Talking to Youth About Sex: What’s Enough? What’s Too Much?

– Originally published on DrKoop.com

North Americans embrace the ideal of providing children with carefree childhoods ripe with opportunities for growth and expression. Fortunate to hold much of the world’s wealth and natural resources, we are commonly able to meet this laudable goal. We promote education and enforce laws against child labour. We enrich our children’s lives with car pool service, birthday parties, and extracurricular activities. We encourage our leaders of tomorrow, supporting their growth into adulthood untarnished by the harsher realities of the world. Few would argue the wisdom of such a philosophy. We know that children raised in an environment of safety, security, and happiness grow into well-balanced, self-actualizing adults. We are richer personally and culturally for providing fertile earth in which to grow our children to adulthood.

We ensure this unworried childhood by shielding our young from the cares and responsibilities of the adult domain. David Steinberg, editor of The Erotic Impulse, uses the term “designated innocents” to refer to this protected class of junior citizens. The problem with remaining innocent, he argues, is that innocence can become confused with ignorance. Knowledge equates with power, so we must strike a balance between protection and education.

This dilemma is enacted in our approach to imparting sexual information. Hoping to spare our adolescent population the responsibilities of unintended parenting, we filter the knowledge afforded them. We warn them of the consequences of intercourse, and the admonitions usually broaden to include all sexual behaviour. Our protection is well intended, but poorly aimed. It is with comprehensive understanding that we are best prepared to make personally enriching decisions, not by remaining fearful and ignorant. Our alarming teen pregnancy rate is one indication that lack of information does not serve our common good, another is the epidemic of sexually transmitted diseases among our youth.

How can we balance the twin goals of innocence and enlightenment? We can begin by demystifying the subject of sexuality. If we encourage our toddlers to feel pride and delight in their bodies, they will be less likely to tolerate inappropriate touching. If we provide accurate, non-judgemental information to our preteens about their maturing bodies, they will better understand the confusing and overwhelming emotions that accompany the physical changes of adolescence. They will have learned that adults tell the truth and provide protection, and thus will turn to their elders for guidance through the turbulence of sexual awakening. Armed with knowledge about the workings of their bodies and faith in their parents’ good intentions, they are better able to weigh Nature’s urgent invitations against the potential consequences.

One of the problems with consequence-only information is that teens soon realize how good sex feels. If they have been warned about the “badness” of sex, they feel duped when they discover the delights of arousal,
inclusion, and intimacy. It is especially now that they need education about the rapturous and bonding emotional aspects of sexuality. Without this knowledge, they are left hormone-driven and bereft of social skills, believing that sex equals intercourse. By telling them “no” rather than “how”, we deny them the very information they need to explore their bodies and their awkward interpersonal relationships in a safer manner. They need to know about caressing and kissing and fondling. We owe them information about how to negotiate, how to judge the difference between what we want and what we need, how to establish and maintain respectful, enduring relationships. We need to be expansive in teaching our children about sex so that they are prepared to meet challenges and opportunities with a strong sense of self and respect for others.

This is, surely, a tall order. We must first address our own ignorance, bashfulness, and shame about sexuality. It would be helpful, too, if we were part of an enriched and enriching union (and society!) that supports respect, intimacy, and honest communication. And of course we must learn to establish the kind of truthful relationship with our children that fosters dialogue. Utopian? Not at all. Difficult? You bet. Worthwhile? Indeed.

Playing Doctor: Curiosity or Danger?

Remember the song we taught our toddlers in day care: “Head and shoulders, knees and toes, knees and toes….eyes and ears and mouth and nose….head and shoulders, knees and toes”? A generation ago we believed it important that our children know the names of their body parts. It was even politically correct to teach them ‘vagina’ and ‘penis’. We empowered kids with programs that taught them to “just say No”. We encouraged our children to distinguish between ‘bad touch’ and ‘good touch’. We got more realistic about abuse and response.

Fast forward to present. America’s accelerated antisexual fervor has changed our societal approach to sex and sex education. I recently watched a daytime talk show on which an actor related how proud she was of her bright young son’s curiosity. That is, until he asked her during a diaper change what “that” was. She panicked, summoned her husband, and fled while her mate handled this delicate question. She asked later what he’d told the lad. Her husband proudly announced, “I told him that was his pee-pee.” The actor and her interviewers laughed in accord with the seeming impossibility of grace with this topic. Dismayed at this role model’s discomfort about a child’s honest question about his body, I shook my head and switched off the program.

Among the important learning milestones of childhood is something called organ constancy, the feeling of ownership of our own body. The timing of this process begins at about six months and continues until the age of about four, and is heavily dependent upon gender. Boys, with their external genitals and frequent touching of their penises during urination, achieve organ constancy as much as three years before their sisters, who are unable to see and are discouraged from touching, their own genitalia. When the girls catch up, they become curious about this newly-perceived distinction and the stage is set for play that informs the toddlers about the differences in their bodies.

Until or unless we are caught at it, we retain little memory of these pleasant experiences. Depending on the adults’ response to their discovery of our innocent behaviour, this milestone either passes unnoticed or becomes our first experience of sexual shame. Today’s parents fret about what we used to call playing doctor. They now label it as sexually inappropriate and/or abusive behaviour. Troubled mothers worry that their sons will become perverts or their daughters victims. Sex is now so villainized that we have forgotten how benign and important our early sex play was. We are now vigilant about protecting our children from the dangers of sex, and danger seems to be everywhere.

However, there is no danger in peer-aged children exploring their own and each other’s bodies. Indeed, such play defines differences between male and female and helps children form strong organ constancy.

This in turn protects children from abuse, for when they feel entitled to their own bodies, they can better differentiate between good and bad touching. If they know the names of their body parts and feel comfortable speaking about them, they are more likely to report unpleasant situations. They will be their own first line of defense against abuse.

On a deeper level, early introductions to organ constancy carry pleasurable physical responses. If shame is not layered on those early memories, we grow up comfortable with our bodies and with our bodies’ responses to arousal. We have a better chance of developing a positive body image, despite the constant media blitz of unattainable perfection. We will enjoy our own bodies and those of others. Early curiosity becomes fused with adult desire resulting in fearless intimacy and sexual abandon. Isn’t that what we all want?

So, parents, please be gentle with your young sons and daughters. Help them to accept and honour their bodies and to welcome pleasure. Without the hormones of puberty, they lack the capacity for lust. Their curiosity is innocent and important. It is also easily addressed. The playing doctor stage is brief if left alone. Take this opportunity to share some introductory sex education books with your tots. They’ll learn what they need to know and move on to their next developmental stage.

Sometimes we make things far more complicated than they need to be. Until we teach them differently, kids are neutral about their body parts. Our job is to foster their healthy acceptance of their bodies. We’d all do well to relax and enjoy.

First Visit Jitters

A number of clients have shared with me their reactions to their initial sex therapy visit. It might be instructive to those of you considering therapy to hear what they had to say.

A man in his mid fifties told me that the pre-session homework I ask of everyone had been enormously helpful. This involves answering two simple questions: “What are the problems?” and “What would need to happen for you to know the problems have been resolved?” He explained how this exercise had focused him, even before our first meeting, on the precise nature of his troubles and on his goals. He added that the questions reminded him that this appointment was dedicated solely to talking about him, which he had been avoiding for ages. This brought up mixed feelings of trepidation and relief.

Another new client, a woman in her thirties, disillusioned by the disconnection between the myth of happily-ever-after and the reality of maintaining a real-life relationship, shared her relief that she had found a place where she could admit her fears and doubts to someone who would not judge her. Though her friends offered a comfortable place to vent and share good times, they could not give her a neutral and confidential ear. She also appreciated learning accurate information about her body and its sexual functioning.

Then there was the couple who had grown so estranged that visiting me marked their last attempt to save their marriage. I noticed that they did not touch or even make eye contact. They were still emotionally connected and got along well, but it had been a long time since they had experienced any intimacy. I asked them if they would do exercises at home. They admitted they had not like the idea—felt it was juvenile and pointless—but they agreed. Their willingness to risk feeling awkward and vulnerable with each other signalled their willingness to change the character of their relationship.

Sometimes people come in just because they need a safe place to talk about something. It can be difficult to find someone non-judgmental and uninvolved, especially regarding sex. Clients generally tell me they feel a bit anxious when they first arrive, but that it doesn’t last long.

Other times clients need accurate information and want help in determining how that information best applies to their lives. Often that can be sorted out in a session or two. Still, it can feel a bit humbling to admit we don’t know something about sex. We all want to be knowledgeable about something that’s supposed to “come naturally.” I try to make the learning fun and relaxed.

Still other times clients come in who feel quite hopeless about their sexual situation. They arrive bursting with questions and emotions. I can hardly give them information and support fast enough and I watch their anxiety dissolve as the session progresses. Their body language and even their breathing change over the course of the visit. I hear phrases like “I never thought of it that way before” and “I wish I’d come in ages ago.”

Few people have contacted a sex therapist before. I’m used to that. I appreciate the trust put in me as folks stretch their boundaries to learn more about their sexuality and relationships. I hope this peek into what initial sessions can be like helps you to feel comfortable in approaching the process of sex therapy with anticipation. It can be an exciting adventure. After all, the potential reward is great sex for the rest of your life!

The Cost of Knowledge… and Hubris

This article is dedicated to the memory of David Reimer, aka Bruce (and later Brenda), aka John/Joan/John, an unwitting and unwilling hero/victim in a grand experiment that showed great promise but went terribly, terribly wrong.

It began in 1966 when the eight month old twin boys born to rural Manitoba parents Ron and Janet Reimer were taken to Winnipeg to undergo what was thought would be routine circumcisions. (It is ironic that the book later written about this case would be entitled As Nature Made Him, for had baby Bruce been left as nature made him, he would never have become the subject of such interest). The procedure was horribly botched, reducing Bruce’s penis to a charred remnant. In 1966, phalloplasty was unknown.

What transpired next can be explored by listening to the audio posted at the NPR web site. Click here. Suffice it to say that the distraught parents made their way to Dr. John Money at Johns Hopkins in the States. There they learned that nurture, and not nature, determined gender identification, and the family, steered by Money, embarked on a course of action that ended thirty-eight years later with the little boy’s despondent suicide.

I believe Dr. Money meant well. I believe he believed he was correct when he stated that gender was malleable before the age of two or three. I believe he thought he was doing the youngster, and the world, an important favour.

But despite young Brenda’s (as she was renamed) protestations and copius evidence that the experiement had failed, Money held fast to his beliefs, his hubris overtaking his scientific responsibility to searching always for the truth. Brenda eventually refused any more visits to the doctor, refused any more hormones, refused to conform to the expectations of her parents and her culture. She led a tortured childhood until a day in her teens when her father, who could witness his child’s despair no longer, took her out for ice cream and told her the truth. Brenda, heartbroken and relieved, reverted to maleness and renamed herself David.

John Colopinto, a journalist, happened upon this story in the late 1990s and, following exemplary research and innumerable interviews, penned the story of this sad little child. As Nature Made Him kicked open all of David’s doors. He became, overnight, a media sensation. Dr. Money, on the other hand, retreated behind his academic walls and refused to make comment.

After his return to his proper gender, David set about making a life for himself. He eventually received some much-delayed phalloplasty and married a woman with three children. It began to look like this tragic story might have a happy ending after all. But earlier this month we learned that David Reimer took his own life. Despondent after losing his wife and children to divorce, his schizophrenic twin brother to suicide, and his fortune to a swindle, he quit fighting and overdosed.

And so we lost a reluctant hero who showed us that gender cannot be decided by anyone but ourselves. We come with gender, and temperament, and eye colour preordained. They are not for us to manipulate.

We need more compassion in how we greet those different from mainstream expectations. We need to listen to our children when they insist a mistake has been made in assigning them to the blue or pink lines. We’ve no right to make one more child suffer needlessly after poor David taught us so well that each of us is the expert on ourselves.

So here’s to you brave baby boy Bruce. We did you wrong, and you paid the extreme sacrifice for our devotion to seeing what we wanted to see. May you be the last that suffers such consequence.

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David Reimer’s Obituary as posted on the CBC web site

Man raised as girl dies

WINNIPEG – A Winnipeg man who was the subject of a ground-breaking gender experiment has committed suicide.

David Reimer’s parents were advised to raise their baby boy as a girl after a failed circumcision in 1966. Reimer was castrated and subject to mental, social and hormonal conditioning to help him live his early life as a girl named Brenda.

Medical experts followed his development and socialization closely, comparing him with his twin brother in an experiment that came to be known as the Joan-John case during the 1960s and ’70s.

Reimer was a social outcast as a child and battled depression. He discovered the truth about himself when he was a teenager and decided to live as a male. He underwent testosterone injections, a double mastectomy and a phalloplasty and started a new life as a man.

Reimer eventually married and raised three stepchildren in Winnipeg.

The flawed experiment received worldwide publicity, and Reimer stepped out of anonymity in 2000 to reveal his story in the book As Nature Made Him: The Boy Who Was Raised As A Girl by John Colapinto.

Reimer took his own life last Tuesday. He was 38 years old.