Parents slow to speak of some scary facts of life

Mary Hanafin launched an advertising campaign this week to encourage young girls not to smoke. It looks at the pros and cons of smoking, points out how your health improves if you stop, and gives practical tips to help girls to quit.

Seeing this campaign made me wonder about the probability of the Department of Health waging a similar campaign in relation to teenage sexual activity. The words slim and none did spring to mind. How is it that we have no problem being directive when it comes to young people and nicotine or other drugs? Yet we are overcome with sudden attacks of shyness at the possibility of even suggesting that young people should not engage in early sexual activity.

The health risks are well documented, particularly for young girls. Nevertheless, the perception remains among the public that teenage pregnancy is the worst possible result of sexual activity. That is not to say that teenage pregnancy is an insignificant outcome, but perhaps we should start being honest with young people about other consequences which are potentially more devastating.

An Office of National Statistics study in Britain in 1997 found an extraordinarily high level of awareness and use of contraceptives among British young people. However, the same study found great ignorance about one of the most common bacterial sexually transmitted infections - chlamydia. The majority of people had never heard of it.

If a similar survey were carried out here the results would probably be the same. This sexually transmitted infection (STI) is quite often symptom-less - you have no indicator whether you have it. If left untreated, up to 30 per cent of women will experience pelvic inflammatory disease (PID) which, in turn, can lead to ectopic pregnancy, infertility and chronic pelvic pain. These are not insignificant risks.

Luckily, the infection can be cleared with antibiotics, though the possibility of reinfection exists.

Incidentally, at one Dublin clinic the prime age group for attendance for STIs is between 15 and 28 and numbers attending have risen fourfold since 1990.

The Human Papilloma Virus (HPV) is even more scary. Since it is a virus, an antibiotic has no effect, although there are treatments for the symptoms. Of the 100 strains of this virus, about 30 cause genital infections. Most people's immune systems can eliminate the virus but a small percentage will go on to develop genital warts, abnormal smear tests or cervical cancer.

The warts, which can develop into cauliflower-like fleshy growths, are the most common STI seen in clinics. It is important to emphasise that those who develop warts do not automatically develop cancer. The crucial point is that condoms do not protect comprehensively against it as it is spread by skin-to-skin contact, not just bodily fluids.

Young sexually active girls are at much more risk of developing cervical cancer. The National Institute of Allergy and Infectious Diseases (NIAID) in the US puts it bluntly. "Delay having sexual relations as long as possible. The younger people are when having sex for the first time, the more susceptible they become to developing an STI. The risk of acquiring an STI also increases with the number of partners over a lifetime."

How is it that this kind of information is often dismissed here as "shroud waving" or scare tactics, yet the risks of smoking are respectable data?

How come we spend thousands on health education in other areas yet are remarkably silent on STIs?

If it stemmed from a natural reluctance to speak about essentially private activities it might be understandable. But instead it stems from a kind of reverse prudery. Where once we were repressive about sex, now we are terrified to point out any downside to sexual activity.

Young people have the notion that a condom protects against pregnancy, AIDS and every other STI. Would that it were that simple. Condoms have a failure rate of 3 per cent to 5 per cent even with perfect use. The real failure rate, which allows for human error, is somewhere around 15 per cent. And at least one study estimates the failure rate among teenagers as more than 18 per cent.

Picturing one scenario, two teenagers drunk outside a disco, helps to explain that statistic. Perhaps the "er" in "safer sex" should be taken as, "Er, not so safe after all".

The NIAID is clear. It accepts that condoms provide some protection against some STIs. However, it also states baldly: "The only certain protection against STIs is a monogamous relationship with an uninfected partner."

An intriguing book which was published this week gives some insight into young people's sexual behaviour. Called Youth 2K and written by David Tuohy and Penny Cairns, the book explores religious belief and attitudes to relationships among young people. The comments made about sexuality are more by-the-way than a definitive analysis, but are interesting none the less.

Among those interviewed, attitudes to sexuality fell into roughly three camps. Some advocated abstinence, mostly for positive reasons. However, in this group there were those for whom fear of STIs and to a lesser extent pregnancy, were key factors.

The second group saw sex as a means of communication in a relationship and, finally, some saw sex as recreation.

They were admirably frank about the role of alcohol in sex. One young man of 19 said: "It could happen for me on one-night stands. I wouldn't really care, I'd probably be drunk at the time. When you have drink in you nothing makes much difference. Whether you are in a relationship or not."

Roughly a third in this study were sexually active. Recently, I was talking to a bright, articulate group of young people, and one of them said to me: "You know, people in the media are never interested in us, the ones who do not go off the rails, who do not have sex or take drugs. Maybe we are just not sensational news, even if we are the majority."

That young woman was right. We act as if the majority is the aberration and do very little to learn from them or to reinforce them in their decisions. We have very low expectations of young people in sexual matters, as though they were incapable of abstaining until adulthood, much less marriage.

And yet, somewhat perversely, we balk at giving them full and accurate information on crucial matters of health. Of course, disease is only one reason why people should delay becoming sexually active. Some day we may develop a "magic bullet" treatment so that the threat of infertility and cervical cancer become a thing of the past.

Magic bullet or not, I doubt if we will ever be able to immunise against the increased cynicism and exploitation which occurs when sex is just a recreational activity. Studies in Britain show that up to 70 per cent of girls who had sex before 17 regret doing so.

Maybe it's not the kids who are the problem but we adults who lack the courage to challenge what has become a culture of silence around negative aspects of sexuality.

bobrien@irish-times.ie