'The Talk'
Forget the Birds and the Bees -- Kids Are Asking About IVF, Transgender Pregnancy and STDs

By Elizabeth Agnvall
Special to The Washington Post
Tuesday, April 15, 2008

Early one morning, Nancy Nisselbaum was readying her 6-year-old son Marshall for school and herself for work when he asked: "Mommy, how does the sperm get from the donor to the doctor?"

A single mom by choice, Nisselbaum had neatly fielded earlier questions about why her son didn't have a dad. But this query momentarily stumped her. Then she took a deep breath and dived in:

"Let's start with . . . married people," she said, and explained the traditional sperm-meets-egg method. "Ewww. Gross," Marshall replied, as any self-respecting first-grader would.

Working up to his original question, Nisselbaum, who lives in New York, next explained the mechanics of masturbation. Marshall listened intently, then moved on to other crucial morning concerns, like getting dressed.

Even for a parent used to frank talk with her children, explaining this particular means of modern reproduction before 9 a.m. can make for a tough start to the day.

Changes in reproductive technology, a new openness about formerly closeted subjects and the flaunting of overtly sexual imagery in news and entertainment outlets have shifted the parameters of the traditional preteen birds-and-bees talk. (Remember? Mothers talked to daughters; dads talked to sons. End of discussion.)

Today, experts urge parents to welcome questions on sexuality by the time their kids can ask why the sky is blue. Recent research has shown that regular discussions of sexuality may improve parent-child relationships and even delay the onset of sexual activity by children. For some parents, that latter effect is taking on new importance in light of a recent study showing that at least one in four teenage girls has a sexually transmitted disease.

What a complex new world parents have to explain today. It's not just that some kids have two mommies, others two daddies or no daddy at all. Or that national debates on abortion and gay marriage, along with news stories on in vitro fertilization and sex changes, are generating a whole new set of questions.

We've also got a transgender person -- born a woman but now living as a man, albeit with female reproductive organs intact -- showing off what seems to be his six-month pregnancy bump on "The Oprah Winfrey Show." Try explaining that to a 9-year-old -- or a 40-year-old, for that matter.

What's more, some experts say there's a disconnect between the Bush administration's sex-education message (practice abstinence until you're wed) and the implicit media message (engage freely in sexual behavior). And in that disconnect lies a danger, says Baltimore-based sex educator Deborah Roffman, the author of "Sex and Sensibility: The Thinking Parent's Guide to Talking Sense About Sex."

"You could do a real disservice with this assumption that you wait until the child asks," she said. "The truth is that we've left our children in a vacuum around these topics, and popular culture has just waltzed into this vacuum."

Which leaves many parents asking: How do you give your kids the tools they need to safeguard their physical and emotional health? And how much should you tell kids to reassure them about their own sexuality but not encourage risk-taking?

Beyond the Big Talk

No one claims finding age-appropriate words to explain sperm donation -- or even simpler topics -- is easy. Self-consciousness and embarrassment sometimes trip up even those who work in the field.

Steve Martino can speak to that. A behavioral scientist with the Rand Corp. in Pittsburgh, he was the lead author of a study in the February issue of Pediatrics showing that the more frequently parents talked to their adolescents about sex, the closer the teens felt to their parents and the less likely they were to engage in risky behavior.

Researchers who surveyed 312 teens and their parents in Southern California four times over a year found that parents who took a one-shot "checklist" approach to talking about sex had less influence than those who introduced new topics gradually, returning to them over time.

"Parents might think that they can talk about a particular topic once and be done with that topic," Martino said, "but as your child ages and develops and has new experiences, the topics take on new meaning."

When parents talk about sexuality with their adolescent children, they are often "defensive, avoidant, impersonal, unsupportive and rule-oriented," Martino and colleagues noted in their study. They tend to stick with relatively safe topics such as menstruation and reproductive facts and avoid more private topics such as masturbation, orgasm and sexual decision-making.

The researchers cited evidence that suggests adolescents are less likely to take risks -- initiating intercourse at a young age, for example -- if their parents are "open, skilled and comfortable" during discussions of sex-related topics.

Open and comfortable? Even Martino admits this is easier said than done.

He said his 9-year-old son recently asked him how the sperm gets to the egg.

"I could feel my face getting red," Martino remembered. "I had my face down, and I was not looking him in the eyes. I thought to myself: 'I have to look him in the eyes.' "

Rather than try to hide his embarrassment, he told his son that he felt a bit uncomfortable, but he wanted to answer his questions.

So how can other parents expect to tackle the tough topics?

Begin early.

"You should start talking to children about sex from the day they can talk," said Maureen Lyon, a clinical psychologist at Children's National Medical Center. "Hopefully, when they reach adolescence there's a little bit of groundwork done."

Often, by the time children are teens, they want to talk to parents not so much about how sex works but about how to negotiate relationships, how to listen, how to say no. That's what came out of a recent teen focus group at Children's Hospital about the spread of AIDS, Lyon said.

She suggested parents look for teachable moments, prompted by news stories or life events, to open discussions. Car rides often offer opportunities for tricky conversations, she added.

Kirstin Madaus, a former obstetrics nurse from Falls Church, said her 9-year-old son and 7-year-old daughter always seem to come up with tough questions while she's driving.

"I usually get stuck in the car," Madaus says, chuckling. "They will ask a question, and all of a sudden," she says, the answers just pour out.

Madaus said she relies on her medical knowledge, trying to explain things simply and clearly. She also works not to pass along cultural prejudices. Because she has a close relative who is gay, she's careful to say "when you find someone to love" to her children when talking about lifelong relationships.

The most recent car-ride challenge? Her kids have friends with two mommies and recently asked how the babies got there without sperm.

"I just started talking and talking. Half of my brain is going, 'Shut up, shut up.' "

Talking Doesn't Equal Doing

Don't worry. Talking won't put ideas into children's heads, says Michelle S. Barratt, a professor of pediatrics at the University of Texas Medical School at Houston and a member of the American Academy of Pediatrics Committee on Adolescence.

"There's this myth that if you talk about something it will be on your child's mind when it wasn't before. Most young children could care less," she said.

Parents can use talk about sex to instill their values, ethics and family beliefs, she said, as well as help children understand their own bodies. Barratt puts discussions with her own children in the context of her religious beliefs. Other parents follow a similar tactic.

When Jennifer Rook's 6-year-old son overheard his parents sharing an off-color joke, he latched onto the word "sex" and asked what it meant. The mother of four stalled a bit by getting out her driver's license and showing him "sex: F."

"It's a good word," her son said. He wanted to write it down and show it to his teacher.

Instead Rook, a Mormon who lives in Neola, Utah, gave a scientific explanation of the other meaning of sex, adding, "In our religion we don't believe in doing this until we are married, but there are plenty of people who don't believe the same thing we do."

In talking about sex, experts say it's important that parents cover a range of topics, including emotions and acts of physical intimacy, such as oral sex and anal intercourse.

Charles Wibbelsman, chief of adolescent medicine for Kaiser Permanente in San Francisco, said reports have shown a marked increase in oral sex among young adolescents in the past five years. In a study published last year in the journal Pediatrics, 44 percent of 618 teens in two California public high schools reported having had oral or vaginal sex or both by the spring of 10th grade. Girls were likelier than boys to report feeling bad about themselves and "feeling used."

By ignoring the emotional aspects of sexual behavior, parents put their children at risk, says sex educator Roffman, though many parents think they've done their duty once they've explained the mechanics of intercourse.

"That sets [kids] on the road of thinking about sex in purely mechanical and depersonalized ways," she said.

Choosing not to talk about sex with children also backfires, she said. By third grade, many children from families where such talk isn't encouraged have concluded that their parents aren't the ones to ask about sex, so they ask on the playground.

Through books, education and discussions, she said, parents can work through their own barriers. At the core, she said, most parents want their children to bring similar values to their sexual experiences: privacy, mutuality, respect, responsibility.

"We have controversies about certain value-laden issues, like abortion, but the values that universally parents want children to bring to their sexual experience are all the same, and they are the values that they want children to bring to all relationships. You are teaching your children about life. This is part of life." ·

Elizabeth Agnvall is a frequent contributor to the Health section. Comments:health@washpost.com.