I was chatting with a patient (let’s call her Liv). Liv was a pleasant young woman who had just gotten married a few months ago. She came into the office for a complaint of indigestion. Like any good medical student, I diligently took her history, silently congratulating myself for getting details like the specific foods that caused her problems (pizza, pepperoni, and breadsticks). She answered all my questions politely and spoke well. I liked Liv.
When we got into her social history, I asked her about her sexual activity. Just fine, of course. But then she dropped the bomb on me:
Liv: “So, we’ve been thinking about having kids.”
Me: “That’s great! When are you thinking of planning for?”
Liv: “Sometime after the holidays. But…I was wondering…do you know the best way? To, you know, get pregnant?”
Me: [blank stare] “Uh…I think it would be a good idea to have Dr. Z talk with you about that. So, are you using any forms of protection during sexual intercourse right now?”
What made it worse is that she couldn’t ask the doctor that question, because the appointment was scheduled for 15 minutes and we were already at least 30 minutes behind schedule. The counseling on its own would have taken 15 minutes, and her more immediate problem was the heartburn. I could have been helpful if I had known the answers to her question, and talked with her while the doctor was seeing another patient–but I didn’t. So while the doctor talked her through the different options for treating heartburn, both of us sat there knowing that she had longer-term questions on her mind that there was no time for.
FAIL. All she wanted to know was, how should I be trying to get pregnant? I feel like these are things that every girl should know. Passed down to them by their mothers and grandmothers, whispered among friends, read in Cosmo, etc. I didn’t want to misinform her, but I had NO idea what to say. Now, having taken a month of Human Reproduction, I have quite a lot to say about how to get pregnant, but shouldn’t topics like these be taught to every high school girl (and boy)?
Thinking back on my own sex ed, I have to say that there was almost none. In sixth grade, our math teacher sat with the girls in one auditorium while we watched a video from the 80s about getting periods and breast growth. That is the last bit of formal sex ed I had. Sex is something that was not discussed in my house; I think my parents would have been fine if I thought a stork delivered me to the front door. Everything I knew about sex up until I went to college was gleaned from rumors about who did what with who and some surprising Google searches.
In college, I went to parties, I took classes on gender studies, I had friends who were passionate about sexual freedom, safe sex, and dealing with sexual assault, so I learned a lot about sex from a theoretical academic POV and an advocate-empowerment POV. But not so much from the practical “how can I get pregnant faster?” POV.
Working with patients has shown me that I know nothing about sex from a very practical POV. What’s the best kind of birth control for me to use if I got mood swings using Yaz? Is it safe to have sex while I’m pregnant? Do Kegels really work? There are a fair number of teen moms at the family medicine clinic, so to talk about these things matter-of-factly with 16 and 17-year olds has been an awakening for me. Why didn’t I know about these basic concerns when I was in high school? And why don’t these girls know either?
It must have to do with the way sex ed is taught. While the US has made improvements in teaching comprehensive sex ed at a national level, there are definite regional setbacks, and overall mediocrity. After all, sex ed is not just education about contraception and abstinence, but also sexual health and to a certain extent, family planning. Teens don’t know what they’re getting themselves into.
At the risk of exposing all my privileges at once, I feel that, at the very least, as a magnet program high school student, with an Ivy League education, in medical school, I should have learned about these sorts of issues a while ago. In a way that was medically legitimate so I wasn’t pulling factoids out of Cosmo and presenting those to patients.