This past April, the North Carolina Values Coalition organized a Sex Ed Sit-Out in order to fight what they called “radical, graphic, tax-payer funded, gender-bending sex education.” Protests occurred across the U.S., and also in England, Canada, and Australia. Along with the sit-out, the organization circulated a petition that garnered nearly 60,000 signatures, speaking out against the use of taxpayer dollars in the promotion of “sexual liberation, deviance, and gender confusion to our precious kids.” They declared their intent to stand together with all parents pulling their children out of school on the day of the sit-out.

This protest is just one example of the push-back against comprehensive sex ed, a form of sexuality education that, as defined by SIECUS, “includes age-appropriate, medically accurate information on a broad set of topics related to sexuality including human development, relationships, decision making, abstinence, contraception, and disease prevention.” At the heart of these objections is the concern that children aren’t ready for this information. That learning about sex will inspire them to have it.

But many adolescents end up faced with relational and sexual decision making they’re unprepared for when they’re not given the information they need. And when they make decisions based upon faulty or inadequate information, there are negative consequences.

At the heart of these objections is the concern that children aren’t ready for this information. That learning about sex will inspire them to have it.
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Though CSE classes are open about the fact that abstinence is the most effective means of avoiding pregnancy and STIs, they also teach adolescents about various safer sex methods, and provide them with developmentally appropriate information about reproductive health, interpersonal relationships, intimate partner violence, and more.

But a lot of what Americans feel and believe about sex ed seems to be wrapped up in our conflicted attitude toward sex, and around the values we attach to it. What sex means to us not from a health standpoint, but an emotional one. As Ashley Bever, the organizer of Opt-Out Day, tells her two daughters, “[Sex] is intended to bring you together with someone else. It is intended to satisfy your soul. But it needs to be in a certain context.” And who gets to define that context can have drastic consequences for public health.

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Where does this this mindset come from? It may actually be a holdover from Christian beliefs beginning in the Middle Ages, when the church first placed marriage under its jurisdiction, eventually elevating it to the level of sacrament. As the church grappled with how to manage marriage, they came to see not just premarital sex—but sexual desire in general—as a distraction from one’s spiritual life unless it was procreative.

Disease also sparked fear. In the early 1900s, America saw the rise of venereal diseases such as syphilis, especially during World War I. At the epidemic’s peak in 1939, syphilis killed about 20,000 people, with an estimated 600,000 Americans infected. But what was even more alarming than this public health crisis, to social health organizations in particular, was what these rates of infection indicated: Americans were increasingly engaging in extramarital sex and prostitution. Members of the American Social Hygiene Association (ASHA) decided that the only way to stamp out prostitution and the spread of STDs was to teach people about the “proper” uses of sexuality. And so, sex education was born from a moral panic.

In her book Talk about Sex: The Battles Over Sex Education in the United States, Janice M. Irvine describes how these socially conservative values around sex eventually led to a movement against sex ed in the 1960s, partially in response to the socially liberal political climate of the time. At that time, both conservatives and Evangelical Christians who felt alienated by this cultural moment banded together against sex ed, and against the organizations that championed it. Since then, the contention that exists between such groups has only intensified.

Between 1972 and 1990, thanks to an increase in contraceptive access, sexual activity outside of marriage rose again. Because abortion was also legalized, sex became increasingly uncoupled from both marriage and procreation. It was this—more than public health concern—that worried people. So in 1982, the Adolescent Family Life Act brought about the first federal funding of abstinence-only until marriage education programs. In the early ’90s, these programs were coupled with the first virginity pledges, kicked off by “True Love Waits.” Even now, many abstinence-only education programs still use some form of these pledges.

Because abortion was legalized, sex became increasingly uncoupled from both marriage and procreation. It was this—more than public health concern—that worried people.
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“There is a very strong push from socially conservative organizations for abstinence-only-until-heterosexual-marriage education,” says Elizabeth Schroeder, who’s been a sex educator for over 25 years. “Their propaganda is based on the assertion that teaching young people about sex and sexuality encourages young people to start having sex earlier. The awful thing about this is that they know this is false—they know there is a lot of research showing that when we talk with young people about sex, particularly parents and caregivers from the earliest ages, young people end up waiting longer to start having sex, and to practicing safer sex whenever they do become sexually active. The hyperbole is designed to scare parents. There is a lot of hysteria that has always been built up around the idea of anything having to do with sex and sexuality being responsible for moral decay.”

Our country continues to double down on its investment in abstinence-only-until-marriage programs. Recently, the Trump administration announced new rules around funding for programs intended to prevent teenage pregnancy, showing a clear preference for programs that emphasize abstinence or, as it has been rebranded, “sexual risk avoidance.” And they move away from a condition implemented during the Obama administration that required organizations receiving federal money to choose from a list of approaches that have been scientifically shown to effectively change sexual behavior.

“The reasons behind why they’re opposing sex ed in its various formats really has to do with this idea that educating young people either encourages them to start having sex earlier, or is taking away their innocence and their purity,” says Schroeder.

Newer comprehensive sex ed programs also challenge traditional gender norms, striving for greater inclusivity for those along the gender and sexual orientation spectrum, and confronting long-held beliefs about conventional, heterosexual gender roles. “Sex and relationships are shaped by gender norms and power,” says Nicole Haberland, a senior associate and researcher at the Population Council, who has found that programs addressing these issues are more effective, “and I think that spills over into the sex ed debate. There’s significant anxiety around people feeling that their traditional power is being threatened and, to the degree that sex ed transforms that, it is a direct threat.”

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Meanwhile, programs that promote abstinence-only until (heterosexual) marriage uphold traditional gender norms. But while these programs may align more closely with the values held by some, they aren’t keeping teens safe.

According to a 2016 report from the CDC, there are an estimated 20 million new STDs in the U.S. each year, and more than 110 million total (new and existing) infections. These infections can lead to long-term health consequences, such as infertility, and can also enable HIV transmission. And some of these numbers are now climbing, despite having been on the decline for years.

And it’s no wonder. The research shows that abstinence-only programs do not delay sexual initiation, nor do they reduce rates of either teen pregnancy or STIs. Young abstinence pledge-takers are one-third less likely to use contraception when they become sexually active, have the same rate of STIs as their sexually active peers, and are more likely to have engaged in both oral and anal sex than their non-pledging peers. In states that offer comprehensive sexuality education, STI rates are actually lower.

The research shows that abstinence-only programs do not delay sexual initiation, nor do they reduce rates of either teen pregnancy or STIs.
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It’s easy to find examples of women whose health has suffered due to inadequate sex ed. Jenelle Marie Pierce, for example—a woman from a conservative rural town in Michigan who later went on to found the STD Project and become the spokesperson for Positive Singles — received abstinence-only education. “All of it was about avoiding pregnancy,” she said. “Avoiding infection. There was never information around [the types of things] that would help you feel good about your womanhood. Just: ‘Here’s your uterus. Here’s where babies are made. Don’t get pregnant.’ I knew I needed to make sure not to be a slut and not to be trashy, but what did that mean?”

As she began exploring her sexuality, Pierce tried to be smart about it, knowing that sex ed left her with a lot of missing information. She drove herself to a Planned Parenthood and got a prescription for birth control. However, she didn’t use other protection when having sex. “I really thought I was being a proactive and responsible person,” she said. “I wasn’t having sex with any of the people who get STDs. The dirty people. The trashy people.” She was blindsided when she had her first outbreak.

“The things that would help you advocate for yourself were not discussed,” she said of her sex ed classes. “I thought that since I was protecting myself, I didn’t have to push my partners about [their testing history or condom use]. I didn’t feel empowered to ask them. Afterward, I thought, ‘This is all my fault. I’m being punished by god. I’m damaged goods. Nobody will ever want me.’ Afterward, I still didn’t know how to have the talk with partners.”

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The consequences of our values-based decisions around sexuality become even more stark when compared to the approaches and outcomes in other countries. Research shows that countries with a more open and positive attitude toward sexuality have better sexual health outcomes, and lower adolescent pregnancy rates. This is reportedly because there is less pressure for adolescents in Western Europe to remain abstinent, and more emphasis on teaching young people to protect themselves. Because of this, government-supported schools in many Western European countries provide—and often require—comprehensive sexuality education, and they offer easy access to reproductive health services.

The Dutch, especially, have received attention for their approach to sex ed. Sexuality education is mandated for all primary school students. And while different schools take different approaches, all programs treat sexual development as a natural process, and assume students have the right to honest and reliable information. Because of this, they happen to have some of the best outcomes when it comes to teen sexual health.

Bonnie J. Rough, author of the forthcoming Beyond Birds & Bees, maintains a deep respect for the cultural attitudes she observed during the time she lived in the Netherlands with her husband and two young daughters. She speaks admiringly of a culture in which body differences between boys and girls were normalized, and of how this seems to have translated to a wider culture of respect and tolerance. They have since moved back to Seattle, and it’s been a challenge to uphold the lessons they learned while abroad.

“The truth is,” said Rough, “I can’t fix this problem for my kids. What they’re missing…what they’re not going to get is the experience of getting educated with their peers…of getting the same education at the same time and everyone being on the same page about what we’re expected to know and what information we’re capable of dealing with and what is acceptable or not acceptable. I can regurgitate knowledge, but I can’t change the culture.”

The cultural attitudes around sex won’t be changing anytime soon. “The more socially conservative a religion,” says Schroeder, “the more likely they are to have restrictive ideas and beliefs about who should or should not be having sex, and under what circumstances. Given that our government was founded by people of Christian backgrounds, and roughly 85 percent of Congress identifies as Christian, these religious beliefs cannot help but inform how people make decisions — including about sex and sexuality.”

“For many social conservatives,” adds Schroeder, “the end justifies the means. They have no problem shaming or judging young people, or not representing all of the facts, as long as it keeps young people abstinent. And that, again, is very evangelical. But that should not be the way people choose to teach others.”

I want to clarify that “middle school” is not a topic that I willingly return to. For me, middle school was a time of bubblegum caught in braces, hormone-charged crushes, and embarrassing growths of every variety. It was also a time when my school first began tackling that universally blush-worthy topic: the human body. I recently spoke to a few of my male friends about their middle school sex education. And honestly, what the hell were they learning?

At my school, the boys were segregated from the girls when the time came to broach the puberty talk. I asked my male friends about sex education because I wanted to know what went on in their separate room. In the “girls room,” we talked about menstruation and were given little period packs filled with tampons and illustrated pamphlets. According to them, the boys had discussed puberty, sexual feelings, and morning erections. The school tailored the talks to the students’ anatomy. In the same way that I didn’t learn about penises and what happens to them in the morning, the boys didn’t learn about vaginas and what happens to them every month.

There were other differences, too. In the room I was in, unlike in the “boys room,” we didn’t talk about the normalization of sexuality, as if the absence of erections cancelled out the possibility of sexual feelings. I, and the girls in the room with me, didn’t talk about sex or dating in a classroom setting until three years later, when all eighth graders had to take a mandatory health class.

At the time, I didn’t think much about the gender separation, and it made sense that we were put in different rooms to discuss the issues that affected us. Like most everyone, I’d been taught from a young age that periods happen to girls and boners happen to boys—a reductive, cisnormative view that, among other issues, erases and stigmatizes the experiences of transgender children. Associating menstruation exclusively with girls can be particularly damaging to trans boys, who may already feel uncomfortable with their periods.

As I’ve grown older, I’ve come to understand other ways, too, in which this enforced segregation can have negative impacts. For instance,I was embarrassed buying tampons when my cashier was male. I didn’t like talking about my period around guys — although I would shamelessly use “period cramps” as an excuse not to participate in gym class (you could almost see my male gym teacher visibly shudder when the word “period” was mentioned). I internalized that periods didn’t just happen to girls, they were not to be acknowledged around men.

My discomfort discussing my period around men hinted at a broader question: Would I still be embarrassed if boys had been present in the room when I learned about menstruation?

I internalized that periods were not to be acknowledged around men.
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I believe that the answer is no. Segregating boys and girls during sex education sessions contributes to a culture in which periods are seen as taboo to talk about with men, or indeed in public at all. During my middle school experience, the physical separation of the girls and boys created the impression that periods are a topic to be discussed solely among women. It is this physical separation which directly contributes to a culture of stigmatization around the topic of menstruation.

The concept of separation leading to stigmatization also works in reverse: Stigmatization leads to separation. In certain communities, cisgender girls and women are required to live in a hut outside of their villages while they are menstruating. In India, for instance, the Gond and Madiya ethnic groups banish menstruating women outside the boundaries of the village for the duration of their periods (Kaur, “Banished for menstruating: the Indian women isolated while they bleed”). Last year, in Nepal, an 18-year old girl died of a snakebite that she sustained while isolated in a “menstruation hut” (Bhandari and Nashar, “Shunned During Her Period, Nepali Woman Dies of Snakebite”). In India and Nepal, women are placed into dangerous situations because of menstruation’s stigmatization.

The shame associated with menstruation also plays a part in religion. In traditional Jewish and evangelical Christian communities, a woman who is on her period is untouchable. According to Chapters 15 to 18 of Leviticus, if you touch a menstruating woman, you become “tum’ah,” or “impure.” The notion that menstruation is impure highlights its stigma. The enforced, unseen boundaries of menstruating women from those around them transforms internal stigma into physical separation.

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The twinned relationship between separation and stigmatization exists because of cisgender male aversion to menstruation. From a young age, boys’ lack of education about the topic leads to discomfort and even prejudice. In 1986, when Dr. J. Brooks-Gunn and Dr. Diane Ruble analyzed the reactions of college-age cisgender men and women to menstruation, they found that men, who had an inferential understanding of menstruation rather than an experiential understanding, believed that periods were more debilitating than women did. The male participants also believed that periods affected women’s “moodiness” more than the female participants. These viewpoints feed into misogynistic tropes about women: they’re moody or “hysterical;” they won’t work as hard as a man on the job because of their “debilitating” periods.

Since the 1980s, there have been a host of other studies that have confirmed that the way men and women perceive menstruation is different, and that men see periods more negatively. In 2016, three decades after the study conducted by Brooks-Gunn and Ruble, Tamara Peranovic and Brenda Bentley found that when male respondents were growing up, they saw periods as “taboo,” and shrouded in secrecy. This impacted their openness to discussing periods as adults, and led them to believe that periods were a “woman’s problem.” Similarly, Brooks-Gunn and Ruble’s study posits that the difference between how cis women and men see periods is due to information asymmetry. Interestingly, certain male respondents in the Peranovic and Bentley study were “dissatisfied with the education they received” about periods.

From a young age, boys’ lack of education about the topic of menstruation leads to discomfort and even prejudice.
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From my own experience as a teenager, I gathered that periods are seen as “dirty,” and are considered a “dirty” topic to talk to men about — my gym teacher’s wince was enough to teach me that men don’t like to think about menstruation. But why should that be the case? Menstruation is a natural function that affects half of the world’s population on a regular basis.

The way that sex education is organized depends on the state. Each state decides on its own sex education policy, and bills concerning sex education have to pass the state legislature. Currently, 24 states and the District of Columbia require public schools to teach sex education, and 33 states and the District of Columbia require students to receive instruction about HIV/AIDS. Decisions on how to actually approach sex ed, however, are mostly left up to individual school districts. It’s difficult to ascertain how many schools segregate puberty talks, or whether schools are even offering puberty talks.

Despite this, parsing the psychological literature about male and female attitudes towards menstruation demonstrates that men and women usually do not receive the same information or education about menstruation. Negative male attitudes towards periods, therefore, are largely down to information asymmetry or lack of male education on the topic.

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It’s time to de-segregate sex education so that cis women no longer feel embarrassed about a natural, biological process. What’s more, de-segregating the sex education space should work both ways. Girls should learn about sexual feelings and male puberty in the same ways that boys do. That way, natural cis male experiences, such as voice drops during puberty, are less likely to be ridiculed by those who do not understand the biological underpinnings of the phenomenon. Demystifying the human body contributes to an open culture in which questions are encouraged and bodies are no longer seen as a source of shame or embarrassment.

Those who favor gender segregation during sex education claim children will feel more comfortable asking questions about their bodies if they’re separated from children of the opposite sex. This viewpoint, however, not only enforces the idea that one should only be comfortable talking about one’s body around those of the same gender, but excludes the experience of transgender and nonbinary students. Educating children about sexual education in the same space ensures that nobody feels misplaced or excluded.

For those who feel this is sure to cause embarrassment, there are strategies. Some schools offer an anonymous question service where students have the opportunity to write their questions on a slip of paper for teachers to answer at the end of the sex education session. Sex ed teachers can hold office hours for students to ask questions they may not feel comfortable sharing with a group. Using these strategies, nobody has to feel embarrassed asking a question, and students of all genders can hear the answers.

The conversations we have with children affect the adults they become. Periods are nothing to be embarrassed about, and if students of all genders were taught about menstruation at the same time, women might not be so uncomfortable discussing their periods in front of their male counterparts — and men might not be so uncomfortable hearing about it.

So, when teaching students about sex education, let’s tackle the body’s processes in a more inclusive way. That way, middle schoolers can focus on the truly embarrassing things in life, like pimples and parents.