This story is part of a series about purity culture, sex education and the role of family, faith and communities in addressing the lasting impacts of purity culture’s teachings.

Cultural norms surrounding sex in the South can lead to long-lasting physical effects such sexual dysfunction, sexually transmitted infections and gynecological cancers, experts say.  

Many adolescents are taught at home, school and church that all sex before marriage is dangerous and morally unacceptable. These teachings – along with the lack of sex education in public schools – can have lasting physical implications, according to clinicians. 

Dr. Misty Smith, a sex therapist in Birmingham, grew up in Walker County, Ala., in a strict religious household. Her rural church, a Universal Pentecostal community, taught abstinence and moral purity, likening a woman’s sexuality to a rose. 

“They gave us a rose and we passed it around the group,” Smith said. “Each person touched a petal, pulled it off, touched the petal, pulled it off. By the time you get around, there’s nothing left. It’s not a beautiful rose anymore.” 

Smith’s experience in the late 80s is not uncommon for many adolescents growing up in the height of the purity culture movement, an abstinence-based sexual education curriculum developed in part as a reaction to the AIDS crisis. Youth groups gathered in school gymnasiums, organizations held large, arena-style conferences, and churches hosted virginity pledge nights and purity balls with young girls and their fathers, all to encourage young people to remain virgins until marriage. 

Smith now works with patients who face various degrees of sexual dysfunction. She said many of her patients are women raised in strict religious homes who, as adults, are unable to have sex without experiencing debilitating physical pain.  

Smith said in many evangelical churches, purity teachings hinge on the idea that sex is only acceptable inside of a heterosexual marriage.  

“Those beliefs were so ‘sex is bad, sex is bad, sex is bad.’ You don’t do it,” Smith said. “And then when you get married, you’re supposed to just be able to do it.” 

But for many newly married women who adhered to the purity teachings, that transition to being sexually active isn’t possible 

Smith said she has many patients who are diagnosed with vaginismus, a physical tightening of the pelvic floor that can be triggered by a psychological reaction to being taught to withhold sexuality and the use of shame to urge against women having sex before marriage. Past studies on vaginismus have not been able to link the condition to strict abstinence education, though scholars have acknowledged the difficulty to acquire subjects for studies due to the nature of the condition. 

“They’ve had this in their head for so long that [sex is] this bad thing that they can’t switch that off,” Smith said. “So when they’re experimenting with their husband, or just even having sex with their husband, it’s really hard for them to kind of get in the mood or to think about initiating because it feels like something that’s dirty.” 

Smith said that in her practice, she uses behavioral therapy to treat women with vaginismus, but often they need a physical therapy referral with pelvic floor physical therapists.  

 In a study published by Cambridge University in 2019, researchers found that women in Arab-Muslim communities can suffer from vaginismus stemming from cultural teachings of sex and sexuality. 

“We found that excessive closeness of family members, allowing the family to be intrusive and exercising pressure on the couple, a strict education which highly values virginity, transmits fear of ‘the male’ and fear of sex, and which links sex with pain, were the common denominator of all patients of our case series,” the study concludes. 

In addition to sexual dysfunction, limiting sex education in churches and schools has also contributed to higher rates of teen pregnancy, sexual transmitted infections and preventable gynecological cancers. 

In 1981 the Reagan administration began federally funding abstinence-only sex education curriculum. Religious right groups such as Eagle Forum and Focus on the Family have continuously fought against comprehensive sex education in public schools. 

In Alabama, where there is currently no requirement to teach sex education in public schoolsthe state requires a focus on abstinence-only education and widely limits information about scientifically proven contraceptive methods. The schools that do offer sex ed in the classroom focus primarily on abstinence-only, heteronormative curriculum. Otherwise, students rely on faith leaders or primary caregivers to provide information about sex education. 

The Human Rights Watch released a report in July 2020 condemning Alabama’s limited sex education and blaming the state’s negligence for its high rates of cervical cancer, teen pregnancy and sexually transmitted infections. 

“Young people need access to accurate information on their sexual health to build healthy relationships and make informed and safe decisions,” said Annerieke Daniel, women’s rights fellow at Human Rights Watch and author of the report. “Alabama can significantly improve health outcomes and possibly wipe out cervical cancer for future generations by guaranteeing comprehensive sexual health education in schools and increasing HPV vaccination rates.” 

Southern states top the U.S. Centers for Disease Control’s 2020 lists for states with highest rates of Chlamydia, Syphilis and Gonorrhea. Louisiana, Mississippi and South Carolina are among the top five states with highest rates of chlamydia. Mississippi, South Carolina, Alabama and Louisiana are in the top fives states with the highest gonorrhea  rates. And Mississippi and Georgia are among the top fives states with the highest rates of syphilis. 

According to a 2016 University of Massachusetts Amherst study, sexually active teenage girls who pledged abstinence for religious reasons were at a higher risk of contracting human papillomavirus and having non-marital pregnancies than those who did not take such a pledge. 

The study used data from more than 3,000 women and found that women who “pledged” their virginity in adolescence were more likely to be taught that condoms and birth control were ineffective in preventing pregnancy and STIs and that a failure to remain a virgin until marriage was a moral failure. These women reported to be less prepared for risks associated with sex and less likely to obtain contraception. 

“Our research indicates that abstinence pledging can have unintended negative consequences by increasing the likelihood of HPV and non-marital pregnancies, the majority of which are unintended,” Paik said in a statement. “Abstinence-only sex education policy is widespread at the state and local levels and may return at the federal level, and this policy approach may be contributing to the decreased sexual and reproductive health of girls and young women.”