Some parents are shocked at the graphic content of their children's sex education, but clinicians are equally alarmed at the numbers of teens catching sexually transmitted infections.
Sunita Azariah's heart sinks each time a 12-year-old walks into her clinic. Treating anyone for a preventable sexually transmitted infection is hard enough, says Azariah, a sexual health physician with the Auckland Sexual Health Service. Treating a child is worse.
She and other clinicians working with sexually transmitted infections (STIs) are worried about the growing number of children under 14 who are having sex and contracting infections.
STIs such as herpes, gonorrhea, genital warts, syphilis and chlamydia (the most common STI in teenagers) are on the rise. So are the numbers of young teenagers catching them.
The figures make sobering reading. Last year, 134 New Zealand children aged 10 to 14 caught chlamydia. The figure leapt to an alarming 3203 in the 15- to 19-year age group with the infection after contracting it from their mothers.
Sex education has been compulsory in all schools for 10 years now, but in that time New Zealand's teenage STI and pregnancy rates have continued to climb.
A national survey by the Adolescent Health Research Group at Auckland University shows that almost 11 per cent of children under 14 are sexually active.
However, Dr Terryann Clark, who chairs the group, says sexual abuse is a factor in early initiation of sexual behaviour. Just over 10 per cent of the under-14 age group reported sexual abuse or "sexually coercive situations".
Family Planning chief executive Jackie Edmond says that the number of younger teenagers catching STIs is growing. "And that's concerning. The numbers of under-16-year-olds coming to see us is growing. They come to us for contraception, STIs and a small percentage for abortion referrals.
"Most of them are 14 or 15 and very occasionally they are as young as 12 or 13. Obviously that's too young and we are very worried about that."
These children, Edmond says, are not just from lower-decile schools or any particular ethnic background.
"It's not isolated to one group. We are seeing all ethnicities and all backgrounds."
The encouraging news is that teens are attending sexual health clinics and getting help. Teenagers spoken to by the Herald on Sunday say they wouldn't feel too embarrassed to go to a family planning clinic. Family planning nurses had visited their sex education classes and reassured them that it was completely confidential.
Although some parents have been vocal about the graphic content of their children's sex education, clinicians such as Azariah say that teens with access to sex education are more likely to delay sexual activity and to use contraception.
"It is not appropriate for children as young as 12 to be taught about oral sex but it is important they are given the opportunity to ask questions and have access to sexual health services," she says.
Edmonds agrees that good sex education is essential in reducing the risky behaviour of sexually active pre-teens. "Sex education needs to be age-appropriate. We wouldn't do condom demonstrations with 12-year-olds. What we talk about with young ones is good relationships, what's right and wrong, what's good and bad behaviour, and how to be safe."
Experts say that parents hoping to stop their children "growing up too fast" are deluding themselves and may put their children at risk. Avoiding conversations and questions about sex is counterproductive, says Edmond. Children are exposed to sexual content on prime time television shows like Home and Away and Shortland St. Instead of switching channels parents could use the shows as a way of having conversations about sex.
"It is important parents take the opportunity to have a discussion when their child starts to ask questions." Sex education should start at home, she says.
Teenagers often don't realise that some STIs, such as chlamydia, are straightforward to treat.
Both Edmond and Azariah are very concerned that young women find it difficult to ask boys to wear condoms. Says Edmond: "I don't know if young women are feeling pressure to have unprotected sex but what we are seeing is that condom negotiation is still very hard for young women and alcohol adds to the complexity."
Azariah says she has treated girls with STIs who say they are too scared to broach the subject of condoms with boys with whom they have had sex. "Girls have difficulty negotiating condom use," she says.
"They worry that if they carry condoms it means they are looking for sex.
"They don't know how to broach it. And girls are drinking more and that impairs their decision-making."
In addition, some teenagers are not aware condoms don't offer full protection from STIs, and that infections, including syphilis, can be caught through oral sex.
Azariah, who has worked for the Auckland Sexual Health Service for more than 10 years, has seen her clients get younger in that time and rates of infections soar.
"The chlamydia problem has grown. Syphilis was not an issue when I started practising but there is a resurgence."
New Zealand has a considerably higher rate of chlamydia than Britain and Australia, she says. The infection often has no symptoms but can lead to pelvic inflammatory disease, infertility or ectopic pregnancies.
On the positive side, more than 150,000 girls and young women have started the human papillomavirus (HPV) immunisation programme since it began three years ago.
HPV can, in some cases, lead to genital warts and cancers in men and women.
That number equates to about half of the young women eligible for the publicly funded programme, says Ministry of Health Immunisation manager David Wansbrough.
"What we're seeing is that once girls and young women start the programme they tend to go on and complete all three doses of HPV vaccine, which is really encouraging.
"We'd like to see uptake reach 70 per cent but that will take some time. This is a new programme. Before it began there was a low public awareness about what human papillomavirus was and how it contributed to cervical cancer."
A review of cases of genital warts diagnosed at Auckland Sexual Health Service already shows a decline in the number of cases in the past two years.
But young people aren't the only ones sexual health clinicians want to target. They are increasingly seeing the older age group with STIs.
Azariah says older people suddenly becoming single and dating again are at risk. "They might have just come out of long-term relationships and be dating again," she says. "And having not grown up with the condom thing they are at risk because they are not using condoms and now there are lots of different internet dating sites it is easier to make contacts."
HPV AND GARDASIL
* Gardasil protects against the human papillomavirus, an STI that affects nearly 80 per cent of all women at some point in their lives.
* Most will have no adverse effects, but some forms cause genital warts and cervical cancer.
* Gardasil protects against the most common forms of HPV that cause 70 per cent of cervical cancers and 90 per cent of genital warts.
* Gardasil is administered in three doses over a six-month period and is free to all girls aged 12 to 18. Women up to age 26 can receive the vaccine, from $165 a dose.
'THEY TEACH US EVERYTHING'
A group of teenagers aged 14 to 16 spoken to by the Herald on Sunday consider themselves well informed about sexually transmitted infections and know the importance of condom use and regular sexual health checks. Many could name some of the long-term effects of STIs, such as chlamydia leading to infertility in women, and knew that some STIs were for life, even if they couldn't name the symptoms.
Esme, 17, Year 12
I think I am really aware. They teach us everything about Aids, HIV and all the others. They tell us all the symptoms, what happens to you when you get them and what you should do if you get them.
Alex, 16, Year 12
I feel like I could ask my teachers anything. It's really open and we don't feel uncomfortable.
Emily, 15, Year 11
They get people from Family Planning and they tell you everything. You start quite young, in third form. It's more awareness on how to avoid getting them and to go to your doctor if you do get them.
Kate, 15, Year 11
I have been having sex education since I was in primary school. We don't learn how to have sex, just about puberty and relationships. If kids aren't informed they just do stupid stuff . They need to learn about protection.
Ashleigh, 15, Year 11
They are very big into chlamydia. You need to use protection to prevent it but you can't tell if you've got it so you have to get check-ups.
Jessica, 15, Year 11
They tell us about herpes, Aids and crabs and genital warts. My mum didn't want me to get the HPV vaccine that stops you getting cervical cancer and genital warts. She read up about it and I wasn't allowed to get it because of the side-effects.
Kayla, 16, Year 11
They teach us everything. There are STIs and STDs. STIs can be cured and STDs can't. [Incorrect, they are the same thing.] They tell us how they are passed on and how to prevent them.
Emma, 15, Year 11
I don't listen in sex ed. They give you that option if you feel uncomfortable, they don't force it on you. I just chill and sit and draw pictures while they are talking.
Lily, 16, Year 11
There's genital warts, crabs, chlamydia and gonorrhoea. Then there's HIV - that's the dangerous one. I don't really know all the symptoms, I just know you can get them from having sex without a condom. I don't think we've been taught the symptoms or the long-term effects. I wouldn't have any problem telling a boy to put on a condom.
Charlotte, 14, Year 10
We started learning about STDs in Year 7 but it gets more in-depth every year. They talk about Aids and that we should use condoms. We got taught how to put a condom on a glass penis.
Zoe, 15, Year 10
Was yours glass? Ours was wooden. They told us to go to Family Planning and about using contraception. I learned that STIs are either bacterial or viral. The bacterial ones like chlamydia can be treated. The viral ones like Aids can't be treated. Herpes can't be treated, you have it forever.
VACCINE NOT FOR HER
Rosie Roger decided not to have the cervical cancer vaccine Gardasil when it was offered to her at school two years ago.
"It just sounded like it had more risks than benefits. I heard it had bad side effects. My best friend's mum knew someone who got really sick from it. And I heard it could lower your chance of having babies," she says.
The 18-year-old Devonport student does not regret her decision against having the vaccine.
"Most girls got it done. No one forced us into it. My mother said it was my choice and the school didn't say anything. They just said anyone who wanted to get it done could and the rest could just stay in class.
"It's a personal choice and girls should be able to choose what they want to do with their own bodies."
Auckland sexual health phys-ician Sunita Azariah says she is angry at the "anti-vaccine lobby" for spreading "completely false" information about the vaccine, including that it can cause infertility.