Reality Health

By Dr. Sara Levine

Dear Dr. Levine,

My daughter is 14 and very innocent for her age.  She has had basic sex education in school and with her physician.  I told her that if she has any questions, she is free to discuss them with me.  My husband feels that speaking about safe sex will encourage her to become sexually active.  I disagree.  I would encourage abstinence, but at the same time give her more information should she ever need it. Help us decide on the best strategy.

You have broached a touchy subject.  Sexual education is a politically and religiously charged subject. It is, however, an extremely important one.  Teen pregnancies are a very real problem.  Sexually transmitted infections can have both short-term and long lasting repercussions, as well. There is no effective vaccine to prevent HIV.  In 2005 an estimated 2 million people in North America, Western Europe and Central Europe were infected with HIV. 65,000 were newly infected.  In the US, sexual behavior is the most important means of HIV infection.  In fact, more than 70% of HIV-positive men and women remain sexually active.  To make matters worse, many of these people continue to engage in unprotected sex.  There are a myriad of educational curricula that address this problem. One such approach is the abstinence program, focusing on abstinence alone as a means of preventing pregnancy and sexually transmitted infections.  Another approach is the abstinence-plus program, also encouraging sexual abstinence as the best means of preventing HIV, but also discussing safe sex practices for those who choose to become sexually active. 

A recent study summarized the research data on the effects of abstinence-plus educational programs on HIV prevention in high income countries. The study showed a reduction in both short-term and long-term HIV risk behavior following abstinence-plus educational programs.  These programs also consistently displayed an ability to improve knowledge of HIV infections.  It must be said that there was only limited evidence that such a program can decrease the incidence of self-reported pregnancy.  That does not detract from the importance of the program.  Programs that focus entirely on pregnancy prevention may not address the multitude of sexual behaviors that can transmit infection. 

Do not worry about your teen’s new “knowledge.” There were no adverse effects related to abstinence-plus educational programs.  There was no increased incidence or frequency of sexual activity. Some programs even resulted in a decrease incidence and frequency of sexual activity.

What worries a parent most about his/ her teen’s sexual decisions? A teenager’s unpredictability. Teens are known to be impulsive and capable of temporary lapses in judgment made worse by their feelings of invulnerability.  You, as a parent, can increase the odds of your child having a good healthy outcome.  Having your child read about HIV and teen pregnancy or listen to a school lecture is only a start.  A frank discussion with your teenager will show him/her just how significant this issue is.  This will help your teen make rational decisions based on logic, not lust.  Make sure your teen has the opportunity to have this discussion with a responsible adult, parent, or physician before she confers with a boyfriend on the topic.

Sincerely,

Dr. Sara Levine is board certified by both the American Board of Internal Medicine and the American Board of Pediatrics and has been practicing medicine for more than nine years. She graduated summa cum laude from Case Western Reserve University and was elected to Phi Beta Kappa. She received her M.D. from Case Western Reserve University School of Medicine. She has completed Advanced Clinical Education in Child and Adolescent Obesity from the University of California, San Francisco. Dr. Levine is in private practice in Boca Raton

Please email all questions to drsaralevine@bellsouth.net