Sexual Health
Testimony Before Congress on the American STD Epidemic
Joe S McIlhaney Jr., M.D.
Thank you, Chairman Bilirakis and distinguished members of the Subcommittee.
I am a gynecologist who practiced medicine for twenty-eight years. I had a rewarding practice of in vitro fertilization and surgery, but I left my practice to commit the remainder of my medical career to helping prevent two of the most profound medical problems of our day, out-of-wedlock pregnancy and sexually transmitted disease. I have been doing this through an organization called The Medical Institute for Sexual Health, which I founded in 1992. The mission of the Medical Institute for Sexual Health is to identify, evaluate and communicate credible scientific data in practical, understandable and dynamic formats to promote healthy sexual decisions and behavior in order to dramatically improve the welfare of individuals and society.
The good news
In 1996, I testified before the House Ways and Means Subcommittee on Human Resources on the proposed Welfare Reform Act. My message then was that sexually transmitted disease and non-marital pregnancy are hurting far more people in society than most members of Congress and other Americans realize. To its credit, in an effort to constructively and meaningfully deal with these pregnancy and disease problems, Congress funded abstinence education with $50 million a year for five years through the Title V provision of the Welfare Reform Act. This funding has helped more than 700 abstinence education programs around the country to devote serious and much needed attention to these problems.
I come today with good news and bad news.
The good news is that there is credible evidence showing that abstinence education is having an impact. More young people are living an abstinent lifestyle, and fewer teens are becoming pregnant. Today, more than half of all high school students are virgins.1 Also; beginning in 1990, the number of teens becoming pregnant began declining. Today we have the lowest teen birth rate that we have had since the 1950s, and teen pregnancy rates are lower than they have been any time since 1976.2,3
A ray of light and hope is emerging.
Trend data showing declining sexual activity among adolescents and declining teen pregnancy rates reveal a societal shift in a positive direction — it is reasonable to conclude that one contributing factor is the concomitant rise in abstinence education programs, though how large of a contributing factor we do not know. Some specific programs, such as the one in Monroe County, New York, and the Best Friends program that began in inner city Washington, DC, show a very marked decline in pregnancy rates.4,5
The bad news
But the bad news is that we still have an enormous problem. Sexually transmitted infection is highly prevalent among adolescents. Three to four million STDs are contracted yearly by 15 to 19 year-olds, and another five to six million STDs are contracted annually by 20 to 24 year-olds.6 Approximately six percent of adolescent females tested at family planning clinics and nine percent of female U.S. Army recruits (12.2% of 17 year-olds) are infected with Chlamydia trachomatis.7,8 5.6% of 12 to 19 year-olds and 17% of 20 to 29 year-olds are infected with herpes simplex virus type 2 (the virus that causes genital herpes).9 And whereas in the 1960s, only two STDs were of real concern, we are now aware of more than 25 (Appendix A)
. It is clear that, if and when young people begin sexual activity prior to marriage, they are at very high risk of acquiring an STD.
One reason STDs have become so prevalent among young people is that, in spite of the recent trend toward later sexual initiation, we had for years been experiencing a trend toward earlier sexual initiation, and the trend toward later marriage continues.10, 11 The combination of these two factors means that people are likely to be single and sexually active for a significant period of time — 5 to 10 years or longer — during which they will normally accumulate a number of sexual partners. In fact, age of sexual onset is a very strong predictor of lifetime number of sexual partners.12 and an individual’s risk of ever having contracted a sexually transmitted disease is strongly linked to his or her lifetime number of sexual partners.13, 14, and 15
