Maia Szalavitz "Girls Fertility Chartbook Stirs Debate" (Health March 20, 2007, p. F 2) describes reactions to Toni Weschler's Cycle Savvy. The book is written in an engaging style and contains medically accurate information for the most part; except for PCOD - polycystic disease of the ovary - which is mischaracterized as due to a high blood insulin, rather than a tonic high LH (Luteinizing Hormone) level which is actually treated by regulating the glucose metabolism.
Her narrative relies on the retrospective, adult understanding of women who reflect on their adolescent behaviors. Despite the fact that adult women wished that they had learned to understand and value their fertility much earlier in their lives, giving unnecessarily complicated physiological information to girls who are still growing toward adulthood and do not process information the same way adults do, does not begin to meet their needs.
Weschler advocates the sympto-thermal method which requires daily monitoring of the waking temperature as well as observing the cyclic cervical mucus (which she calls cervical fluid.) Our extensive experience in teaching teens to recognize and value their fertility in our Teen STAR (Sexuality Teaching in the context of Adult Responsibility) program shows that teens seldom adhere to daily temperature monitoring, while they can observe their mucus all during the day, so missing an observation is not critical.
Using a book rather than personal contact limits Weschler to providing answers to questions about whether or not to have sex, but teens need more than that. They need personal contact, ongoing dialogue and guidance. Because teens are in the process of separating from their parents they very frequently prefer to speak to someone other than a parent initially about sexual matters. But we not only agree with Weschler's invitation to girls to speak to their mothers about their cycles, etc, but require parental permission for entry into our programs, while stressing the need for confidentially about personal communications with a teacher.
Weschler discussed the pros and cons of sexual relations before marriage as wells as contraceptives in a value-neutral frame. Most sexually transmitted diseases are described accurately while HIV is barely hinted at. She explains why she has chosen not to give girls the rules of the sympto-thermal method for pregnancy avoidance, but we do not agree with her rationale. Once a girl knows that her fertility begins and ends with her mucus sign (even if she's not taking her temperature) she will deduce the duration of her fertile phase. But unless she is also taught that fertility continues for three days after the last day of slippery mucus or the third day of raised temperature, which ever comes later, she may misjudge her fertility status with potentially disastrous results. Hence teaching the full method is imperative if one is going to engage on this topic. Our own approach is to give full information while helping students explore the emotional, social, intellectual and spiritual aspects of their sexuality as well as their fertility, and discuss their understanding and the meaning of any behavior within a framework of confidentiality.
Our observations are based on working with thousands of teens on four continents, extensive, published research and continued monitoring of behavioral outcomes from all user groups. Thankfully we can document support for both primary and secondary abstinence, supporting our view that giving less than full information to our students is a disservice. In order to make good choices one must know all one's options.
Hanna Klaus, M.D., F.A.C.O.G, Executive Director Natural Family Planning Center of Wash. D.C. and Teen STAR Program.
8514 Bradmoor Drive
Bethesda, MD 20817-3810
Tel. 301-897-9323 (w) 301-530-9383 (r)