Sexual healing

Surgeon General David Satcher issues a clear-eyed report on sex -- and perhaps signs his own political death warrant in the process.

By Jennifer Foote Sweeney

Published June 29, 2001 7:23PM (EDT)

Praise the Lord and pass the contraception!

One can almost hear the lusty cry echoing from the smoky trenches as a dispatch is rushed past volleys of haughty rhetoric and threats of damnation to those of us cowering at home. The document, sent from the highest medical official of the land, is titled "The Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior" -- a name so evocative of dedication, urgency and honor that it makes one's heart swell. We reflexively imagine the embattled Dr. David Satcher in a candlelit tent pitched on the banks of the Potomac, scribbling hundreds of words with obsessive diligence. Not a moment to lose.

Indeed, our bearded and bespectacled hero is at this moment locked into the crosshairs of conservative bayonets. He has rejected their sacred belief that appropriate sex education must not mention sex. And the most inflamed among them might possibly be Satcher's own commander in chief, George W. Bush, who is reported by at least one senior official to have little confidence in Satcher, whose report angers him greatly. (Bush's confidence, it seems, is in his own approach of withholding information, employed so effectively with his own children and the issue of alcohol.)

It is likely that Satcher will be ordered to fold his tent and limp home, but I pray that he does not leave before the parents of this nation have an opportunity to noisily praise his courageous acts. I read the "Call to Action" with a genuine rush of patriotic feeling, the kind of pride that comes when a government official of enormous influence takes a huge risk to make a case for "human beings," acknowledging without proviso or exception that "sexuality is a fundamental part of human life."

He has written a document that demands we respect not just science and truth but the plight and beliefs of the "economically disadvantaged, racial and ethnic minorities, persons with different sexual identities, disabled persons and adolescents." Our crisis, reports Satcher with no apparent piety, is in the suffering of so many Americans, not in their shameful loss of morality or goodness.

"I have to deal with reality," Satcher told reporters.

And we are grateful. There are few places where the faith-based platitudes of the Bush administration are more bizarre and dreamy than in its promotion of abstinence-only "sex education" programs, which rely on the outrageous premise that if you withhold information about contraception and emotionally batter adolescents with vague threats about the importance of marriage -- an institution they have watched go up in flames -- young people will cease to be interested in sex.

As he said, he has to deal with reality. And this ain't the first time. Satcher created a work group to deal with issues of promoting responsible sexual behavior and sexual health two years ago. He planned to release his report in the fall. The nine-month delay in its publication caused scientists and health professionals familiar with its contents to panic, believing that, with the arrival of the Bush administration, the report would be indefinitely delayed or edited into pablum by abstinence-only crusaders with new access to the White House.

Satcher will only say that this was "the most controversial and sensitive" issue he has dealt with in his time in office. But he is nothing less than explicit in the first pages of the report when he articulates a litany of sadness, supported by research, that makes the necessity of the report and its honesty all too clear:

Sexually transmitted diseases affect nearly 12 million Americans each year; nearly 800,000 cases of AIDS, nearly two-thirds of which involved sexual transmission, have been reported since 1981; an estimated 900,000 Americans are living with HIV.

An estimated 1.3 million induced abortions occurred in 1996; nearly one-half of pregnancies in this country are unintended; an estimated 22 percent of women and 2 percent of men have been victims of rape; and an estimated 104,000 children are victims of sexual abuse each year.

Hardly the case for a moratorium on the discussion of sexuality and contraception. Rather, says Satcher, it is "a call to begin a mature and thoughtful discussion about sexuality."

As expected, in Satcher's evenhanded consideration of all points of view, he has placed a few spoonfuls of rhetorical sugar in the report to help public and private proponents of abstinence-only sex education get this strong medicine down. But in many, even most, cases these buzzwords and phrases are modified, minimized or nullified by strong language and the repeated suggestion that little or no evidence exists to support them.

For instance, he says that "few would disagree" that "sexual abstinence until engaged in a committed and mutually monogamous relationship is an important component in any sexuality education program." But Satcher repeatedly makes the case for thorough, school-based sex education, including the dissemination of accurate information about birth control.

Satcher also discusses the strengthening of families, "whatever their structure," by encouraging stable, enduring relationships, "particularly marriage." At the same time, he indicates that "human sexuality has come to serve many functions in addition to reproduction," and states that one might benefit from staying abstinent not until marriage, but until involved in a committed relationship.

It is possible, while reading certain passages of the report, to be haunted by aural hallucinations of sex-positive whiners screeching and moaning as they spy words like "marriage" and "mutually monogamous relationship" and "abstinence" in the report.

I would ask these well-meaning perfectionists to repeat Satcher's mantra: "I have to deal with reality." And then read the report.

It is a pity that the whole thing can't be reprinted here. But you can get it easily enough at the surgeon general's Web site. In the meantime, it behooves me to mention certain amazing statements, if only because their simple eloquence is very uplifting:

  • "We need to appreciate the diversity of our culture, engage in mature, thoughtful and respectful discussion, be informed by the science that is available to us, and invest in continued research."

  • "Sexual health is not limited to the absence of disease or dysfunction, nor is its importance confined to just the reproductive years ... It includes freedom from sexual abuse and discrimination and the ability of individuals to integrate their sexuality into their lives, derive pleasure from it, and to reproduce if they so choose."

  • "We cannot afford the consequences of continued or selective silence."

  • "Sexual orientation is usually determined by adolescence, if not earlier, and there is no valid scientific evidence that sexual orientation can be changed."

  • "Close, warm parent-child relationships are associated with both postponement of sexual intercourse and more consistent contraceptive use by sexually active adolescents ... However, parental control can be associated with negative effects if it is excessive or coercive."

  • Simply being affiliated with a religion does not appear to have great effect on sexual behavior."

    These are not fighting words; they are the succinct utterances of the 16th surgeon general of the United States, backed by the research and review of dozens and dozens of researchers, academics and health professionals who cite more than 100 scientific sources for their statements.

    Infuriating as it may be to blinkered partisans who believe that sexual health is a political issue, the report is devoid of advocacy but full of urgency and concern. It is that rare governmental text that acknowledges, in real time and with no nonsense, the fears and wishes of its citizenry. It manages to respect parents without picking political favorites, address adolescents without condescending blather and view all sexual humans without judgment.

    If David Satcher is removed from his post, it will be our duty to take up the battle, demanding, with this report as our primary weapon, that his vision be followed. As he points out in the cover letter of this report: "Doing nothing is unacceptable."

  • Jennifer Foote Sweeney

    Jennifer Foote Sweeney, CMT, formerly a Salon editor, is a massage therapist in northern California, practicing on staff at the Institutes for Health and Healing in San Francisco and Larkspur, and on the campuses of the Alta Bates Summit Medical Center in Berkeley.

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