A Grown Up Discussion About Sexuality for Valentine’s Day

Dear Reader,

Here’s an arrow to Valentine’s hearts: Sex for Americans has become rarer and riskier. Not only have our frolics grown less frequent, they’re more fraught due to a resurgence of sexually transmitted diseases — some scary.

Although it may be part of a global trend, this phenomenon has gone from the positive (fewer unwanted teen pregnancies) to a growing concern (plunging fertility rates and even depopulation).

What’s with our bedroom doldrums? How can you safeguard your health and well-being when acting on one of humans’ most powerful and important drives?

Let’s have a little grown-up discussion about sex.*

(*Don’t forget, if you see text in this email with color in it, those are hyperlinks that you can click on for more information online

Less sex, more infections

It started in the 1990s, and now more kids say they haven’t rather than have: There has been a steady decline in the reported frequency of sex among the young, those in their prime and usually most robust years of sexual activity. The federal Centers for Disease Control and Prevention says high schoolers having sex fell from 54 percent in 1991 to 40 percent in 2015.

This is more than just fodder for late-night comedians like Jimmy Kimmel. It has meant that teen pregnancy rates have halved since the 1990s, now hitting historic lows.

Good news, right? Who wouldn’t applaud fewer unwanted teen pregnancies? But experts now also see the drop in sexual activity and pregnancies as cause for concern in other ways: Are young people failing to make the connections and getting the experiences they need to be good partners in the future? Is their focus on cyberspace and electronic devices dimming how they’re learning to love?

The youthful austerity has been accompanied by dips in older Americans having sex, too. The Atlantic magazine reported on research by California psychology professor Jean M. Twenge:

“[T]oday’s young adults are on track to have fewer sex partners than members of the two preceding generations. People now in their early 20s are two and a half times as likely to be abstinent as Gen Xers were at that age; 15 percent report having had no sex since they reached adulthood …. Gen Xers and Baby Boomers may also be having less sex today than previous generations did at the same age. From the late 1990s to 2014 … the average adult went from having sex 62 times a year to 54 times. A given person might not notice this decrease, but nationally, it adds up to a lot of missing sex. Twenge recently … [has said] that in the two years following her [2014] study, sexual frequency fell even further.”

Sex studies may generate quibbles. They rely on participants fessing up to private matters, and so may be less than candid.  As the nation discovered during a presidential impeachment scandal, some folks — genuinely or falsely — think certain activities aren’t “real” sex. The data on oral sex hasn’t changed enough to persuade researchers this possibility skewed the drop in sexual activity.

But here’s an inarguable point: Fertility rates have headed to the cellar. Their 30-year low means that we’re not having enough kids to repopulate the country, the CDC says.

Even as Americans appear to be ducking the needed intimacy, human contact, and relationship-building of sex — more on that in a second — they’re putting themselves at more risk when they do engage.  Sexually transmitted diseases have spiked for years now, with 2.29 million cases of gonorrhea, syphilis, and chlamydia reported in 2017 alone.

Americans have grown lax in protecting themselves from sexual infections, wrongly believing them minor and easy to treat, experts say. Risky sex — promoted online with “hookup” apps — also occurs too often, increasing infections among men who have sex with other men, among the poor, and in communities of color. HIV-AIDS has become a chronic condition that can be treated — not an automatic death sentence. But anti-viral drugs that can keep the disease in check also have become part of Pre-Exposure Prophylaxis, aka the PrEP prevention regimen. Alas, users may be safeguarding themselves against HIV with PrEP, while putting themselves at risk for other STDs by not wearing condoms.

In the meantime, misuse, overuse, and abuse of antibiotics have boosted the rise of superbugs, including virulent new and tough-to-treat strains of STDs. Public health officials fear the spread of gonorrhea resistant to previous ranges of drugs and treatable now only with the antibiotic ceftriaxone.

STDs, which authorities had tamped down with awareness, prevention, and aggressive treatment campaigns, returned as a menace partly due to reduced interest and diminished public support and public health funding, experts say. The diseases, whose symptoms may be mild and missed at first, can worsen and cause arthritis, brain damage, blindness, and infertility, and may even contribute to deaths. They can be detected with common tests, and treatments can be safe and effective.

It is hard to fathom, with modern prevention and treatment options, that venereal diseases known to the ancients — and common in the Third Century time of St. Valentine — plague us still in the 21st Century, helping to reduce interest in what should be positive, healthy sex.

What goes on outside bedrooms makes a big difference in what happens, or doesn’t, inside

In modern America, there are plenty of buzz kills for good sex — the kind that builds and deepens  loving, committed, healthful relationships.

We’re having less sex partly due to our economic insecurity and inequality, including the punishing Great Recession from which many haven’t recovered. It takes at least two wage-earners to keep afloat: 4 in 10 Americans live so paycheck-to-paycheck they would be staggered by a surprise bill of $400 or more, the U.S. Federal Reserve says. Americans put in crushing hours at work, then are slammed by soul-sucking commutes. We also try to keep up with friends, adding yet more racing around. We’re so exhausted we struggle with a calamity of sleeplessness. Who hasn’t barely made it in the door, stuffed down something forgettable, then collapsed into bed? And we’re not talking about going there for anything but fitful slumber.

Indeed, the excessive pace and high demands has left too many of us:

  • anxious beyond the norm our world riven by politics and controversies about race, gender, sexual orientation, and social and economic inequality

  • battling depression, with major episodes afflicting more than 16 million of us each year

  • smoking or vaping too much

  • drinking too much booze

  • Ingesting or smoking marijuana, now legal in many more places and all but habitual for a chunk of users — 1 in 5 of whom toke up daily

Smoking not only makes for smelly, hygiene-challenged partners, it damages their hearts and circulatory systems in ways injurious to their sex lives, too. Alcohol and marijuana take a toll on judgment and sexual performancePrescription and over-the-counter medicationscan cause sexual impairment. This is true for OTC meds for allergies, as well as drugs for anxiety, depression, and hypertension.

With their stressful, harried lives, Americans also eat badly, scarfing down too much junk and harmful fatty, salty, and sugary foods. Experts say 40 percent of us carry too much weight and struggle with the consequences, including heart disease, diabetes, and cancer — to name a few of the diseases that debilitate and kill us. (We can do something about this, now, to improve our health in 2019.)

Does this sound like a general health manifesto and not a discussion about sex? There’s a reason: When doctors treat patients with sexual uninterest or difficulties, here’s what they home in on, as noted by the Cleveland Clinic:

“What causes sexual dysfunction? Physical causes — Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetesheart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of some medications, including some antidepressant drugs, can affect sexual functionPsychological causes — These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, concerns about body image, and the effects of a past sexual trauma.”

A Valentine wish for more support, love, and acceptance. Healthy sex, too.

Sex matters to all our lives.

Our nation’s future depends on it — without procreation for a robust next generation, who will care for our fast-graying population, much less keep the country’s economy running and our shores safe?

Other industrialized nations also are seeing plunging fertility rates, while Japan has been hard hit by uninterest in sex, low birth rates, a giant elderly population, and their strains on its economy and society. The Chinese, who engaged in a sweeping and historic meddling in their people’s private lives with gender and population controls, now face dropping birth rates and burgeoning numbers of the old.

But more than for societal health, sex is vital to our personal health, and it is a bellwether of our individual and social well being. Here are some good words from the World Health Organization:

“Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.”

We’re making progress, for now, in ridding sex of some of its shame and stigma. It’s human to be curious. We all could use less coarse discourse about what others do in the privacy of bedrooms and bathrooms. Still, our tempestuous national politics suggest that women may be seeing a degree of fairer consideration and treatment. Multiple women want to be president? Fine. Gay and lesbians are out and proud as governors, members of Congress, and presidential aspirants. A-OK. The #MeToo movement is helping us address inequities and violence against women. We’re hearing more about the damages inflicted by  “toxic” masculinity. We’re deploring anonymous hookupsvia devices and apps, and rampant porn online

We’re getting better at understanding that sex can and should be golden for us, no matter our age. Biology, however, cannot be ignored. We’re reminded by couples’ struggles with infertility that technology and medical advances haven’t altered how central sex is to the lives of the young, especially getting on a right track for them early and helping them stay there. There’s an urgency for grown-ups helping youngsters with sex, because the onset of puberty occurs earlier than ever — especially in girls but also in boys. Where girls on average reached sexual maturity at ages 16 or 17 before the 1990s, it since has fallen to 12 and 13, with parents reporting it is not uncommon at 10 or 11. For boys, it once was 11 or 12 but now may be closer to 10 or 11. (Diet, obesity, and other factors may be the cause).

This means that grown-ups need to have “the talk” much sooner. The message can’t be abstinence only. It needs to be broader than just reproduction and disease, including lots of IRL (in real life, as kids say) about love, values, relationships, safety, fairness, responsibility, and equity — not to mention the range and variety of sexuality and orientation. If parents can’t tackle these topics, they should allow pediatricians and educators to do so, without blue-nose interference. Schools should educate kids about sex, without extremists and absolutists dictating how. We must restore funding for public health programs to combat STDs and HIV-AIDS.

As a society, we have more heavy lifting to do to ensure Americans benefit from healthy sex. Frankly, it’s hard to have it — grown-up relationships, too — if our kids still live at home. We need to slash higher-education costs and crushing student-loan debt, so they can better afford their own digs. It’s unacceptable that a hedge-fund  bazillionaire can buy the planet’s most expensive Manhattan home (one of several), while millions live on the streets and even college-educated kids can’t afford a starter house in big American cities.

We need to address income inequality and reexamine how we can better balance the chase for the buck and all that stuff, so we all have the time, energy, and space to enjoy our lives, too. We need to support women more, so their choices and opportunities are wider. They shouldn’t carry the burden alone of making unbearable choices about careers, relationships, and having families. We need to ask why men, except for a select few, aren’t pursuing higher education that will get them into better employment for life. It’s tough to be sexy while camped all day on the couch or toiling at a dead-end job.

If you expected by this point in this missive that there would be Masters and Johnson-style advice about better sex, sorry to disappoint. There’s plenty online to peruse (on Slate, from provocative Dan Savage, from mainstream media like Esquire or Cosmopolitan, or health and medical sites like Healthline or Everyday Health, in best-selling books, and especially from Uncle Sam and WHO.)

The take-away here may be that for better sex, we also need more support, acceptance, and love — for ourselves, our partners, and our neighbors. This might help us combat a crisis in loneliness and an epidemic of despair and suicide.

We also can have better sex by being healthier to enjoy it. For Valentine’s Day, why not skip that $5 saccharine greeting card, and, instead, draw up and sign a plan for the both of you to drink less, eat better, exercise more, and spend cozy time together rather than drop money on unneeded stuff? If you’re smoking, stop. If you’re doing dope, reconsider, especially how much and how often. How about buying fewer chocolates and flowers and forgoing that calorie-laden splurge at the upscale bistro? Commit, instead, to simpler nights throughout the year of salads, walks, movies, and loads of private time with your favorite person. As always, I wish you not only a wonderful February 14 but also lots of love, good sex, and perfect health in 2019 and beyond!


Less sex, more infections

What goes on outside bedrooms makes a big difference in what happens, or doesn’t, inside

A Valentine’s wish for more support, love, and acceptance. Healthy sex, too.

Fear of sex, plus a lack of facts: A terrible mix

Local resources available for testing, counsel about STDs


2.29 million

Number of  gonorrhea, syphilis, and chlamydia cases in 2017. This was the fourth year of spiking infections, now at record levels.


Percentage of high schoolers  in 2015 who reported having had sex. The same figure was 54 percent in 1991


Percentage of teen girls who had to block or unfriend someone flirting with them in uncomfortable fashion, double the 16% of boys who took this step.

$25 billion

Estimates on how much Pfizer raked in since 1998 from 62 million men using Viagra, a onetime blood pressure med that became a top-selling prescription sex enhancement drug.

Fear of sex, plus a lack of facts: A terrible mix

In the 21st Century, just how afraid are some Americans of sex? They’re willing to let women die because of it. That may sound extreme. But medical scientists, public health officials, and pediatricians say they’re fighting an uphill battle to persuade parents to vaccinate their daughters and sons against human papillomavirus, or HPV.

The infection has many types, some severe and others not. Almost 80 million Americans in their late teens and early 20s carry and spread HPV, deemed the most common of all sexually transmitted diseases. Most of those infected don’t know it, and it doesn’t affect their health.

It can cause genital warts. But here’s what’s crucial to know, according to the federal Centers for Disease Control and Prevention:

“HPV can cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer). Cancer often takes years, even decades, to develop after a person gets HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers. There is no way to know which people who have HPV will develop cancer or other health problems. People with weak immune systems (including those with HIV/AIDS) may be less able to fight off HPV. They may also be more likely to develop health problems from HPV.”

Experts say HPV prevention and harm reductioncould be advanced in a big way, if only more parents would vaccinate their kids. The shot is safe and effective (yes, all vaccinations, like any medical procedure, carry risks). But vaccine opponents (anti-vaxxers) and blue noses have fought efforts to increase HPV inoculation.

The shots work best if given before patients become sexually active and potentially infected. This means boys and girls should get vaccinated at age 10 or 11. This has riled some parents who say they don’t want to discuss sex with their youngsters at that age, and the shot would cause unwelcome curiosity. Other parents have argued, without evidence, that giving kids the HPV shot encourages early sexual activity and promiscuity.

Those are dicey claims, given that the onset of puberty occurs earlier than ever now. Research also contradicts the claim that the shot itself fuels sexual activity or worse. That hasn’t stopped the hysteria, with one national politician falsely blaming the vaccine for having been forced on a child and having purportedly caused the girl to be mentally injured. Anti-vaxxers, meantime, can’t be swayed. Their  ignorance not only harms us all by reducing uptake of the HPV inoculation, it also is contributing to measles outbreaks unlike any that have been seen in recent times in Manhattan and Portland, Ore.

As for HPV, experts note that cervical cancer has declined as a leading cause of death among women, because of improved screening and testing — which needs to be done, appropriately. Still, more than 13,000 women each year will be diagnosed with cervical cancer, and more than 4,000 will die of it. More than 8,000 Americans each year will be diagnosed with anal cancer and more than 1,000 will die of it. And 53,000 of us will be diagnosed with oral or oropharyngeal cancer and almost 11,000 will die of these diseases

Just think of the pain, misery, and cost that could be averted if not for unfounded thinking, including about the bogeyman of sex.

Local resources available for testing, counsel about STDs

Be safe and don’t spread sexually transmitted diseases. Get informed and tested.

In the nation’s capital, help is available at Planned Parenthood’s Carol Whitehill Moses Centerthe DC Health and Wellness Center, or at multiple locations through Whitman-Walker Health.

The Virginia Disease Prevention Hotline (800) 533-4148 can provide information on STD and HIV-AIDS testing and screening. Baltimore City Health has two STD clinics, while such services also are available through Montgomery County at the Dennis Avenue Health Center in Silver Springand in Prince George’s County at the STD Control Program in Cheverly.

The Maryland Health Department web page on sexually transmitted infections includes a feature that can help pinpoint testing sites by zip code.

The federal Centers for Disease Control and Prevention (CDC) also offers a similar feature on its web page on STD testing, which also carries helpful guidelines about who should be screened and when.

These tests also can be obtained through private doctors’ offices, at hospitals, and at urgent care or emergency care centers, facilities often in chain drug stores.

Although home medical testing has grown popular, NPR reported that STD screening has lagged  as start-ups struggle with the complexity, cost, regulatory approvals, and other feasibilities of these tests.

The federal Food and Drug Administration has approved two at-home HIV tests, which can be purchased over the counter: the Home Access HIV-1 Test System and the OraQuick In-home HIV test. Online ads show these can be purchased at pharmacies and stores (Target) and cost from $40 to $70.

Planned Parenthood, which provides noteworthy reproductive health services, says this of the costof STD testing, which may involve urine samples, cheek swabs, or a finger-stab:

“How much you pay for STD testing depends on where you go, what tests you need, your income, and whether or not you have health insurance. Because of the Affordable Care Act (aka Obamacare), many insurance plans cover STD testing. So, you can probably get STD testing for free or at a reduced price if you have health insurance. STD testing can also be free or low cost with Medicaid and other government programs. And some clinics — including many Planned Parenthood health centers — give free or low-cost STD tests, depending on your income.”



Patrick Malone
Patrick Malone & Associates