S2E16: Normalizing Sex Education

Bushra: Bundle up. Let's talk about sex, baby. Sorry, Chloe. I'll make this fast. Okay, everybody. We are talking about sex, more like sex education, because that is something that we've kind of been discussing. There's a new show on Netflix called "Sex Education," and it's actually a British show, which is very telling, I think. And it just kind of encapsulates like this group of kids who are in high school who are obviously engaging in sex, but they kind of takes it from a standpoint that is a little bit educational I would say.

Did you guys ever have in school . . . what is it called? Maturation or something?

Margaux: Yeah, maturation class.

Bushra: Yeah. Where you talk about like, you know, body development, and I think you're supposed to talk about sex, but I'm not sure if that actually happens.

Margaux: Yeah, I think it's supposed to happen in stages. So I think maybe in fourth grade you just learn about the changes that will come in puberty, like pubic hair and basically the Tanner stages, breast development, scrotal enlargement. So I think that's fourth grade.

And then I think, as you move into middle school, sixth and seventh, eighth grade, then you're supposed to talk about sex. But I know that the rules vary between states. And here in Utah, I think you're really not supposed to talk about engaging in sex. It's rather an abstinence-only view in public schools here. But having gone to private school, I did have maturation starting in fourth grade, and then we had lots of sex education all throughout middle school and high school.

Bushra: And then I think there are various health education classes where you talk about STDs and the scary things, like the consequences of having sex and stuff like that. I just remember going through all of those stages and thinking . . .well, okay, I thought a couple of different things. For me it went from, "Ew, that's gross," and then the other aspect was like, "This is very embarrassing. I don't want to talk about it with anybody." And I just kind of like walled myself off from the topic entirely.

The reason is, well, I live in Utah and it's pretty conservative, and I come from a cultural background that we never discuss sex ever. And that's just kind of the way that I grew up. And so you can imagine how it might be uncomfortable to even start off that conversation and not necessarily understand your own development and your own feelings that you have and kind of process that.

Margaux: I think that can leave a lot of people feeling isolated, when there's not a normalization or a conversation around normal puberty and changes in your body. And you may notice something changing in you and then you're afraid to ask if that's normal. And there's a lot of anxiety attached with that and feeling like you are a weirdo or something because it's happening to you and not to someone else because there's no conversation around it.

And the other thing I think is interesting about maturation in the way that we had it was that it was split in boys and girls. And I feel like that just propagates this notion that men don't need to be involved in and understand women's periods, people who have periods, right? And vice versa. I think the classes should be together to have an understanding go both ways.

Bushra: Right. And understanding of anatomy as well, both male and female. I remember going over female anatomy, but I don't think I ever learned anything at that stage about male anatomy. Actually. I don't even think it was until college that we talked about reproductive system as a whole, which is I would say pretty late in the game.

One of the things that I appreciate about my conversations with Harjit and with Leen particularly is because I feel like we have similar backgrounds. We all identify as different cultures or whatever, but the topics of sex and other things that are crazy to talk about in the family, we kind of have those same experiences.

Harjit: And I think, Bushra, that's great that you bring it up, because for a lot of people from those cultures, their only source of education comes from schools. And I think our sex education is extremely lacking in this country. Where, you know, we came to this country, I remember my parents being like, "Oh, people are very open-minded," and when they said open-minded, they meant they talk about sex, drugs. And those conversations do happen, but the way they happen is very traumatizing and damaging to us.

I remember when I was in seventh grade, we had . . . I remember I had a substitute in seventh grade for an art class, and I swear I think he was talking about sex. I don't even know why he was talking about sex in an art class. I think he said something like, "Thinking about sex is actually almost like a disease." And I think he connected it to mental addiction, like sex addiction.

And I stored this memory away from my head, and it's so fuzzy that I'm like, "Is this even something that happened?" But it did happen, and I remember. I think that's a huge thing I carried even into college, and I think it traumatized me. I was scared to even think about it. I'm getting scared at home to talk about it, and if I'm not getting the proper education in schools, where, you know, this is a place where I'd get that knowledge so I can push my own knowledge, what a disservice that is.

Bushra: I think the reason why being educated in this realm is important is to have resources. You know, it's pretty cheesy when people say knowledge is power, but I truly, truly, truly believe it, because the people can protect themselves. Something that we all realize is that people are going to have sex, right? And you can't stop them from having sex. So the next thing is to educate them to protect themselves from getting sexually transmitted diseases, from unwanted pregnancy, and also just safe sex practices in general.

And so, when we don't have that education, that's when you see people, and teenagers mostly, who have unwanted pregnancies. I remember being in high school, in middle school actually, and seeing pregnant classmates just walking around the halls and I was like, "Wow, I can't believe that that's happening in high school." But of course it would, because we weren't taught any better. We didn't have those resources to make informed decisions about our bodies. And so the consequences seep into our social climate. It just does, because cause and effect.

Margaux: To build on that point, Bushra, of knowledge and access to knowledge is key. And then also your point, Harjit, is that the way it's taught now is fear based, fear of pregnancy, fear of STIs, fear of addiction. It creates a very negative connotation and blocks the conversation about it.

But the reality is sex is pleasurable for many people, and so that's why they choose to engage in it. But if they don't have the access and the resources to have the conversations about how to practice sex safely within what their goals are, you end up with adverse outcomes, like teenage pregnancy, sexually transmitted infections, and things like that.

So I think it's crucial to start teaching that, yes, sex is pleasurable, it's a human experience, but there are things that come with it, with making that choice, and here is what you can do to manage those consequences of your choice. I shouldn't even say consequences, because that's still negative, right? We have so much negative language even when we're trying to speak about it positively.

Leen: The negative connotations very much surround women's sex education, but I think that is the more important aspect that we must focus on because the consequences societally are much worse for us. And, you know, from a cultural context, it's like since you're a kid . . . I come from a very Middle Eastern culture. Since you're a little girl, they always call you, "Oh, you're like a bride. You're a little bride. You're going to get married one day." But then you talk about sex, you talk about maturation, things like that. It's like, "No, you don't even say those words."

And then come to the future. It's like, well, there's a reason that there's so much confusion out there and that there's a reason that the women health rates are what they are, globally and here in the U.S., and we have the issues with the lack of access and even the knowledge base of where to get the access to protection and health maintenance and these situations.

Growing up in southern Utah, that's kind of where I had my maturation program. I think the first time they did it, you know, all the kids were giggling. This is something you don't really talk about. And they split us up. Boys go on one day. Girls go on the other day.

I remember sitting there with my mom. You have to bring your parent. And so we're all sitting there with our parent. My mom, the first few bits, she was like, "This is science. You need to learn this. This is a science." And I was like, "Okay, cool. I'm learning this." But then as it started happening to me, it started getting a lot more awkward in that situation. And I started noticing a shift in kind of the advice my parents would be giving me and the advice the culture would be giving me.

I'm going to share this really funny story, but I remember today in class we were talking about ethical issues and religion and things like that with OB/GYN. And I remembered making a comment and I was like, "I didn't even know where the vagina was when I was a kid." But I remember getting my first period and my mom saying, "Are you happy about this?" And I'm like, "I don't know. It's exciting." And then she says, "Well, just remember don't stick anything up there." And I was like, "Where? Where does this thing go?" So I was like, "What are we talking about?"

And so, from there, the negative connotations kept happening, and culturally women would talk about it and be like, "Does she get her period? Does she not get her period?" It's like such a secret, right?

And then culture aside, I think I grew up in a religion that very much addressed this situation. It's like, "It's a normal part of being human. You're going to go through it. And sex is also a very normal part of being human." Just religion gives us kind of an organizational way of doing it, you know?

And then I got to middle school and then we never talked about sex, but they showed us a birthing video in high school, which . . .

Harjit: They show everybody that video.

Bushra: "Miracle of Life."

Leen: You know which video and talking about? But I remember in high school having the health conversation, and we had a teacher who, "If you don't want problems, girls, keep your knees together." And that was our sex talk for up until I got to college.

Bushra: That's so interesting.

Margaux: So inflammatory.

Bushra: Yeah, because the conversation is "girls, keep your knees together" as if women just get pregnant, poof, by themselves.

Leen: Just like that. It's like Mary.

Bushra: You know what I mean? And the thing is, that is perpetuated, I think, in every . . . if you look at every single culture, that thought process is perpetuated again and again. And that's mainly because, you know, the proof of the sex having had happened is women typically carry a child, right?

And so one thing that I've had an internal struggle with is that why is it that only one sex has to bear "the consequences of that action" where the other . . .

Leen: When it takes two to tango.

Bushra: Exactly. I would agree with you and on that level 100%, but I would think that, you know, it's 2019. Things should probably be changing at this point. And the fact that it hasn't and the way that we talk about everything regarding sex and rape culture and pregnancy and teen pregnancy and STDs is also always in a context where, "Well, women, if you didn't do X, Y, and Z, then this wouldn't happen." So it's very frustrating.

Leen: That is an absolute important point, because in all aspects of maturation from the minute you're deemed female, woman, whatever, in this society you're going to be having problems, whether it's from sex education to access to birth control, to even . . . what is it? They're taxing feminine products?

Bushra: The pink tax I think it's called.

Leen: And then now it's pregnancy and abortion. It's a huge problem in globally. The number one killer of women, maturity. Maturity, is that what it's called?

Harjit: Mortality.

Leen: And I think it's really interesting. There's a rule, and I don't know if it's in Utah or if it's campus policy, but at my old university in the women's health center, they had a shelf full of all sorts of products, from protection to feminine hygiene products. The only rule was we are not allowed to touch the product and give it over. They must grab it themselves. And I didn't work there, but these are from all my friends who worked there. And I just thought that was fascinating. To the point where it's almost you're stigmatized for grabbing this, right? How do we change as a society if we're going to deem 50% of it to shame of what you were made embryologically?

Margaux: I think it shouldn't come down to genders. It should be everyone's responsibility to have conversations and normalize it and understand that everybody feels a little bit differently about sex too. And as long as it's in a respectful and safe way, then everyone should be able to experience sex in the way that they want or explore it in the way that they want without shame.

Harjit: All of these conversations bring up a really important point of there are these symbolic themes that occur, be it sex education, be it conversations with your friends, with your parents, that are constantly bred into you every single day of your life to think of this topic as something that is surrounded by secrecy, right?

And that secrecy and that fear also create so much miseducation that I think it's directly impacting all of the "things that are harming our society." The thing is, if people know about it, if people know about access, about practices, about pleasure, about every single aspect of sex, it would just be safer. If we all have the tools and know what's going on, we can create our own choices. And I think that is something that we all want to strive, is to really understand who we are.

Margaux: And to be fair, some people don't enjoy sex, and that's fine too. And I think there's a big culture of like, "We're not going to talk about it, but everyone has to have sex." It's an expectation that you're going to be a sexual person, but some people just are asexual, and that's okay too.

Bushra: And that's an excellent point, Margaux. Seriously, though, one thing about normalizing sex is also about normalizing that some people are just not interested in it, which is totally fine.

It's crazy because when you watch TV and look at commercials, everything is hypersexualized. And so, I think that's one thing going back to when I was growing up . . . oh my gosh, if I ever saw people kissing on TV and my mom was sitting right there, I just got so freaking embarrassed.

Leen: Still do that.

Bushra: About everything, and then everything is hypersexual and you're like, "Ugh, so gross." And then there are people who are okay with that kind of thing, who have more of an open relationship with their parents, and that's fine too. We just need to recognize that it's a spectrum.

Leen: As a society, we've also merged romantic gestures with sexual connotations, and this is it. And so, we need to separate that as well because there are different forms of how we achieve relationships, right?

But I think really going back to the knowledge is kind of the key answer here. I'm very passionate about this. I think the first time when I took embryology in medical school and I realized how the genders are made embryologically and I'm like, "Oh my gosh, they come from the exact same parts." The gonads both are the same thing in the end and the tubes are all the same thing, whether they're there as ligaments or they're there still as something else. And I got so passionate. I was like, "Are you kidding me? This whole entire gender fight is fake." You know what I mean? It's not real in the sense of biology. We come from the same biochemical pathways and structures.

I think, for me, I feel like the key is we need to implement some type of embryology education on the level that, you know, general public can understand and for high schoolers and even in college. I feel like that's a must, because then you start understanding what each part is and how it relates. They're all synonymous.

I remember fighting on Instagram on a comment somewhere random and I was saying this, and someone's like, "No, you're crazy. That doesn't exist." I was like, "No, I know. I studied it." They're legit synonymous. And what you have here is what you have there. It's the hormones that make them different and different biochemically. Structurally, sure, at the same time, but they're synonymously structurally as well. And that's why such procedures as gender transformation are possible. It's the lack of knowledge we have as a society that causes these rifts in our societal status quos, right?

Margaux: Right. Leen, I think it's a really good point to say that gender is fluid. Female and male are social constructs that we as a society or societies and cultures have decided to create and define. But like you were just talking about, the way we develop, human development, can change and not fit that box. And when you try to force people into the box, then it doesn't work and you're going to have a lot of dissonance for a lot of people.

And so, like Bushra was saying, sexuality is on a spectru. So is gender. And that sexuality, everything can be fluid. Nobody has to stay on one part of that spectrum for any part of their life. And I think there's a lot of resistance in our society of letting be fluid along that spectrum and explore and experiment and come back and go forward and backwards. So I think we need to ride the spectrum, guys.

Bushra: I think that's a such a great point, Margaux. And I wanted to add that there are people who know that education is power. And I think that is why a lot of people aren't getting that sex education. It's basically keeping people in the bottom. And I think that's another perspective that we have to think about.

Margaux: A hundred percent. I think it plays a huge role. One of the things I've been really surprised about during third year is how comfortable I am saying . . . and I didn't even realize how comfortable I am saying these words that are socially stigmatized, like penis and vagina and vulva and anus. I'm going to say them, and if you're listening, you should repeat those words and be comfortable saying them in everyday conversation because that is what they are called. And all these slang names that we use for them only make it more stigmatized and more awkward.

So, for example, if you're having a conversation with a patient about a sensitive topic, for example, hemorrhoids or something, and you're using the word "butt" or something, that doesn't feel professional. So if you as a professional . . . and if you watch a doctor do it or you do it yourself, you can really read the patient's body language, that by normalizing and saying that word without any attachment or judgment to it really makes that patient feel a lot more at ease.

Harjit: Margaux, I've noticed that too, and again, kind of going off Bushra and Leen, I also come from a culture where we do not talk about sex. I am actually really surprised by my own self that medical school has really helped me be so comfortable with these topics, because they interact in every aspect of our health, right? From gyn health to mental health to heart disease, like random things that you wouldn't even be connected. Because of that, I also, kind of on my own journey, am trying to understand who I am and what sex means to me.

Bushra: So I'm on my pediatric rotation. Part of peds is you have to do an outpatient clinic week. So when you have well-child checks, particularly probably 12 years old and up, you have to do what's called a HEADSS exam. And basically, that's like part of the social history and asks a bunch of different questions including sex, drugs, and rock and roll, right? Exactly. Rock and roll. And for me, I'm not going to lie, I was a little bit apprehensive talking to kids about this, teenagers about this, and being so awkward when the topic came up that I just would shut off and not say anything.

But I think it's important that we as doctors talk to kids about what kind of sexual activities they are engaging with. What kind of protection are they using? What do they know about sex? Who are they talking to? Who are they hanging out with? Who are they linking up on social media? These things are important because it directly affects their health.

Harjit: And each question becomes an education point that you can talk about.

Bushra: Right. And the more you normalize that relationship with your doctor . . . and by the way, we have this conversation with the kids, just one on one. We excuse the parents to leave so we can have an open and honest conversation, which is also pretty freaking important if you ask me.

Me as a teenager versus me now, I'm more comfortable in my own skin and I have a more developed prefrontal cortex and I can process things a little bit more. And so, it's really interesting to see that shift and just kind of paying it forward to the future generation, if you will.

I think one thing that I do when I conduct a HEADSS exam is encouraging them to have an open and honest conversation with their parents, because at the end of the day, your parents want what's best for you. And I know that it's scary because I've been there before, but I also think that it's important to have that baseline of understanding with each other. And you won't know until you try, and I just never tried.

Harjit: Bushra, I think that's such an important point. I remember when me and my sisters were growing older, we had one-on-one conversations with our mom about sex. And I think, at first, she was very apprehensive, but she also learned a lot about her sexual history and things that had occurred to her both positive and negative. And it just makes you feel comfortable that you understand what went through your life.

Leen: So recently, I think being on OB/GYN . . . you know how you kind of have shower thoughts where it's random thoughts that come in? So I call them retractor thoughts, and it's basically when the physician attending throws you a retractor in surgery and you're holding it for two hours straight doing nothing.

So I was having a retractor thought and it hit me. I was like, "Why am I denying all of this? Why am I denying my passion for wanting to normalize female anatomy, female health, and bring it to all spectrum and all ages as well as bringing education to . . ." I taught high school anatomy beforehand and I was like, "Why am I denying all this?"

And it hit me that I have to do this. As a physician, I want to be someone who can normalize all the spectrum of sexualities, all the spectrum of gender fluidity, make it normal for both genders to understand the process that they're going through. What is the process of how they even started being man, female, whatever? And I want to be able to make curriculums and teach and outreach to a lot of these populations that I feel would really benefit society in the future by understanding these things. And so, that would also help me outreach to other physicians and other colleagues to say, "Hey, what can you bring to this conversation to help facilitate and normalize all of this?"

Margaux: I love it, Leen. I think that's very powerful.

Bushra: And just for our listeners out there, if you do want more resources, a great resource is Planned Parenthood. You can go ahead and visit their website and figure out where they're located and everything like that.

Thanks for joining us in this wonderful conversation, and I hope you guys enjoyed. If you have questions or thoughts, anything that you want to add, go ahead and hit us up on Instagram. And until next time, bye-bye.