I Guess You Just Have to Be Prepared to Die!

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:

  • Heart disease: 631,636
  • Cancer: 559,888
  • Stroke (cerebrovascular diseases): 137,119
  • Chronic lower respiratory diseases: 124,583
  • Accidents (unintentional injuries): 121,599 (38,648 of those are from car accidents)
  • Diabetes: 72,449
  • Alzheimer's disease: 72,432
  • Influenza and Pneumonia: 56,326
  • Nephritis, nephrotic syndrome, and nephrosis: 45,344
  • Septicemia: 34,234
  • Intentional self-harm (suicide) 33,300
  • Chronic liver disease and cirrhosis 27,555
  • Essential hypertension and hypertensive renal disease 23,855
  • Parkinson’s disease 19,566
  • Assault (homicide) 18,573

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:

  • you eat a lot of meat, dairy or greasy, processed foods
  • you get in a car
  • you own a gun (or keep company around those who do)
  • you get the flu
  • you smoke
  • you drink
  • you're a black male (after all, black men have the lowest life expectancy)
  • you do recreational drugs OR take perfectly legal, prescribed medications (any kind of drug use can be a common cause for some of the leading causes of death)
  • you interact with other people in any way, especially any way that might make them unhappy (because they might kill you)
  • you do anything at all that may be linked to cancer (beyond the obvious, that can even be things like like dying your hair, using artificial sweeteners or deodorant, eating foods treated with pesticides, getting stressed out -- maybe from people yelling at you that you're going to die, for example...)
  • you don't manage your sugar intake
  • you don't see a dentist or brush your teeth often enough (tooth infections are a common cause of septicemia)
  • you get pregnant (at any age, married or not)
  • you have certain genetics that may incline you to certain disease or conditions
  • you don't lead a basically healthy lifestyle, like eating well, getting enough exercise, getting enough rest, avoiding or limiting things like smoking or drinking and yes, very risky ways of having sex
  • you leave the house, ever, especially when not wearing a hermetically-sealed bubble
  • or you get old

...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.