Sex Education and Mental Health 

Dr. Ali Hashmi

 

“Only the educated are free.”

Epictetus, Discourses 

Psychiatrists are often accused of being obsessed with sex. Some of this began with the theories of the founder of the treatment method called Psychoanalysis, Dr. Sigmund Freud who can be credited with bringing sexual matters back into the public arena to be discussed and debated openly. That he did this in the 19^th century Victorian era famous for its social and political conservatism makes it all the more remarkable. Many of his most significant ideas have persisted to this day and continue to influence present day thinking and our efforts to understand human behavior.

Any father who has a son older than 5 or 6 has already observed the ‘Oedipal’ stage of development, named after the mythical Greek king, Oedipus, who was damned by the gods forever for (unknowingly) killing his father and then marrying his mother, something expressly prohibited in all religions. In its most basic form, this phase is the desire that male children between the ages of roughly 3 to 5 or 6 years of age have in which they want the complete attention and affection of their mother and want their father (or significant father figure) excluded from this affection. I had, of course, amusingly observed the Oedipal phase that my sons went through where they did not want any overt displays of affection between their parents. Freud went on to identify this complex as one of the causes of mental illness (called neuroses in his day) i.e. a son’s wish to possess his mother and eliminate his rival for her affections, that is, the father. Successful resolution of this developmental phase prevents the occurrence of later problems (according to this theory).

Freud developed an analogous formulation for girls that he called the ‘Elektra complex’, although he never it developed it as much as his Oedipal theory.

Parents are also reminded of another of Freud’s theories when a male child happens to see his baby sister’s genital area during a diaper change and exclaim “She doesn’t have a ‘pee-pee’ (penis)!” perhaps to be calmly told that she is a girl and her ‘pee-pee’ is on the inside.

What is ‘Sex Education’? When should it begin? What should be covered? Does it encourage sexual promiscuity? Does it increase the chance of sexually transmitted diseases or pregnancy? Is education about sex and sexual matters related to mental health?

Everything that I have described above can be considered elementary sexual education. A child’s education about this central fact of life begins as soon as he or she is born. When a child cries to be changed because their diaper is dirty, it is responding to a condition that involves its sex organs. By a few months of age, children have discovered that touching themselves ‘down there’ is fun and feels good and they will do it as often as possible, mother’s disapproval not withstanding. The Oedipal years (roughly from ages 3-5 or 6) are followed by a period of relative disinterest in the sex organs except as it pertains to hygiene and urination/defecation. Beginning with puberty, with the maturation of the internal sexual organs and the appearance of outwards signs of sexual maturity including the growth of pubic hair in both sexes, enlargement of the breast and the beginning of the menstrual periods in girls and the capacity for orgasm and ejaculation in boys, the sexual organs again take center stage.

Educating a child in an age appropriate fashion about the bodily changes taking place (and the accompanying mental and emotional upheaval) removes a lot of the mystery, misinformation and fear about these developments. It is also a central feature of prevention of unwanted pregnancies and transmission of sexually transmitted diseases in later years. Contrary to popular opinion, education about sex does not lead to more promiscuity in the majority of cases. Lack of education can, however, lead to the unwanted and, potentially life altering consequences mentioned above. Lack of education can also reinforce and in some cases, cause, mental illness such as anxiety, depression, drug abuse and more severe illness.

Sex education needs to begin at an early age and should be geared towards the developmental stage and interest of the child. For pre-pubertal children this should include general information about the sex organs, urination, defecation and, if necessary, basic information about pregnancy, child birth or whatever else the child may be interested in. If the opportunity presents itself e.g. if the child has a rash or any other kind of symptom involving the genitals, a basic, concrete explanation about how the genitals function may be helpful. There is a wealth of information available online as well as numerous books about this geared towards young children. Usually, children at this age of development have no interest or desire to learn about sexual functioning, sexual intercourse, sexually transmitted diseases etc and ‘forced’ explanations are more likely to confuse and scare the child than help.

Following the onset of menarche in girls and at a similar developmental stage for boys as evidenced by the appearance of ‘secondary sexual characteristics’ such as deepening of the voice and the appearance of facial hair, more in depth explanations and discussions are helpful. It should be noted that the onset of menarche i.e. the beginning of the menstrual period in girls and the beginning of ejaculation in boys signaling sexual maturity can be a difficult time for both sexes if mishandled. Usually, girls are more likely to seek help from parents and care givers since their new ‘problem’ is both more visible and may feel more traumatic. Boys may begin experiencing ejaculations initially as nocturnal emissions followed by intentional or accidental discovery of masturbation but either way can hide this new development better. Girls, on the other hand, will require the help of parents, both for practical purposes i.e. what to do about the menstrual flow, what to expect over the several days each month that it continues, help with any initial physical symptoms such as pain or cramping etc as well as with the subsequent emotional unease about the development of breasts and other secondary sexual characteristics.

Both sexes will benefit from open, age appropriate, non-judgmental discussions about both the physical aspects of these changes as well as the mental and emotional changes that the adolescent is undergoing at this time. Hormonal changes that lead to these bodily phenomenon also cause emotional upheaval that signals the end of the ‘latency’ period of Freudian psychological development during which children are (usually) compliant, eager to please and generally happy. With the onset of adolescence and its associated bodily turmoil begins a new round of emotional chaos that is the hallmark of the process designed to lead a child into adulthood. This is also the time that educational demands on children escalate along with greater parental and social pressure to perform at school and at home in anticipation of adulthood.

As with every stage, a loving and affectionate attitude in the parents is a good beginning. Parents must also educate themselves about basic physiology and sexual functioning in order to pass on the knowledge to children. Discussions about sex at this stage must include basic education about accidental pregnancy and its prevention as well as sexually transmitted diseases. As before, this should be done in an age appropriate, non-judgmental way, preferably following the lead of the adolescent who is being educated so they do not feel ‘force-fed’. It is normal for adolescents of both sexes to be more interested in their own bodies as well as in the opposite sex and this is a good time to discuss masturbation or self-pleasuring as something natural and a safe alternative to unsafe sexual practices. Parents need to remind themselves that not discussing these issues with their children does not mean that teens will not indulge in these practices, just that they will be at higher risk of unwanted pregnancies and sexually transmitted diseases because of lack of information. Again, it is worth remembering that discussions of these issues, in general, does not encourage the behavior and in fact, may do the opposite.

Some of this can be made harder by the fact that as adolescents continue to grow and develop, they may confide less in their parents preferring to talk to their peers. This too is a natural developmental stage. All parents need to ensure at this stage is that the ‘lines of communication’ are kept open but at the same time that there is no pressure on the teens to force a conversation they do not want.

First generation immigrant parents from more traditional and religiously conservative societies such as India, Pakistan, Bangladesh and other countries of South Asia may face a more steep challenge: how to balance their pre-existing values, customs and beliefs, which they imbibed while growing up in a different culture with the needs and demands of their Western born and educated children who will, naturally, reflect the values of the culture they are being raised in. Some parents may object to sex education in schools on those grounds. Others may prohibit mixed sex gathering of children and teens or forbid children to date. While it is possible to handle these matters in a sensitive way, this situation poses a more complex problem. In the end, parents have to realize that it is both impossible and undesirable to impose the parenting style that they learned in a foreign land and culture on children born elsewhere. The best resolution would be to try and meet each other ‘half way’, deciding at each step, cooperatively and lovingly, what should be done and accepting that each party will have to give up something in the interest of the family as a whole. Even in this situation, education about basic physiology, pregnancy prevention etc as outlined above should be shared as openly and honestly as possible.

One positive aspect of living in Western societies is that, due partly to the lack of religious prohibition, basic information about sexual matters is much more easily available than in more religious societies.

Is sex education necessary for adults as well? Absolutely. Basic information about family planning and contraception should be made available to all adults and as a routine part of pre-marital counseling. In addition, education about the effects of pregnancy on sexual functioning and basic information about sexual functioning in the young and middle adult years (25-45 years of age) would go a long way towards preventing marital and couples conflict which can lead to many mental health problems including depression, anxiety, alcohol and drug abuse. This should include continuing education about contraception, the function of a healthy sexual relationship within a loving marriage or monogamous relationship and education about pregnancy prevention and sexually transmitted diseases for adult singles.

With the approach of middle age, education about menopause for women and its effects on sexual desire and sexual functioning should be emphasized. This will help single women as well their partners or spouses. The uncomfortable, sometimes painful symptoms of menopause and its accompanying physical changes can be made much less stressful this way. In addition, for parents with children entering teenage, this can be a difficult time. This may be the time that adults have to deal with the illnesses and deaths of their own parents while dealing with children who are increasingly assertive and sometimes defiant. This can put a strain on marriages and relationships. A satisfying and loving sexual relationship can go a long way towards preventing family and marital conflict. However, this can be complicated by the difficulties posed by menopause which can affect the physical sexual response as well as desire and libido. Continuing education about these changes along with simple interventions to allow continued sexual functioning can be helpful.

Sexual functioning in old age varies. While physiologically, most people can function as well sexually as young people, due to physical and hormonal factors, there is less urgency to the sexual drive. However, even in old age, a satisfying physically affectionate sexual relationship can strengthen and enhance a marriage or monogamous union. For some, the absence of the possibility of pregnancy can be liberating. Again, basic sex education including, if necessary, explanation of how emerging medical problems and medication side effects can affect sexual functioning can be helpful and productive.

At all stages of life, a dissatisfying, dysfunctional sexual style, either one that involves indiscriminate, reckless promiscuity or inhibited withdrawal from sexual activity can cause or worsen depression, anxiety, alcohol or drug abuse and, in extreme cases, cause more severe mental illness. In addition, the effects of these illnesses on families, workplaces and society in general can also be harmful and destructive.