Shortly before my eighteenth birthday, at my annual physical, I told my doctor I was thinking about having sex.
She gave me her “sex talk,” which consisted of asking me what might happen if and when I lost my virginity (her words). Like the good student I was, I recited the risks of unwanted pregnancy and sexually transmitted diseases. She said, “Yes, when you decide to have sex there are a couple of risks. You could get pregnant; you could get an STD; and you will get your heart broken.” Then she wrote me a prescription for a low-dose birth control pill, talked to me about proper condom usage, and that was that.
I was startled. Minutes earlier, she had also given me her “college talk” because I would be starting school in the fall and her “driving talk” because I was on the verge of getting my driver’s license. Neither of these talks had included unsolicited assumptions about the capacity of my heart to withstand such oh-so-adult experiences. I wanted to push back on my doctor’s odd warning, but her “I’m a grown-up and I know these things” smile silenced me. It wasn’t worth explaining that I knew my heart, mind and body better than she did, adult and credentialed though she may be, and that this particular type of sex did not feel like a rite of passage to me. It certainly wasn’t worth explaining that I had already had sexual experiences that left me feeling confused and newly vulnerable, experiences that didn’t involve intercourse and thus carried no disclaimers from well-meaning, condescending adults.
This story frustrates me deeply, but the heartbreak comment is not the most upsetting part. I was self-aware enough to know at the time that it was bullshit, and at this point I mostly just hope my doctor has since removed that line from her “sex talk.” The part of the story that bounces around in my brain on bad, obsessive days is the part where she put me on the pill.
When I started taking birth control, I was just shy of eighteen and a late bloomer in many ways. I had gotten my period for the first time only three years prior, and it had never reached full regularity. I had limited sexual experience, alone or with partners, and had only experienced one or two years’ worth of orgasms. After three years of birth control, I now experience sexual pleasure differently than I did previously, not to mention other side effects: of the pill itself (having extreme difficulty self-lubricating, leading to severe discomfort in daily life and certainly sexually) or of going off of it after three years (significantly more body and facial hair than I ever had before, which is just a big old bummer). Though none of this is a great tragedy, and I am now in a very happy relationship with my Mirena IUD, I can’t help feeling upset for my teenage self and any other teenagers who accept what they’re given without full information. Without any kind of open discussion, without full informational resources, I was given one form of contraception that would affect my still-developing body, mind, and certainly sexuality.
This matters to me, as an individual and a sex educator, for several reasons. Perhaps most importantly, doctors rarely mention sexual side effects even when they do discuss contraceptive options and their pros and cons. Sexual pleasure is important for those who want and enjoy it; doctors, parents, educators, and really everybody must be able to talk about pleasure and to acknowledge its significance. Besides which, young people have a right to make decisions about their bodies. They have a right to make informed decisions about their bodies. Too often, young voices are devalued when talking about their own sexuality. Discussion with adults is helpful and necessary, but adults should not assume they know best. They don’t. Each individual is an expert – the only expert – on their own body, mind and needs.
To be fair to my doctor, this appointment predated a flurry of recognition by medical experts that Long-Acting Reversible Contraception (IUDs and implants) are arguably the best contraceptive option for teens. I myself had no frame of reference for anything but the pill, since all of my friends who used contraception used the pill and/or condoms. I don’t fault my doctor for putting me on the pill; she did at least put me on the lowest dosage possible, though it increased a year later, and I’m certainly glad I had access to birth control of some kind. But I wish I had been given other options, with the kind of wistful, over-dramatized longing I see on the cover of Nicholas Sparks movies. So I guess she was right: I got my heart broken, after all. (And as soon as I finish writing this, I’ll go pitch the screenplay for a reproductive health-centered remake of The Choice.)
Is the pill an amazing option for many, many people? Yes. Is it vital that hormonal contraception be available to every single individual who wants it? Yes. Is my story one of extreme privilege, in which I had legal and financial access to contraception, as well as parents and a doctor who were willing to facilitate that access? Absolutely, one hundred percent, yes. And might I have still chosen the pill, even with all the options laid out before me in full, unbiased detail? Sure. With all of that in mind, I write this to say: Contraceptive access should be completely universal, meaning that everyone who wants to should be able to get not just contraception, but various options as well as comprehensive information about those options. Anything less is as presumptuous, sexist, and often ageist as telling a teenage girl that sex will end with a broken heart.