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Second Opinion: Surgeon General Report on Sexual Health
Hosted by Abigail Trafford
Washington Post columnist
Tuesday, July 17, 2001; 2 p.m. EDT
Welcome to Second Opinion, a weekly column and Health Talk discussion with Post Health columnist Abigail Trafford.
Today's guest is Surgeon General David Satcher to talk about his recent report on sexual health education and promoting responsible sexual behavior.
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Surgeon General David Satcher
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In his recent report, Surgeon General Satcher unveiled science-based strategies which represent an effort to find "common ground" upon which the nation could work to promote sexual health and responsible sexual behavior. Read The Surgeon General's Call to Action released last month.
The transcript follows.
Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
Abigail Trafford:
Hello everybody! Sex. What do you want to know? What is sexual health? Send us your comments and questions.
Abigail Trafford:
Dr. Satcher, welcome to Health Talk. Tell us about your new report on sexual health. What are the main points?
Surgeon General David Satcher: This is the Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior. It is a report which takes the public health approach to sexual health, beginning by defining the major public health challenges we have in that area, and describing the major risk factors and protective factors, but also examining some of the interventions that have been most successful.
Abigail Trafford:
Talking about sex is hard in the U.S. What has been the main response to your report?
Surgeon General David Satcher: The response has been overwhelmingly positive in terms of letters, e-mail messages, newspaper editorials and op-ed pieces, and other communications. However, we have looked very carefully at the negative responses (about 10 percent or less) because one of our major goals in issuing this report was to try and jump-start a national dialogue on sexual health and responsible sexual behavior. The most controversial areas of the report include issues related to condom use and distribution, abstinence-only programs, the call for an appreciation of diversity in sexual orientation, and -- for some people -- sex education in the schools.
Abigail Trafford:
What in your view is the ideal sex education program for schools?
Surgeon General David Satcher: I am not sure there is an ideal sex education program for schools. We do feel that sex education in the schools should start early, be age-appropriate and continue throughout the learning years. Initially, it is important for young people to understand human sexuality and the fact that it includes mental, social, physical and even spiritual aspects of one's make-up. We are all sexual beings, whether we are sexually active or not, and that starts early and extends throughout the lifespan. Just as subjects of biology and sociology are adapted to children's developmental status, so should sex education.
Ideally, parents should be the primary sex educators, and schools should be their partners in this very important venture.
Washington, D.C.:
What is the most important sexual health problem facing Americans today?
Surgeon General David Satcher: Among the public health problems which we outlined in our report were sexually transmitted diseases, including HIV/AIDS (40,000 new infections a year), unintended pregnancies (nearly half of all pregnancies in the U.S.), and sexual abuse (104,000 children abused each year, and more than 20 percent of women reporting having been victims of forced sexual acts.).
Washington, D.C.:
Hello Dr. Satcher,
I just wanted to compliment you on your bravery in releasing an honest, scientifically sound report on sex education in this current political climate.
How hopeful are you that educators will follow your recommendations?
Surgeon General David Satcher: We are very hopeful that many school systems throughout the country will utilize this report to implement or improve their sex education programs. We are also hopeful that it will be helpful to parents, ministers, and others who are involved in educating or counseling individuals and families. Judging from the response that we have received to other reports -- such as mental health and suicide prevention -- we expect this report to generate much discussion and activity across the country. Already, the national dialogue we called for has clearly begun in all forms of media, and we hope it will continue.
Newtown Square, Pa.:
Do you support giving teenagers information and access to contraceptives in schools?
Surgeon General David Satcher: In the report, we pointed out that it should be left up to the community to decide the most appropriate place to make sexual health and reproductive health services available. There are models of these services being available in community clinics, in churches, as well as in schools. In
Jackson, Mississippi, for example, a former mall was transformed into a community clinic which included these services and others.
Abigail Trafford:
The administration has just announced funding of abstinence only-programs in schools. Yet your report found no evidence that abstinence-only program are effective. Why is the government pursuing this course?
Surgeon General David Satcher: The budget for abstinence-only programs in 2001 was approved by Congress last year, and those programs are being actively supported based on that budget. I don't know what the government will do in the future as it relates to these programs. Our hope is that, as we recommend in the report, we will see more balanced programs that include a very strong emphasis upon abstinence but also makes available information which young people and older people need to prevent unintended pregnancy and sexually transmitted diseases. While we do not yet have studies showing the efficacy of abstinence-only programs, it is very clear that balanced programs as described above have been effective, that they do not increase sexual activity in teenagers, and they even have been shown to delay the onset of sexual activity.
Columbia, Md.:
I am a health educator and an advocate for education of all communicable diseases. I have taught in a public school system, one that is a "Blue Ribbon School." This school is far from writing sexual education into its curriculum. What is your plan for implementing this life-saving information into our public schools, which are controlled by the state and community?
Surgeon General David Satcher: We do not control decisions at the state and local level as it relates to the content of education. The role of the Surgeon General is to communicate directly with the American people on the basis of the best public health science and to hope that these messages will influence the behavior of people at every level of government and community.
Washington, D.C.:
What are your thoughts on the way sex education differs globally? In many European countries, sex awareness and contraceptives are readily available in Junior High schools and beyond. Consequently, the rates of unwanted pregnancy, STDs, etc., are much different/better than in the United States.
Why does the United States not adopt such a protocol, since these
methods obviously work? -
Surgeon General David Satcher: Clearly, countries such as the Netherlands, France, and Germany -- where sex education programs have been carefully and comprehensively developed -- have much lower rates of abortion, sexually transmitted diseases and teenage pregnancies than we do. Interestingly, they also have a later age of onset of sexual activity among their teenagers. The feeling of many people in our country that teaching sex education increases sexual activity is not supported by studies in this country or in other countries.
Reston, Va.:
Dr. Satcher: Should medical schools require physicians-in-training to learn how to ask these questions and work with future patients on behaviors and safety? Additionally, should hospitals/health plans etc., include in practice guidelines requirements for physicians to ask about sexual behavior and discuss all the potential problems, etc.? I guess the root of the question is, how do we get the medical community to get on the stick on this issue, and make it standard practice to discuss this topic with each and every patient, across the agr groups?
Surgeon General David Satcher: As we pointed out in our report, many patients report that they feel that their health care provider was or is not comfortable discussing topics related to sexual health. We believe that it is critical and obligatory that all health professionals receive clear instructions in areas of sexual health and responsible sexual behavior. In addition to medical school, nursing school, and schools of public health, etc., continuing education programs must be put in place to compensate for deficiencies in past education.
Plano, Texas:
Have studies been done on how the European approach to sex education would work in the USA. In Europe the general approach is to teach how to have good, safe sex with your partner. It would seem that this approach must work since most of the EU countries have dramatically fewer unplanned pregancies and STDs problems.
Surgeon General David Satcher: There have certainly been studies in this country showing that the European approach to sex education can be effective in reducing unplanned pregnancies, sexually transmitted diseases and related problems, and that these programs do not increase sexual activity in teenagers, and that in many cases actually delay the initiation of sexual activity.
Maryland:
I just want to first say how glad I am that you are behind this issue.... I only wish this issue had been a bigger deal when I was being raised I am now a mother of a 5 year old and am about to celebrate my 21st birthday.... I have herpies and I dropped out of highschool.... I am trying to get my life back together but because of financial restraints I am unable to continue my education... if only someone had talk to me about sex .... maybe I would not be in this situation..... ( I got pregnant the first time I did it and got herpies the first time)... then my parents decided to talk to me by then it was to late.... and I was one of the lucky ones... I did not catch HIV or anything that would jepordize my life.... if people would just educate and not be so scared to talk about sex... many of us teenagers would be able to make smarter choices... well thank you for letting me get that off my chest... please please tell my story maybe it will make one parent reading this relize it is important to talk to your kids...if you don't their friends will.... and there is no telling what they will say.... Abigail Trafford:
Thank you for your story. It is soooo important for parents to talk to kids--and for communities to support education on sexual health. Otherwise, you get information from your peers who may not know any more than you do. . . . . Dr. Satcher, where do teenagers get most of their information on sex? From peers? Entertainment shows?
Surgeon General David Satcher: Thank you for sharing that very important story. Unfortunately, it is a very common story in the United States, where we have over 800,000 teenage pregnancies each year, where 45 million Americans have been infected with herpes, and there are 1 million new infections each year. But it is time for this story to end. By working together, we can in fact build on this report and make changes in communities throughout the country.
Rockville, Md.:
Please describe how the AIDS epidemic is changing in the USA and what you are doing to alert heterosexual men and women to their apparent increasing risk of exposure.
Surgeon General David Satcher: When the AIDS epidemic began a little over 20 years ago, it was an epidemic seen predominantly in white gay men. Over the years, the epidemic has become increasingly heterosexual and increasingly impacting communities of color as well as women and the young. While the AIDS virus is not easily spread, it can be spread heterosexually or homosexually when having unprotected sex with someone who is infected. It can also be spread by other activities, where intrinsic body fluids -- especially blood -- is spread from one person to the other, such as in the sharing of dirty needles among injection drug users or among people who receive tatoos.
It is important to remember, however, that while in this country the predominant mode of spread has been and still is men having sex with men, globally 80 percent of AIDS cases have been contracted through heterosexual spread, and that is increasing rapidly in this country.
For the last three years, we have been involved in the Surgeon General's "Leadership Campaign on AIDS," in which we have been attempting to identify leadership in the various communities (especially minority communities) where the virus is now spreading most rapidly. In addition, we have sent crisis response teams to communities where leadership cannot be identified in order to help organize programs of prevention and to enhance access to treatment.
Fairfa, Va.:
Kudos on telling the scientific, rather than the politically expedient, truth about this topic.
A comment: I grew up in a rural area mainly populated by the more fringe Protestant and Catholic denominations: girls not allowed to wear pants because it was a sin, and kids who couldn't trick-or-treat because it was a pagan ritual (they apparently ignored the history behind Christmas and Easter celebrations). I feel cheated that my public school education did nothing to counteract the lies I heard in church (my parents ignored the subject completely) that made me feel that my body was something to be ashamed of. These kids are the ones who most need a comprehensive education on their reproductive parts, because they are given such erronous biological information at home and in church (e.g., the usual "it'll make you go blind" comment).
In particular, I thank you for looking at the special needs of homosexual students. At my school, the slightest appearance that you could be gay made you fodder for a beating that would put you in the hospital. Teachers and administrators did NOTHING to help those kids, and I shudder to think of the fear that some of my friends lived in.
What efforts can be made to meet the needs of gay students in locations where being homosexual is considered a worse sin than molesting a child?
Surgeon General David Satcher: In our report, we have tried to put the issue of sexual orientation into clear perspective. We said that most scientific studies suggest that sexual orientation is determined before adolescence, and that to date there are no valid scientific studies showing that sexual orientation can be changed.
While this is one of the most debatable aspects of the report, our bottom line was that it is time for Americans to appreciate diversity in sexual orientation. We hope that by better educating people in communities throughout the country about the nature of sexual orientation, that in time attitudes will begin to change. That is certainly happening in many places throughout the country today.
Unfortunately, however, as we reported, 80 percent of gays and lesbians report that they have been verbally threatened or attacked because of their sexual orientation and almost 20 percent that they have been physically attacked because of their sexual orientation. Clearly, we have a long ways to go, but again hopefully, this report will help.
Orono, Maine:
Is it too early to start talking to my 4-year-old about sex?
Surgeon General David Satcher: Great question. Parents are the most important sex educators, in that the earliest sex education should be natural and should basically respond to the natural curiosity and questions of children. Parents should answer their questions in a very positive fashion, encourage them to ask more, and help them to feel good about themselves and their sexuality. This has nothing to do with sexual activity. It has everything to do with human sexuality.
This also includes the relationships among adults which children observe. Positive, kind supportive relationships between the sexes, based on mutual respect and responsibility, is a lesson which should begin at home.
Abigail Trafford:
A poll by the Kaiser Family Foundation found that most parents look to sex education to provide their children with practical skills--how to use condoms (85%), how to deal with pressures to have sex (94%), and how to deal with the emotional consequences of becoming sexually active (94%). Yet, few school programs provide this information. What can be done to improve sex education in schools?
Surgeon General David Satcher: When children reach the appropriate age, and this certainly would include middle school, they should be provided the information necessary to have healthy sexual relationships. They should not be encouraged to become sexually active before being involved in an enduring, committed, mutually monogamous relationship, but they should have the information necessary to protect themselves and others from pregnancy and sexually transmitted diseases.
Support for this should come from all the sectors of the community, including the church, and many churches are beginning to be very active in this arena. They are active because they care about people, about their health, and their futures.
Washington, DC:
Dr. Satcher:
A comment and a question. First, the comment: Thank you for pointing out the importance of giving students the means to prevent pregnancy. I'm thrilled to have you out there standing up for such an important issue.
And the question: With skyrocketing heart disease and cancer rates, shouldn't the government stop feeding kids unhealthy, meat-laden school lunches? When we've got a captive audience of kids in the cafeteria, shouldn't we feed them a more plant-based diet?
Surgeon General David Satcher: Yes. As Surgeon General, I talk consistently about the community responsibility for healthy lifestyles, including physical activity, good nutrition, avoidance of toxins (especially tobacco) and responsible sexual behavior.
Those are the items on the Surgeon General's prescription. Schools have a specialy responsibility to model good health behavior by teaching exemplary physical activity K-12 and by modeling good eating habits for the students. This means diets that are low in fats, sweets and salt, and that include at least five servings of fruits and vegetables a day.
I've often told the story of the elementary student in Boston who wrote me with a question: "Dr. Satcher, I know that you put warnings on tobacco, but are you sure that our school lunch is safe?"
Washington, D.C.:
Are conservatives actually leading to an increase in STDs and teen pregnancy by denouncing your recent report and preventing wide acceptance and understanding of it? Abigail Trafford:
Dr. Satcher, what kinds of groups have opposed your report? The Family Research Council, for example, called your recommendations a "mixed bag." It said your call to de-stigmatixe sexual orientation was "most disheartening." What impact have these groups had on the nation's sexual health? What has been their influence on sex education in schools?
Surgeon General David Satcher: I am not convinced that conservatives are preventing the widespread reading and understanding of our report. We have had the opportunities to appear on television, radio talk shows, and to do interviews with newspapers throughout the country. This type of activity will continue, and we are convinced that this report will stand the test of time.
While I don't remember the specific names, a coalition of conservative groups wrote a statement opposing the major findings of the report. It is true that these groups have had a tremendous influence on the nation's agenda relative to sex education, sexual health and resonsible sexual behavior. We are hoping that the overwhelming majority of Americans who support a public health science-based approach to these issues will begin to carry the day. The health of our children and the health of our nation depends upon it.
Abigail Trafford:
As you point out, sexual health is a life-long issue. How can you improve the sexual health of adults--many of whom didn't get much education on these issues in school?
Surgeon General David Satcher: It is really critical that sex education continue throughout the lifespan. We are hoping that communities will respond to this report by moving to put in place programs for persons of all ages. Again, churches, sororities, fraternities, and other community organizations can play a major role.
Today's Washington Post has a very important article in its health section about the spread of AIDS among persons over 50 years of age. This epidemic among the 50-plus of HIV/AIDS only dramatizes how critical it is that sex education be continued throughout the life span. So many adults, while having experienced a lifetime of sexual activity, pregnancy and parenthood, still have trouble optimizing their sexual health. We all pay a price.
For example, over one-third of the marriages in this country involve extramarital relationships, and many persons with HIV/AIDS have been infected within the context of marriages that were not mutually monogamous. Many people also experience dysfunctions in their sexual relationships because of negative experiences which they had as a child and the difficulty which they have sharing a mutually positive relationship.
Abigail Trafford:
If you are having a sexual problem, who should you consult for help? Where can you get medical and spiritual support for sexual development?
Surgeon General David Satcher: Clearly, this varies by community. But one should begin with their primary health provider in dealing with sexual health problems. However, many ministers have taken it upon themselves to become proficient in helping their congregants to deal with these types of problems. Some of these ministers participated in developing our report. In addition, of course, in some communities there is the availability of counselors in these areas outside of the health profession and the church.
Abigail Trafford:
What groups have been most supportive of your report? What impact have they had on sex education in schools?
Surgeon General David Satcher: It is too early -- less than three week since the report came out -- to discuss the impacts of this report beyond a national discussion, which it has certainly prompted. We have received letters of support and we have seen editorials and op-ed pieces from virtually every segment of society. Most noteworthy have been letters received from clergy, thanking us for this report and relating their own experience in dealign with sexual health problems in their congregations.
It is also amazing the number of grandparents who have written thanking us for this report and relating experiences which they had because they had not received education in sexual health. We have also heard from many young people about their experiences in schools and their appreciation for the report.
Philadelphia,Pa:
Doctor, when is your term of office finished?
Then you can join that other goofy S.G., the
one that advocated masturbation for all little kids!!!
Surgeon General David Satcher: My term of office ends in February 2002. Several Surgeons General have had problems because of discussions of sexual health, even though this is the first official Surgeon General's report on sexual health. For example, following World War I there was a major venereal disease problem which started with soldiers who particpated in that war. Dr. Thomas Parran, who would later become Surgeon General, was assigned the task of developing a venereal disease control program for the state of New York. One one occasion, he was scheduled to speak on a network radio program about venereal disease control, but when they found out he wanted to use the word "syphillis" the invitation was withdrawn.
Likewise, in the early 1980s, in response to the early AIDS epidemic, Surgeon General C. Everett Koop did an extensive report describing the nature of the epidemic and how the virus was spread, including some explicit description of sexual intercourse. His report was not supported by Congress or the Administration, but he was allowed to distribute it to homes throughout this country. It became a very critical part of our fight against the epidemic.
So America's difficulty in discussin sex and sexual health did not begin with Dr. Elders and unfortunately will not end with me.
Abigail Trafford:
Let's talk about marriage. Fewer people are getting married these days and more couples are living together in a committed relationship. Is there a difference between sexual health in marriage and sexual health in cohabitation?
Surgeon General David Satcher: First, let me point out that we believe that this report is strongly supportive of marriage as an institution. However, it recognizes that not all marriages are mutually monogamous, and so it points to enduring, committed, mutually monogamous relationships as one way of reducing sexually transmitted diseases. Recognizing the pattern of increasing cohabitation without marriage in this country, this message is even more important.
Abigail Trafford:
Alas, our time is up. Dr. Satcher thank you very much for this great health talk. Thank you all for your questions and comments. Join me same time, same place next week. The subject: the birth of septuplets after fertility drugs.
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