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Emotional and physical toll
Helen Power, a senior lecturer on women's studies at Washington University, says the emotional fallout of having oral sex can be devastating to teenage girls.
"If they're doing it to get boys and keep boys and not doing it for their own sexual satisfaction, it seems quite sick," she said. "It's a sense of domination and reaffirmation of the whole heterosexual ideal that you'll do anything to have a boy or man in your life."
And then there are the physical repercussions, like the ones Dr. Beth Gearhart discovered. Gearhart, a Missouri gynecologist, found herpes simplex virus type 1 lesions in the genitalia of about a dozen teenage girls over a two-month span a couple of years ago. Herpes simplex 1 is normally found in or around the mouth.
She recalls the first of those patients — a 17-year-old who considered herself a virgin. When Gearhart discovered the lesions, her conversation with that patient went like this:
Gearhart: "You said you haven't been sexually active. Are you sure?"
Patient: "Yeah."
"Have you had oral sex?"
"Well ... yeah."
Surprised at the attitude, she began calling school districts to see if they were aware of such a trend. The answer was yes.
When Gearhart offered to visit schools to talk about the risks, she got a mixed reaction. Administrators told her that parents didn't want the topic raised directly with their children.
Dilemma for schools
Parents have long been divided over how best to address sex education in the schools.
One in three schools nationwide teaches an abstinence-only curriculum that forbids discussion of oral sex or safe sex.
But a Kaiser Foundation study found that 80 percent of parents surveyed wanted their teenagers to be taught how to use different forms of birth control in junior and senior high school. Ninety-four percent said they wanted teachers to discuss with students the pressure to have sex and the emotional consequences of becoming sexually active.
The Kaiser survey didn't specifically address oral sex, said Tina Hoff, vice president for public health information at the foundation. But based on the strength of opinion, she believes parents are looking for more, not less, to be covered in the classroom.
Health educators in Puget Sound say they're torn: Without good definitions, kids form their own. But when talk gets too graphic, parents can become alarmed.
"Our teachers have to be careful," said Lloy Schaaf, director of curriculum and instruction for the Mukilteo School District, which will soon update its HIV-AIDS unit curriculum. "They have to stick closely to what the district has adopted, because that's their safety net. It's tough — you walk a real fine line as an educator."
In Seattle Public Schools, specific discussion of oral sex is not mandated by the curriculum. And the health-risks survey the district conducted in 1999 did not ask about it separately, or make it clear whether oral sex was included in the question about "sexual intercourse."
The survey, which included questions from the Centers for Disease Control and Prevention used to track risk behaviors over time, shows the percentage of kids who say they've had sexual intercourse dropped between 1995 and 1999. At Nathan Hale High School, for example, in 1995, 45 percent of students said they'd had sexual intercourse; by 1999, that percentage dropped to 31 percent.
However, the drop could reflect a trend toward oral sex if teens didn't consider it to be "sexual intercourse," conceded Pamela Hillard, manager for health education for Seattle Public Schools.
'You have to be really clear'
Even though the curriculum doesn't make it mandatory, in the classroom Seattle schools' health educators are trying hard to make it clear oral sex is included in the continuum of risky behaviors, said Hillard. "We want to be certain our children understand this is a form of sex, and a behavior that is risky to their health and development."
Tamara Brewer, a health educator at Ingraham High School, presents clear definitions for her ninth-grade health class in a presentation called, "At what point am I having sex?"
"In the adolescent world, being subtle or talking around a subject does not get the results you want — you have to be really clear," said Brewer, who said she's been addressing oral sex seriously for the past five or six years.
"I worked in a clinic, and I was getting kids saying they were virgins, presenting with STDs, having oral and anal intercourse," Brewer recalled. "This whole confused area is causing kids to think they are protected, and they are not. ... I truly believe, if we want kids to practice abstinence, we need to talk about this."
At Nathan Hale, Nickie McDonald says she also takes the straightforward approach in her ninth-grade health class. While she's blunt with her definitions, "I don't give them a lesson how to do it."
But being blunt is necessary, she said. "Some kids don't know what it is. I assume that most of them don't know. ... I hope most of them don't know."
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