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.

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