A new study, released early this week, found that 10% of young people who tested positive for one of three common STDs—chlamydia, gonorrhea and trichomoniasis—claimed they had abstained from sex (defined as vaginal intercourse) in the last 12 months.
Although the researchers do point out that some of the youth could have simply forgotten they’d had sex, or contracted the infection more than a year ago, or engaged in other kinds of sexual activities that could transmit STDs, their conclusion is that teens and young adults’ self-reported sexual histories are not to be trusted. And so doctors should screen all youth for STDs to be safe.
And while I’m all for more STD testing, I agree with Cara at the Curvature that this conclusion—that youth lie about having sex, so doctors should do more testing—misses some key points. Instead, we should be asking why young people aren’t honest about their sexual behavior and how doctors can ensure better communication with them.
“What unnerves me is the casual glossing over of the inadequacy of the questions asked — and the complete absence of a recommendation that doctors should ask better ones. I say that better than assuming young people to all be a bunch of liars, doctors should work harder to establish meaningful communication with patients and, importantly, to interact with them in a non-judgmental way. A way that doesn’t assume them to be straight, a way that doesn’t assume there’s only one kind of sex, a way that doesn’t suggest imminent judgment if a female patient says she has had sex, a way that doesn’t suggest an assumption that a non-white patient or low-income patient must have had sex. A way, in other words, that treats patients compassionately and humanely.
It’s also important to get to the root of the problem that’s even more insidious than the extremely common and even cultivated feeling of fear and intimidation towards doctors — the social fear of sexuality, and the dominant attitude that sexual activity is something to hide.”
Of course teens are tempted to lie about their sexual behavior—especially to adults in positions of authority like doctors. You only have to revisit this great photo essay in Slate to be reminded how thoroughly fucked up the U.S. approach to teen sexuality is.
Sometimes it’s easy to forget that sex-negativity—and the stigma around teen sexuality in particular—has real, direct effects on young people’s health. It’s not just about the pain of being slut-shamed, and the fear of being labeled “not normal,” and the many, many other ways our relationship to our sexuality is distorted by living in a culture that fears it. It also means that the teen birth rate in the U.S., even when at a record low, remains much higher than in Western Europe because we don’t do enough to encourage teen contraceptive use. It means that a 16-year-old faces disapproval and judgment when she makes the extremely responsible decision to get an effective, long-term form of birth control. And it means that some young people don’t feel like they can trust their doctors—people whose very job is to provide them with the information and tools needed to lead healthy lives in a confidential, non-judgmental way.
Thankfully, there are some great programs out there working to help establish “meaningful communication” between young people and their doctors. For example, Physicians for Reproductive Health and Choice’s Adolescent Reproductive and Sexual Health Education Project (ARSHEP) trains health care providers to teach fellow providers about the best practices for adolescent reproductive healthcare. And the Adolescent Health Care Communication Program (AHCCP) at the National Institute for Reproductive Health (full disclosure: I work there) trains teens to give workshops to providers on better communicate with their youth patients and act as Standardized Patients to give providers an opportunity to practice interacting with real teens.
The fact that some teens hide their sexual histories from their doctors should be recognized for what it is: an unacceptable consequence of the fear and stigma surround teen sexuality. And it should be tackled at its roots in our sex-phobic culture, instead of simply side-stepped through more testing.