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. TUESDAY JANUARY 29 2002 The Times The price of casual sex
BY CAROL MIDGLEY Britain is suffering from a sexually transmitted diseases
epidemic, with huge numbers of young people becoming infected The West London Centre for Sexual Health or clap clinic, to use the vernacular is tucked into the right-hand corner of
Charing Cross Hospital, away from the main entrance where hordes of visitors
loiter buying chocolates. Thats good, you think, as your heels click along the silent,
white corridor to its front door. Nice and quiet. Not much chance of bumping
into many other people who might guess that you have an embarrassing little
problem. So you step into the clinics main reception area and take a sharp breath. It is about as
quiet as the M25 in rush hour. The place is teeming with people who have
walked in off the street for on-the-spot treatment. Every chair is occupied,
mainly by under-35s who sit, jaws clenched, affecting to read magazines as
they await diagnosis of their problems. It is not yet 10am. The staff, from receptionists to consultants, are busy, busy,
busy, yet they treat each patient with an unhurried courtesy now extinct in
most GPs surgeries. They are, after all, pleased that these people have come
in at all. New studies show that Britain is suffering a sexually
transmitted disease (STD) epidemic, which is troubling the Government a great
deal. Diagnoses of almost every STD have risen dramatically during the past
five years, especially among young people, and in some cases to an
astonishing degree. In London, for instance, where statisticians gauge the nations
sexual health, cases of gonorrhoea have increased by 74 per cent in men and
75 per cent in women since 1995. Syphilis in men has risen by 211 per cent in
the past three year; two thirds of those infections were in heterosexual men.
But it is chlamydia an
insidious bacterial infection that has few symptoms but can cause infertility
and ectopic pregnancies in women if left untreated that has seen the most frightening upsurge. Since 1995, the
condition has been diagnosed in 87 per cent more women and 120 per cent more
men, and it is thought that one person in ten is now infected, often without
knowing it. And here is the really scary bit: the rise is most virulent
among girls aged 16 to 19, who recorded a 141 per cent rise and who face a
possible future without children. One of the most tragic consequences of
chlamydia is that it causes pelvic inflammatory disease (PID), which can scar
the Fallopian tubes for life. The good news is that these figures may be explained partly by
the publics increased willingness to be checked out for venereal disease at
user-friendly clinics such as this one. But promiscuity is also an important
player here. The average age at which girls now lose their virginity is 14,
and most will have had several sexual partners by 18. One in ten
morning-after pills now goes to girls under 16. The rampant spread of STD is the endgame to all this fun, and
the people who show up at the clinic represent a mere fraction of the total
number affected. But there will be no moralising here. It is central to the
clinics mission that people come in and get treated before they infect anyone
else, and they are not likely to do that if they fear a character reading at
the end of it. Nicola Smith, a consultant and one of four young doctors who
work all day diagnosing and treating STD, says it is crucial that staff are
non-judgmental. In sexual health clinics the word promiscuous is never used,
she says. Its a subjective term. If you have had only one partner in your
life, someone whos had two is promiscuous, so its meaningless. We never
judge, but we do encourage people to have safer sex. If a woman wants to have
15 one-night stands, thats fine with me, but Im worried if it affects her
sexual health and that of others. Smith leads me into a small consulting room, where we meet a
young man of 22 lets call him
Andy dressed in jeans and trainers
who is looking very dejected indeed. He has been with his girlfriend for two
years, but last year, unbeknown to her, he slept with another woman and is
worried he may have caught something. A check-up has shown that he has
chlamydia; now he has to own up and tell his girlfriend to come to the clinic
because she, too, will be infected. Andy stares at the floor and asks three times if there is any
way, other than sexually, that he might have caught it. No, this is an
infection passed through sex, says Smith in a kind but nonnegotiable way. So
does that means its an STD? he asks again, the penny dropping that he is in
trouble at home. Its very important that you bring your girlfriend in because it
could stop her having children, says Smith firmly. She offers him health
counselling, but he declines and trudges off clutching his antibiotics. There is every chance in cases like this that the girlfriend
will never show up; in general, partners opt to keep quiet rather than face a
show-down. But the treatment is useless unless the girlfriend is treated,
too, since she will simply reinfect him. The service is strictly
confidential, so there is no question of the clinic contacting partners
separately. Sometimes couples come to the clinic together, and there have
been fights in the waiting room when one is found to have an STD. Some people get angry with their partner, some burst into tears,
but most people are just quiet, says Smith. They feel ashamed and
embarrassed, which they shouldnt be, because theyve done something about it. In another consulting room is Sophie, a travel worker aged 30,
whose experience proves that STDs can be down to sheer bad luck. She was a
virgin until the age of 25; soon after she started having sex, she went for a
routine smear test and found that she had contracted the human papilloma
virus (HPV), a strain of which can cause genital warts, the most common STD
in Britain. She had suffered no symptoms. Types of HPV can increase the risk
of cervical cancer and Sophie had to undergo extensive laser treatment and
must now have smear tests every year, which is why she is here. She has had
two sexual partners in the past month but used condoms. I freaked when I first found out, she says. It completely
stressed me and I kept looking it up on the Internet over and over again. I
felt dirty. But I know how common it is and I always use a condom when I have
sex now. The screening shows that Sophie has bacterial vaginosis, a
relatively harmless but unpleasant infection, so the smear test must be done
again when it has cleared up. After genital warts, the most common infections are chlamydia,
gonorrhoea and NSU. This clinic sees a huge cross-section of people, ranging
from middle-class bankers to 13-year-old schoolgirls. Some call in on their
lunch hour (though they may face a three-hour wait) or when they get an
unexpected day off. We get a big surge when there is a Tube strike, says
Smith. On some days the clinic is so busy that it must close to comply
with fire regulations, and there is often a queue when it opens at 8.30am.
Once it filled to capacity within seven minutes. The clinic, run by Chelsea and Westminster Hospital Trust, sees
many teenagers, some of whom give false names as they do not want results
posted to their parents homes. Ceri Evans, a health counsellor, says
teenagers often just give their mobile numbers. Our telephone bills have hit
the roof, she says. Anyone who walks in is entitled to treatment and a full STD
screening that would cost more than 200 privately. With men, the urethra is
swabbed with a fine cotton wool instrument and the sample tested for all
STDs, with an optional HIV test. Women are given a full internal examination
and tested for the same infections, as well as bacterial vaginosis and
thrush. GPs do not test routinely for chlamydia, even when conducting smear
tests, but this was tried out in Portsmouth recently and revealed that one in
12 women aged 16 to 24 across social classes was infected. The same scheme is
being conducted in Hammersmith and Fulham, with a similar if not higher ratio expected. There is no simple explanation for the relentless rise in STD
infection among young people; there is no doubt, however, that the sexual
climate is more relaxed now. People who were teenagers in the 1980s were
petrified into monogamy by the Governments Aids campaign, which featured
icebergs and tombstones. Todays teenagers were just babies when those
television adverts went out, and research shows that young gay men increasingly
associate HIV only with older men who were active in that generation. Is it possible that people are simply not afraid of STDs now?
That they are no longer considered life-ruining diseases and can be cleared
up with antibiotics with little fuss? After all, even being HIV-positive is
no longer seen necessarily as a terminal condition. The number of HIV
diagnoses has risen steadily, especially among the heterosexual community,
while the number of deaths has plummeted. But if young people do not take STDs
seriously, they are very misguided, says Smith. Aids, hepatitis B and cervical cancer can all kill you.
Chlamydia can cause ectopic pregnancies, which can kill you. And there are
chronic conditions, such as herpes, that you cannot cure. What has caused the
increase is the million-dollar question, says Smith. It must mean that there
has been a change in sexual behaviour, that people are using condoms less
frequently and changing partners more often or having more than one at the
same time. But we dont know why. One positive effect of the HIV epidemic has been to draw some of
Britains top medics into the speciality. Sexual health, once the Cinderella
department of the NHS and often consigned to dingy hospital basements, is now
one of the most sought-after areas of medicine. The West London Clinic
reflects that with its bright decor, plants and low-slung armchairs. In a counselling room Ceri Evans is talking to a middle-aged man
who has come for an HIV test. He has previously been married but has now been
in a year-long relationship with an HIV-positive man. Evans asks how he will
react if the test is positive, and he is confident that he will cope.
However, he has taken every safety precaution and never had sex without a
condom. He must come back for the result in person in three days. Some people are completely clued up about sexual health but some
dont even know what STDs are, says Evans. She finds people react particularly
badly to learning that they have herpes. You can tell them its not
life-threatening and doesnt affect fertility, but psychologically the damage
is done because it is incurable, whereas you can treat gonorrhoea and
chlamydia and it goes, so people can pretend that they never had it. Women cope less well than men because they are immediately
thinking about the future and their next partner. One girl said to me the
other day Well, thats it then. My lifes over. Smith is now speaking gently to a sad-looking woman who fears
that her partner is cheating on her. She started seeing him two years ago and
immediately contracted chlamydia. He will not use a condom to have sex with
her and she fears that he has passed something to her again. The same questions are put to every patient. When did you last
have sex? How many partners? Have you injected drugs? Have you had sex with
anyone from Africa, South-East Asia, the Caribbean or South America? You see
a lot of people who come here because they think that their partner is seeing
someone else but they wont confront them, says Smith. Does she ever get angry with people who return time and time
again with infections, despite being told the risks? You can be treating
someone for gonorrhoea for the tenth time and be thinking why?, but when you
talk to them you realise that something bad has happened to them somewhere
along the line and they are really screwed up about sex. You have to be realistic, deal with life as it is. If you are
too prescriptive, people might not come back next time. We then come to the most depressing case of the day. A very
pretty girl of 17 dressed in Gap is complaining of bleeding and a rash. Last
month she slept with a boyfriend, got pregnant and had an abortion. But the
bleeding has not stopped. She first came to the clinic a year ago for the
morning-after pill and was advised to go on the regular Pill. She didnt. But she is cheerful and intelligent and hopes that it might be
the three-monthly injections of the Pill that she has just had that is
messing with her cycle. She is wrong. The examination shows that she has PID, a
condition often caused by untreated chlamydia, but sometimes related to
abortion. If she had gone on the Pill last year, she would not have got
pregnant and thus would not have needed an abortion and probably would have
avoided getting this infection. There is now a one in five chance that she
will need in vitro fertilisation (IVF) treatment to conceive in the future. Dealing with the consequences of PID, ectopic pregnancy and
infertility costs the country an estimated 100 million a year, the strongest
possible motive for the Government to halt the advance of disease among the
young. But what chance of that if television programmes such as Club Reps and
Ibiza Uncovered continue to celebrate teenage girls having 15 one-night
stands and three-in-a-bed sessions on holiday islands? As Nicola Smith says,
we have to encourage young people to go for quality, not quantity with sex. I
doubt that these young girls are getting much out of this sex anyway, she says.
Basically we have to make it uncool to sleep around. carol.midgley@thetimes.co.uk Copyright 2002 Times Newspapers Ltd. This service is provided on
Times Newspapers' standard terms and conditions. To inquire about a licence
to reproduce material from The Times, visit the Syndication website. ************************************************************* Lynette Burrows spoke at the ManKind 2000 Conference. TUESDAY FEBRUARY 26, 2002 The Daily Telegraph, p22 Casual sex isn't safe,
no matter what the slogans say Lynette Burrows says
the increase in STDs, especially among teenage girls, is the direct result of
inaccurate advice about sex from educationists The Government is expected shortly to
launch a sex education campaign in reaction to alarming figures for the
growth of sexually transmitted disease. But previous attempts to educate the
young and sexually active out of dangerous practice have been sadly
counter-productive. Indeed sex education in this country has
progressed rather like a seduction. Modest and undemanding at first, it was
content merely to teach the facts about human reproduction and to answer
questions. Then it seemed to become inflamed by its own material and has
become increasingly lewd, leering and graphic. Nowadays, a lot of it reads more like
the compulsive obscenity of a dirty old man rather than anything educational.
Consider the Family Planning Association's Primary School Workbook (Teaching
sex education within the National Curriculum) for seven- to 11-year-olds:
"It is always best to have sex with someone you know very well, trust
and have a commitment to." Seduction, or what? The failure of the sex-education
policy-makers to achieve their goals is now a matter of public record. We
have the highest illegitimacy rate in Europe, abortions on young girls are in
the thousands and now, the knell of it all, there is a real, and not
prophesied, epidemic of sexually transmitted disease (STD). There are currently about 1.5 million
people infected with an STD in this country. A lot of them are young, and the
biggest rise of all since 1995 has been in infertility-inducing chlamydia,
which, in girls aged 16 to 19, increased in the five years from 1995 from
30,000 to 64,000 new cases a year. These are figures compiled from genito-urinary
clinics only, and it is estimated that they would be 10 times higher of
undetected cases and those treated by their GPs were included. Most commentators, when faced with the
scale of the problem, are at pains to avoid being judgmental and "moralistic".
This is a perfectly respectable and, indeed, kindly response, but it rather
misses the point that the moral law is based on the laws of nature. It is
nature that is now acting remorselessly
in consequence of promiscuous behaviour. Compared with modern man,
nature is prim and proper in most of its sexual relations. Animals have a
code of behaviour that is instinctive, not moral, and was evolutionarily
developed to protect them. Young people are perfectly capable of
seeing this and have great sympathy for the "natural" as opposed to
the synthetic. Their biggest problem at the moment is that they are almost
completely ignorant of the risks of casual sex, having been reassured since
primary school that science can make it safe. Try asking a group of young people =
even at top universities - what the failure rate of condoms are, and you will
be met with blank incomprehension. "There isn't one," they say.
"Haven't you heard of safe sex?" They are incredulous when told the
contraceptive industry's own statistics give a 15 per cent failure rate
against pregnancy. For those regularly active between 15 and 20, there is a
one-in-six chance of getting pregnant when using a condom; the same odds as
Russian roulette. Ask them why it is called "safer
sex" now, rather than just "safe", and the crafty ambiguity in
the slogan is immediately apparent. A majority says that you were
"safe" before, but now you are even "safer". A minority
thinks it means "safer than nothing", which is, in fact, the case. Unfortunately, this information is not
made available to young people. A booklet is currently being distributed by
health authorities to all 13-year-olds. It contains a highlighted box which
says: "Fact: Only condoms provide an all-in-one protection against pregnancy
and sexually transmitted infections, including HIV.” Compounding this misinformation, another
highlighted item warns young people in this way: “Factoid: Up to one in 14
young people have a STD called chlamydia. Often it shows no symptoms but, if
left untreated it can leave 10 to 15 per cent of sufferers infertile. Always
use a condom.” Again, language is being unfairly used against inexperienced
young people, who will think that it means they cannot get chlamydia if they
use a condom. They are not alarmed by the figures “10 to 15 per cent” because
they seem so small. Only is they were alerted to the existence of tens of
thousands of cases of chlamydia would they being to see the risk attached to
what they have been propagandised to believe is just a leisure activity. These risks are being played down,
despite the evidence that they are very real. In America, a non-profit
organisation, the Medical Institute, published a report in July 2001 drawing
on information from the National Institutes of Health in the United States.
It reviewed the medical literature of the past 20 years on eight of the 25
STDs. Condom Effectiveness
for STD Prevention (www.medinstitute.org) found that, while consistent use of condoms reduces the yearly
risk of contracting HIV and also reduces the risk of transmitting gonorrhoea
from women to men, there is no clear evidence that condoms reduce the risk of
other STDs, including gonorrhoea and chlamydia in women. This is bad enough,
but the findings are even worse on our own most common STD, genital warts
(HPV – which has been linked with cervical cancer). Condoms, they found, had
no impact on the spread of the disease. So the question about why disease is
spreading is answered and the government-sponsored booklets to young people
are medically inaccurate. The question that remains unanswered is why this
report surfaced without trace here. Perhaps the answer is that there are just
too many people who have either a financial interest in promoting contraception,
or an ideological attachment to sexual freedom. Supporting each other, these
two motives have silenced the public discussion of the danger of casual sex. In this context, the only vital
knowledge that children need is that condoms are only safer than nothing.
“Don’t die of ignorance,” we were told in the early Aids campaign. It was
premature warning for most people then; it isn’t now. |
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