Roundups Sexual Health

Sexual Health Roundup: Porn Not So Influential?; Latinos Support Sex Ed; German Textbook ‘Too Explicit’

Martha Kempner

A new study suggests that porn might not influence young people's sexual behavior as much as we thought, and it turns out that even Europeans have limits about how explicit sex education can be, at least when it's for first-graders.

Sexual Health Roundup is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Porn Might Not Be So Bad for Young People

Today’s young people are growing up in a very different world than any previous generation. While their parents may have had a copy of Playboy hidden under their mattress or watched a grainy version of Debbie Does Dallas, today’s youth have a wide array of X-rated materials at their fingertips. Many parents, educators, and researchers are worried about the impact this has on their attitudes and behaviors around sex, and fear that it encourages riskier sexual behavior and promotes an unrealistic picture of what sex is like. New research out of the Netherlands takes on the first of these issues and finds that pornography might be less influential than feared.

Researchers at the University of Copenhagen conducted an online survey of 4,600 young people ages 15 to 25 in the Netherlands. Participants were asked about their pornography viewing habits as well as their sexual behavior. Specifically, they were asked if they had ever engaged in “adventurous sex,” a category that included threesomes, sex with same-gender partners, and “transactional sex.” They also asked about “partner experience,” which included age of sexual initiation, number of lifetime parents, and frequency of one-night stands.

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The survey found that 88 percent of males and 45 percent of females had seen sexually explicit material through the Internet, magazines, videos, television, and/or other media in the past 12 months. Researchers concluded that consumption of sexually explicit material was significantly associated with “adventurous” and “transactional” sex in ways that control variables (such as demographic characteristics and other media usage) were not. Consumption of sexually explicit material was also associated with partner experiences for women but not for men. Though they were statistically significant, the associations were very modest, accounting for between 0.3 percent and 4 percent of differences in sexual behaviors.

Martin Hald, the study’s lead author, said in a press release, “Our data suggest that other factors such as personal dispositions—specifically sexual sensation seeking—rather than consumption of sexually explicit material (SEM) may play a more important role in a range of sexual behaviors of adolescents and young adults, and that the effects of sexually explicit media on sexual behaviors in reality need to be considered in conjunction with such factors.”

He went on to say, “These findings contribute novel information to the ongoing debates on the role of SEM consumption in sexual behaviors and risk and provide appropriate guidance to policymakers and program developers concerned with sexual education and sexual health promotion for young people.”

These results may be biased, as they are based on a voluntary online survey. It is reasonable to assume that those who chose to participate might be more likely to watch pornography and/or engage in “adventurous” sex than those who did not participate. Moreover, it is unclear if the results could be generalized to other countries, such as the United States, that have very different sexual attitudes than the Netherlands.

New Poll Shows Latino Support for Sex Education and Birth Control

A new poll commissioned by New York University’s Center for Latino Adolescent and Family Health and the Planned Parenthood Federation of America (PPFA) surveyed a sample of over 1,000 Latinos over age 18 in both Spanish-speaking and English-speaking families. The survey asked about sex education, teen pregnancy, and birth control.

It found that nine out of ten Latinos think sex education should be taught in high school and middle school. More specifically, a large majority of Latinos polled said they think high school students should be taught about sexually transmitted diseases (97 percent), healthy relationships (94 percent), abstinence (92 percent), birth control (91 percent), and sexual orientation (82 percent).

The poll also focused on teen pregnancy. It found that 87 percent of Latinos said it is very important for teens to avoid getting pregnant or causing a pregnancy. In fact, 51 percent said avoiding pregnancy is even more important for Latinos than for other groups. The respondents also believe that parents, schools, government, and the media have to work together to address teen pregnancy.

Vincent Guilamo-Ramos, a professor and co-director of the NYU center noted in a press release, “This poll is important because there’s been so little focus on Latino attitudes toward a problem that affects them disproportionately.”

Leslie Kantor, vice president of education at PPFA, added, “The data clearly shows that Latinos see teen pregnancy as a major issue, that they believe we all have a role to play to address it, and that they see access to birth control and comprehensive sex education in both middle and high school as critical.”

German Sex Ed Textbook Is Too Explicit

We are used to Europeans having a much more open attitude about sexuality and sex education than we do here in the United States, but last week a textbook in Germany made headlines for being too explicit even there. Originally published in 1991, the textbook is titled Where Do I Come From? (translation). It includes illustrations of a couple, Lisa and Lars, in various stages of having sex, including one picture in which Lisa puts a condom on Lars’ erect penis and another in which they have intercourse. The accompanying text reads, “When it’s so good that it can’t get any better, Lisa and Lars have an orgasm. The vagina and penis feel nice and tingly and warm.”

While this might be acceptable if were aimed at older kids (at least in Germany), this book claims to be appropriate for children ages 5 and up and was recently shown to first-graders in Berlin. That school did not immediately respond to parents’ complaints, but after the book was reported on by the local press, people began to complain to Berlin’s equivalent of a city council. The controversy quickly became national with members of Parliament weighing in.  For example, Dorothee Bär of the Bavarian political party Christian Social Union, noted, “Sex education should accompany the development of children, but not speed it up.”

The publisher has since said that it would not reprint the book because it was “no longer up-to-date.” It will be replaced with s new version called Was I in Mommy’s Stomach Too?

I’m hoping the opening line is “No, you were in her uterus.”

Commentary Politics

No, Republicans, Porn Is Still Not a Public Health Crisis

Martha Kempner

The news of the last few weeks has been full of public health crises—gun violence, Zika virus, and the rise of syphilis, to name a few—and yet, on Monday, Republicans focused on the perceived dangers of pornography.

The news of the last few weeks has been full of public health crises—gun violence, the Zika virus, and the rise of syphilis, to name a few—and yet, on Monday, Republicans focused on the perceived dangers of pornography. Without much debate, a subcommittee of Republican delegates agreed to add to a draft of the party’s 2016 platform an amendment declaring pornography is endangering our children and destroying lives. As Rewire argued when Utah passed a resolution with similar language, pornography is neither dangerous nor a public health crisis.

According to CNN, the amendment to the platform reads:

The internet must not become a safe haven for predators. Pornography, with its harmful effects, especially on children, has become a public health crisis that is destroying the life [sic] of millions. We encourage states to continue to fight this public menace and pledge our commitment to children’s safety and well-being. We applaud the social networking sites that bar sex offenders from participation. We urge energetic prosecution of child pornography which [is] closely linked to human trafficking.

Mary Frances Forrester, a delegate from North Carolina, told Yahoo News in an interview that she had worked with conservative Christian group Concerned Women for America (CWA) on the amendment’s language. On its website, CWA explains that its mission is “to protect and promote Biblical values among all citizens—first through prayer, then education, and finally by influencing our society—thereby reversing the decline in moral values in our nation.”

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The amendment does not elaborate on the ways in which this internet monster is supposedly harmful to children. Forrester, however, told Yahoo News that she worries that pornography is addictive: “It’s such an insidious epidemic and there are no rules for our children. It seems … [young people] do not have the discernment and so they become addicted before they have the maturity to understand the consequences.”

“Biological” porn addiction was one of the 18 “points of fact” that were included in a Utah Senate resolution that was ultimately signed by Gov. Gary Herbert (R) in April. As Rewire explained when the resolution first passed out of committee in February, none of these “facts” are supported by scientific research.

The myth of porn addiction typically suggests that young people who view pornography and enjoy it will be hard-wired to need more and more pornography, in much the same way that a drug addict needs their next fix. The myth goes on to allege that porn addicts will not just need more porn but will need more explicit or violent porn in order to get off. This will prevent them from having healthy sexual relationships in real life, and might even lead them to become sexually violent as well.

This is a scary story, for sure, but it is not supported by research. Yes, porn does activate the same pleasure centers in the brain that are activated by, for example, cocaine or heroin. But as Nicole Prause, a researcher at the University of California, Los Angeles, told Rewire back in February, so does looking at pictures of “chocolate, cheese, or puppies playing.” Prause went on to explain: “Sex film viewing does not lead to loss of control, erectile dysfunction, enhanced cue (sex image) reactivity, or withdrawal.” Without these symptoms, she said, we can assume “sex films are not addicting.”

Though the GOP’s draft platform amendment is far less explicit about why porn is harmful than Utah’s resolution, the Republicans on the subcommittee clearly want to evoke fears of child pornography, sexual predators, and trafficking. It is as though they want us to believe that pornography on the internet is the exclusive domain of those wishing to molest or exploit our children.

Child pornography is certainly an issue, as are sexual predators and human trafficking. But conflating all those problems and treating all porn as if it worsens them across the board does nothing to solve them, and diverts attention from actual potential solutions.

David Ley, a clinical psychologist, told Rewire in a recent email that the majority of porn on the internet depicts adults. Equating all internet porn with child pornography and molestation is dangerous, Ley wrote, not just because it vilifies a perfectly healthy sexual behavior but because it takes focus away from the real dangers to children: “The modern dialogue about child porn is just a version of the stranger danger stories of men in trenchcoats in alleys—it tells kids to fear the unknown, the stranger, when in fact, 90 percent of sexual abuse of children occurs at hands of people known to the victim—relatives, wrestling coaches, teachers, pastors, and priests.” He added: “By blaming porn, they put the problem external, when in fact, it is something internal which we need to address.”

The Republican platform amendment, by using words like “public health crisis,” “public menace” “predators” and “destroying the life,” seems designed to make us afraid, but it does nothing to actually make us safer.

If Republicans were truly interested in making us safer and healthier, they could focus on real public health crises like the rise of STIs; the imminent threat of antibiotic-resistant gonorrhea; the looming risk of the Zika virus; and, of course, the ever-present hazards of gun violence. But the GOP does not seem interested in solving real problems—it spearheaded the prohibition against research into gun violence that continues today, it has cut funding for the public health infrastructure to prevent and treat STIs, and it is working to cut Title X contraception funding despite the emergence of Zika, which can be sexually transmitted and causes birth defects that can only be prevented by preventing pregnancy.

This amendment is not about public health; it is about imposing conservative values on our sexual behavior, relationships, and gender expression. This is evident in other elements of the draft platform, which uphold that marriage is between a man and a women; ask the U.S. Supreme Court to overturn its ruling affirming the right to same-sex marriage; declare dangerous the Obama administration’s rule that schools allow transgender students to use the bathroom and locker room of their gender identity; and support conversion therapy, a highly criticized practice that attempts to change a person’s sexual orientation and has been deemed ineffective and harmful by the American Psychological Association.

Americans like porn. Happy, well-adjusted adults like porn. Republicans like porn. In 2015, there were 21.2 billion visits to the popular website PornHub. The site’s analytics suggest that visitors around the world spent a total of 4,392,486,580 hours watching the site’s adult entertainment. Remember, this is only one way that web users access internet porn—so it doesn’t capture all of the visits or hours spent on what may have trumped baseball as America’s favorite pastime.

As Rewire covered in February, porn is not a perfect art form for many reasons; it is not, however, an epidemic. And Concerned Women for America, Mary Frances Forrester, and the Republican subcommittee may not like how often Americans turn on their laptops and stick their hands down their pants, but that doesn’t make it a public health crisis.

Party platforms are often eclipsed by the rest of what happens at the convention, which will take place next week. Given the spectacle that a convention headlined by presumptive nominee (and seasoned reality television star) Donald Trump is bound to be, this amendment may not be discussed after next week. But that doesn’t mean that it is unimportant or will not have an effect on Republican lawmakers. Attempts to codify strict sexual mores are a dangerous part of our history—Anthony Comstock’s crusade against pornography ultimately extended to laws that made contraception illegal—that we cannot afford to repeat.

Commentary Sexual Health

Don’t Forget the Boys: Pregnancy and STI Prevention Efforts Must Include Young Men Too

Martha Kempner

Though boys and young men are often an afterthought in discussions about reproductive and sexual health, two recent studies make the case that they are in need of such knowledge and that it may predict when and how they will parent.

It’s easy to understand why so many programs and resources to prevent teen pregnancy and sexually transmitted infections (STIs) focus on cisgender young women: They are the ones who tend to get pregnant.

But we cannot forget that young boys and men also feel the consequences of early parenthood or an STI.

I was recently reminded of the need to include boys in sexual education (and our tendency not to) by two recent studies, both published in the Journal of Adolescent Health. The first examined young men’s knowledge about emergency contraception. The second study found that early fatherhood as well as nonresident fatherhood (fathers who do not live with their children) can be predicted by asking about attitudes toward pregnancy, contraception, and risky sexual behavior. Taken together, the new research sends a powerful message about the cost of missed opportunities to educate boys.

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The first study was conducted at an adolescent medicine clinic in Aurora, Colorado. Young men ages 13 to 24 who visited the clinic between August and October 2014 were given a computerized survey about their sexual behavior, their attitudes toward pregnancy, and their knowledge of contraception. Most of the young men who took the survey (75 percent) had already been sexually active, and 84 percent felt it was important to prevent pregnancy. About two-thirds reported having spoken to a health-care provider about birth control other than condoms, and about three-quarters of sexually active respondents said they had spoken to their partner about birth control as well.

Yet, only 42 percent said that they knew anything about emergency contraception (EC), the only method of birth control that can be taken after intercourse. Though not meant to serve as long-term method of contraception, it can be very effective at preventing pregnancy if taken within five days of unprotected sex. Advance knowledge of EC can help ensure that young people understand the importance of using the method as soon as possible and know where to find it.

Still, the researchers were positive about the results. Study co-author Dr. Paritosh Kaul, an associate professor of pediatrics at the University of Colorado School of Medicine, told Kaiser Health News that he was “pleasantly surprised” by the proportion of boys and young men who had heard about EC: “That’s two-fifths of the boys, and … we don’t talk to boys about emergency contraception that often. The boys are listening, and health-care providers need to talk to the boys.”

Even though I tend to be a glass half-empty kind of person, I like Dr. Kaul’s optimistic take on the study results. If health-care providers are broadly neglecting to talk to young men about EC, yet about 40 percent of the young men in this first study knew about it anyway, imagine how many might know if we made a concerted effort.

The study itself was too small to be generalizable (only 93 young men participated), but it had some other interesting findings. Young men who knew about EC were more likely to have discussed contraception with both their health-care providers and their partners. While this may be an indication of where they learned about EC in the first place, it also suggests that conversations about one aspect of sexual health can spur additional ones. This can only serve to make young people (both young men and their partners) better informed and better prepared.

Which brings us to our next study, in which researchers found that better-informed young men were less likely to become teen or nonresident fathers.

For this study, the research team wanted to determine whether young men’s knowledge and attitudes about sexual health during adolescence could predict their future role as a father. To do so, they used data from the National Longitudinal Study of Adolescent Health (known as Add Health), which followed a nationally representative sample of young people for more than 20 years from adolescence into adulthood.

The researchers looked at data from 10,253 young men who had completed surveys about risky sexual behavior, attitudes toward pregnancy, and birth control self-efficacy in the first waves of Add Health, which began in 1994. The surveys asked young men to respond to statements such as: “If you had sexual intercourse, your friends would respect you more;” “It wouldn’t be all that bad if you got someone pregnant at this time in your life;” and “Using birth control interferes with sexual enjoyment.”

Researchers then looked at 2008 and 2009 data to see if these young men had become fathers, at what age this had occurred, and whether they were living with their children. Finally, they analyzed the data to determine if young men’s attitudes and beliefs during adolescence could have predicted their fatherhood status later in life.

After controlling for demographic variables, they found that young men who were less concerned about having risky sex during adolescence were 30 percent more likely to become nonresident fathers. Similarly, young men who felt it wouldn’t be so bad if they got a young woman pregnant had a 20 percent greater chance of becoming a nonresident father. In contrast, those young men who better understood how birth control works and how effective it can be were 28 percent less likely to become a nonresident father.9:45]

Though not all nonresident fathers’ children are the result of unplanned pregnancies, the risky sexual behavior scale has the most obvious connection to fatherhood in general—if you’re not averse to sexual risk, you may be more likely to cause an unintended pregnancy.

The other two findings, however, suggest that this risk doesn’t start with behavior. It starts with the attitudes and knowledge that shape that behavior. For example, the results of the birth control self-efficacy scale suggest that young people who think they are capable of preventing pregnancy with contraception are ultimately less likely to be involved in an unintended pregnancy.

This seems like good news to me. It shows that young men are primed for interventions such as a formal sexuality education program or, as the previous study suggested, talks with a health-care provider.

Such programs and discussion are much needed; comprehensive sexual education, when it’s available at all, often focuses on pregnancy and STI prevention for young women, who are frequently seen as bearing the burden of risky teen sexual behavior. To be fair, teen pregnancy prevention programs have always suffered for inadequate funding, not to mention decades of political battles that sent much of this funding to ineffective abstinence-only-until-marriage programs. Researchers and organizations have been forced to limit their scope, which means that very few evidence-based pregnancy prevention interventions have been developed specifically for young men.

Acknowledging this deficit, the Centers for Disease Control and Prevention and the Office of Adolescent Health have recently begun funding organizations to design or research interventions for young men ages 15 to 24. They supported three five-year projects, including a Texas program that will help young men in juvenile justice facilities reflect on how gender norms influence intimate relationships, gender-based violence, substance abuse, STIs, and teen pregnancy.

The availability of this funding and the programs it is supporting are a great start. I hope this funding will solidify interest in targeting young men for prevention and provide insight into how best to do so—because we really can’t afford to forget about the boys.