What is the state of sexual health education in 2009? Does the internet help or hinder the process of getting helpful information out there?
Elizabeth Boesky, Ph.D., has been educating herself and others about safer sex and STD's since her high school years. From peer counseling in college, through her professional writing in numerous books and publications, to her educational STD information website at about.com, to her new project, 101 Ways You Can't Get Pregnant, she's been committed to talking about healthy bodies and healthy sex lives throughout her professional career.
Is there an area of sex education that you feel is being overlooked by the current crop of sex education websites, writers, and other professionals? Do you have any thoughts on how sex education in general will change in the coming years?Couldn't ask me an easy question, could you Sarah? I've been looking at this question for two days, trying to come up with an answer. I can't think of any one issue that's being comprehensively overlooked, but I don't think that most are really comprehensively covered either. I think that sex educators all have their little enthusiasms - mine are STDs and self efficacy, someone else's might be contraceptive options and access. It's hard to talk about everything, which is why I think it's so important to have multiple resources out there, and I'm glad they exist.
I think, under the new administration, that we're going to be moving away from abstinence only as policy. States were already rejecting federal funds to provide research-based, comprehensive education and things are only going to improve with someone in the White House who actually pays attention to science. As for what specifically will happen... I'm not sure. It will be really interesting to find out.
How can you tell the difference between an oral canker sore and herpes? I asked a doctor this once and he was unable to answer the question.
I heard recently that 30% of people have an STD. Could that be true? If so, then once you account for the fact that older people have less sex and are less likely to have multiple partners, then it would seem that possibly something like 60% of college students might have an STD.30 percent? That number actually seems like it could be low to me. Estimates are that, at some point in their lives, 1 in 4 women and 1 in 5 men will be positive for herpes viruses alone. Still, I understand why you're confused. Estimates like that include chronic, often asymptomatic, viral diseases such as herpes and HPV that people can carry for years. Just because someone hasn't had sex recently, doesn't mean they aren't infected... and haven't been for years.
You are right that young people are, for various reasons, more susceptible to STDs and have higher rates of infection. However, older people do still have sex - one study found that 60% of individuals over 60 have sex at least once a month. Combine that with the fact that they are less likely to practice safe sex, and you see why the number of new HIV infections is actually growing faster in individuals over 50 than in people 40 years and under. Elderly people unquestionably are at risk for STDs.
Oh, and to answer your other question, if it's not clear what type of sore it is by looking at it a doctor could, conceivably, swab it to check for virus. That's not a really accurate test, though, particularly if it isn't an initial herpes outbreak. Honestly, it can be very difficult to tell. Remember, though, that if an individual has herpes (which they may not know) they can transmit the virus even when they're not having an outbreak... and the virus can be transmitted from the mouth to the genitals during oral sex.
Thanks for the great questions! Hopefully I haven't failed miserably in my formatting and this all makes sense
You're quite younger (and sexier!) than most professors I know. What was the journey to PhD-dom like, and do you have any tips for fellow doctoral hopefuls, especially in the sexual health field?
The inevitable question: what is your favorite sex toy?Gosh, you say the sweetest things.
I went straight into my Ph.D. program after leaving undergrad. I had been supposed to go to the Ivory Coast with the Peace Corps to do HIV education, but when I was offered the space in the microbicide lab, I jumped on it. I was so excited to work with people who were not only excited about sexual health, but who were explicitly planning on developing a product that gay men could use as well.
Near the end of my Ph.D., I realized that my passion was more for education and policy. That's why I followed it up with a Masters in Public Health. Had I it all to do over again, I might have done my Ph.D. in a public health program instead, but I'm still thrilled with the education I got. I wouldn't trade my years in basic research for the world. It gives me a really useful perspective, and I learned a lot.
Specific advice for doing a Ph.D. in sexual health? If you haven't found a program already, you have lots of options. You shouldn't limit yourself to sexuality departments - which are few and far between. You can do a sexual health Ph.D. in psychology, anthropology, sociology, public health, microbiology, immunology... depending on the specific area of your interest. The most important thing is your graduate advisor. Find someone who is doing research you're interested in,and who will support you in finding your own topic and pursuing your passion. That's far more important than going to a name school, or having a particular subject area on your diploma. Besides, it's a great way to find a program. Do a medline search, or even a google search, on the topic you most want to study... and see whose brain you most want to pick for 5 years. (Alternatively, if you have a specific method you want to work in - qualitative interviewing, primate research, etc - you might look for an advisor who works with that method and is open to your applying it to a topic in sexuality.)
Oh, and my favorite sex toy? Tough choice. I have to admit that I'm really partial to the three (THREE! I must really like them) lucid dreams vibrators I have. Do I have to pick between them?
Do you think humor can help us deal with difficult topics in the sexual world, like STIs or unwanted pregnancies?I think that sometimes humor is a good way deal with difficult topics. A lot of people don't feel comfortable talking about sex and sexuality other than as a joke. Bringing humor into the equation gets them started having the conversation. Then, once they're talking about it, you can give them the information they need and answer the questions that they have. Besides, as a sexual health educator, there will be days that you need to laugh to get through your job.. and it's a lot more fun if you're not laughing alone.
I think the trick is that if you're going to use humor in such delicate situations, you can't use it as an attack. It can't make the people you are talking to feel more vulnerable, or like you're mocking them. Humor has to be a way into the discussion, and sometimes it can be very hard to use it in a way that doesn't lock people out. It's not for every situation, not by any means, but I do think that sometimes it can help diffuse tensions and make people more comfortable.
Specific example : If I need to get someone comfortable enough with me to talk about STIs, I often tell them the true story of how a friend of mine graphically described his symptoms to me and then asked me out on a date... after they stop laughing, very few people are reluctant to talk about their own concerns. I have a lot of humorous stories about STDs. It helps people remember that being diagnosed with one doesn't have to be an epic tragedy.
Do you believe sex education in middle and high schools should include information other than just sex as a means of reproduction (such as telling boys only a small number of women can orgasm through penetration alone--and emphasizing the importance of the clitoris)? Would this be more harmful than helpful?I'm of mixed opinions on this. I think that it's really important to tell kids that sex can be pleasurable, and should be pleasurable, but I'm not sure that specific discussions of technique are necessarily appropriate (I'm also not sure they're not... this is an area outside my expertise, but something I think about a lot... something I think about a lot without coming to a conclusion.) That having been said, other than the purely technical aspects of safer sex education (the biology of pregnancy and stds, contraceptive options, etc.), I think the most important thing that needs to be taught, and often isn't, is how to say yes and how to say no.
Kids often aren't empowered to make, and enforce, their own decisions about sexual activity. Good sex education teaches kids that it's okay say yes to sex, but it's also okay to say no. It teaches them that if they say no, that they should be listened to immediately. It teaches them how to walk away from someone who is pressuring them. It teaches them not to pressure their partner. It builds self esteem so that kids can make their own decisions without worrying so much about the norms and expectations of their peer group.
One thing that I think _should_ be discussed in safe sex classes? Masturbation. If kids can be taught that masturbation is normal and healthy, not only will that provide a low risk sexual outlet it will teach them about their bodies... so that they can teach their future sexual partners what they do and don't like. It constantly amazes me how many women don't masturbate. Masturbation is a great way for people to figure out what works for them, and if you're not willing to touch your own body and discover your own pleasure, how can you communicate it to someone else?
How do you tailor sexual health education to various cultural communities? The first thing that comes to mind is how sexual health is discussed within various immigrant communities, but I can also see different geographic regions and religions being part of this diverse audience. I think the age/gender divisions are certainly things we're aware of, but your profile got me thinking of all the other demographic divisions that exist in this country.
If your goal is to promote reproductive health and healthy sexuality, how do the tools you use to achieve that end change based on the cultural composition of your audience? Are there messages that resonate throughout all communities regardless of their background? Are there messages that you would use, for example, in a group of 30-something white women that would never work in a group of 20-something Muslim men?Lara,
What a FABULOUS question. People have written books, or at least dissertations, on just that topic. You absolutely have to change your tools and methods depending on the cultural composition of your audience. Not only are there different cultural vocabularies in play around sex, there are also different concerns. For example, one issue that comes up frequently with working with women of Carribean descent is douching, which can be a nightmare for sexual health. On the other hand, it's much less of an issue in most white women, so you wouldn't want to spend as much time focusing on it.
I think there are definitely universal messages. The factual issues surround sex education don't change. However, I think that the more specific you can get when communicating to different cultural groups, the better off you are. Often when scientists are doing sexual health research, or designing intervention, they'll try to work with informed people from the community to develop their products. People in a community know the words their peers use to talk about sex, they know how it might be most productive to approach a taboo, and whether their peers would be more comfortable talking with one of their own or an outsider (You actually see both circumstances, depending on a community. In some cases people are more willing to talk about sensitive issues with a stranger than with someone they perceive as tied into their social network. Similarly sometimes a male educator will be more successful than a female, or completely unaccepted. It depends on the community.)
Are their universal tools? Eh. There are general tools you can use with any group, but you're always going to be more effective if you can tailor them to your audience. Men are different then women. Young people want to interact differently than older people. Immigrants, religious groups, there are always things to think about if you want to communicate as effectively as possible. You need to make yourself understood, to give people the information they need in a way that they can learn and accept. The best way to do that is to first spend some time learning about them. After all, a good educator knows that teaching is a two-way street.
Where do you feel the line is between being open and honest with children about sex? As a parent I do not want them to view sex as dirty or only as a way to procreate, but I also want them to be responsible and not promote promiscuity.
Do you think teaching primarily abstinence is still an effective way of preventing the spread of STD's in the teen and young adult population?Teaching primarily abstinence doesn't work. It's never been an effective way of preventing the spread of STDs since abstinence education puts a focus on virginity and, generally, fails to provide to give teens and young adults the skills they need to have safe sex if they do choose to have sex. Virginity focused education may also shift kids to practicing oral and anal sex, since it makes them think that pregnancy is the primary risk associated with sexual activity, rather than STDs - and many don't know that both of those activities put them at risk of infection. Comprehensive sex education doesn't make kids any more likely to have sex (there is lots of research showing this), but does make them more likely to have safe sex. Abstinence education may, occaisionally, lead to a small delay in sexual onset, but has no effect on STDs.
As for my feelings on your first question.... I am not a mother. However I believe with every bone in my body that when I become one, my philosophy will be the following:
I will give my children information about sex from an early age. I will not treat it as dirty. I will let them know that it can be an enjoyable experience. I will talk to them about contraception and std prevention... and I will strongly, strongly encourage them to wait to have sex until they are emotionally capable of handling it and it is something they want to do with their whole hearts - rather than something they are being pressured into by their peers.
There is nothing that prevents a parent from both being open and honest about sex and being open and honest about telling their kids they want them to wait and to be selective about potential partners. Providing an environment where your kids feel comfortable enough to talk to you about sexual health can help them make smart decisions about it. I think it's been very clearly shown that giving kids information about sex doesn't encourage them to have it, particularly when that information is combined with a) reasons why they shouldn't and b) the tools they need to resist peer and partner pressure.
In other words, I think if you do a good job covering the facts, and tell your kids something along the lines of "Look. Sex can be a wonderful thing. It can be fun, and pleasurable. It can also be unpleasant and emotionally or physically damaging. You really don't want to do anything you'll regret, because it can affect the rest of your life. I'd love it if you could wait to have sex until you found the person you want to marry, but if you can't, I hope you will at least wait to have sex until you have found a partner who you truly care about, and who cares about you and your emotional health and well being. If you do decide to have sex, please remember the following things. First: you always need to have safe sex and protect yourself against both pregnancy and disease. Second: you should never have sex with someone because they are pressuring you or because you want to fit in. Third, and most importantly, know that there is _always_ another chance. You _never_ need to have sex that night. It is _always_ your prerogative to stop, or wait. Anyone who tells you differently is someone you should walk away from at full speed. When in doubt, come home and talk to me. I may not be happy that you're thinking about having sex, but mostly what I care about is that you are safe - emotionally and physically. I'll try and help you make the right decision, and if it's one I disagree with... I'll at least be supportive enough to make sure you have the tools you need to minimize your risk."
I have a rose-colored view of the world. I want to believe that most parents, if they really think about it, would rather take steps to keep their children healthy than simply cross their fingers and hope they can remain abstinent. There's nothing wrong with telling your kids not to have sex. However, it's critical to do so in a way that if they _do_ decide to go against your wishes they at least know how to stay protected. It's bad enough having a disobedient child without having a disobedient child with an unintended pregnancy or an incurable STD. (Or, for that matter, a perfectly treatable STD that ends up making a young woman infertile after it doesn't get noticed for 5 years because she isn't practicing safe sex or having regular gynecological visits.)
What is your goal with "101 Ways You Can't Get Pregnant"? There are just a few posts at this point. Are you hoping that it will prompt open discussion or do you actually foresee making a list of 101 things and then stopping?I just started the page with a friend of mine last week, but our goal is to offer a "fun" alternative sex education site. I doubt we'll stop at 101, although it might take us a little while to get there...
Dr. Boesky, what was your thesis topic? What was your post-PhD path to where you are now (postdoc, straight into teaching.....etc)?Men, close your eyes, my thesis topic generally make heterosexual males wince:
"The role of vaginal bacteria in vaginal acidification"
(After which I have to go into the fact that yes, the vagina is mildly acidic, and no, it's not so acidic it's going to damage anything.)
Basically I studied something "everyone knew" - namely that lactobacilli are responsible for vaginal acidity. Except that a different faction of "everyone" knew that vaginal epithelial cells were responsible for making the acidic environment themselves. As it turned out, there hadn't actually been much research to support what either group of "everyone" knew... so I did some. Lactobacilli all the way!
When I finished my Ph.D., I spend a year completing an M.P.H. while waiting for funding to come through on my postdoctoral research grant, and then I did a short post doc as a researcher on a study of risk factors for premature birth. After that, I was offered a faculty position, and I was full time faculty for several years before I switched to part-time teaching and writing for a living. I love teaching. Even when I wanted to leave the university, I couldn't give it up.
I personally have heard some pretty ridiculous ways that pre-teens believe they can get pregnant. Top of the list would be through kissing. What is the most ridiculous one you've heard and corrected?Most ridiculous... it's hard to choose. Still, a perennial favorite is the"can I get pregnant if my boyfriend and I are dry humping, and he comes while we're both still fully dressed?" There was also a really great one a couple years ago about lying on wet bedsheets, but I can't remember the details.
What sparked you to decide to do this type of work? You've been doing it since high school so did you just wake up one day and think, "This is what I want to do?"My junior year in H.S. was during the height of the early AIDS epidemic, and, midway through the summer, the boy I had my first big crush on told me that he was worried he might be HIV positive. That's what put me on the path. I really thought I was going to grow up to be a lawyer, but I found a different way to help people. One more suited to my personality.
How has sexual education changed since you were first being educated? Are you finding that it's easier to talk about now than it was then or do you still run into those who think, "If we don't talk about it, it will go away"? I ask this because that is how my parents viewed sex and sexual education when I was younger. Are there still people out there who believe this?It's actually really interesting to me. Coming of age, as I did, in the height of the AIDS epidemic, in a liberal area of the country, I got detailed, in depth, sex education in school. It's probably why I held off on having sex for so long - the information was terrifying! 10 years earlier, or 10 years later, the level of sex education would have been significantly less frank.
I've actually been really horrified during the past few administrations about the shift to abstinence only education in schools. It's not research based, it's not scientific, and it doesn't work. Still, it's out there, both because of the religious right* and because there are huge numbers of parents who want to pretend that their teens aren't sexual beings. They'd rather avoid talking about sex and hope for the best then have open, frank conversations about safe sex and healthy sexuality. I'm really excited that Obama has such sensible ideas on this issue.
I had a conversation just a few months ago with the father of two teenage boys who didn't want them to learn about condoms. I was appalled. So many teens these days are sexually active, and there are so many risks. I actually lectured him over dinner. His logic - he didn't want to encourage them to become sexually active by talking about it. My response - research has shown time and time again that talking to kids about safe sex and healthy sexuality doesn't encourage them to have sex. It just encourages them to have sex safely if they're going to do so anyway.
*Although it was Clinton who forced Joycelyn Elders to resign after she said that it might not be inappropriate to teach that masturbation is a part of human sexuality.
While educating others on sex, safe sex and STI prevention, do you promote the use of sex toys as a way to maintain abstinence?Not perse. I tend to advocate strongly for masturbation, but I don't think I've ever explicitly promoted sex toys as part of sex education. Mind you, I think sex toys are great, and if I was ever asked I'd recommend them highly, but... I haven't promoted them to this point.
You may find it interesting that I got into an argument with another sex educator about two years ago because she told a young woman that if she penetrated herself with a dildo she would no longer be a virgin and it would devalue the first time she had sex with a man. I thought, and still think, that this was the most ludicrous thing that I ever heard.
Do you think it's healthy to include information about toys during sex-ed classes?Healthy? Why not. Practical? Probably not... at least not when dealing with teens. That having been said, there are several sex toy companies that work basically like tupperware. Women throw sex toy parties (my friends like to call them shtupperware parties) and invite a saleswoman over to sell toys in a "safe" environment. These parties tend to include a strong educational component, which I think is great. I love buying toys on the Internet (more selection! better prices!), but for women who are new to the concept of sex toys, a party like that can educate them as to why they might be a useful component in their sex lives and give them other sexual health information as well. The parties and the toys are a great teaching tool - they can be used to get women talking about subjects that might otherwise be too difficult to discuss. The first time I attended one, I couldn't help thinking "This is a sex educators wet dream!!!"
What methods do you feel are better for educating people on STDs as well as getting pregnant? Do you feel that your new project is a lighter way of looking at it, since there are some who don't like going into too much depth or graphics, or do you think that education at a more scientific level is more effective? The project that you've begun is really funny and humorous, but also has good insight to things that people might not understand, and that's an innovative and new way to look at sexual education.I think science has to be a part of it. I talked a lot about my philosophy of good sex education in another answer, but science is essential. People need facts, supported by research, to give them the tools they need to make good decisions. Humor is a useful tool (and thanks for your kind words! I'm having a lot of fun with it), but there is a strong factual component necessary for effective sex education. It's a scientific discipline, even though if you're going to do it right, it involves teaching a lot of personal development skills as well.
In many areas of the country sex education is still a subject schools refuse to look at progressively sticking to the abstinence only policy or worse. What kind of techniques can be used to create more open discussion and provide valued resources to students who are being misinformed or not being educated at all?This is a great source of frustration for me. Personally, I think that talking to parents, policy makers, and school officials about all of the research showing that their fears about comprehensive sex education are unjustified should change their minds, and sometimes it does, but sex is a topic that many people are irrational about. Sometimes all of the logic in the world won't convince people that comprehensive sex education is a good idea.
The question becomes, I suppose, whether or not we should legislate a level of health education that is mandatory for school curriculum. I'm not crazy about such a plan, because it has seemed that legislating what teachers have to teach is often detrimental, rather than beneficial, to the quality of education. However... I do take a certain perverse glee in the idea of a policy that, instead of the government only being willing to fund abstinence-only education (previous administration), the government would only be willing to fund science and health education that is based on high quality peer-reviewed research. Of course, that would require politicians to understand that there is a value to science, research, and review, but... it would be an enormous improvement.
All that having been said, it is clear to me that what has to exist, and what fortunately does exit, is a myriad of other options for teens and other vulnerable populations to educate themselves about sex. There are wonderful information resources on the Internet, Scarlet Teen for one, and excellent books as well. The trick is figuring out a) how to help the people who need them find them b) how to educate them to weed through the information out there and sort the quality information from the b.s. Since there are a lot of college students, and professional adults, who are still willing to use Wikipedia as a primary source*... we have a long way to go.
*Wikipedia has its uses. It's great for forming general ideas about a topic and figuring out what the primary sources might be, but for goodness sake, don't stop there!!!!
As a sexual health educator, what are your views about how an organization liked Planned Parenthood influences our society and impacts sexual education? What are your feelings about why our society is so divisive on this subject?I'm not really certain what you're asking with respect to Planned Parenthood. I think as a major Title X service providable they play an essential role in the women's health infrastructure. I think it's a shame that people think of them as primarily an abortion provider*. They do family planning, STD screening, and provide a whole host of necessary services in an affordable way for women who may not have any other practical options. They also provide a great deal of educational information for both professionals and consumers.
As for why our society is so divisive on the issue... I really think it's because we don't talk about sex and sexuality. We assume that sex is shameful, that talking about sex is dirty, and by making these assumptions we make it difficult or impossible to approach the topic with logic, science, or reason. There are moral issues surrounding sex, yes, but there are also physiological, social, medical, and historical issues. If we could talk about sex rationally, in the light of day, there would probably still be divergent opinions, but I don't think people would be so _angry_ about them.
*And they are NECESSARY as such a provider Very, very few doctors these days are being trained in pregnancy termination. It is a travesty to me that in some OB-GYN curricula, such training may be elective or not even provided. Doctors need to know how to care for their patients health, and their personal religious views should not be allowed to get in the way of that. Coverage of the issue, in brief, can be found here
As we all know, the 'family planning' portion of President Obama's stimulus bill was filibustered into oblivion. If you were granted an audience with our new President, what sort of counsel would you offer him in regards to sex-ed, family planning, and STD awareness/prevention? And do you think we could benefit from having a 'sex czar'? (Forgive me; the term 'sex czar' was just too good to pass up.)
These days, it seems that scientific fields are best elevated when there's a single person positioned at the front of it, right toward the mainstream. For instance, astronomy has Neil DeGrasse Tyson; gastronomy has Alton Brown; kids once had Bill Nye; and mainstream America had Dr. Ruth Westheimer. Do you feel that sex-education (and STD/STI education in particular) needs a new 'public spokesperson', so to speak - someone who can appeal to the masses? If so, would you apply?I love the term sex czar. Just imagine the business cards! Who wouldn't want that job, for the power trip and comedy value alone...
I think there is a benefit to having a clear voice advocating for science based health education, and particularly science based sex education. That having been said, I get the impression that the president knows we need it. During the campaign, at least, he spoke quite sensibly on the issue of sex education. The problem is that him knowing isn't enough. We need to convince Congress.
The appropriations bill was a decidedly mixed bag. I'm thrilled that the Affordable Birth Control Act stayed in. I hate that there's still a money for abstinence only education - and a lot of it at that. Would a sex czar have helped to prevent that? Somehow my instinct is that appointing a figurehead is too much "politics as usual" to make a difference in politics as usual. I wish I thought that giving congress mandatory lectures on the science of the issues would help. I'd show up myself with my power point slides and my laser pointer. Not to mention a pile of peer reviewed literature.
As for your other question... I would love to be the Alton Brown of sexuality education (and am trying my darndest to get a job doing just that). The man is brilliant, funny, and does a great job of educating people about the science of a subject in a way that is both educational and fun. Could sex education be made that accessible and fun? I think so, but I have to admit that I don't know if the audience would agree. The general public may not be ready for the level of frankness the issues really require... particularly when it comes to talking about STDs. Still, I think it would be a great boon to help them get there.