You may have heard that the FDA may finally remove age restrictions for the morning-after emergency contraception pill in the United States. If you've heard that, you may have started to hear some panic or fear-factoring, not just gratitude and relief.
Currently, in the United States, someone must be over the age of 17 in order to get Plan B at a pharmacy without a prescription. Until two years ago, the age limit was 18. It's still kept behind the pharmacy counter for people of all ages, but those over 17 do not need a prescription from a doctor or a clinic to purchase it.
For a long time now, organizations like ours and many, many other reproductive choice, justice and health organizations, have been lobbying to remove that age restriction, something other nations -- like Canada, Australia, Denmark, Norway, Sweden, Israel and others -- do not apply; a restriction which has never been supported by sound health data. The restriction per age has long been about politics, not health.
In fact, a medical council formed expressly to inform the FDA about Plan B in 2003 recommended it be provided without prescription regardless of age then, a recommendation the FDA did not follow. More than one staff member at the FDA during the years this has been an issue, including the highly dedicated Susan Wood, resigned in protest of decisions about Plan B access and the political motives for those decisions, which stood counter to sound medical information, what the basis of FDA decisions are supposed to be about.
We feel, like so many other sexual health and adolescent health organizations feel, like you might yourself, that young people should have the same rights with their reproductive choices that those over the age of majority do, including the ability to access safe contraceptive methods the same way as those over the age of majority do. We feel that decisions for all citizens like this need to be centered on credible health information, not political or personal agendas or religious beliefs.
Given this possible sea change, you may find yourself, not unlike some former members of the FDA, having discussions or heated arguments about this with people who really do not get it for a while, and in those, you're probably going to face a serious lack of facts. In case you need them, here's a quick and dirty roundup of some typically uninformed statements with some factual information and context to counter them with.
But Plan B is so unsafe! It's like a GIANT dose of birth control pills!
A lot of over the counter medications, also without age restrictions are not only dangerous, but far more associated with serious health risks.
For instance, you can get all of the following over the counter here in the U.S., none of which have any age restrictions (links are to informational listings about them, including health risks): ibuprofen, acetaminophen, cough syrups or cold medications which contain dextromethorphan or pseudoephedrine, sleeping pills or energy drinks. Heck, you can get candy bars within reach even if you are still only crawling around in footie pajamas, but we don't hear people talking about putting them behind the counter for the safety of diabetic kids.
Plan B is a medication just as safe or safer than some of those things, especially when those things aren't used as directed, which happens a lot, no matter how young or old people are. No deaths have been linked to Plan B, and we can't say that about any of the other things I put on that list above.
It's also not quite right to say that it's a "giant dose of birth control pills."
Most people who use the pill use combined oral contraceptives: a combination of a synthetic estrogen and a synthetic progestin. And while both of those things carry potential health risks, especially for people who have health or lifestyle issues that heighten those risks, the larger risks tend to lie with the estrogens or the combination of estrogen and progestin. Plan B does not contain any estrogen, only levonorgestrel, a progestin. That matters and makes it tough to compare to the most common daily-use oral contraceptives. That's also some of why reputable medical organizations assert that emergency contraceptive pills are usually safe even for people for whom regular contraceptive pills are unsafe. The World Health Organization lists no medical condition for which the risks of emergency contraceptive pills outweigh the benefits.
Too, people who use either combined birth control pills or minipills tend to use them for longer than one or two days like with emergency contraceptive pills, but instead will take a pill every day for weeks, months, years or decades, depending on how long they use them for. Very few people will start using birth control pills and only take two out of a pack.
Most oral contraceptives have 100 to 150 micrograms of levonorgestrel per pill; emergency contraceptive pills contain either two two 750 microgram levonorgestrel pills to be taken 12 hours apart (or together: taking them apart is mostly about reducing the chance of feeling nauseated) or one 1500 microgram pill, to be taken 12 hours apart. Almost everyone who uses a birth control pill for more than a week or two is taking in as much of the hormone in Plan B or, and most typically, far more. And these medications aren't like a sleeping pill or even an advil when it comes to overdose, if that concerns someone about the amount of hormone in Plan B. Not only do we know this is a safe amount to be used as directed, "overdosing" with oral contraceptives does not present the kinds of dangers we see with other kinds of medications. It might also help to take a look at the facts about frequent use of emergency contraception: in a word, we have no evidence so far, after more than decade of research, that has found any more or different risks than ongoing, proper use of other hormonal contraceptives.
Let's not forget that pregnancy can be one of the riskiest things there is when it comes to people's health. Preventing pregnancy with a safe medication like Plan B poses far less risk to someone's health, especially a young teen's health, than a pregnancy does.
But, but... it is SO DANGEROUS for TEENS!
But, but... it isn't. Not that anyone has discovered so far with many years of scientific study, anyhow. There has NEVER been broad medical or scientific support for the decision to require a prescription for minors, but not older people. It's been the other way around: most healthcare professionals and medical organizations, like the World Health Organization, the American Academy of Pediatrics, the American Medical Association and the American College of Obstetricians & Gynecologists, as well as, again, many doctors at the FDA, have objected to these age restrictions. The people who tend to oppose it most are people like this. (Note: that link is to an anti-choice site, the American Life League, which is hopefully obvious from the first sentence, but may become more so by the total lack of contextualization with the information given there, such as a lack of mention that all the risks they list for the MAP exist with a pregnancy. And maybe when reading their website.)
So much of what people know and have heard about emergency contraception has been informed and greatly influenced by people and organizations who are anti-choice, and who oppose Plan B and often other kinds of contraception, not because of concerns for anyone's health, but because of their political agendas to limit the control people -- most commonly women -- have over their bodies and reproduction.
Again, know what's dangerous, sometimes truly, earnestly dangerous? Pregnancy. Now, that doesn't mean people need to be afraid of pregnancy or that we're saying people who want to become pregnant shouldn't make that choice if it's a wanted choice. But there's a reason why maternal mortality rates are so high in places where pregnant people can't get sound, consistent care during pregnancy, labor and deliver from healthcare providers, including educated midwives. That's because pregnancy is dangerous. Preventing pregnancy with safe, studied contraceptives is always statistically safer than becoming pregnant. So, if someone wants to flip their lid about how dangerous contraceptives like Plan B are, they better at least be pulling out all the same stops and more about how potentially dangerous being pregnant and giving birth can be, too.
And even though legal abortion is also very safe, and in the first trimester, safer than a full-term pregnancy, emergency contraception is safer than abortion, too.
Some people have concerns that teens will not be able to understand how to use EC properly without getting a prescription from a doctor. While it doesn't make much sense to have that concern about EC and not all the other medications a young person can currently get over the counter, some studies have found that concern also is not sound. "Two studies were published in 2009 regarding emergency contraceptive label comprehension for teens. Raymond et al. found that 79% or more of adolescents aged 12-17 correctly understood six key concepts found in labeling: 1) EC prevents pregnancy after unprotected sex 2) it should be taken as soon as possible 3) it should be taken within 72 hours 4) it should not replace regular contraception 5) it does not protect against sexually transmitted infections (STIs) 6) it should not be used by women who are already pregnant." (The Reproductive Health Technologies Project, Tough Questions and Answers about Adolescents and Over-the-Counter Emergency Contraception, 2009) By all means, patient and consumer literacy is always something to be concerned with, but we have no reason to believe this is a greater concern with teens regarding Plan B than it is with people of all ages.
It might also help to know that there are already some contraceptive methods as available to teens as to those over the age of majority which we know or suspect may pose different or greater risks for them, like Depo-Provera, which may present risks around bone density for younger teens. And young people should be informed by their doctors or pharmacists of any risks these or other medications or devices present to them based on age, when there are any, just like people should be informed when older age increases a risk, or when a given health condition or lifestyle issue may increase risks.
And if there were different or greater risks with Plan B for young people than those one, three or ten years older, those same standards should be applied and, you can be certain, would be applies. Thing is, based on all the study of these medications so far, we don't have any data to suggest the risks are different or greater for those under 17.
I am not okay with teenagers being able to give themselves an abortion by just walking all willy-nilly into a pharmacy.
Even as a strongly pro-choice person, I don't know if I'd feel comfortable with that, either. I am, however, a fan of walking willy-nilly. It's much more fun than just plain old walking, that's for sure.
But that's moot, since no one of any age can give themselves an abortion by just walking into a pharmacy and getting Plan B, including in places where people of every age can access emergency contraception without a prescription. That's because you can't use emergency contraception to terminate pregnancy.
A lot of people -- some out of ignorance, some who know better but know how easy it is to obscure the facts by just muttering the A-word -- have the odd idea that emergency contraceptive pills and a medical abortion, or "the abortion pill" are the same thing. They're not. Plan B and other emergency contraception not only is a very different medication, it does very different things. Even if someone wanted to terminate a pregnancy with Plan B, this medication can't do that: it lacks that capacity.
You can get information on the "abortion pill" -- a bit of a misnomer by itself, since medical abortion involves two medications, not just one -- here.
But more people will have sex without using birth control if they can just get EC easily.
Emergency contraception has the word contraception in it because that is what it is: it, like other methods, is contraception. Is it as effective as several other methods? Nope. It's also more expensive, too, especially if people are using it often.
I'm not sure why anyone is this concerned about people choosing this method of contraception rather than others by this token, but for those who are, so far, we also don't have any data that shows that when EC is made more available, including giving minors the same access those older have, that there's any basis for that concern. As reported by the Alan Guttmacher Institute years ago, providing adolescents with advance doses of emergency contraception neither increases their likelihood of having unprotected sex nor negatively affects their use of condoms or hormonal contraceptives.
Perhaps more to the point, if one is worried about people not using contraception, then it's tough to figure how it makes sense to limit their access to contraception.
Want more information about emergency contraception, including teen health concerns? Check out these links:
If and when you get tired or arguing with someone about this who just will not let go of the non-facts, do yourself a favor and just print them out, pass them on, and give yourself a breather. Bashing one's head into walls is something we know isn't healthy. :) If, on the other hand, like some of us (coughcough) you seem to have dedicated much of your life to arguments like this and you find what we gave you here isn't enough? Leave a comment with an aspect or issue you want more information about or help voicing. We're glad to help you out.
This is a guest entry by Max Kamin-Cross, originally published at abortiongang, that's part of the month-long blogathon to help support Scarleteen!
Sex ed. We hear that word a lot, but who really knows what sex ed is? It’s short for “sexual education,” but what’s that?
According to my handy dandy dictionary, sex education is: “education about human sexual anatomy, reproduction, and intercourse and other human sexual behavior.” Lots of words, but it’s pretty much learning about the human body and its reproduction. Pretty much straightforward, right? Wrong.
I know how un-straightforward sex ed is, probably more than any other blogger you read. That’s because I attended health class, every day, for 20 weeks less than a year ago.
Every single morning at 7:40am I was in Mr. Hanson’s (he requested I not use his real name) class for 46 minutes. Monday-Friday from December all the way to February, I had to sit in this class. This was a chance for New York State and Pittsford Central School District (the place where I go to school) to tell me everything they think I should know, or more importantly, not tell me what they think I shouldn’t know. We covered everything from eating habits, to drugs, to sex. Overall, I can’t complain too much about it. When it came to the sex ed part, Mr. Hanson made sure I knew “the consequences of engaging in sexual activity and the benefits of choosing abstinence.” Though it mostly focused on abstinence, our curriculum included the word condom, but pretty much nothing on birth control, even Plan B. Either way, I think Mr. Hanson did a pretty good job teaching what he was supposed to, and luckily what he was supposed to teach us was generally true. Sadly that isn’t the case in many of today’s sex ed classrooms.
Over the past several months, I’ve talked to hundreds of youth, adults, and educators from around the country about their sex ed experiences. From this I learned that I had a pretty good sex ed class, even though Mr. Hanson’s curriculum didn’t acknowledge the existence of non-heterosexual sex, or that condoms are almost 100% reliable if people use them correctly. Even though during those 20 weeks I never heard the words dental dam, or received instructions on how to correctly put a condom on, I still had a “great” curriculum compared to most.
One of the worst stories about a sex ed class came from a teen living in Utah. I met Emma this summer, and she told me about a video she had to watch in her middle school sex ed class. The video was about two people getting married. Not too bad, marriage is pretty normal and all.
Sadly, this video was anything from normal. It started with a man and woman about to get married, but before they did, they exchanged tennis shoes. The man’s shoes were nice and clean, while the woman’s were scuffed up and dirty. The man says to the woman “It looks like you let the whole football team run in these” and she responds by saying “But I made them all wear socks.” Right as the video ended, the man decided to break off the marriage with the girl.
In this video the tennis shoes represented their virginity. The man chose not to engage in premarital sex, so his “shoes” were nice and clean. The woman was supposed to have been sexual active with some football players, so her “shoes” were dirty. She explained that she made them wear “socks,” (or condoms) but the man was still mad her “shoes” weren’t as clean as his. As a result, he couldn’t follow through with the marriage.
This video, that a school district in Utah feels is important for every middle school kid to watch, is saying that if you have premarital sex (even with a condom) no one will want to marry you. Though some people may not be comfortable dating or marrying someone who had premarital sex, this video is blatantly untrue for that majority of Americans. Some studies put the number of people who have premarital sex since 1940 as high as 95%. If a result of premarital sex was no one wanting to marry you, there’d be a lot more singles out there and a lot less weddings to attend. Though it might be nice not to have to buy another toaster or blender for all those people, this video does nothing but lower the self esteem of teens that someday may have premarital sex.
This is only one example of the misinformation many sex ed classes give American students every day. It’s been proven time and again that abstinence only sex ed, where the entire curriculum is designed around telling teens not to have sex until marriage, does not work. Most of these curricula don’t talk about contraception or STD/STI prevention at all. As a result, teens are left starved for information about sex. One study in Wisconsin (where, up until recently, they had an abstinence-only curriculum) showed that teen girls believed that one of the best ways to rid themselves of gonorrhea was to sit in bleach.
Teens need a place that they can go and get real information on sex that they don’t get in school. Whether that be information about treatments of STD/STI’s (which do not include bleach!), information about contraception, or anything else about sex, Scarleteen provides it.
Though I hope for a day when every teen in America will be educated about sex by a highly trained professional in health classes with a comprehensive sex-ed curriculum, I don’t see that coming anytime soon. Until that happens, Scarleteen is vital for today’s teens, but for that to happen they need your help.
The site receives no government funding, which means you can get real information about sex without any interference from today’s politicians. Because Scarleteen doesn’t receive government funds though, it also means that they need your help to continue working to educate today’s youth and young adults. Please do your part and make a small contribution to this fantastic site today. To find out more about how to donate to Scarleteen, please click here.
I'm bisexual, and I really would like to tell my friends. I mean, they seem pretty open-minded, being pro-gay rights and generally accepting. The thing is, they're being open-minded from afar. If they found out that one of their closest friends is bisexual, I'm not sure they'd be too keen on the idea of having a bisexual girl friend. One even has said that she wouldn't want to have sleepovers at a girl's house if she liked girls. I'm honestly not attracted to her or any other one of my friends (well, maybe one a little, but I'd never make her uncomfortable or anything) but they don't get that. I don't know how to tell them that I like girls but that doesn't mean I like all girls. I'm not sure they'd believe me. Help, please?
What's the typical use effectiveness rate for abstinence? All I can find anywhere, even at organizations that teach abstinence, or say it's the only effective method of contraception, is the perfect use rate. How well does it really work for people in real life? Why doesn't anyone have that information on this method when we do for every other method?
That's the verbatim response to the question "What if I want to have sex before I get married?" in "No Second Chance," a film that is part of Sex Respect, an abstinence-only program. Sex Respect has a host of other special and oh-so-factual messages for you in their student workbook, including such sparkly gems as:
"A young man's natural desire for sex is already strong due to testosterone...females are becoming culturally conditioned to fantasize about sex as well." (p. 11) Did you know that without cultural conditioning, women don't have any desire for sex? Of course you did. Did you know that women don't have any testosterone in our bodies, too? Note: neither of these things are true. But you knew that already.
"A guy who wants to respect girls is distracted by sexy clothes and remembers her for one thing. Is it fair that guys are turned on by their senses and women by their hearts?" (p. 94) So, when it comes to sex, men don't have emotions and women don't have any of our five senses. Fascinating. And no: that's totally not fair, but then gender stereotypes rarely are.
"These are simply natural consequences. For example, if you eat spoiled food, you will get sick. If you jump from a tall building, you will be hurt or killed. If you spend more money than you make, your enslavement to debt affects you and those whom you love. If you have sex outside of marriage, there are consequences for you, your partner and society." (p. 11) Including the not-to-be-missed consequence of having to pay over a billion in U.S. tax dollars to fund stellar education just like this.
But this particular message in the video, that sex (and only sex outside of heterosexual marriage) equals death is a common thread in many, if not most, abstinence-only curricula and programs. I figured it was high time we just unpack it, take a good look at the real deal, and be done with it.
I'm pretty familiar with common causes of death, but I thought I'd channel my inner goth and do some homework on death anyway. I even -- though most of me knew better -- prepared myself to discover that sex INDEED posed far larger risks of death than I thought, and prepared myself to share that information if I discovered it. After all, if I had any agenda or educational model that required my not being truthful about any part of sexuality or sexual health, then as far as I'm concerned, the impetus would be on me not to lie or misrepresent that information but to adjust that agenda or the way I educated. Clearly, this is a way of thinking lost on some folks.
I'm keeping this to the U.S. for a few reasons. One biggie is that if I were to pull international statistics, I'd be including nations where ultimately, very serious lack of access to healthcare or basic, healthy living conditions was often the real cause of death: where what someone died from often would have been preventable with care and a better environment. That's hardly a non-issue here in the States, but it's not the kind of issue it is here as it is in much of Africa or some areas in Asia. I'm also being kind to the ab-onlies in sticking to the U.S. If I included, for instance, HIV-related deaths from the least developed nations, I'd be showing up even more clear evidence than we have in the States that marriage doesn't prevent sexually transmitted infections. "In Rwanda and Zambia, for example, an estimated 55-93% of new infections occur within marriage or in cohabiting relationships." Same goes for deaths for pregnant women. We have to include those if we're addressing death related to sex, but while maternal death rates for the U.S. are high for a developed nation, they're peanuts in comparison to those of third world nations. Conversely, the rate of abortion-related deaths is also far, far higher in areas where abortion is illegal.
Let's go ahead and look at some current death statistics. According to the CDC, in 2006 there were 2,426,264 deaths in the United States. The top 15 leading causes of death, and how many deaths for each of those causes there were, is as follows:
It's perhaps worth noting that in 2006, there were "30,896 gun deaths in the U.S: 12,791 homicides (41% of total deaths), 16,883 suicides (55% of total deaths), 642 unintentional shootings (2% of total deaths), 360 from legal intervention (1.2% of total deaths) and 220 from undetermined intent (.8% of total deaths)." In that same vein, here is a list of U.S. military deaths in Iraq for 2006: there were 920 U.S. Military deaths (during active duty) for 2006, total. If it seems silly to mention such a relatively small number, keep reading.
You'll notice that STIs and pregnancy (including labor/delivery or abortion) aren't on that list at all: they don't even make the top 15, which might be pretty surprising when someone is making it sound like if you have sex (oh, sorry: premarital sex) you're not only going to drop dead, you're going to drag everyone else you know to the grave with you.
Of course, some of the deaths in some of those groups may have been related to sex. For instance, three leading causes of death for pregnant women are heart disease, homicide (often directly related to being pregnant) and vehicular accidents. Septicemia can also occur due to miscarriage. Similarly, those who died from HIV/AIDS may have actually died of pneumonia or influenza. And sometimes people (though not usually people your age) really do have strokes during sex. I should also mention that some of those homicides would have included hate crimes: assaults to those who were of a gender or sexual orientations others didn't like, though that's not really about how sex itself can kill you, but how people who are deeply screwed up about sex, gender and sexuality issues can.
To pick up some of those gaps, "The rate of maternal mortality in the United States declined dramatically over the last century; however, an increase in the rate has become evident in the past several decades. In 2006, the maternal mortality rate was 13.3 deaths per 100,000 live births, compared to a low of 6.6 in 1987. In 2006, there were a total of 569 maternal deaths (those resulting from complications during pregnancy, childbirth, or direct or indirect obstetric causes up to 42 days after delivery or termination of pregnancy)." That rate includes deaths due to abortions, but is mostly deaths due to sustaining a pregnancy or to labor or delivery. The rate of death for abortion overall is far lower than for that of sustained pregnancy: it's "one death for every one million abortions at or before eight weeks to one per 29,000 at 16–20 weeks—and one per 11,000 at 21 or more weeks." And only 1.4% of abortions in the U.S. occur after 21 weeks, the majority of which are performed due to serious complications of pregnancy which can include serious health risks for those pregnant women.
In 2006, the estimated number of deaths of persons due to HIV/AIDS in the United States and dependent areas was 12,113. In other words, while most deaths due to HIV/AIDS are included in the death statistics for other direct causes, this is exactly how many HIV/AIDS-related deaths we had in 2006. Sparing any deaths from cervical cancer related to HPV, and Hepatitis-related deaths (which often is acquired nonsexually), most other STIs do not result in death at all, let alone make the grade for leading causes of death.
This article (Sexually Transmitted Infections 2005;81:38-40) lists deaths directly related to sex, though for 1998, not 2006. That's important because some of these rates are different than they are now: for instance, our maternal death rate has increased and our HIV-related death rate has decreased by nearly half). Would that we had the same study for 2006, but this is the only thing like this I can find anywhere:
As part of an analysis of the burden of disease and injury in the United States, we identified and quantified the incidence of adverse health events, deaths, and disability adjusted life years (DALY) attributed to sexual behaviour. In 1998... 29,782 such deaths (1.3% of all US deaths) occurred... Viral infections and their sequelae accounted for nearly all sexual behaviour related deaths—mostly HIV/AIDS.
The table of data for that piece shows the vast majority of those deaths were HIV-related (22,455), and again, that's almost twice the rate of HIV-related deaths as we see in the states currently, primarily due to advances in HIV medical care and treatment. The next highest group was cervical cancer likely due to HPV (4,921) -- which would be included in the total rate for all cancers -- and the next rung was from Hepatitis B and C, which may or may not even have been acquired sexually. The same is likely true for some (but not the majority) of those HIV/AIDS deaths; a minority of those cases may have been due to IV-drug use, for instance. This data apparently also only included deaths related to unwanted, not wanted, pregnancy. That leaves only 414 deaths from other STIs or from unwanted pregnancy death outcomes.
Now that we've got all that sorted: by all means, having sex can result in some health issues or conditions (and some of them certainly are or can become serious) and can be related directly to a death. Comprehensive sex educators and organizations like Scarleteen want you to know that, it's something we mention (and always have) when it's relevant, and we want you to know how -- which is why we do that funny thing where we tell you how -- you can protect yourself as best you can from death and other unwanted health outcomes from sex, either by abstaining from partnered sex or by utilizing safer sex practices if and when you choose to engage in partnered sex (whether you're married or not). In other words, someone saying sex could result in death isn't lying. It can.
But. You are much less likely to die from sex than you are from a whole host of other behaviours or circumstances, some of which the same folks would not warn you about with anything close to the same urgency or intensity. I just don't see driver's ed teachers telling you that if you get in a car at all, you need to be "prepared to die," even though more people die in car accidents than those who die as a result of having any kind of sex. (I also don't imagine they say that wearing a seatbelt when you are in a car is playing "Russian roulette.") I don't see them telling that to a class about enlisting in the military. I don't see them saying that to nearly everyone eating things in the lunchroom every day which could put them at risk for the most common cause of death. "Time for lunch, everyone! Prepare to die!"
Anyone who is stating or making it sound like sex or premarital sex is something more likely to kill you than anything else is being baldly dishonest. Whether you have sex with a partner in or out of marriage, with a partner of any given gender, at any given age and even IF (though we don't advise it) you take risks with your health and don't have sex safely, it is not, by any stretch, highly likely to kill you, and you do NOT have to "be prepared to die" if you choose to be sexually active. Not any more than you need to be prepared to die because we're all going to freaking die at some point no matter what we do, anyway.
And unless the same people telling you that if you have sex YOU WILL DIE are also telling you, with the same hysteria, force and fury that YOU WILL DIE if:
...then those folks are being particularly dishonest, especially if they're telling you that they're trying to scare the crap out of you expressly out of concern for your health, rather than because they want you to conform to their own personal set of values. Because doing any or all of the things in that list are directly related to or causes of the ACTUAL leading causes of death: the real ways you are most likely to die.
Since you're here at Scarleteen, I know I don't have to tell you that if you're going to have sex with other people, we think it's a wise idea to have sex safely and responsibly (in ways which have been soundly and scientifically proven, over time, to protect your life and health, something public health agencies all agree on). I know I don't have to tell you that if you and/or any partner aren't ready to do that, we think it's a good idea to put sex on hold until you are all ready, willing and able to have sex safely and responsibly. Not just until you're married, if marriage is even an option for you or something you want to do at all. One of the reasons we think that is because some kinds of sex (most primarily vaginal or anal intercourse) sometimes can pose a risk of death, and another, the more pressing, is because far more often, some kinds of sex can pose risks to your health and the quality of your life.
But we also think that just like you choose to go ahead and drive in that car even though it's one of the most common causes of death; just like you choose to leave your home at any time even though it may expose you to things like flu viruses or people who might shoot you, that you're capable of -- and absolutely entitled to -- making choices about what possible risks in your life you want to take for the possible benefits those same actions or behaviors might offer. Because that's simply a part of living your life, the life that, by virtue of merely being alive, is going to kill you some day whether you have sex or not.
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