Just To Be Safe


Sexual-AssaultBy 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.


About The Author

Disclaimer: the views expressed by guest writers are strictly those of the author and may not reflect the views of the Vanguard, its editor, or its editorial board.

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8 thoughts on “Just To Be Safe”

  1. sisterhood

    Good morning, Tia.

    What an excellent article. It should be printed & made available to every incoming freshman during orientation.

    What books do you recommend to parents when they have the talk (hopefully, ongoing talks) with their own kids?  I liked Our Bodies, Ourselves for my daughter.(and son)  Is there a similar book for boys?

    A few years ago, my husband and I were separated and I was thrust back into the dating world. What surprised me was most men my age hated condoms & had to be coaxed into using them. I imagined if a grown man who has lived through the epidemics of V.D, Herpes and AIDS, (and has probably met at least one person who has contracted one of them), still does not want to wear a condom, how difficult it must be for college women to get the guy on board? Or maybe young adults are better at this? From your article, it sounds like little progress has been made. What a shame.

  2. Tia Will


    I had no idea that I would come across sounding so bleak. Real p.rogress has been made on a number of fronts.

    We are seeing a significant and ongoing drop in the number of teen pregnancies in Yolo County. I attribute this to improved awareness on the part of young women and an increasing acceptance of the LARCS ( the shot, Nexplanon ( the rod placed in the arm ), and IUDs). It used to be rare for me to get a request for one of these options, and I am now placing them daily. I would say that we are reaching a critical tipping point in which woman are hearing about the benefits from their friends instead of having to be talked into trying one by a provider. Unfortunately, we also seem to be seeing a corresponding uptick in the number or STDs as couples who feel very safe with regard to the risk of pregnancy abandon the use of condoms.

    I also feel that, although completely anecdotal, I am seeing and increase in women who are coming in with their daughters to either introduce them to me, to obtain contraceptive information and or the actual contraception before the girl becomes sexually active. I am hoping that this represents a critical shift in thinking about primary prevention rather than reaction after harm has occurred and also a shift in the openness with which families are willing to deal with this issue critical to young people’s success and future.

    I would  attribute at least part of this step forward to my colleagues in pediatrics who have begun to treat sexuality as a part of human growth and development to be discussed openly and honestly, not hushed up. The advent of the HPV vaccine targeted at both boys and girls prior to onset of sexual activity has been helpful in opening the door to these conversations since most parents can see the value of cancer prevention even if they cannot accept that STD prevention or pregnancy prevention will be part of their child’s life.

    As for books, I agree that Our Bodies, Our Selves is a good starter. Unfortunately I haven not vetted any such books for boys and also am not aware if their are any more current books for girls.

  3. Biddlin

    Excellent article, Tia. Thank you. I was raised in a fairly open minded home, for the 1950s and 60s. I had the good fortune to be studiously inquisitive and always got the straight dope on sex. When we had children, my missus and I were/are always honest, even when we didn’t/don’t know the answer to their questions and then sought out the best information, together.

    As always, being informed is the best defense.


    1. Tia Will


      Thanks for sharing your experience. If everyone took this approach, OB/GYNs could concentrate much more of our time and attention on healthy pregnancies, cancer prevention and treatment, and healthy aging issues.

  4. Topcat

    Provide free and readily accessible long term reversible contraceptives to anyone who expresses the need at a place of convenience to them.

    Good article Tia.  You make a lot of sense when you write about these issues.

    I wish that our political and religious leaders could understand that avoiding unwanted pregnancies would be  a tremendous positive for individuals and society.

  5. Dan

    Tia, I enjoyed your column. One of your fellow columnists, David Hafter, wrote an excellent book for boys called ‘Growing Balls’.  I bought it for my son several years ago and highly recommend it to anyone raising a teenage boy. Adults will enjoy Dave’s sense of humor but boys will really get some insight into understanding their own maturation and sexuality. And they learn a few things about how girls think about them.


  6. Tia Will


    Thanks for the addition. I will check it out. One pitfall of my specialty is that unless we actively seek out information from the “other side” it is easy to lose track of the what is available for boys and men.

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