How I Got Into Sex…Ed — Meet Former U.S. Surgeon General Joycelyn Elders

We are running excerpts from How I Got Into Sex…Ed. Get a free copy of the ebook here. Order the print book here.

Joycelyn Elders, MS, MD

How I Got Into Sex…Ed

How I Learned to Swim in Jello

Looking back, I can see that life is about passages; development in one area evolves somehow into another area and into another. I began my profession as a medical doctor in pediatric endocrinology. Enlightening experiences and opportunities moved me into research and professorship at a medical school. More enlightening experiences led me into public health and to my position as the Director of Public Health in Arkansas, where I began to focus on the heartwrenching problems at hand — teenage pregnancy and all the problems and suffering that go with it: poverty, lack of education, illegitimacy, low birth-weight babies, and high mortality.

My realization that the plight of youth in our society was vulnerable came gradually. Although I can look back and see the vulnerability of boys and girls throughout my younger life, it was in the years of my training in pediatrics that it became clear that we are not all the same at birth, neither in material things nor certainly in genetic makeup.

While many adults cringe at simply seeing the words, “adolescent” and “sexuality” paired together, the adolescent hormonal imperative continues its relentless takeover of youthful thinking and often, action. When children experience puberty, natural intensification of sexual feelings soon follows. Even worse for parents is when this normal process doesn’t begin. I saw boys who should have gone through puberty but had not developed their sexual organs who were brought in by their concerned fathers. Children who were gender misidentified or had ambiguous sexual identification were all patients in my field of endocrinology. Humans are not always clearly male or female; we come in all manner of gradation. All of this helped me to understand that every one of us needs to be more informed — educated — in order to provide a healthy culture in which all people are valued and in which our vulnerable youth can develop to their full potential as human beings.

It became obvious to me that many young women were stuck in horrible predicaments that seemed to be inextricable. As a pediatric endocrinology resident, I saw young patients with endocrine problems, which included sex organs and sex hormones. But what struck me was a pretty 13-year-old girl from the Ozarks, who I will call Mary, who had a large goiter on her neck and bulging eyes — classic symptoms of hyperthyroidism. The doctor who referred her also wrote that she had severe nervousness, smothering spells, high blood pressure, bed-wetting, weight loss, and poor performance in school. After hospitalization, we were able to control her thyroid condition and were ready to release her to go home. When I told her, she began to cry and, after sitting with her for a while, said that she didn’t want to go home. I thought, “Who doesn’t want to go home from the hospital?” She finally explained that on Saturday nights at home her father and uncles got drunk and “used” her. When I tried to bring it up with the mother indirectly without making accusations, she denied knowledge of any problem. At that time, laws prevented us from interfering in a situation like this. In court or in a police station, it would just be the father and uncles’ word against the young woman. So, I had no choice but to send her home. I saw her twice more in the clinic over the next two months. Her thyroid problem was doing fine, but the last time I saw her, she was pregnant. Her life seemed to be ruined; here she was at 13, pregnant by a close relative. Abortion was illegal even in a case like Mary’s. How did she go on?

Stories like this continued throughout my residency and practice until the law changed. Thankfully, doctors and nurses went from not being able to do anything legally in these situations, to being mandated to report suspected abuse. I was a pediatric endocrinologist, not someone who would ordinarily run into the Marys in the world of medicine. If I was seeing this many patients who had been sexually abused, how many were there? What was education doing to address problems in sexuality?

When Governor Bill Clinton offered me the job as Director of Public Health in Arkansas, he said that he wanted me to improve the horrible teenage pregnancy statistics in Arkansas. Finally, in 1987, I agreed to take the job with him agreeing to back me up as I attempted to bring innovation to the Department of Health and “jump their engine,” moving them into a new direction as he requested. This was an opportunity that ultimately evolved into a focus on sexuality education that would stay with me for the rest of my life.

Shortly after beginning the new job, Dr. Debbie Bryant, the maternal/child health chief, brought me up to date on the status of sexual health in Arkansas. We were the state with the second-highest percentage of teenage pregnancy, with the United States having the highest rates of all the developed countries in the world. Therefore, Arkansas had the second highest teenage pregnancy rate for the developed world.

Of course, we also had all the things that go with a high teenage pregnancy rate — high illegitimate birth rate, high infant mortality, low birth weights, poverty, and lack of education. Fifty percent of teenage mothers never finished high school, and only two percent went to college. This presented a picture of a culture that was clearly suffering and was keeping Arkansas from flourishing.

At a press conference with all the state department heads, Governor Clinton, whose heart was close to youth issues, asked each person to state briefly what they were going to do the next year with their agency in regards to the “Youth at Risk” conference in Washington, DC. When my turn came, many people looked as though they were about to dose off until I declared, “The health department is going to reduce teen pregnancy.” In 1987, this was NEWS! Some reporters roused a little. One asked, “How are you going to do that?” I said, “We are going to have comprehensive health education and school-based clinics.” Everyone was awake now. “Does that mean you are going to distribute condoms in schools?” I answered, “Yes, it does. We aren’t going to put them on lunch trays, but yes, we intend to distribute condoms.” That’s how I became the Condom Queen. In that moment, I transitioned from pediatric endocrinologist, researcher, professor, Director of the State Health Department to Condom Queen. I still hold that title.

I began going out into the state to bring the message of sexuality education, healthcare, and hope for the future to young people. Also, I began the huge job of persuading Arkansas legislators that protection of our most vulnerable citizens — the youth — through education and access to healthcare was one of our most important tasks. Although resistant in public, behind the scenes most of the seemingly negative legislators were supportive of my ideas. All of this experience told me that we had to take education to the people — talk to them about subjects that were usually forbidden in public. We had to get people talking about sexuality using facts, not myth, or our people would be doomed to suffer in ignorance forever. I knew that we had to use multiple strategies, education of adolescents, schools, churches, communities, media — everybody. No one group could do it alone.

Each time I transitioned into another area, I felt as though I were swimming in Jello. Then, gradually, clarity came (after a lot of hard work). The nature of passages is not to make life easier. Rather, they are a way for life to present opportunities. It is always a good thing to remember that opportunities don’t always come around again and again. So, it is best to grab the ones that matter most the first time around.

During the passages of my life, I learned seven things that were important for my successes.

  1. Be clear about your own goals; know what you want and what it takes to get there.
  2. You must use common sense and realize that you never want to give anyone else your own personal power or the power of your office.
  3. You must keep your eye on the prize; have stick-to-itiveness; be persistent. The prize for me was that all young people would have the opportunity to grow up healthy, educated, motivated, and have hope. Healthy sexuality is an essential part of that, and it is everybody’s responsibility.
  4. Never worry about who gets the credit; just get the job done.
  5. You must have gumption. Ask for what you want; you might get it sometimes.
  6. Look for the smartest people to help with your goals and collaborate with them to make a difference.
  7. Remember all the shoulders you had to stand on to get there!

Want to read other great stories? Get a free copy of the ebook here. Order the print book here.

How I Got Into Sex…Ed is a treasure! If you’ve ever wondered if this path was right for you or what it feels like to be a sex educator or how to get the right kinds of education, training, or opportunities to work as a sexuality education professional, this book is for you!”

Debby Herbenick, PhD, MPH
Director, The Center for Sexual Health Promotion
Indiana University