Health and the Forbidden Fruit: Balancing Sex and Safety
November 30, 2007
Sex: that illustrious fruit by which we were (almost) all conceived; that pleasurable act in which many of us partake; that pesky complication to an otherwise simple world that brings with it a slew of health-related concerns. However you prefer to think of sex, the fact is that many of us are already sexually active. It is thus essential that everyone have a firm understanding of the health and wellness factors surrounding sex, both physical and mental.
“Sexual health is part of basic health,” says Nikki Bruce, a spokesperson for Tufts VOX. “It’s just as important as remembering to floss or getting your flu shot.” Her point is an important one for the Tufts community. In a recent Observer survey [see gray boxes on pages 5 and 7] of 42 students, 50 percent of freshmen and 86 percent of seniors surveyed said they were sexually active. “[We must] treat our sexual health with respect and responsibility,” Ms. Bruce says.
While many Tufts students are sexually active, it is by no means a requirement. An anonymous male senior explains his reasons for abstaining from sex: “I feel no rush or pressure to [lose my virginity] because I know that it will be exponentially greater with that one special person or people, over time. Nothing religious is holding me back and I’m not waiting for marriage, just the right person at the right time. I feel a little uneasy when my guy friends tell me their accounts, but am also reassured when they tell me, ‘It was alright’ or my female friends say, ‘My first, it was alright, you’re not missing out on anything. It’s nothing special.’”
For those that chose to be sexually active, however, new challenges present themselves. While some may yearn for the days when sex was mysterious, exciting, and without burden, there is no reason why maintaining one’s sexual health should be a tradeoff for the pleasurable experiences sex offers. “Being sexual can be a beautiful thing,” Ms. Bruce says — but we must always bear in mind the responsibilities necessary to maintaining a healthy sex life.
Put Up or Hook-up?
While the prevention of sexually transmitted infections (STIs), pregnancy, and sexual violence are imperative to one’s sexual health, the ways in which one chooses to be sexually active have a major impact on both the mental and physical well-being of each sexually active individual. At the forefront of college sexual relationships is the hook-up, one-night-stand culture. While Stacey Sperling, a physician at Tufts’ Health Services, doesn’t think hooking up is “as prevalent as the media would make you believe,” she agrees that “it’s certainly more prevalent than previous generations.” The Observer survey found that, of the sexually active, 30 percent of freshmen and 42 percent of seniors had had sex under the auspice of the hook-up. In both freshman and senior populations, males were significantly more likely to hook up than females.
Yet despite the large number of students who are hooking up, few students seem to feel satisfied by sex within the context of the casual “hook-up.” Of the sexually active, 100 percent of the freshmen and 79 percent of the seniors said that they preferred monogamous romantic relationships over hooking up, “friends with benefits,” or a monogamous sexual relationship.
This ideal is shared by the majority of sexually inactive students. 90 percent of sexually inactive freshmen said they would be most comfortable becoming sexually active in a monogamous romantic relationship; 66 percent of sexually inactive seniors agreed.
Empty, Pathetic, and Destructive
Dissatisfaction with the hook-up culture was echoed by many of the students and professionals consulted for this article. Lara Levi, the Tufts Daily sex columnist, called the hook-up culture “pathetic” and described it as “a game where you go out, hook-up, and don’t talk to that person afterwards. Hook-up culture plays on insecurities. You don’t have the self-esteem to demand better, to ask for exclusivity.”
Dr. Sperling agrees. “I think sex should be fun,” she says. “It should be fun and spontaneous. You don’t need to only have sex with people you’re going to spend the rest of your life with, but, on the other hand, I think this hook-up culture is very scary. I think it’s scary and sad. I think that it removes sex from being an intimate, meaningful experience.” Dr. Sperling sees many students who “got drunk, hooked up, and were not so happy about it in the morning.”
One anonymous freshman male says that he had recently come to the “realization that the hook-up culture is so empty and routine.” He continues: “It really transforms people into single-serve sex objects and nothing more. It’s all good until you realize you aren’t dealing with something inanimate. You’re dealing with people.” He feels that the net effect of the hook-up culture was to prevent students “from seeing the beliefs, ideas, and beauty we all possess.”
Mariel Montuori, a senior, feels that the hook-up culture is preventing healthier forms of relationships from developing at Tufts. “Dating is something that just doesn’t happen much,” she says. “Most of the time people will meet through mutual friends and end up at a party where they grope each other on the dance floor for forty-five minutes and then leave to hook up.”
The Alcohol Factor
The campus hook-up culture thrives on the use of alcohol by students. Senior males reported having been under the influence of alcohol during about half of their sexual engagements over the previous year. For senior females, this number was lower but significant. They drank alcohol before or during 20 percent of their sexual engagements. These numbers are probably lower than the actual numbers within the hook-up scene; the aforementioned statistics include students in long-term relationships where the use of alcohol during sex is traditionally significantly lower than it is for students in casual hook-up relationships.
Senior Jaime Roura asks: “Why do you have to get wasted to hook up?” When considering the general dissatisfaction the student body feels with hooking up, the use of alcohol in such situations is not surprising. Could it be that, intrinsically, students are not okay with hooking up? Is it only through the relaxed inhibitions provided by the influence of alcohol that students are able to mask their inner feelings and engage in the hook-up culture? Dr. Sperling feels the use of alcohol as a facilitator for hooking up is part of the greater problem of alcohol abuse on the Tufts campus. “To have six to ten drinks in the course of an evening, to me, seems abnormal,” she says. “It seems like that’s because you want to get drunk. You’re not using alcohol as a social lubricant, you’re getting shit-faced, as we say. How do you put a stop to that?”
Ms. Levi writes in her column that “alcohol in college is detrimental to relationships.” The anonymous freshman described it as “getting drunk, meeting drunk girls, and trying to score.” Mr. Roura asks, “Don’t you enjoy sex when you’re sober?” Would it be a stretch to say that the hook-up culture would simply not exist if not for the availability of alcohol?
The Physical Collateral
The substitution of hooking up in place of more satisfying forms of sexual relationships poses a clear and present danger to one’s emotional well being. But aside from emotional damage, the hook-up culture, especially when accompanied by alcohol, has the potential to cause serious physical problems. Andrea Northup, president of Public Health at Tufts (PHAT), tells the Observer that “any situation where people are engaging in risky behaviors (casual sex), especially when impaired by drugs or alcohol, is a recipe for a serious public health issue.”
It should come as no surprise that there’s a direct connection between the number of sexual partners one has and the likelihood of contracting a sexually transmitted infection. Thus, as the hook-up culture promotes maximizing the number of one’s sexual partners, it also maximizes one’s likelihood of contracting an STI.
The fact that alcohol is so pervasively tied to the hook-up scene also doesn’t bode well for one’s physical health. The probability of condoms and other forms of birth control being properly used during any form of sex drops when one is under the influence of alcohol. This, of course, also raises the likelihood of contracting an STI or causing an unwanted pregnancy.
Ms. Northup sees “efforts to shift college students away from the awkward and socially unproductive hook-up scene to more fun, meaningful and memorable social outlets as a way to tackle the STD issue as well as improve the social and mental health of Tufts students.” At the very least, it is evident that the hook-up culture is capable of inflicting more than merely emotional harm.
On occasion and for certain people, casual sex may work out fine. But the pervasive presence of the hook-up culture as one of the primary forms of sexual relationships on campus can be seen as troubling. The fact that it still occurs even when most students find it very unsatisfying, and when almost all students would prefer more meaningful relationships, is perhaps even more troubling. The hook-up culture can clearly be detrimental to both one’s emotional and one’s physical sexual health.
The P-Word
Hooking up aside, the most relevant negative consequence of sexual activity for Tufts students is the risk of becoming pregnant, at least, that is, for females. Eighty-three percent of freshman females surveyed ranked pregnancy as the number one potentially negative consequence of sex.
Fifty percent of senior females replied the same. In a classic and somewhat questionable disconnect between the male and female psyches, zero percent of freshman males believed pregnancy was the number one negative consequence of sex, opting instead for STIs (c’mon, guys). Fortunately, senior males seemed to be more in touch with their female counterparts, as 60 percent named pregnancy as their first concern.
Few college students are interested in becoming pregnant, but many wish to be sexually active. Thanks to 20th century medicine, this is not a difficult feat to accomplish. Condoms and hormonal birth control methods like the Pill seem to be the Tufts pregnancy prevention method of choice. Over 75 percent of all students surveyed reported using condoms for birth control while over 65 percent reported using hormonal birth control. Since condoms are 98 percent effective when used correctly and most hormonal methods are over 99 percent effective when used correctly, it would seem that the Tufts population has the issue fairly under control. Both condoms and hormonal birth control options are available via health services, and the health practitioners there are no strangers to answering questions about birth control. “Many kids come to me for birth control,” says Dr. Sperling. Condoms are freely available in the lobby and females may schedule an appointment to evaluate their hormonal birth control options.
STIs and You
Like unintended pregnancy, the risk posed by sexually transmitted infections is not to be taken lightly. On this front, luckily, many students are fairly well informed. Both freshman and seniors surveyed by the Observer ranked the adequacy of their sexual health education just above an eight on a scale of one to 10. Only about 30 percent of the sample were educated in abstinence-only or abstinence-promoting curriculums.
Interestingly, there was no correlation between students who attended abstinence-centered programs and their level of sexual activity. It thus appears that most Tufts students have studied STIs and their associated risks at some point during their sexual education. That said, there still is room for improvement. While many students are aware of the risks posed by STIs, few sexually active students undergo testing for common STIs on a regular basis.
Dr. Sperling says that the federal Center for Disease Control and Prevention (CDC) has now recommended that everyone who is sexually active have a HIV test with their physical exam. Additionally, health services “certainly makes it clear that women should be coming in for annual GYN exams,” Dr. Sperling added. During these exams students are often tested for Gonorrhea and Chlamydia. Despite these recommendations for regular STI testing, only 33 percent of sexually active freshman females and 25 percent of sexually active freshman males reported being tested for STIs on a yearly basis. The outlook improved only for females over the course of four years at Tufts; 43 percent of sexually active senior females and 20 percent of sexually active senior males reported being tested for STIs on a regular basis.
STI Testing at Health Services
The disconnect between STI education and STI prevention indicated by the above numbers has an easy remedy: make an appointment to get tested, today. For those not aware of the fact, Health Services is fully equipped to perform any necessary STI testing. “The most common tests we do are Chlamydia, Gonorrhea, herpes, and HIV,” says Dr. Sperling, but “we can test for everything.” As part of the research performed for this article, the author and contributor underwent STI testing at health services. The process begins with the scheduling of an appointment in person or over the phone. For women this appointment can be part of a 45-minute annual GYN exam or scheduled purely for the purpose of STI testing. For men a 15-minute STI testing appointment is all that is required. Appointments can easily be scheduled within a week after contacting Health Services.
The STI testing appointment begins with a private one-on-one consultation with a health services professional. This is to help the student to determine which STIs he or she should be tested for. While one could be tested for every STI in the book, this would be most often unnecessary and always expensive. Depending on the student’s history, symptoms, and wishes, she or he and the physician decide which tests to have performed. The most common tests for students exhibiting no external symptoms are HIV, Chlamydia, and Gonorrhea. For men, these tests involve no more than heading downstairs to the lab to have blood drawn and to submit a urine sample. For women, in addition to the blood and urine tests, a pap smear is also commonly performed to check for HPV and other risks. The HIV test performed at health services is a rapid test, meaning that results will likely be available within twenty minutes.
The cost of an STI consultation and testing appointment are covered in the student health fee, paid by all Tufts students at the beginning of each semester. For students with the Tufts student health insurance, the cost of the lab work is also covered. Students with private health insurance are billed for the cost of the lab work. As most health insurance plans cover preventative STI testing, this cost can usually be forwarded to a private insurance provider. If, however, a student’s insurance does not cover the costs, or if he or she wishes to insure that STI testing never appears on any record, the student has the option of paying the costs of the tests out of pocket. The HIV test costs $20, while Chlamydia and Gonorrhea tests cost about $42 each.
STI testing is readily available at Health Services and any sexually active Tufts student should take it upon himself/herself to undergo regular testing. While regular STI testing goes a long way toward insuring the well being of one’s sexual health, a significant component of STI prevention lies in barrier sex protection. It is unlikely that one will ever be able to guarantee whether or not every sexual partner they have is “clean” of STIs, even if 100 percent of all sexually active students were being tested on a regular basis. For that reason, a condom should always be used when having sexual intercourse, for both STI and pregnancy prevention purposes.
HPV and the Gardasil Vaccine
HPV (human papillomavirus) is one of the most widespread STIs. Dr. Sperling estimated that 80 percent of the American population is infected with some form of HPV. The various strains can cause everything from normal warts to genital warts to cervical cancer. This link to cervical cancer is what makes HPV a great concern within the realm of sexual health.
Traditionally, HPV transmission is difficult to prevent. Condoms cannot completely block HPV transmission, as any form of skin to skin contact is enough to infect a partner. Additionally, HPV is almost only tested for after a woman receives an abnormal pap smear result, and it is not tested for in men. While not at risk for cervical cancer, men act as carriers of the virus. Today, however, a new option is available to women who wish to protect themselves against the four strains of HPV most closely associated with cervical cancer: the Gardasil HPV vaccine.
The vaccine, supplied in a series of three shots, is available to women under the age of 26. It has been heavily recommended by many health professionals since its release; Dr. Sperling feels that “women on this campus have been extremely responsible about seeking out information on Gardasil and getting the vaccine.” Eighty-five percent of Tufts freshman females surveyed have received or begun receiving the HPV vaccine, compared to 63 percent of Tufts senior females. While these numbers allow room for improvement, they show that many women at Tufts are aware of the vaccine and the protection it offers.
Some medical professionals were hesitant to recommend the vaccine for large scale use immediately after it release, due primarily to the lack of information available on the possible long-term side effects of a new drug in such a large population. A year later, no unexpected effects have been reported, and most have accepted the high effectiveness and low risk suggested by Gardasil’s clinical trials. Health Services highly recommends the vaccine to female students, and almost all insurance companies cover the cost of the vaccine.
Sexual Assault and Prevention
Another major facet of sexual health is sexual assault and relationship violence. Most statistics indicate that 25 percent of all women will be sexually assaulted while in college and 12.5 percent will be raped. As part of the effort at Tufts to combat sexual violence, a new student group, PACT (Prevention, Awareness, and Consent at Tufts), was formed this year.
Caitlin McDowell, a member of PACT, says the group is currently working to “break down” the myths surrounding sexual assault. She brought up the common misconception that rape is committed by strangers, saying, “Nine times out of ten it’s committed by people that you know.” PACT is also working on implementing “bystander-training,” to teach students the appropriate ways to intervene when they feel a friend is in danger of becoming victim to relationship violence. Ms. McDowell also explained that PACT was working to support a sex-positive culture at Tufts by providing students with the means to talk about sex. Most students “don’t have the vocabulary to talk about sex in a healthy way. Is it okay to say, ‘Oh, I’d really like a blow job’? How do you negotiate that without sounding creepy?”
Formerly a major resource for victims of sexual assault at Tufts was the phone hotline SSARA. The hotline has been shut down due to underuse and students are now being referred directly to the Boston Area Rape Crises Center hotline which has Tufts-specific info.
The role of alcohol in sexual assaults is another major education avenue that PACT is pursuing. “The number one facilitator of sexual assault is alcohol,” Ms. McDowell said. “In Massachusetts, if you are incapacitated by drugs or alcohol, you are not able to [legally] consent to sexual relations.” Many people are under the misconception that the use of “roofies” is the most common date rape drug. While Dr. Sperling says that she does see patients who have been “roofied,” she sees it infrequently. “The number one date-rape drug is alcohol,” she says.
The Beautiful Thing
Sexual health is an incredibly important part of one’s holistic health. Whether it is STIs, sexual violence, or hooking up in place of meaningful relationships, endangering one’s sexual health puts the body and mind at risk. Fortunately, staying healthy while being sexually active is not difficult. Use condoms, get tested for STIs on a regular basis, work for the prevention of sexual violence, and always be in touch with what you truly want from a sexual relationship. In these ways one can insure sex remains the “beautiful thing” that it has the potential to be. O