Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Preventing or encouraging teenage sexual behaviour!
- Jameel Rahman (20 May 2002)
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Re: Preventing or encouraging teenage sexual behaviour!
- Jonathan E Isaac (21 May 2002)
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A Positive Approach To Emergency Contraception
- Craig Wheelans (22 May 2002)
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Re: Re: Preventing or encouraging teenage sexual behaviour!
- James E Parker (22 May 2002)
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Dear George
- Roger P Worthington (22 May 2002)
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“Mega” dose emergency contraception
- Ellen C G Grant (23 May 2002)
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Re: Re: Re: Preventing or encouraging teenage sexual behaviour!
- Olga E. Loeber (24 May 2002)
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Sleeping beauties
- Peter Henry Millard (29 May 2002)
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Jameel Rahman, Staff Physician, AA MH, UAE.
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Sir, Nobody can prevent or gaurentee illicit sexual relationships. No sane society in the world allows this.Yet in the name of so called 'personal rights' our modern day societies have turned so corrupt that no one points even, that out of marraige sex is illicit and wrong. The yougsters have virtually hijacked the elders. There seems no way but to say,"yes, go on but do not produce babies." Instead of discouraging we are indirectly encouraging them to go on and on. Why do not we at least tell them this is wrong to have illicit sex in the first instance. Isn't this proper teaching? Why we are out to destroy our whatever remaining social fabric. Yes it is a natural instinct, does that mean we should forget decency. The authors here must be feeling high for doing a great job, but had that not been appropriate to tell these 12-15 years budding souls, what decent behaviour means. It is just like telling a cyber-thief a password and telling him not to use it. The point is why to tell him the password in the first instance. Sir, I know I may sound orthodox, perhaps out of time to bring this discussion but may be some of your readers would agree with me. Dr.Rahman J, Physician. AAMH, AbuDhabi, UAE. |
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Jonathan E Isaac, Project Manager CHC, Ladywell House, Newtown, Powys SY16
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I agree with other respondents that the elation of this achievement must be balanced with the sad reality that we are currently encouraging young people to abandon themselves to their unbridled desires. Apart from the moral implications for the fabric of family life, the "safe sex" philosophy also emphasises the avoidance of pregnancy, but massively understates other risks of sex e.g. STDs not prevented by emergency contraception or even condoms. Perhaps the author can also confirm or otherwise the massive hormonal dose which the morning after pill delivers (40 x a normal contraceptive pill)and the matter that the morning after pill was only trialled on adults in developing countries - not on adults, let alone young people in Western Europe. Perhaps better news would be the promulgation of an "abstinence" practice amongst our young people which treats them with dignity and respect and really safeguards them for their future. |
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Craig Wheelans, GP Registrar Taylor & McColl Medical Practice, Thornliebank Health Centre, Glasgow, G46 8NY.
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Dear Sirs, I myself have to praise the authors of this paper for their positive approach to the promotion of emergency contraception. I feel that having previously worked as a Gynaecology SHO it makes far more sence to offer this advice in order to prevent the heartbreak and distress caused by an unplanned pregnancy and subsequent termination of pregnancy. We have to accept that young people are having sex and if we can promote the ease of availability of contraception maybe young people will take a more responsible attitude towards their sexual health. I agree that condoms should be promoted as a form of contraception but young people should know how to access help when their condom fails. I am sure that if one pregnancy is prevented by the work undertaken by the study then it has more than justified it's means. Yours faithfully, Dr. J. Craig Wheelans
MB, ChB, DGM, DRCOG.
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James E Parker, Retired Paediatrician 289 McCallum Rd. Abbotsford B.C Canada V2S 8A1
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I am in total agreement with the sentiments expressed by Jonathon E Isaac in his BMJ eletter of May 21 2002. The 'safe sex' message to teenagers has unfortunately become 'the joy of sex' in western society. The promulgation of an 'abstinence' practise amongst young people which treats them with dignity and respect really would safeguard them for their future. Sadly however society appears to have abandoned it's youth. In Canada the age of consent is 14 years and here in British Columbia a recent supreme court decision (R v Sharpe) has declared child pornography to be an art form !. If parents are unable or unwilling to provide their children with the appropriate knowledge to protect themselves then it is up to medical or educational authorities to do so but this requires some invocation of moral values. Abstinence is an option. James E Parker |
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Roger P Worthington, Lecturer in medical law & ethics St George's Hospital Medical School, London
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Please send a copy of this paper to the Oval Office. It seems that the present occupant is unaware that providing education on contraception (emergency or otherwise) does not result in gross promiscuity, or automatically lead to increased sexual activity. |
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Ellen C G Grant, Physician and medical gynaecologist 20 Coombe Ridings, Kingston-upon -Thames, Surrey KT2 7JU , UK
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EDITOR - Graham et al want to improve teenagers' knowledge of emergency contraception.1 Their emphasis is on timing use correctly rather than on the consequences of repeated use of large doses of a powerful, immunosuppressive and potentially carcinongenic progestogen. The belief, that hormonal contraception is a “mega” dose of hormone which works by poisoning you, is conveniently, but inaccurately, dismissed as a myth. The biological effect of an oral progestogen is “mega” compared with natural progesterone. Micronised levonorgestrel is 1000 times more powerful than oral progesterone. Emergency contraception now consists of two pills of levonorgestrel 750 micrograms giving a very large 1.5 mg dose in a 12 hour period. Another 750 ug dose is added if there is vomiting. Micronisation doubled the potency of progestogens and levonorgestrel is twice as potent as norgestrel. Therefore the current regime is 120 times more potent than the 50 microgram daily dose of unmicronised norgestrel tested in the 1960s. Among four progestogen-only regimes norgestrel produced the most endometrial blood vessels changes including substantial thickening of arteriolar walls and dilated sinusoids. 2 Such changes are known to relate to systemic vascular side effects such as the risk of migraine and fatal stroke.3 The safety references the authors cite seem inadequate. It is not enough to compare a combined regime with a progestogen-only regime and assume safety because the latter, being more powerful and more immunosuppressive, prevents more pregnancies and causes less nausea and vomiting. Only 1001 women used this emergency regime on one occasion in the 1998 Task Force study. One woman died of meningitis while 21 more were lost to follow-up.4 In contrast,the evidence that progestogens are 2 to 8 times more likely to cause breast cancer than oestrogens should give even the keenest advocates of hormone use cause for concern.5 After all antioestrogens are used to prevent or treat breast cancer. Progestogens also increase the risk of cervical cancer. It is extremely sad to learn that a quarter of 14-15 year-olds are having high-risk sexual exposures when we know there are many unfortunate outcomes including pregnancy. Exogenous hormones are also teratogenic and the expected possible pregnancies range from 5% to 42% if norgestrel 1.5 mg is taken within 24- 72 hours of unprotected coitus.4 Surely if teenagers were taught the real facts of life they would be less vulnerable to the promotion of hormone use among ever younger females. Mega doses of hormones can be harmful. Dr Ellen C G Grant
1 Graham A, Moore L, Sharp D, Diamond I. Improving teenager’s knowledge of emergency contraception: cluster randomised controlled trial of a teacher led intervention. BMJ 2002 ;324:1179-83. 2 Mears E, Vessey M P, Andolsek I A, Oven A. preliminary evaluation of four oral contraceptives containing only progestogens. BMJ 1969; 2: 730-34. 3 Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity and mineral imbalance. J Nutr Environ Med 1998; 8: 105 –116. 4 Task Force on Postovulatory Methods of Fertility Regulation. Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet 1998; 352: 428-33. 5. Dixon JM. Hormone replacement therapy and the breast. Editorial BMJ 2002; 323:1381-82 and electronic responses at bmj.com. |
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Olga E. Loeber, M.D. familiyplanning institute Zijpendaalse weg 101 6814CH ASrnhem
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I would like to submit to my colleagues to read the IPPF charter on sexual and reproductive rights. Young people should be educated to make responsible decisions for themselves. They should be able to decide for themselves if and when to start sexual relationships. They have the right to know about contraception, also about emergency contraception and the access to it, if necessary. All patients, including young people, have a right to an unmoralistic respectful approach by sexual health professionals. |
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Peter Henry Millard, Emeritus Professor of Geriatrics St. George's Hospital Medical School
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Editor Teaching stories are powerful instruments. They work on the conscious and subconscious mind. At each new stage of civilization, fables and fairy tales have been modified in reaction to the needs and conflicts of people within the social order1. With that in mind, let us consider the 21st Century fable used in the research reported by Graham et al 2 (British Medical Journal 18th May 2002) with the 17th Century version of Sleeping Beauty3. In “La belle au bois dormant” Charles Perrault worked on the subconscious mind of children of the bourgeoisie, especially the girls, to teach them the importance of maintaining their virginity. The Moralité at the end of the original story includes the line: “On ne trouve plus de femelle, qui dormist si tranquillement” In other words, fertile female animals would not behave like this, but you are not animals. Let us now unpack the 21st century fable in the teaching story used by Graham et al. to educate teenagers about the contraceptive pill. The girl in the story “met friends at the bus stop on her way to school” i.e. she was probably under eighteen. “She … met Mike, someone she had previously fancied” - suggesting it’s all right to have sex if you fancy someone. “She had been drinking and dancing all evening” presumably alcohol. And “…she possibly had sex in the early hours of the morning on the way home from the disco.” If she did not know whether she “had sex” was she too drunk to know? Did she give informed consent? Was it rape? Following the one-lesson, teaching story intervention, the knowledge of the school children in the intervention group about the time limits for use of emergency contraception improved. But there was no difference in the outcome of sexual activity in the intervention group and the control group. For the increase in sexual activity - as judged by respondents saying they were no longer virgins – was the same in both groups. Correlation does not indicate causation. If the conclusions of the classic “Pygmalion in the classroom4” study are not untrue, the same statistical result with regard to knowledge could have been achieved by simply telling the teachers to read the classic version of Perrault’s classic tale, followed by a classroom discussion that focused on the action of the post-coital contraceptive pill. If the purpose of the sex education industry is to reduce childhood pregnancy, the outcome with regard to post-coital pill knowledge of the “Sleeping Beauty approach” may well have been the same. But, it the 17th Century ‘mind-benders’ were not incorrect, the loss of virginity in the intervention group could well have been less. Peter Millard
References 1 Zipes J Fairy tales and the art of subversion. The classical genre for children and the process of civilization. London: Heinemann,1983 Page 7 2 Graham A, Moore L, Sharp D, Diamond I. Improving teenagers’ knowledge of emergency contraception: cluster randomised controlled trial of a teacher led intervention. BMJ2002;324:1179-1183 3 Histoires ou contes du temps passé, avec des moralitez. Par le fils de Monsieur Perreault de l’Academie François. Suivant le Copie, a Paris. MDCXCVIII. 1698. 4 Rosenthal R, Jacobson L. Pygmalion in the classroom. Rinehart and Winston Inc.1968 Conflict of interest. None |
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