Sex and Teens: When Knowledge Does Not Translate Into Action

Little by little, the American public is becoming aware that providing teens with a small amount of accurate sexual information seldom leads to avoiding sexual contact. Communities around the country are saying "no" to "Just Say No" as a reliable way to deter the initiation of sexual activity with a partner during the teen years. But, we still have some learning to do as providers of sex education. Here's a study that shines a bright light on one aspect of the problem.

A study done in New York City involving 92 men and women between 18 and 24 enrolled at an urban city college found that even when armed with information, students often overestimated their safety from sexually transmitted diseases. What researchers O'Sullivan, Udell and Patel (reported in The Journal of Sex Research, Nov. 2006) found was a seeming paradox in which young people continued to engage in unsafe sexual practices despite a moderate to high level of general knowledge about the risk of contracting HIV. These college students were ethnically diverse and resided in inner-city neighborhoods characterized by very high rates of HIV. They recorded their sexual activity over a two-week period.

Despite their knowledge about HIV transmission and the need to use condoms during intercourse, students engaged in risky sexual activity over the two-week period at relatively high levels -- as well as during the two months that preceded the study. This tells us that these young people had not effectively integrated general knowledge about HIV into their personal lives in ways that could help them prevent infection. Or it tells us that they were unwilling or unable to incorporate the few means of prevention available -- abstinence, sexual behaviors that did not exchange bodily fluids, or condom use.

How much were they ignoring what they knew?

Many were having intercourse within what they believed to be a monogamous relationship. Whether that was, in fact, the case we cannot know -- about 80% had a romantic partner, but only one was married and nearly all of them did not live with their sexual partner but at the home of their parent(s).

Nevertheless, one fifth of them had two or more sexual partners during the two-week period, as well as in the two months preceding the study. These are likely to be underestimates of the actual rates of multiple sexual partners since under-reporting in sexual surveys is quite common and generally more common than over-reporting -- particularly among women.

Women did link some of their beliefs of being safe from sexually transmitted conditions to the use of a condom, but they also reported this feeling of safety when there were no condoms used and bodily fluids were exchanged. It seems they based this feeling on a hunch, trust, or wishful thinking.

People may plan to refrain from intercourse, engage in foreplay with the expectation of using a condom at the next stage, or initiate sex believing that they will interrupt the process to do so. Yet they may underestimate: the power of the situation, their desires, or possibly the concerns in the moment about their partner's reactions to their plan for safer sex. Resolutions do break down in the "heat of the moment." It's my strong suspicion that this scenario is not limited to inner-city young adults.

Lessons from sex education and sexually transmitted disease efforts nationwide have not been sufficiently integrated into the private lives of young people in ways that motivate or enable them to choose and follow through on safer sexual practices. It means that we still have a long way to go in reaching and influencing the decision-making processes related to the risks of sexual behaviors. We need to develop more public health and educational interventions to promote healthy sexual behaviors.

Related Topics:

• WebMD Video: HIV Education
• Kids' Safe Sex: Supportive Mom is Key

Technorati Tags: sex education, parenting, public health, HIV

What Some Sex Offenders Have in Common

A Canadian study conducted on 701 adult men who were patients in the Kurt Freund Laboratory of the Centre for Addiction and Mental Health found some interesting similarities in the life histories of some types of sex offenders. Before I describe the findings, bear with a few definitions so that the findings make some sense.

The men were divided into four groups based on their histories and their responses to sexual materials. They were:

1. Pedophiles: Men sexually interested in prepubescent children (114 men)
2. Hebephiles: Men sexually interested in pubescent children ( 377 men)
3. Teleiophilic Offenders: Men sexually interested in adults and who had committed a sexual offense against an adult (139)
4. Teleiophilic Non-Offenders: Men sexually interested in adults and who had no known history of any sexual offenses ( 71 men).

The researchers examined many aspects of these four groups of men. What showed up was this: When compared to Teleiophilic Offenders, the Pedophilic and Hebephiles and Pedophiles showed about double the odds of failing a grade in school or being enrolled in special education classes.

There were no significant differences between the Teleiophilic Offenders and the Teleiophilic Non-Offenders on these two facets of their history. The four groups studied showed rates of grade failure or special education placement of approximately 30 to 60%. These are much higher than that of the general population.

The researchers concluded that these findings were consistent with the hypothesis that an erotic age preference for children sometimes results from what they called a "perturbation of neurodevelopment" occurring in early life -- specifically prenatally or perinatally. They did not specify in their publication in Archives of Sexual Behavior, Dec. 2006 what the "perturbations" would be but the inclusion of both "before" birth and "just after birth" offers us much to think about -- from genetics, to pregnancy conditions, to trauma and injuries.

It is important not to hop on some runaway train with this research. This does not mean that men who have had special education or failed a grade should be hunted down, forced out of town, or put on some list. These men all probably drank milk as well.

What is interesting is that the men who were sex offenders of children often (though not always) had markers of neurological impairment. This is one very interesting step toward understanding the multifactorial path in which many circumstances join together to result in pedophilia or hebephilia and much, much less often resulting in sex offense directed toward adult victims.

Why do I mention the research at all? To suggest that there may be room for a small amount of compassion toward such offenders -- along the same lines of the often quoted, " Hate the sin, but love the sinner." I look forward to a day when our knowledge of the causes of sex offenses are so well understood that our society could curtail them all together.

Related Topics:

• Explaining Pedophilia
• Protecting Your Child from Sex Abuse

Technorati Tags: crime, sexuality

The Futile Path of Exhibitionism

Exhibitionists tend to be like gamblers. They know that the odds are stacked against them, but they think that if they just keep doing it, they'll hit that elusive jackpot. I would venture to guess that the odds of "winning" are even worse for exhibitionists. Finding that one in a zillion woman who will be aroused by an unplanned encounter with a man flashing his genitals at her is nearly impossible.

Each of the exhibitionists that I have treated in my therapy practice had the hope of a woman seeing him engaged in his sexual act (often masturbation) and her finding it sexually arousing -- extremely so. They often picture the woman thinking, "Wow! This is my lucky day!" But in all the times that I treated these men in my therapy office, none of them could report an incident in which the woman was aroused. They were all disgusted and/or afraid.

I have fielded questions from exhibitionists on the Sex Matters Message Board and in that anonymous setting, some were pretty candid about what they were doing. One man admitted that he had done it five times in the prior month. His compulsion was in high gear and he was on a clear path to arrest and the potential destruction of so much of his future. He needed to be in sex therapy right away.

But, it's often difficult to persuade the exhibitionist of the level of risk that he's taking. I've treated men from many walks in life -- from ministers to Air Force pilots -- who did this and saw their careers come crashing down. They wound up with the lifelong tag of "sex offender."

Though most exhibitionists don't have harm in mind for the women they "flash," that's not how most women view it. Women tend to view it as very threatening and one step away from assault. I'm probably the exception. Here's my story:

One night about fifteen years ago, I was walking to my car after leaving my San Francisco office. I had stayed late to complete paperwork, so it was about 8 p.m. I was going to be on a national TV show the next morning and was deep in thought about what I was going to say -- and I was exhausted.

Since one of San Francisco's few shortcomings is parking, I was walking about two blocks uphill into Pacific Heights (an elegant area) to my parked car. Nearly to my car, a BMW sedan pulled up next to me. A 30-ish, reasonably attractive man was driving. I expected him to roll down his window and ask where such-and-such singles bar was since there were a few nearby.

Instead, he got out of his car. He was wearing a white cotton men's business shirt, a necktie, dark shoes and dark sox. That was his complete attire. He reached down grabbed his penis, swung it around in a circle from its base and with eager excitement said, "What do you think of this?"

I tiredly sighed and said, "Not much." He jumped back into his car and, probably with great disappointment, drove off. Had I been more alert, I might have reached into my purse to fetch a business card to suggest that he consider making an appointment during office hours.

Related Topics:

• Internet to Sex: Defining Addiction
• Is Pornography Addictive?

Technorati Tags: sexuality

Do Creative People Have More Sex Partners?

One study of 425 men and women found that creative people had more sexual partners than non-creative people. The study done in New Zealand reported that the average number of partners for professional artists and poets was seven. Non-creative people had three partners.

One of the authors of the study, Dr. Nettle, said, "Creative people are often considered to be attractive and get lots of attention as a result. It could also be that very creative types lead a Bohemian lifestyle and tend to act on more sexual impulses and opportunities, often purely for experience's sake, than the average person would. Moreover, it's common to find that this sexual behavior is tolerated in creative people. Partners, even long-term ones, are less likely to expect loyalty and fidelity from them."

This set of findings supports a theory offered by evolutionist Geoffrey Miller, in his book "The Mating Mind" (2001), that artistic ability may have evolved as a form of human sexual display. He believed that artistic men were more likely to have multiple sexual partners than women. Yet Dr. Nettle's study (conducted with Helen Keenoo of the Open University) found no differences between men and women.

I think that there are many more facets to sexuality than one particular trait -- such as professional level artistic talent. For example, if we were to base a projection on stereotypes alone, professional athletes or actors might also be expected to have a higher number of sexual partners. Clergy members might also be expected to have fewer partners.

There's a risk when conducting a study about sexuality -- whether the questions asked and the answers received reasonably lead to the apparent conclusions. And, there's one more risk -- whether the sample of the study has provided reliable answers in the first place. People routinely lie about their sexuality in many of life's settings. There's no reason to think that lying would not also occur in the course of a research project.

That's why I am always a bit hesitant to rely heavily on the newest and latest sex study.

Update: The phrase referring to Catholic priests has been removed, with apologies for any offense caused to readers. - WebMD Blog Administrator

Related Topics:

• Premarital Sex the Norm in America
• Who's More Satisfied: Men or Women?

Technorati Tags: sexuality, creativity, Daniel Nettle, Geoffrey Miller

When Viagra Isn't Helpful

There's a growing trend for young men to try Viagra (or Cialis or Levitra, the other PDE5 Inhibitors) at the first sign of anything that they consider a sexual problem.

It doesn't even always need to be an erection difficulty (which is what the PDE5 Inhibitors are designed to treat). I've had male patients ask for them when they had rapid ejaculation, delayed ejaculation, or low levels of sexual desire. There is a slight connection between lack of sexual desire and a PDE5 Inhibitor. Here it is: If a man also happens to have erection difficulties, he may find that using such a medication will strengthen his sexual desire because he has greater hopes (and probability) for a pleasing experience when using it.

When young men (under 40 years) have a sexual problem, it is most often due to a psychological issue rather than a physical one (there are exceptions, but the percentage is likely under 10%). Sometimes those who are somewhat anxious during sexual interaction are among the first to seek a PDE5 Inhibitor from their doctor -- often before they have tried addressing it (even briefly) from a psychological perspective. I would hazard a guess that some young men consider as few as two negative sexual experiences reason enough to seek out this type of chemical help.

There's also a trend for younger males to want to take PDE5 Inhibitors for sexual enhancement when there's nothing wrong with their functioning. They're looking to maximize their sexual experience -- and sometimes that of their partner. I've sometimes found a blend between the "maximizers" and those who ejaculate quickly. They sometimes hope that they could more easily get another erection or they hope that their erection will be at its fullest (and therefore pleasing to a partner) -- even if it is short lived.

In my local weekly alternative newspaper, a journalist tried to see if he could get a prescription for Viagra when he didn't really have a sexual problem. He reported on his "quest." He fell into the category of "the curious." He wanted to know if it would feel any better -- sort of the same way that over time people have experimented with having sex while under the influence of other chemicals of all kinds.

I recommend that a male with an erection difficulty seek out a sex therapist for a quick assessment of whether the cause might be physiological or not. The best scenario includes that therapist having a good working relationship with a urologist who is interested in male sexual functioning. The sex therapist can work through what might be contributing psychologically and the urologist can make sure of the bodily health.

Another trend has begun that concerns me as well -- the prescription of a PDE5 Inhibitor to any man who asks for it by some physicians. I am well aware that the number of minutes that most physicians tend to spend with each patient is limited (sometimes by their own choice and sometimes by the setting in which they work). Unfortunately, this has led to offering a quick way to have tried to "help" without a careful differential diagnosis.

Some young men take the PDE5 Inhibitor path very early in their sexual difficulties and then grow dependent on it. They then sometimes grow very hesitant to have a sexual experience without it. It makes it somewhat more difficult to treat this from a psychological perspective -- which is what is most commonly needed.

Related Topics:

• Viagra: How Young is Too Young?
• Before You Try Viagra, Fight Sex Problems with Exercise