Talking to your Teen about Safe Sex

By Dr. Monica Henning

Wow, how did we get here?  You go from rocking your little baby in your arms, then made it through the terrible two’s and three’s, and somehow you blinked, and now you have a teenager on your hands!  

And along with teens, comes their moodiness, surliness, ability to cold-shoulder you or talk back to you. But they’re still your little baby, and it’s your job as a parent to protect them.  We protect them from physical harm… we bolt the furniture down so it won’t tip over, we put covers over the electrical outlets, we put locks on the cabinet doors, gates in front of the staircase.  But do we teach them how to protect themselves from infections that they can easily catch from sex?

Whoa, wait a second, you say.  My kid is not having sex. First of all, they’re just a kid, and second of all, they’re not even in a relationship with anyone.  Well, unfortunately as an Ob/Gyn doctor, I have delivered many teen girls who barely knew the father of the baby. It’s happening.  

Many teens have casual sex. They aren’t necessarily in a relationship with the person they sleep with. The fact of the matter is, that nearly 50-60% of high school students are sexually active, with the percentage increasing they older they get. Their hormones are raging, and they don’t necessarily have the maturity to handle themselves responsibly.  I hate to say it, but my youngest pregnant patient was 11 years old. Now when we were 11, we got giddy over “going steady” with someone and holding hands in front our classmates. But times have changed, and if we have to stay in the know if we want to protect our kids.

Proportion of high school students who have sex at least once, 1991–2009.

(From Eaton DK, et al. Youth risk behavior surveillance—United States, 2009. MMWR Surveill Summ 2010:59 [SS-5].)

Gonorrhea, Chlamydia, Syphillis, Herpes, genital warts, Hepatitis, HIV, Trichomonas, HPV…. These can all be caught through sex.  And we do NOT need our kids to be catching them.

There are so many infections, some cannot be treated by antibiotics because they aren’t even bacteria.  Some are viruses and will stay with a person throughout their whole lifetime. Some can cause chronic pain, meningitis, arthritis, blindness, infertility, or even cancer!  

This is why it is sooooo important we talk to our kids about how to be safe. If they don’t know about safe sexual precautions, they could easily catch something that leads to much bigger medical problems.  Can you imagine, a preventable sexual infection being the cause of a cervical cancer or penile cancer? An ounce of prevention is definitely worth a pound of cure. We cannot afford to NOT have this conversation with our kids.  

Not to mention, when you protect yourself against these STI’s (sexually transmitted infections)’s or STD’s (sexually transmitted diseases), you also add another layer of protection against unplanned pregnancy.

According to the national surveys conducted by the National Campaign to Prevent Teen & Unplanned Pregnancy, teens report that their parents have the greatest influence over their decisions about sex – more than friends, siblings, or the media.  

Really?! Who knew, that they might actually be listening. Buuuuut, that’s only if you are talking to them about it.

But how? This is such a hard topic to try to approach a teen about. No parent likes to do it, but it definitely pays off. Most teens say they share their parents’ values about sex, and making decisions about delaying sex would be easier if they could talk openly and honestly with their parents.¹ Studies have shown that teens who report talking with their parents about sex are more likely to delay having sex and to use condoms when they do have sex.²

Okay, so how do we parents broach this difficult awkward subject of sex and safe sex?

It’s important to talk about this frequently and in a way where they can converse with you. They don’t want to hear a lecture. They got that in sex ed class. It’s supposed to be a conversation.  You want them to feel like they can come to you with questions, and not have to turn to their friends or social media, who may not be a very accurate source of information.  And try not to be stiff and awkward about it. These teens can pick up on this. But the more frequently you talk to your teen about this subject, the less awkward it will become.  

I find in the car to be an excellent time.  They are a captive audience, but you don’t have to awkwardly look each other in the eye during the whole conversation.  Dinner time works too. Or even if following watching something on a TV show or a movie. Let it be your segue onto the topic.  And remember, try to not sound judgmental or threatening.

“So Will and Heather are going out?  That’s good. They seem cute together.  Are there a lot of other couples in your grade? Where do they go on their dates?  Do they show a lot of PDA? What do you think of that? Do you think they’re having sex?   What do you think of that? You think they use protection? What do you know about protection? What about birth control?”  

“Well that brings up a good topic… are you interested in anyone at school?  Have you gone on any dates with them? Do you think it will ever get to the point where you guys might have sex?”

It’s amazing, how scary the math can be on past sex partners… I like to give the analogy of it’s like all the past partners sharing an apple.  You initially have this delicious, fresh, crisp red apple. It’s so ripe, you have been saving this apple for a while, and have been looking forward to eating it all day.  Then Tiffany took a bite out of it. Then Tiffany slept with Brad. So Brad took a bite out of the apple. Then Brad slept with Jen, so Jen took a bite out of the apple too.  Jen slept with Will, who took another bite out of the apple. Will slept with Lisa, who took another bite out of the apple. By the time the apple makes it to you, so many people have taken a bite out of this apple, it’s not looking so delicious and crisp.  It’s now brown, and soft, and not looking appetizing at all.

This is how it can be more risky, the more partners you rack up.  Or even if it’s your very first partner, depending on who they slept with before you, you’re still at risk for an STD / STI.  Your chances of catching an infection increases with the more people you sleep with because they have most likely slept with others before you.  It all adds up, just like your chances of getting sick from that apple so many people have taken a bite out of and left their saliva on.

Important things to bring up to your teen:

• Sometimes an STI can have symptoms of vaginal / penile discharge, burning when you pee, a blister in the genital region, etc.
  • But most STD’s don’t have any symptoms at all so you can’t tell if your partner has an STD just by looking at them.
  • A good way to be safe is to go with your partner and get tested before you ever start having sex with them.
• An STI can get passed on from person to person through any type of sexual contact, whether it is through penile-vaginal “normal” sex, oral sex, or anal sex, and some just through skin-to-skin contact or what some of us refer to as “outercourse”.  
• The only way to surefire way to 100% protect yourself is to not have sex at all (abstinence).
• The next best way, is of course by using a condom.  Now it isn’t 100% like abstinence, but it’s the only thing available.  Remember, a condom doesn’t cover the entire penis or vagina, so anywhere where there is direct skin to skin contact, you could catch something like genital warts or herpes.  
• It may seem safe to have oral sex and anal sex because one can’t get pregnant from it, but you can still get infections that way, including something as deadly as HIV.
  • Even with oral sex, you can get gonorrhea of the throat or syphilis.  I know it seems like overkill and unnecessary, but you need to use a condom even with oral sex.  And if someone doesn’t respect your wishes of wanting to use a condom, they don’t deserve to have sex with you.  
• Very important for you to understand NOT just to use a condom, but know HOW to use a condom.
  • There are male condoms to cover the penis, and there are female condoms to put inside the vagina. This link shows how to use a female condom.
  • There are condoms made of latex and non-latex (Polyurethane, polyisoprene, and lambskin). Latex tends to be more elastic and less likely to break.  Some of the non-latex are not as effective as preventing pregnancy and STI’s but are a suitable substitute for those with latex allergies.
• Even if you and your partner are using a birth control medication of some sort, like pills, or a patch, or an implant, they don’t protect against infections.  
• If you don’t feel comfortable talking about these things with me, at least talk to your doctor about it.  They are health care professionals and are experts about this. Everything you speak to them about is confidential and won’t share it with the parents (unless doc believes you are going to harm yourself or others).  (Now parents do have the right to request a copy of medical records, and also may know some things through insurance billing)
  • Your healthcare provider can help you figure out how to keep safe as well as how to test for STD’s / STI’s.
• And again, remember….The only fool proof 100% safest method of course is no sex at all!

Other Facts:

• Even though 15-24 year olds are only ¼ of the sexually active population, they account for ½ of the 20 million new sexually transmitted infections that occur in the US each year per the CDC.  That’s 10 MILLION newly diagnosed infections in 15-24 year olds in the USA EACH YEAR!!!
• Chlamydia 1.59 million cases in the USA per year  (CDC)
• Gonorrhea 468,514 cases in the USA per year; 18.5% rate increase since 2015
• Primary and Secondary Syphilis 27,814 cases; 17.6% rate increase since 2015
• Congenital Syphilis 628 cases; 27.6% rate increase since 2015
• 66% of sexually active US teens use contraception  (Guttmacher institute)
• CDC recommends annual chlamydia testing for all sexually active women < 25 yo

Useful websites:

• Teenpregnancy.org is now powertodecide.org
• Get Yourself Tested
• www.cdc.gov/std/
• www.cdc.gov/healthyyouth/protective/pdf/talking_teens.pdf
• www.plannedparenthood.org/learn/birth-control
• www.girlsmarts.org  (designed for teen girls specifically)

Other References:

• Guttmacher Institute
• www.cdc.gov/STD/
• https://www.cdc.gov/healthyyouth/protective/pdf/talking_teens.pdf

1. Albert B. (2012). With one voice: America’s adults and teens sound off about teen pregnancy. Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy. Retrieved February 11, 2014, from http://thenationalcampaign.org/ resource/one-voice-2012.
2. Markham CM, Lormand D, Gloppen KM, et al. Connectedness as a predictor of sexual and reproductive health outcomes for youth. The Journal of Adolescent Health 2010;46:S23‒41.

:::::

Monica Henning, MD, is board certified in Obstetrics & Gynecology & a clinical assistant professor for the University of Oklahoma’s School of Community Medicine.  Dr. Henning has 2 young boys of her own.