The Report, January 6, 2003, pp. 50, 51
The only safe sex is no sex
Sexually transmitted diseases
are becoming epidemic, especially among teens
By MARNIE KO
Joe McIlhaney, an MD in Austin, Texas, still remembers the last patient in his gynecology
practice, 10 years ago. She flew in from New Jersey for in vitro fertilization
(IVF). She was 41, had been married about two years and could not get pregnant
despite months of effort. She had previously been "very sexually active,"
says Dr. McIlhaney, and at some point likely contracted a sexually transmitted disease
(STD). By the time she came to Dr. McIlhaney, her Fallopian tubes were destroyed and
she was suffering from pelvic inflammatory disease. Her reproductive organs were so
ravaged by the disease that even though she became pregnant after IVF, by five months'
gestation her baby died in utero. She will never be able to bear a child.
Despite years of sex education in schools that liberal
educators insisted would inform adolescents about safe sexual behaviour, Dr. McIlhaney,
who is director of the Medical Institute for Sexual Health in Austin, says the project has
largely backfired. America is facing an epidemic of STDs, with more than 15 million
new STD infections diagnosed each year, just in the U.S. Teenagers in both Canada
and the States, he maintains, have developed a false sense of security, believing that sex
is OK as long as they use a condom. Indeed, thousands of North American
organizations directed toward youth have for more than 15 years promoted the idea that
condoms equal "safer" sex. Take, for example, the Web site created by the
Washington, D.C.-based Coalition for Positive Sexuality. Their "Just Say
Yes!" tour (at www.positive.org) tells teens,
"Safe sex is always better! It's fun, and you don't have to worry as much
we're tired of people telling us what we can and can't do.
Condoms are 98%
effective when used correctly."
But what if there is no such thing as "safe sex"? What if
condoms are not effective? Dr. McIlhaney says the proof is in the epidemic of STDs
affecting North Americans, and especially teenagers. About half of adolescents begin
sexual activity between ages 12 and 19, and one-quarter of them have at least one STD, he
notes. About 20% of sexually active teens will contract an STD each year, and by the
time young adults are in their 20s many will be carrying two or three STD. Some will
not even know it. With chlamydia, for example, 85% of the time there will be no
Dr. McIlhaney left a thriving obstetrocs-gynecology private practice, where
his "saddest" work was with adult women who could not have children because of
an STD contracted as a teenager. In 1992 he formed the Medical Institute for Sexual
Health in an effort to provide the public with factual scientific data on the risks of
sexual activity. He now spends his time educating teenagers and their parents about
the latest STD research.
For example, 5% to 10% of women who are sexually active beginning in their
teens will be infected with chlamydia, a disease which can cause sterility, and, in 20% to
40% of women who contract it [suffer from] pelvic inflammatory disease (PID). The
bacteria spread into the uterus, Fallopian tubes and ovaries. PID can scar and
obstruct the Fallopian tubes, making a woman unable to conceive. If they do
conceive, women who suffer PID are seven to 10 times more likely to have an ectopic
pregnancy, in which the baby develops outside the uterus. The baby very rarely
survives. At worst, the mother risks death, and, at the least, she usually needs
About three to four million new cases of chlamydia are diagnosed in the U.S.
each year. Indeed, a study five years ago of all female army recruits in the U.S.
discovered that 12% of the recruits were carrying chlamydia but had no outward symptoms.
Both sexes can be infected with the bacteria (which can also lead to sterility in
men) through sexual contact. But family planners and educators insist
Dr. McIlhaney argues the latest research proves the "reduction" is
nearly worthless. "If you talk to teenagers and their parents, you find they've
been told that condoms eliminate the risk of getting an STD," he says. But a
new Harvard study, soon to be published, finds that
condoms used 100% of the time only
reduce the risk of contracting chlamydia, gonorrhea or syphilis by 50%. When
are not used 100% of the time, "there is no protection at all," warns Dr. McIlhaney. The same holds true for herpes.
Condoms offer only partial
protection, reducing the risk of getting the disease by about half.
Figures are still worse for human papilloma virus (HPV), which is blamed for
up to 99% of cervical cancers in women, because HPV is spread by skin-to-skin contact,
often in places not covered by a condom. "Even teens and adults who use a
condom every single time are likely to get infected with HPV." says Dr.
McIlhaney. "There is no protection with
Perhaps it is assurances from family planners that
condoms will prevent the
spread of STDs that explain why to cite just one stunning statistic almost
half of all black teenagers in the U.S. have genital herpes, and one in five Americans
carries the disease. It may also explain why half of all new chlamydia cases each
year are teenage girls aged 15 to 19, and one in 10 U.S. teenagers already has the
disease. Teenage girls are especially vulnerable to STDs, as their cells are still
developing and are less able to fight viral infection. A study from New Mexico found
that 50% of all sexually active American teenage girls have HPV, and 20% of adult women
are infected with Type 16 HPV, which is one of the cancer-causing strains.
"Canadian figures are much the same," says Dr. McIlhaney.
What is the solution? Dr. McIlhaney tells teens the only "safe
sex" is "maintaining sexual abstinence until an individual forms a long-term,
monogamous relationship, usually marriage, with a non-infected, healthy partner."
Not everyone thinks that is realistic advice. "I guess you can
tell women to decrease their number of partners, if that's possible," says Dr. Alice
Lytwyn, a Toronto pathologist who studies HPV. "I don't think women can.
Many women are serially monogamous. How can you guarantee not to be infected unless
you never have sex, forever and ever?"
So how can parents protect their teens? Dr. McIlhaney says the answer
is to tell them the truth: "Warn them that 'safe sex" as an unmarried teen or
young adult simply doesn't exist."
In 1960, there were two sexually transmitted diseases (STDs) that caused the
greatest concern among medical doctors: gonorrhea and syphilis. Herpes was rarely
seen. In the 1970s, one adolescent in 47 contracted an STD. Today, that figure
is one in four, and there are now over 25 STDs which are contracted primarily
through sexual activity, 50 to 100 different types of human papilloma virus (HPV) and
perhaps another 50 diseases which may be passed through sexual activity.
About 15 million new STD infections occur each year in the U.S., one-quarter
of them in people younger than 20. A recent study of 18- to 22-year-old sexually
active women showed 50% were infected with HPV at some time during the three-year study
period. A sexually transmitted disease is responsible for more than 99% of cervical
cancers, and nearly all abnormal Pap smears. Using a condom, even 100% of the time,
does not eliminate the risk of an STD.