Bioethics

What if sex had no health consequences?

By Chris Rangel MD ⋅ June 17, 2006 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

Recently the FDA approved a vaccine (Gardasil made by Merck) against human papiloma virus (HPV) to prevent cervical cancer. This cancer kills about 3,700 women per year in the US. The vaccine prevents 70% of cancer causing HPV types and 90% of the HPV that cause genital warts. The problem is that in order to be effective the vaccine needs to be given before the woman is exposed to HPV and for all practical purposes this is before the initiation of sexual activity. In the US this means that the vaccine should be given to girls prior to the age of 11-12.

Well then . .

If you’re an evangelical Christian this is just one more step on that ever shortening road to Sodom and Gomorrahland. Conservative organizations such as the Family Research Council and Focus on the Family have been very critical of the vaccine. Mostly they claim that such a vaccine is not needed if we all make like good Christians and delay sex until mirage and not screw around.

Ahh, but if the world were perfect then we wouldn’t need conservative Christian organizations.

And yet,  this medical advancement raises some interesting issues and questions. What if there were no health consequences to sex? It’s not such a theoretical possibility. Most of the deadly and harmful STDs (HIV, hepatitis, herpes) are caused by viruses, which are particularly susceptible to vaccines (the effort to produce the HPV vaccine took over 15 years). It’s possible that within the next 10-20 years the spread of these STDs will be prevented by vaccines.

It is also entirely possible that the next 10-20 years may see the development of the ultimate birth control technology; I.e. a simple and harmless procedure that can be given once, is 100% effective, and lasts until the person decides that they are ready to reproduce at which time it is easily and effectively reversed. Think of it like a tubal-ligation or vasectomy but in injection or pill form. The technology is already beginning to take shape.

Should such medical advancements become reality then society will be facing the same questions posed by the development of the HPV vaccine. Should we be giving these vaccines and temporarily sterilizing children when they reach the age of sexual maturity, i.e. the ages of 9-12? Or do we assume as the evangelicals assume that this will only give horny kids carte blanche to engage in sexual activity? Would you as a parent sleep better at night knowing that your sexually capable teenager is protected from pregnancy and the worst STDs or would you prohibit them from receiving such treatments, cross your fingers, and hope that all those abstinence contracts your teen signed actually work?

But crossing our fingers is what most parents do now even though there is not much evidence that either sex ed or abstinence only education work very well to prevent the spread of STDs or pregnancy. Even though there has been a slight decline in teenage sexual activity in this country in the last 20 years, a significant drop in the teenage pregnancy rate can be attributed to the use of injection depo contraception. Because these injections need to be given only once every three months the improved effectiveness comes from improved compliance. Clearly technology has the capability to make unexpected (and often unwanted) pregnancy a thing of the past. But only if it is used.

So what will it be? Should we aim to protect our teenagers from the risks of what is a normal human body function or do we adhere to our traditional puritan morality; that we need not protect people against the risks of something that they should not be doing in the first place? At some point in the near future we may be forced to face our own sexual mores. Is sex “bad” only because it has health consequences? If those consequences go away then is sex “neutral” or still bad if it is not monogamous? Should teenagers be sexually active even if they have no health consequences? If not then when and why should we arbitrarily decide when it is ok to become sexually active?