by Meg Meeker
Should she read Cosmo or thumb through a Victoria’s Secret catalog as an eight-year-old? No. Throw them out. If her mother gets them, she should keep them out of sight. Should your daughter go to sleepovers where “cool” parents let underage kids see movies rated PG-13 or R? No. Let other parents—and your daughter—know your standards. And have your daughter call home if they’re violated. She’ll be embarrassed, but she’ll get over it. Defend your daughter’s right to be a kid.
Defending her in a toxic culture is challenging when she is eight, nine, and ten. The challenges can intensify as she grows older. Notice that I said “can.” This is because I’ve found that girls whose parents are reasonable, firm in their guidelines, and not overbearing understand early on that their parents are on their side and “get” what is going on in their world. That minimizes battles over movies, clothes, and the rest.
When battles do heat up, however, you have to kick into high gear. Don’t be mean, loud, or aggressive. Kindness and strength in your beliefs work better. When your sixteen-year-old bounces into the kitchen with a bikini barely covering her large breasts and pubic area, smile and tell her that it’s a gorgeous color, but the suit is too scant for her beautiful body. Tell her she needs to find a more modest suit that won’t make other girls feel jealous. When she is twenty-five, she’ll thank you.
Standing guard over your daughter’s sexuality is tough. It is nothing short of war. But teaching her that modesty is a strength and not a commodity of the prudish will pay off with enormous dividends.
Protect Her from Sexual Activity
According to the Medical Institute for Sexual Health, in the 1960s doctors contended with basically two sexually transmitted infections—syphilis and gonorrhea. I was in elementary school. In the 1970s, when I was in college, chlamydia gained momentum. But really, no one paid much attention because the sexual revolution was taking hold and the last thing that college students wanted to hear about was chlamydia. In the early 1980s, when I was in medical school, HIV appeared, though it didn’t make big headlines at first.2 Then herpes simplex type 2 (genital herpes) increased wildly in the United States.3 Again, you didn’t hear about it in the news. As a medical student I remember being taught that cervical cancer was probably caused by an infection transmitted through sexual activity. Doctors had come to that hypothesis because they noticed that nuns never got it. In the 1990s we got the proof when researchers discovered that cervical cancer in women was caused almost exclusively by human papillomavirus, a sexually transmitted disease.4 Pornography that encourages sexual behaviors previously frowned upon has helped spread disease. One study has shown that with the surge of popularity in oral sex among teens, herpes simplex type 1 (cold sores) now causes more genital infection than herpes simplex type 2.5
Over the last forty years doctors have gone from treating two STDs to more than twenty-five different types today. The true numbers depend on how you count. For instance, do you count HIV as one infection or two, since there are two strains of HIV? And with HPV, there are eighty to a hundred strains. Fortunately, only twelve cause genital infections that can lead to cervical cancer. So does HPV count as one infection or twelve? The simple answer is that however you count, our kids are facing an epidemic of STDs.
Of the fifteen to eighteen million new cases of STDs that occur every year, two-thirds occur in kids under the age of twenty-five.6 This is not okay with me, and as a father it should not be okay with you.
Don’t assume that because your daughter is in a private school, or a parochial school, or a public school in a quiet small town that she is safe from all this. She isn’t. The problem with bugs is that they don’t discriminate. These infections cross all socioeconomic, racial, and religious barriers. Perhaps they didn’t a decade ago, but this is a different day.
I am a pediatrician, and I have seen this epidemic develop even though I, like most of my colleagues, didn’t immediately recognize it. Like many mothers and fathers of my generation, I grew up watching television, politics, and mass communication change with the Internet, and changes in marketing that started using sex to sell things to kids. Some of these changes bothered me, but my generation grew up discounting complaints from parents (including our own) about the awful influence of television and popular music, about radical and disrespectful kids, and about falling moral standards. So, when all of this happened, honestly, I didn’t pay much attention. Change is part of life.
As a young intern and resident I worked with teens and their babies. I loved it. Having gone to Mt. Holyoke, an all-women’s college, I was passionate about championing health issues for young girls. The best way to help them, we were taught, was to keep them in school and load them up with birth control: give them shots of Depo-Provera, get them on oral contraceptives, or refer to them to an ob/gyn who could insert Norplant under their skin. Preventing pregnancy is medically quite simple, but I got burned out working with kids who got pregnant anyway. So I decided to take a break.
In the meantime, my husband and I started raising our own three daughters. As they grew, they wanted to go to the mall and buy clothes. Their dad never took them, I did. And when they became young teens, they wanted to buy their jeans at Abercrombie & Fitch, because that’s what their friends did. The moment we walked into the store, we were confronted by an enormous poster of a gorgeous and apparently naked twenty-something young man. Pretty soon I noticed that such sexualized marketing, directed at kids, was everywhere.
I shrugged it off until I noticed changes in my medical practice. Kids were starting sexual activity at ever-earlier ages. In the 1990s, I had patients who were sexually active in the sixth and seventh grades. Then I saw an influx of genital herpes. And I started seeing some horrible consequences.
One young mother delivered her baby not knowing that she had herpes because she had never had a herpetic sore. Shortly after birth, her otherwise healthy baby began having terrible seizures. She would turn blue, shake all over, and her breathing became so erratic that she looked like she was dying. An MRI of the baby’s brain tissue showed that it was punctured throughout with holes. This baby was suffering the consequence of herpes—and here’s the kicker: not only did the mom never know she had an infection, but her husband had contracted herpes many years before from a girlfriend and had tried to keep his wife “safe” throughout their marriage by not telling her.
The stories grew in number. I had a beautiful thirteen-year-old girl with advancing cervical cancer. Just before her fourteenth birthday, her gynecologist removed most of her cervix to halt the cancer’s progression. If that poor girl gets pregnant now, she will have a high-risk pregnancy because her uterus might have difficulty keeping a baby inside.
I saw the pressure to have sex rise among kids—all kids. Parents sometimes find it hard to realize how things have changed, but they have, dramatically. In the 1970s most kids—teenagers—were not sexually active. Today, most kids are.
Even if we know this statistically, we can still fail to see how very significant it is. It’s not harmless. The epidemic of STDs is life-threatening for your daughter. And the pressure on her to engage in high-risk behavior can be overwhelming. If your teenager is not sexually active, chances are that she will be treated as a social outcast, an unsophisticated, abnormal geek. You have to counterbalance that peer pressure. If you don’t teach your daughter why she should defer becoming sexually active, she will start. And you’ll need to teach her how to live up to your standards. That’s just the way it is. Her friends are having sex and even the nice guys she dates will expect it—very shortly after they start dating.
I noticed another trend in my practice. The early onset of sexual activity meant not only rising cases of STDs, but also meant that many of my young patients had had multiple sexual partners at young ages. And I saw something else: a rapidly increasing number of girls suffering from depression. I, like my colleagues, wasn’t really trained to treat depression while I was in medical school. We left that to psychiatrists. We didn�
��t have antidepressant medications or even the understanding of the roots of depression like we do now.
But I had kids as young as nine being dragged in by their parents because they knew something terrible was wrong with their daughters. Over time, I found an obvious correlation among my patients: if they were sexually active, they were at high risk for depression. So much so that I have come to consider depression another sexually transmitted disease. Studies couldn’t confirm what I was seeing in my practice because studies weren’t being done (though they would be later, as we’ll see later). No one was paying attention to our kids.
Every day after I left my office, I was struck by a social and cultural disconnect. In my practice, I was seeing younger and younger girls ravaged by depression and sexually transmitted diseases. And at the mall and in magazines and on television, I saw a popular culture that didn’t seem to care. Beautiful young girls were being seduced into sexual activity through brilliant marketing programs. Sex sold them clothes, shampoo, CDs, and pencils. Sex was sold to them in glamorous media messages. But outside that world of make-believe I saw sex giving young girls one infection after another. I saw girls falling into depression. I saw girls wanting to commit suicide.
And everyone was silent. We doctors were silent. Pastors never preached about sex. Priests didn’t include talk about sex in their homilies. Parents didn’t want to broach the subject. We didn’t shield our kids. We took it for granted that they watched R-rated films splashing sex across the big screen. We left it to teachers to tell our kids to wear condoms, as if that were the answer to preventing depression or even the rising number of STDs (it doesn’t work for all of them).
Finally, I began talking to my friends in medicine. “Are you telling girls about the risks of HPV? Or that chlamydia can cause infertility? Or what herpes can do to her baby?”
No, they weren’t. Not because they’re bad doctors, but for two reasons. First, they don’t have time to go into lengthy discussions. Insurance companies pressure doctors to see many patients a day. Second, many doctors simply believe that talking to kids is no use. I hear all the time, “All kids are sexually active these days. Look around, there’s nothing we can do about it.”
So many simply give more shots of Depo, hand out packs of birth control pills, or plead with girls to insist that their boyfriends use condoms. I understand exactly why my colleagues do this. They feel overwhelmed. And so do I. But the truth is, many of us—physicians, teachers, and nurses—haven’t been doing our jobs. We’ve been settling for damage control rather than trying to get kids back on the right course. Condoms are damage control. For me, that was no longer good enough.
I’ve studied the medical data. I’ve thought long and hard about my patients. I’ve talked to kids and parents. I’ve consulted with my medical colleagues. There is a solution to the problem of girls having sex too soon and with too many boys. The answer is: YOU.
Fathers can ensure that their daughters grow up with healthy ideas about sexuality. You can guide your daughter to make smart decisions about sex. You know that your teenage girl shouldn’t be popping birth control pills, applying condoms, and being treated for STDs. She deserves better than that. If you as a father saw what I see every week in my medical practice, you would know what to do. And you’d succeed.
You need to know some data because your daughter needs your help. Take a look at what the medical research shows about your daughter and her friends.
If present levels of sexual activity among kids continue, by the year 2025 (fewer than twenty years from now), 39 percent of all men and 49 percent of all women will test positive for genital herpes.7
Three to four million teens in the United States contract a new STD every year. That works out to approximately 10,000 kids a day who get a new STD.8
Nationwide, gonorrhea rates are highest among girls ages fifteen to eighteen.9
Of the top ten most frequently reported diseases in the United States in 1995, STDs accounted for 87 percent of all cases reported.10
Nearly one in four sexually active teens is living with an STD at this moment.11
Although teens make up only 10 percent of the population, they contract 25 percent of the STDs .12
HPV causes 95 to 99 percent of all cervical cancer.13
Some strains of HPV have been linked with cancers of the head and neck. 14
45 percent of African American teens and young adults test positive for genital herpes.15
As a father, you might be shocked by these statistics. Good. We need to recognize that we have a very serious problem on our hands.
Angela’s father did. If he had only known how miserable she became, he said later, he could have helped, perhaps before her depression got out of hand. When Angela was sixteen, she was dating a guy she thought might be “The One” (girls often think in these terms). Tack was older than Angela and was getting ready to graduate from high school and go on to college. Since they had dated for a month, Angela felt it was time to give Tack what he wanted. (One month, according to many teens, is a long time to date; it means the relationship is serious.) She was hesitant because she was a virgin. She had heard her friends talk about their sexual experiences and how disappointing they had been, and she really wanted to wait. But, she said, she didn’t want to lose the guy she thought she might marry. (Fathers: this is exactly the kind of thinking—common in teenage girls—that you need to correct.)
They went to a movie, then to dinner. On the way home, Angela let Tack know about the decision she had made. He was thrilled. But before he got too excited, she told him that there were limits. She wanted to have sex but remain a virgin. And she wanted to be safe from infection, she said, so they had to stick to oral sex. That was fine with Tack—at least for the meantime, he said. So they did. In the back of his car, they exchanged oral sex.
Within a couple of days, he told his buddies. And, as guys and girls do, they talk to other people, and pretty soon most of their friends knew what Angela had done. They were amazed, Angela told me, because everyone in her class assumed she was the one who would never cave in to the pressure to have sex. She was too principled.
Four weeks later Angela broke out in sores around her genitalia. She had terrible pain urinating and even had difficulty sitting down. She had a horrific case of genital herpes—not caused by herpes type 2, but by herpes type 1 (oral herpes). Her intense pain lasted about four days and she needed narcotics to keep it under control. But even more painful to Angela was what Tack did. He not only told his friends that she had contracted herpes, he dubbed her “Miss Herpes,” and she quickly became the girl that no boy wanted. She was humiliated and became very depressed. And remember, she endured this even while she still felt herself to be a virgin.
Six months later, in the bathroom in her home, Angela swallowed two full bottles of Tylenol. She couldn’t take it anymore. Life just wasn’t worth it. So she decided to give up and die.
Her parents were shocked. Angela had friends, excellent grades, and a promising future. They never linked her suicide attempt with Tack because they believed him to be a nice, respectable young guy. Surely he would never have taken advantage of her; they would never have had sex.
You can’t bet your daughter’s life on these kinds of assumptions. Too many parents who do pay a terrible price.
Here’s another very important medical fact: the fewer sexual partners a girl has, the less likely she is to contract an STD.16 And the longer she waits to start having sex, the more likely she is to have fewer partners. 17
So, dad, you must help her, teach her to wait. Even Dr. Julie Gerberding, the head of the Centers for Disease Control and Prevention, says so. Recently she wrote a letter to Congress about preventing HPV infections in young women. Why? Because infections are out of control and women (particularly young women) bear the brunt of the problems incurred by these infections. I was privileged to testify at the congressional hearing and this is essentially what Dr. Gerberding said: She told Congress that HPV c
auses cervical cancer in women and that we need to curb the spread of the virus. The best way, she said, was to have women reduce the number of sexual partners to as few as possible and to delay the onset of sexual activity as long as possible. Also, women should avoid sexual contact with an infected person. (The problem, however, is that HPV doesn’t cause symptoms unless it is the strain that causes warts, and these strains don’t cause cancer. Moreover, only 1 percent of HPV infections cause warts.)
Now, you may wonder, what about the gold standard backup plan? The panacea of all panaceas: the condom. Why didn’t Dr. Gerberding simply reemphasize the importance of using condoms to prevent HPV infections? It’s simple: condoms don’t adequately protect against HPV because it is spread from skin to skin. For all that we in medicine, health clinics, and teachers in sex-ed programs have pleaded with teens to use condoms, and even handed them out for free, the sad fact is that condoms will not protect your daughter from all the risks she faces from sexual activity, including depression.
When parents and kids ask me, “Do condoms work?” I give them the best answer I have. I learned it from a colleague of mine who is referred to as “The Condom King.” The man knows every piece of research ever done on condoms. The most truthful and medically accurate answer I can give is: it depends.
How well condoms work to prevent pregnancy and sexually transmitted infections depends on many factors. First, in order for them to be effective, condoms must be worn during every single episode of intercourse and they must be worn correctly every time they are used. Studies tell us that condoms are frequently used incorrectly.18 Second, it depends on which infection you’re talking about. The condom’s track record is best with HIV and poorest with HPV.19 Infections are transmitted quite differently. HIV resides in body fluids and it makes sense that a piece of rubber provides a pretty decent barrier against fluids. But a herpes sore, like a syphilis sore, can be on skin not covered by a condom.
