I'm quoted in Texas Monthly

Over the weekend, at the annual convention of the Texas Medical Association, a friend said that she'd read my quote in "Texas Monthly." I assumed she meant an old article in Texas Medicine, the journal of the Texas Medical Association. I was wrong. (And, maybe now I know why I can't get appointed to any of the TMA Councils or Committees!)

In an article titled, "Faith, Hope and Chastity," in the very liberal Texas Monthly the author (without contacting me at all, by the way) used a statement that I made at a 2004 Texas School Board hearing on the content of high school textbooks on sex education.

The board met to consider these textbooks in July and September of 2004. More than one hundred people testified or submitted written testimony. Those who testified in person were given three minutes each to make their case. According to Gordon Crofoot, a specialist in HIV and STD treatment and research, many of the board members appeared totally uninterested in his testimony. Crofoot cares for about one thousand patients in his practice in Houston and is currently seeing more young patients with HIV than he has in his 31 years of practice.

“These textbooks do not meet the criteria and are factually and scientifically incorrect in what they say,” he told the board, “but their major fault is in what they don’t say and the resulting consequences. . . . If we do nothing [about STDs], the direct cost over the next ten years would be $10.6 billion. Comprehensive sex education programs might reduce this cost by fifty percent. Can Texas afford this cost?”

Crofoot was cut off when his three minutes were up. He offered to answer any questions. The board had none. Later in the day, he watched as Beverly Nuckols, a family doctor in New Braunfels opposed to comprehensive sex ed, was asked about the implications of human papillomavirus for men. She answered that HPV affected women differently than men before stating her position that condom instruction, in her experience as a family doctor, would do little good. “Yesterday I saw a boy who had had three partners in the last month,” she said. “He’s had twenty-two partners. He’s eighteen. He uses condoms every time. Unfortunately, a lot of the times he’s drunk and so they break or they don’t work. I mean, condoms are not a solution for teenagers outside of monogamous relationships. They don’t use them right even if we teach them.”

I'm not quite sure why I was chosen as the representative of those who "opposed comprehensive sex ed." I can't quite remember telling the story, but I probably did -- however, I don't think I would say, "I mean . . ." In order to read it in the journal, you'd have to turn to the "continued on page 200-something." However, I believe that the story was to refute testimony that high school boys and girls should be taught that condoms are the answer to all risk from the consequences of sex. My more common story is to note that condoms are more likely to be used correctly by couples in a monogamous relationship, that couples get better as time goes on, and that if a hundred couples use condoms to prevent pregnancy, 11 of them will get pregnant within a year.

The part that I remember addressing was a comment from a nurse practitioner who stated that there was no risk of contracting the Human Papilloma Virus for a girl, if the male wore a condom. The concern, according to her, is the infection of the girl's cervix. This was about the time that the public was becoming aware that cervical cancer is caused by HPV 99% of the time. According to the nurse, the tip of the penis when covered by the condom wouldn't actually touch the cervix. I felt compelled to delicately explain that the most common human sexual activity involves ins and outs, and that there is much more contact and potential for spread of the virus to all of the male and female genitalia -- except for the parts actually covered by the condom.

Let me correct one thing: I'm not against comprehensive sex education. I disagree with some people about the definition of "comprehensive," and believe that anything beyond the basics of very boring biology - the medical and legal responsibilities of human sexual activity - ought to be vetted by the parents in the local school districts. The school is not the place to teach methods and techniques and condoms are not the panacea they're far too often made out to be.

I do believe that the State (schools) should encourage sex within monogamous marriage, since that is the healthiest for individuals, families and their children, and for the taxpayer. While some people do very well in different arrangements, it takes a lot more work and the risks are far greater.

"Modest" Increase in Sexually Transmitted Diseases

After a decline in STD's in the late '80's and '90's that is believed to have been driven by "safer sex" strategies brought on by the spread of HIV, numbers of infections have increased for the second year in a row.

The increase may actually be the result of increased efforts at screening and more sensitive tests, according to the CDC.

The report notes that the greatest risk is found in men having sex with men and girls 15-19. These numbers may simply reflect the fact that these populations are more likely to be screened for diseases and that there's been a push to increase screening, particularly in the former demographic.

There's a physiological explanation about why younger girls are more likely to catch diseases like chlamydia and HPV, the virus that causes abnormal pap smears and can lead to cervical cancer. There's also a behavioral explanation: younger girls are more likely to engage in riskier behavior, have higher-risk partners and have more partners.

The cells of the cervix of the young girl are more susceptible to injury and to invection. As the girl matures, the columnar epithelium is replaced by squamous cell epithelium. (At the risk of grossing people out being indelicate - think of it as the difference between the tissues of the inside of your cheeks and the tissue on the outside of the lips.)

(Similar risk factors probably apply to the men having sex with men category, too, although I didn't see any specific discussion about these risks for girls or men in the mainstream press articles here, here, and here. This this article in a gay publication does review the girl's tissue changes and the difficulty of notifying the partner of an infected patient who is more likely to have anonymous sex partners. )


It is alarming, however, that the two vulnerable groups are also the people who are most likely to have life-long consequences of STD's. The girls risk early pregnancy and infertility and the men having sex with men risk truly deadly diseases like drug resistant strains of HIV/AIDS, syphilis, and gonorrhea.

I'm afraid that this report will fuel criticism of abstinence education. But let's face it, teaching condom use and oral contraceptives are not the answer for either of these populations.

We know a little about what works and a lot about what doesn't.

Edit, 11/27/07, grammar typos.