By Tia Will
We are currently witnessing another case of alleged rape in Yolo County. As a long time gynecologist in Davis, I have some observations to make about sexual activity in our community. Due to the proximity of my office to UCD, I have an unusually high proportion of 18-24 year olds in my practice and thus have a very high proportion of patients who are at risk for unsafe sexual encounters.
Almost every day I am faced with a woman presenting for birth control or sexually transmissible disease testing after an unsafe sexual encounter. Two very common expressions that I hear used are, “It just happened” and “I just want to be safe”.
I would like to spend a little time discussing the fallacies behind these two phrases.
Both men and women in our society receive mixed messages about sexuality. We do not have a clearly defined space and time in which girls and boys receive uniform, factual, comprehensive information about our reproductive organs, sexuality, and the personal, spiritual, social and economic implications of the use of these organs prior to the time when they become sexually active. What is readily available in our society, however, is a mythologized, glamorized and wholly unrealistic view of sexuality portrayed on television, in the movies, online, in literature, and on our playgrounds and streets. We see it in the marketing of clothing, alcohol, cars and virtually any other product one can name. Even children’s toys are frequently sexualized. Think of Barbie if you doubt this.
Given the mixed messages of our society that sex is not something we talk about, but it is something that we see represented freely albeit unrealistically in our society, we should not be surprised when our young men and women have very ambivalent attitudes toward sexual activity. I encounter many young women who have a lot of emotional conflict about sexual activity. From my perspective, they often use alcohol and other recreational drugs as justifications for activities they actively choose or passively engage in, so they can claim that “it just happened.” This is too frequently used as a crutch to excuse behavior they may regret.
This dynamic can have devastating consequences. For many women, rapes go unreported due to the fear they will be vilified in public. Those who do choose to report a rape frequently find that their lives are subjected to more dissection than the life of their assailant, especially if that assailant is “a big man on campus”. However, there are also some women, for reasons only known to themselves, claim that a sexual encounter was a rape, when in fact it was either consensual or at least not contested by the woman who chose to remain a passive participant. This can have devastating life long consequences for her, but also for the young man who may be falsely accused.
With regard to the desire for sexual safety, I frequently encounter young women who confuse prevention with early detection. The two are not the same. Primary prevention does indeed keep women safe. Obviously, the 100% safe option with regard to primary prevention of pregnancy or sexually transmissible diseases is abstinence. However, to pretend that this will be the option selected by all or even most young people has been demonstrated again and again to be unrealistic and ineffective. Testing after the fact will only allow early treatment of those conditions which are treatable. It does not in and of itself confer safety.
So with the goal of maximizing safety in a realistic manner, I urge the following to every patient I see: choose in advance, in a realistic way, what degree of safety is acceptable to you. Be aware that lowering your inhibitions with drugs or alcohol increases the risk of unsafe activity. If you choose to be sexually active, accept it for what it is, a choice, and accept full responsibility for your actions. Prepare yourself in advance with statistically effective contraception and condoms for STD prevention. Becoming too drunk or too high to express yourself is not an excuse for subsequent mishaps, sexual, or otherwise. This is not a matter of “blaming the victim”. It is a matter of teaching young women that to remain safe means becoming proactive in the management of your own sexuality and for not placing themselves in a vulnerable state by choice.
My message to young men would be exactly the same if I saw them in my practice. Young men are also prone to using exactly the same defense. “I was too drunk or high to realize what I was doing,” is a nonstarter as a defense for rape. I have also another admonishment for young men. I still see the attitude being expressed that contraception and the prevention of sexually transmissible diseases is the responsibility of the woman. Men ought to be taught that when they engage in sexual activity, prevention of these conditions is as much their responsibility as it is that of the woman. And if they are the instigator of the activity, then they should assume the lead in the prevention of unintended consequences as much as they are willing to assume the lead in the activity itself.
In summary, my advice to my patients and their potential partners is:
1) Be honest about your sexuality
2) Be proactive in taking charge of your own sexual behaviors
3) Educate yourself and protect yourself with immunizations, contraceptives, and condoms to provide a level of risk vs. protection that is acceptable to you in the sober state.
4) Be aware that any substance such as alcohol or recreational drugs that lowers your inhibitions raises the risk of unsafe activities and should be avoided for both your physical and sexual safety.
My advise to our community and society is:
1) Be honest in all portrayals of sexuality
2) Educate our young people on the full range of sexual expression including its pleasures and hazards.
3) Provide age appropriate education about human sexual organs and their uses just as we provide age appropriate education about our circulatory, digestive and muscular systems.
4) Provide free and readily accessible long term reversible contraceptives to anyone who expresses the need at a place of convenience to them.