDs. When researchers gave 66 young adults (13 to 24 years old) attending a health fair a 13-question exam, most came up with only six correct answers. Some of the questions stumped nearly everyone.

Four out of five, for example, didn't know that most people who get an STD never develop symptoms.

They're starting too young. Half of all students in ninth through twelfth grade have had sexual intercourse. This is particularly dangerous, since studies show that the earlier a teen begins having sex, the more partners he or she will have. In fact, of those having sex, between 12 and 20% have had four or more sexual partners in their young lives. The more partners, the more exposure to infection. The 17-year-old who's had six sexual partners (all of whom have had six sexual partners, and so on and so on) may have been exposed to the diseases of 63 people.

I cannot stress this enough:

The longer a teen can wait to begin sexual activity, the less likely it is that he or she will contract a sexually transmitted disease.

They're confused about what "sex" means. Millions of American teenagers have seen infamous sex scandals unfold on the six-o'clock news, codes of acceptable language disappear from television and popular music, and an inescapable deluge of sexual images floods movies, electronic games, magazines, and comic books. Sexual pictures, stories, and advertising copy pop up on their computer screens while they're doing their homework. No wonder the very definition of sex seems unclear to our kids.

Out of the thousands of teens I've counseled, most reason they can safely engage in oral sex and "outercourse" (in which they mutually masturbate with their clothes off). To them, these activities are acceptable recreation, not "real" sex. Since semen doesn't enter the vagina, kids think they're playing it safe, while still maintaining their virginity and staying disease-free. So today they're having oral sex in the back of school buses and in dark movie theaters. (Ask any middle school teacher.)

And oral sex is becoming a fad with kids. Very recent studies show that even oral herpes has shifted from causing 25% of genital herpes infections to 75% of them. How? Through oral sex. Here's another oral sex statistic if you want one: An online sex survey done by Twist magazine found that out of 10,000 girls who responded, over half (5,700) were under 14. Amazingly, 25% of girls who said they were virgins responded that they engaged in oral sex.

Unfortunately, just because they're avoiding penetration doesn't mean they're avoiding disease. Many of these infections can spread simply from any sexual contact—mouth to penis, semen to skin—without intercourse.

Teens are also having group sex, and moving from one relationship to another, often within weeks or even days. Some engage in such behavior for the thrill or because they're bored. Others do it to be popular with their peer group. If you think your kid could never do such things, think again. Peer pressure is subtle, pervasive, and powerful. For the sake of your kids, you cannot afford to be naïve. You need to know exactly what your teen is up to sexually. Your child's life depends upon it.

Teenage anatomy and health. There are differences in a teenage girl's anatomy that make her far more vulnerable to infection than an adult woman is. For instance, the cells covering a teenage girl's cervix are physiologically different from the cells lining a 25- or 30-year-old woman's cervix, and are therefore far more susceptible to infections.

Treating sexually active teens is also more difficult because many parents stop taking their children to pediatricians for regular -checkups and immunizations after age 10 or 12. Yet it is precisely during those adolescent years that health needs climb and teenagers desperately need someone to talk to. I've found that most of the kids who are reluctant to tell their parents they're sexually active are relieved to finally tell someone else—their doctor, for instance. So even if your teenager is healthy and you're certain he's not sexually active, please, take him to see a family physician at least once a year.

Because teens often have questions about psychological issues, their own development, or sex, make sure you choose a doctor who knows how to talk to teenagers, and is willing to give these kids all the time they need to discuss whatever's on their minds. I always schedule my teenage patients for 45-minute visits (instead of the 15-minute visits younger children get) because I know we'll do so much talking.

Allyson's Story
Allyson, a 14-year-old patient of mine, is a perfect example of what I see happening with teens. I'd been seeing her for yearly medical checkups since she was 3 years old. But when she turned 11, her mother stopped bringing her in. Shortly after her 14th birthday, however, Allie returned to my office complaining that she "just wasn't feeling good." Her mother said she'd become irritable, was difficult to be around, and was beginning to run with "the wrong crowd." While her behavior could have been passed off as that of a "normal teen" experiencing some adjustment difficulties, Allyson's mother was finely tuned in to her daughter's moods and knew something was wrong.

I immediately noticed the change in Allyson's physical appearance from the last time I'd seen her. She'd developed quickly, and appeared much older than 14. She wore tight, low-slung pants and a short-cropped shirt that flaunted her well-developed chest. Several holes pierced her earlobes, which peeked out from beneath her long, silky, auburn hair.

After Allyson's mother described her concerns, I asked her to leave, then turned to Allyson. "What do you think about what your mother just told me?" I asked.

Allyson agreed with her mother's descriptions. She said she often felt sad and angry, yet didn't have a clue what was wrong with her. "And I fight and yell a lot," she said, "without understanding why."

As she talked, I could see how relieved she felt to finally let out her concerns. Eventually, after much probing and backtracking, Ally revealed that much of her irritability had begun about six months before. She cried as she described the event that, we concluded, had turned her life upside down.

She'd heard some kids were going to have a "rainbow party," but had no idea what that meant. Still, she thought it might be fun, and arranged to attend with a friend. After she arrived, several girls (all in the eighth grade) were given different shades of lipstick and told to perform oral sex on different boys to give them "rainbows." Once she realized what was happening, Allyson was too stunned and frightened to do anything. When a girl gave her some lipstick, she refused at first but, with repeated pressure, finally gave in. "It was one of the grossest things I've ever done," she told me, crying. Afterward, she said, "I just wanted to hide and die. I felt like vomiting."

When it was over, she couldn't even look at the boy on whom she'd performed oral sex. Over the next several weeks and months, her crying spells and bouts with self-disgust felt overwhelming. Her self-esteem plummeted, and her angry eruptions at her mother, who was the person closest to her in the whole world, precipitated a breakdown in their relationship. She began dressing in sexually explicit ways, garnering attention from boys while at the same time hating their attention. Within a few months, she began having intercourse with boys. This was the point Allyson had reached when her mother brought her in to see me.

I checked Allyson for sexually transmitted diseases and, fortunately, didn't find any. I also performed a Pap smear, checking for any precancerous changes in her cervix that could have been caused by HPV. Again she was fortunate—I didn't see anything suspicious. However, I knew from long experience as a physician that she was quite likely to go on and become even more sexually active. And it was equally likely that most of the other girls—and boys—at the party would continue to be sexually active.

I spent a long time with Allyson that day, reassuring her that her feelings of sadness and disgust were normal, healthy reactions to the trauma she had been through. She had begun to believe she was going crazy because the other kids around her seemed to believe what happened was okay.

Allyson was suffering from depression and post-traumatic stress disorder. We talked that day about depression and she agreed to get help. For the next nine months, she saw a counselor once a week. Today, she's doing well. She's more careful in choosing her friends, although she has difficulty trusting people. She no longer wears sexually explicit outfits, and she abandoned her black clothing as her depression lifted. But after two years, she still needs more time to heal.

Allyson was and is a normal, healthy, all-around great kid who happened to be in the wrong place at the wrong time. Because of that, however, I have to see her every six months to check for precancerous changes or other "hidden" STDs, and the emotional scars of her experience will remain for life.

But at least Allyson got help. I often wonder how many more Allysons are roaming our high schools, feeling depressed and crazy from one, two, or three similar sexual episodes. Because I know, based on the hundreds of teenage girls I see and talk to, that only a handful say they enjoy the experience. If it were just a matter of kids doing something they didn't like, I wouldn't care. Let them do crazy stuff if it doesn't hurt them or anyone else. But sex does hurt our teens, physically and emotionally, and we must care enough to get in the way.

I've been lecturing on adolescent sexuality and high-risk behavior in teens for more than six years. Everywhere I go, I hear the same question from parents, doctors, and educators: Why didn't we know about this? Where has this data been?

It's been right in front of us. But we haven't wanted to see it. We live in a world so saturated with sexuality that we no longer know the meaning of it. Television, movies, magazines, and music tell us what we want to hear: Sex is fun, and has no attached repercussions, certainly no diseases.

Mayhem in the Media
Consider Friends, one of the top-rated television shows for the past several years. Here we see half a dozen young people sleeping with each other or with other people while rarely making a peep about protecting themselves from sexually transmitted diseases. Statistically speaking, at least one character in the show—Monica? Joey?—must have an STD, but we never hear about that. Instead, in the rarefied world of Friends, the only repercussions to sleeping around are pregnancy and the occasional heartbreak.

In the music media, the images are even more suggestive. Popular music blares out sexually explicit lyrics. CDs are filled with line after line of expletives and raunchy themes, such as those, for example, from the popular hip-hop rapster Ja Rule.

In one song from a current CD, "Livin' It Up," this singer calls women "bitches," sings about "s*cking d*ck," "f***ing," having phone sex, and in general treating women in abusive ways. In another song, "Always on Time," he raps about sex being a game, "smacking your *ss," and "f***ing you all wild." These are just a very few illustrations in any one track.

Consider another popular artist, Lil' Kim. Her song titles alone, such as "S*ck My D*ck" and "F**k You," tell an indecent story. In addition, you may be surprised to hear the sentiments in songs such as "How Many Licks," in which she sings about "Dan," her "nigga from Down South," and how he liked her to "spank him" and have her "c*m in his mouth." The song goes on to list a number of "lovers," and depicts graphic images of oral sex, rough sex, large sex organs, and dominance.

One more example: Kid Rock, another artist popular with teens, who created the song "F**k Off" in 1998. Here, the Kid has been "f***ing all your bitches," and, as he says, "don't f***ing give a goddamn." In another verse, Kid Rock says he won't leave a party until he sees "naked bitches" dancing drunk and "touchin' each other." The chorus: "F**k Off."

(Author's note: I've used paraphrases and images from these songs to give you an idea of the baseness of the sentiments being communicated to our kids. It was tough enough to even type the above paragraphs, let alone read the actual lyrics. But I encourage you to do so to see firsthand the brutal sexual messages that exist here. Note, too, that these are popular artists. Incredibly, some of rapper Eminem's lyrics are even worse; he writes about raping then killing women. This is "popular" stuff with many kids across all social and economic ranges.)

And yet, while the media aggressively and persistently sells sex and sexual freedoms to us and our children, doctors like me "mop up the messes" every day in our offices.

Curriculum for the Classroom
There is another even more worrisome reason for our ignorance: a conspiracy operating behind the scenes of public school sex education. Just a handful of writers design the curriculum for these classes, affecting millions of American children with their decisions and their agenda. And I do believe they have an agenda: to maintain sexual freedoms rather than prevent disease, maximize psychological health, and ensure healthy sexuality among our teens.

Just consider the guidelines from the Sexuality Information and Education Council of the United States (SIECUS), an advocacy organization that has heavily influenced the sex education curriculum in many of our public schools. The purpose of the guidelines is to provide a framework for educators who wish to teach our children about sex. The claim is that sex education "assists children in understanding a positive view of sexuality, provides them with information and skills about taking care of their sexual health, and helps them acquire skills to make decisions now and in the future." Do the SIECUS guidelines live up to that claim? Here are a few of them. Decide for yourself.
    For children ages 5 to 8
  • Sexual intercourse occurs when a man and woman place the penis inside the vagina.
  • Touching and rubbing one's own genitals to feel good is called masturbation.
  • Boys and girls have body parts that feel good when touched.
  • Some men and women are homosexual, which means that they will be attracted to and fall in love with someone of the same gender.
    For children ages 9 to 12
  • Words related to sexuality that may be appropriate with friends may not be appropriate at school, home, or work.
  • Masturbation is often the first way a person experiences sexual pleasure.
  • Being sexual with another person usually involves more than sexual intercourse.
  • Sexual intercourse provides pleasure.
  • When a man and woman want to have vaginal intercourse without having a child, they can use contraception to prevent pregnancy.
  • Homosexual love relationships can be as fulfilling as heterosexual relationships.
    For children ages 12 to 15
  • People should use contraception during vaginal intercourse unless they want to have a child.
  • Masturbation, either alone or with a partner, is one way a person can enjoy and express their sexuality without risking pregnancy or an STD/HIV.
  • When two people express their sexual feelings together, they usually give and receive pleasure.
  • Being sexual with another person usually involves different sexual behaviors.
  • People may fantasize while they are alone or with a partner.
  • Having an abortion rarely interferes with a woman's ability to become pregnant or give birth in the future.
    For children ages 15 to 18
  • Some sexual behaviors shared by partners include kissing; touching; talking; caressing; massaging; sharing erotic literature or art; bathing or showering together; and oral, vaginal, or anal intercourse.
  • Some people use erotic photographs, movies, or literature to enhance their sexual fantasies when alone or with a partner.
  • Some sexual fantasies involve mysterious or forbidden things.
  • Most people enjoy giving and receiving pleasure.
Once you review these statements, it seems clear that SIECUS places sexual freedom for teens above their health. As long as the idea of sexual freedom remains the driving force behind national sex education, the STD epidemic will continue.

In many ways our efforts as a society and, in some instances, as parents to be open-minded and mature about our children's sexuality, to understand their sexual freedoms, have backfired. Many parents were taught that one cannot judge youngsters who choose early sexual activity because to do so would violate some inalienable personal right. Some parents and educators find themselves trapped in a no-man's-land: believing in personal and sexual freedom, yet facing deadly diseases spawned by unrestrained and premature sexual activity.

The epidemic of STDs our children face is too serious to ignore. The only way to stop it is to curb the conspiracy of those who urge total sexual freedom and argue that it has no costs and causes no harm.

How do we do this? We must stand between our kids and the media and big businesses who aggressively sell them sex. If we fail to teach teens to postpone sex as long as possible, the price they pay may be their very lives.

Teaching them won't be easy. Some won't listen. Some will argue. Some will nod their heads at everything we say, then go off and do as they please. But with patience, honesty, and determination, we can help them understand. And we must. As parents and concerned adults who love the children in our lives, it is our responsibility to do so. The other piece of the puzzle—knowledge, based both on solid research and on real-life experience—is what I hope you will find in the chapters ahead.

From Your Kids at Risk: How Teen Sex Threatens Our Sons and Daughters by Meg Meeker, M.D. Regnery Publishing, Inc., Washington, DC. Copyright 2007.