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We Need to Talk About Sex in the Bible Belt

Op-Med is a collection of original articles contributed by Doximity members.

Let’s talk about S-E-X. Those three little letters that will make most people blush, clear their throat, loosen their tie, or clutch their pearls. It’s strange how such a small word can lead to such big consequences.

And no, I’m not just talking about the responsibility of growing, birthing, and raising a child. I’m also referring to monumental, life changing issues. Like the pelvic inflammatory disease from an untreated chlamydial infection that left a 17-year-old girl hospitalized for the better part of three months with a hysterectomy baring her from ever experiencing the joy of childbirth. Or the woman whose mother sat with her every day in the hospital as she laid there dying in her early 30s from HIV-associated CNS lymphoma. Or the ever-rising rate of congenital syphilis in the state of Louisiana, which happens to be over five times the national average.

One Small Word, One Huge Problem

With STIs at an all time high, prevention is a key to helping make an actual difference in this contentious public health and policy issue on local and national scales. Advocacy, health education, and patient centered conversation need to be revised in order to change the narrative in regards to life-saving topics such as contraception, sexuality, and sexually transmitted infections

As a Med-Peds provider in the South, I’m uniquely situated to see the detrimental effects from the lack of high quality sexual education to patients at both ends of the age spectrum. From the 16-year-old that I counseled in the ER during her third visit in as many months for STD testing who had no idea that she could get re-infected with an STI if her partner wasn’t treated. To the 60-some-odd-years-old woman I saw in my Primary Care clinic who (hand to God) did not know that she could contract an STI from oral sex. I regularly see the disparate effects of poor policies, funding, and practices of sex education in my community.

But that seems to be the state of providing care in the South, where sexual education is deeply rooted in conservative cultural and religious standards leading to restrictive guidelines and obstructive environment high-quality sex education. Unsurprisingly, the state of Louisiana does not require instruction in sexual health education at any grade level but is allowed to be taught in 7th through 12th grade. When it is taught, sexual health education must emphasize abstinence — or specifically, the concept that students have the power to control personal behavior. This education must, in no way, “counsel or advocate” abortion or distribute any contraceptive device (including condoms).

Abstinence-only. Chose not to have sex. You have the power to resist your sexual urges. What a strange concept to expect teenagers with developing frontal lobes — the decision-making center of the brain — to realistically master given their propensity to give into emotional impulses. It comes as no surprise to me that as of 2017, Louisiana ranked fourth in the nation for new HIV cases, third highest in new AIDS cases, third in the nation for primary and secondary syphilis (with a large percentage of new HIV and syphilis diagnoses occurring among adolescents aged 13-24 years), and seventh in teen pregnancy.

Image from the Centers for Disease Control and Prevention (CDC).
Table from the Guttmacher Institute, Sex and HIV Education State Laws and Policies.

But the misguided legislative decisions focusing on the morality of sex outside of marriage instead of the health and welfare of citizens is not unique to my state. Actually, only 24 states and the District of Columbia mandate sex education. With only 13 states requiring the instruction be medically accurate. Compared to other states in the Bible Belt, Lousiana doesn’t fall too far from the status quo.

According to the CDC, the South has some of the worse rates of STIs and teen pregnancy in the nation. In 2017, rates of reported cases of chlamydia were highest in the South (560.4 cases per 100,000 population, which is a 6.8 percent increase from 2016). The South had the highest rate of reported gonorrhea cases (194.0 cases per 100,000 population) among the four regions of the United States in 2017. In 2017, the highest rates of congenital syphilis were observed in the West and in the South. (They defined the South as AL, AK, DE, DC, FL, GA, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, and WV). But not to just throw shade on the South, but the United States as a whole, like is usually does for most health statistics, pales in comparison to our other western, industrialized counterparts.

Saving Sex in the South

Okay, so now you’ve seen the numbers (that I’m sure you weren’t surprised to see) and you’ve let me rant about the detrimental effects caused by a lack of a proper, medially accurate sexual education. Now, I hope you’ll give me just a paragraph or two more before you leave your angry, religious fueled *insert name of religious text* quotes to sway me into thinking that abstinence-only is the “right” way. Regardless of your religious affiliation or personal beliefs, the fact is that abstinence-only until marriage programs, which started in the 1980s before the advent of sexting, Wi-Fi, and mobile ride share services, has not made enough of an impact on young people’s behavior to stop the rise of STIs and teen pregnancy. It is perpetuating lasting and cyclical affects on the health of entire generations of people.

Put simply: these programs just don’t work! But there are other methods that are able to make an impact.

Research shows that comprehensive sexuality education doesn’t increase the sexual risk that young people aged 15-19 years, but it does reduce the pregnancy rate by 50 percent compared to those who received abstinence-only education. And in 2010, under former President Barack Obama, two small funding streams for teen pregnancy prevention programs were started, one of which is the Teen Pregnancy Prevention Program (TPPP). The TPPP was created to provide grant funding and support for evidence-based programs that support adolescent sexual health education and reduce unintended pregnancies. Unfortunately, the legacy of these programs are being corrupted by the current administration. But we still have the opportunity, as health care providers to provide education and health resources to reduce sexually risky behavior and make an impact on this public health issue.

Here are the options: People in the South should just move to Vermont. Or we can continue to tell adolescents to just not to give into their sexual urges and just hope it sticks. Or we can try to encourage real change in sexual behaviors through proper and accurate sexuality education. Sexual identity, STI prevention, and pregnancy prevention are all topics that we have to address in order to help halt the rise of STIs in this country. And a cornerstone of effective reproductive health education is assuring that there is readily available, accurate information on contraception, human relationships, and sexuality.

It is the duty of health care providers to distribute age-appropriated sex education in our clinical spaces while advocating for the legislative changes in order to promote proper and lasting education regarding sexuality and fertility. Be they hormone-riddled teenagers or horny grandparents (uncomfortable as it may be for both parties), health providers have a duty to educate our patients about safe sex practices. And why not? Come on, let’s talk about sex.

Dr. Chioma Udemgba is a third-year Med-Peds resident physician currently training at Tulane University in New Orleans, LA. She is passionate about creative writing, graduate medical education, and working with underserved populations.

Dr. Udemgba is a 2018–2019 Doximity Author.

Image: iofoto / shutterstock

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