List of clinics

By Valentina Cardenas, 17, Ramona Convent
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This interview contains frank information about teens and sex. After consulting with L.A. Youth’s teen staff and their friends at various schools, we prepared these questions to give teens the information they want to know, but might be afraid to ask. Our purpose is not to offend, but rather to help teens make informed decisions.

Dr. Mark Schuster

Dr. Mark Schuster, director of the UCLA/Rand Center for Adolescent Health Promotion, answered our questions about sex. His book for parents, "Everything you never wanted your kids to know about sex (but were afraid they’d ask)" was published in 2003.

1. What is the safest way to have sex to avoid pregnancy and disease?

"I guess one thing we should talk about is what is sex? Does it mean vaginal intercourse, oral sex or anal intercourse? If we’re talking about pregnancy, I think we are talking about vaginal intercourse. There are various ways of preventing pregnancy. The most definite way to prevent pregnancy is not to have sex. The hormonal methods are generally the most effective and those are what’s called the pill, or the oral contraceptive pill. If used the correct way, and you always take it when you’re supposed to, it’s over 99 percent effective. If you use it not quite regularly, and you skip every now and then, then it’s not as effective. There’s also the Depo-Provera shot, which is the monthly shot. There is now a vaginal ring, which is more of a newer one. There’s a patch, there are a lot of different methods that release hormones and can prevent pregnancy. Those as a group tend to be very effective. Again, they have to be used in the correct way.
     Those don’t prevent disease at all; the only contraceptive that prevents disease is condoms. There’s the male condom and the female condom, which isn’t as well known. They’re not perfect—the condom can break for example—but if used the correct way, they’re very good. I think everyone needs to remember that they’re not perfect and need to be used properly."

2. Which is the best method of contraceptive?

"I think it depends on a person’s individual needs. Each person needs to read about the different options, or talk with his or her doctor or nurse or parents for advice. The pill is very effective, but you have to remember to take it. There are some people that remember to take it when they brush their teeth. It’s easier if you can leave it on a bathroom counter or someplace else where you can see it, or if you have to hide it, you know, in a drawer. It depends if you’re comfortable with others even seeing the pill. But if you’re someone who has trouble remembering to do something regularly, the pill can be hard and then you can forget to take it. The shot is much easier to take, you gotta go and get it, but it’s not that often. It’s only four times a year. It’s easier to make your appointment to go get your shot, have it on your calendar and then go get it so that I think particularly for people who might not be as organized and who might be a little forgetful or just tired and busy, the shot is more dependable. Condoms are not as effective but they also help prevent disease so often physicians recommend using two methods, often one method that’s really effective against pregnancy but they also use condoms to prevent disease."

3. Which birth control method is the most affordable?

"That would depend on if the teen has health insurance and if the health insurance covers certain prescription contraceptives. So I unfortunately do not have a really simple answer to that question. For anything but the condom, you’ve got to go to your physician or nurse practitioner to get a prescription anyway. That’s’ a very important question to talk over with your physician because you can discuss your specific insurance plan and what is and isn’t covered."

4. Who should take responsibility?

"Both. Well, it could be two men, it could be two women, and it could be a man and a woman. No matter which person you are in a relationship, I think it is everybody’s responsibility. The guy shouldn’t say ‘Well, it’s her job, she’s the one that can get pregnant, I don’t have to worry about this,’ because it’s his kid too. Likewise she shouldn’t say, ‘Well, you know, he’s the captain of the football team, you know, who am I to challenge him? He says that we don’t have to worry about these things.’ Everybody needs to take responsibility."

5. When would be the proper time to put the condom on, like if the two teens are fooling around and then they put on the condom. Is this a bad idea?

"I would say, put the condom on, definitely before the penis goes into the vagina. You don’t want to sort of have intercourse, but then stop, put the condom on, and then keep going because little bits of sperm and if there’s a disease that can be transmitted right away. Some people say "oh they’ll just put a condom on right at the end." It takes an enormous amount of will power for the boy to pull out, and then put on a condom and keep going. He may ejaculate before he’s pulled out, which is one of the bigger problems with condom withdrawal method of birth control. The idea that he’ll pull out before he ejaculates. But little bits of sperm have probably already gotten out and a lot of boys don’t really pull out when they plan to, and they just get caught up in the moment. So, definitely before he plants his penis in his vagina. But I would say really, I guess that’s the simplest, clearest answer. But you also don’t want the penis really close up to the vagina either, I mean there’s still little bits of sperm. Basically if the penis is getting near her vagina, it’s time to put the condom on."

6. What do you mean when you state, using the condom properly?

"Well the main thing that people do wrong is not use it every time. So if you ask someone if they use contraceptives and they say yes and you say ‘Well what’s your contraceptive?’ and they say ‘Well condoms’ and you say ‘Do you use it every time’ and they’re like ‘No, but I use it 8 out of 10 times’ but there’s always those times when they don’t use it and they can get pregnant or catch a disease. The main thing is just to use it. But there are all sorts of other things that are important:
• You don’t want to store it like in your glove compartment where it’s going to get really hot in the summer and melt.
• When you open a condom, you have to be careful not to rip the condom. If you do rip it, throw it away and use another one.
• There’s an expiration date on the little packet—make sure that it’s not expired.
• Always have at least several with you in case one breaks.
• It needs to be rolled down the proper way, there’s one way you can roll it and another way you can’t. If you put it on the wrong way, don’t just turn it over. If you do it wrong, throw it out and use another one.
• The first time, it’s much better to have opened a condom when you’re not having sex just to see what it’s like, see what it feels like, see what it’s like to open a package, how hard it is. That’s a much better way when you’re not all stressed out, or excited about having sex.
• There are actually instructions on the condom packages that probably no one ever reads. There would be a lot fewer pregnancies and diseases if people actually read it. I don’t think adults read them either, maybe sometimes."

7. Many teens assume that using two condoms during vaginal intercourse would prevent pregnancy more effectively than one condom would. Is that true?

"That’s not a good idea because it makes it more likely for them to break, the friction of the latex over latex."

8. What happens if they have sex without any contraceptives? What happens after that?

"There’s nothing to prevent disease at that point. They can prevent pregnancy. You should be checked by a doctor and you can get emergency contraception, which is really just very high doses of the same hormones that are in contraceptive pills. They can call the doctor or the pharmacist and get them." [Editor’s note: Emergency contraception should be taken within three days (72 hours) of unprotected intercourse.]

9. As far as the pill, for people who take the pill to be on a regular cycle, or for acne, would that still serve as a contraceptive pill allowing them to have sex?

"Usually I would think that if you’re taking it for acne, you would be covered for pregnancy, but that’s a really important question the woman would have to discuss with her doctor."

10. Can you get STDs if you don’t have sex?

"A lot of people mean vaginal intercourse when they have sex, and you can definitely get STDs from anal or oral sex. You can get some STDs if you’re even just touching, but that’s not as likely. But, you can get STDs from all sorts of sexual activity and that’s the thing that not most everyone realizes. Most think ‘Oh, oral sex is safe from everything, you can’t get pregnant, you can’t get a disease’ and that’s just not true. You can’t get pregnant but you can definitely get a disease."

11. Can lesbians get STDs as well?

"Yes, for several reasons, studies show that a lot of lesbians at some point in their life have sex with a man, so that makes them, in terms of an STD risk, same as any woman who’s had sex with a man, whether she’s a lesbian or not. When they were younger, often lesbians have had sex with a man, and so they could have caught diseases then. But you can also get the disease transmitted between two women, so absolutely. It is the case of lesbians that they have much lower STD rates than others do, but it’s not zero."

12. What kind of behaviors put you at risk of getting a sexually transmitted disease (STD)?

"Well, any sexual behavior that involves another person, like if you masturbate alone you won’t get an STD. But any intimate sexual activity has some chance of getting an STD if the other person is infected. But I’d say, vaginal intercourse, anal intercourse, oral sex, can all transmit STDs. Mutual masturbation doesn’t easily transmit STDs but it can transmit HPV (Human papillomavirus). So, any activity can transmit something, but anal intercourse appears to be the easiest. Vaginal and especially anal intercourse would be easiest to transmit disease. But oral sex can definitely also transmit disease although not everybody realizes it. Even mutual masturbation, or lying on each other naked can also transmit HPV, but you’re not going to get HIV from just lying on each other naked or from mutual masturbation, but everything has at least some that it could transmit. Using a condom, properly and every time, will reduce your chances of getting most STDs, but it’s not 100 percent."

13. Should you get tested for STDs before you have sex?

"No, there’s no need to do it before you’ve ever had- but then again we should be careful what we mean by sex. If you’ve never had oral sex or vaginal sex or anal sex, then no you don’t need to get tested before. But once you start having sex, if you do start, then you should talk to your doctor about getting tested regularly. I recommend every 6 months, that’s actually more often than most people recommend, some people recommend every year. But I think that if you’re having sex then you should get tested. I think it’s better safe than sorry."

14. Does it always hurt the first time for vaginal sex?

"Well, no, that really depends on the individual. I haven’t heard of it hurting for boys, but it can hurt the first time for girls. It doesn’t always hurt, but she should know that it might hurt and she shouldn’t be surprised. She shouldn’t think that if it hurts the first time it will always hurt in the future. The pain depends on the individual and how much they react to pain. It could be totally insignificant to hurting a lot. Not usually being so much that she wishes to never have sex again, but enough that it’s painful. She can also have a hymen, the little band of tissue covering the vagina, we often say "breaks" during intercourse. It doesn’t really break; it’s almost like it gets stretched. In some cases, it’s very tight, so when the penis is going through it, it can really hurt a lot."

15. Will using a tampon, or horseback riding, or just being very athletic, can that loosen the tissue?

They say that, a tampon might stretch a very tight hymen, but you shouldn’t assume that if you’ve used a tampon, that you won’t have any pain. You still could have some pain, absolutely. The tampon is not as large as the typical penis, it’s not usually going to so-called "break" the hymen. They also say that gymnasts or horseback riders usually break their hymen, it’s not clear how true that really is. It can break or be stretched out without having had sex, but it’s not always the case. I guess in the past, this was used as an excuse by some women who wanted to claim they had never had sex, they would say that they broke their hymen while horse-back riding. But I don’t want to take their excuses away from them.

16. When does puberty usually start for a preteen and how do they know it has started, and what happens if it’s started earlier?

"Well, there’s a range of ages where it would typically start. For a girl, it will start from anywhere between 7 to 8 to age 13. But, it is really variable. When it first starts, she might not even know it. The first thing that most girls become aware of is that they begin to start the development of their breasts. It feels like a little pea near their nipple, or several little peas. That is often the first step. They’ll often menstruate within two years of that. Their bodies are already starting to go through changes before they’re even aware of it. If it’s early, then they should go to the doctor and get checked. Often there’s no explanation. But the doctor will often want to check and make sure there is nothing else to worry about.
     And for boys, it’s more like 9-14. If boys are early, it is more often a real issue, a medical issue, and the doctors have to check it rather quickly. You worry about there’s a tumor that is causing hormonal problems. I’m giving you the full age spectrum, I mean most boys don’t start that early."

17. Has puberty been starting earlier?

"You know, it’s about two years earlier than it was 100 years ago. We don’t have any evidence that it just keeps dropping and dropping over the past 20 to 30 years. It’s been leveled for as long as we know. It could be all sorts of things, it could be better nutrition, environmental factors."

18. What is the difference between a female and a male orgasm?

"Well, that’s something that is not as well known as you might think it might be. I would say that, male orgasm is usually signaled by ejaculation. It’s possible to have an orgasm without ejaculation, but usually there is ejaculation, it’s physical evidence. A woman’s orgasm may be more subtle, she may lubricate more, but she may not really be aware of that.
     One issue is that when a man and woman are having sex, the man usually has an orgasm. He and she are very conscious of him having an orgasm. Women don’t always wind up having orgasms, particularly if intercourse is not stimulating them in a way where it brings them to having an orgasm. Women sometimes need to tell the man that she wants to have an orgasm, then he needs to do other things to help her have an orgasm, and that can involve stimulating her clitoris with his hands, or with his tongue or whatever. Very few men have never had an orgasm, but some women get to middle age without having one. They have children, they’ve had sex with their spouses for years, but they’ve never really experienced an orgasm."

19. How much masturbation is normal?

"There is no simple answer to that. Some people never masturbate; some people masturbate many times throughout the day. And I’d say that normal is kind of a funny word. Is there an amount that’s too much? If you’re masturbating to the point where you’re not getting together with friends, you’re not doing your homework, you’re not engaging in your regular life activities, that’s probably too much. Masturbation should not be interfering with the rest of your life. So, there isn’t an amount of masturbation that anyone has found dangerous, so it’s more if it’s affecting the rest of your life. Many more men than women masturbate, but the majority of people masturbate."

20. What does it mean if teens are not curious about sex and do not want to try it? This was asked by a 17-year-old male, and he was worried.

"I’d say, that no, it’s perfectly fine not to want to try sex. He may want to wait until he’s married; he may want to wait until he falls in love. Some people want to have sex all the time, with anyone they find who’ll have sex with them. Others want to have sex in the context of a long-term, committed relationship where there is a large emotional overlay, and in the confines of a marriage. There could be many reasons why a 17-year-old doesn’t want to have sex and he shouldn’t feel there is something wrong with him.
     If he has no sexual desire, no sexual attraction, then that’s uncommon. It doesn’t automatically mean that something is wrong, but I think a 17-year-old who has no sexual desires, doesn’t see other women or men and find somebody attractive, someone that makes them feel sexual, I think that’s a reason for them to talk to their doctor and just see if there might be anything going on. But the lack of the desire to have actual sex could be explained by all sorts of things, and just the desire to wait until he’s in love or married."

21. How do boys know if they’re gay?

"For boys, usually they’ll feel attracted to other boys, but they might not be so sure about what their attractions are. Partly it might be that they are gay, but they’re scared to acknowledge what they’re feeling, so they’re struggling with it, hoping they’re not gay, trying to make themselves feel attracted to women. They may have a friend who’s a woman they might like and so they aren’t sure if it means they’re attracted to her, even if they feel more physically moved by men. But it sometimes could be that a boy is straight, but happens to be good friends with another boy and isn’t really sure what it means about people being gay and whether the fact that he has a close friend means that he’s gay. So kids can get confused, but if a boy has fantasies about other boys, if he has sexual dreams about other boys or sexual fantasies, those are usually pretty good evidence that he is gay, or at least bisexual."