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ASHINGTON, June 28 -- In what he described as a bid to give scientific grounding to the volatile debate over sex education, the surgeon general of the United States urged communities today to provide young people with thorough and medically accurate sex education as a way to reduce the number of unwanted pregnancies, rapes and sexually transmitted diseases.
The long-awaited report from the surgeon general, Dr. David Satcher, said there was insufficient research to back claims that courses teaching abstinence until marriage had any success in delaying sexual activity among unmarried teenagers. Such programs, which account for the single largest federal effort in sex education, teach that the only reliable way to avoid pregnancy and disease is to remain chaste until marriage.
With financing for the abstinence- until-marriage programs up for reauthorization later this year, Dr. Satcher's report drew swift criticism from conservatives.
While praising the value of teaching abstinence, Dr. Satcher said youngsters also needed instruction in human sexuality. His report found no scientific support for fears that talking about sex in the classroom led teenagers to have sex at an earlier age. But several studies showed that when students who had taken sex education did become sexually active, they were more likely to use protection, his report said.
Dr. Satcher called on individuals and communities to respect diversity in sexual orientation, saying there was little evidence that sexual orientation, once discovered in adolescence, could be altered. But he said there was proof that physical abuse, insults or isolation of young people who are gay can undermine their mental health, sometimes resulting in depression or suicide.
Dr. Satcher defined abstinence as celibacy outside of a "mutually monogamous relationship," not necessarily marriage, and said, "Every child needs to have equity of opportunity for sex education . That's the point we are trying to make."
Originally scheduled to be released in the fall, the report, "The Call to Action to Promote Sexual Health and Responsible Sexual Behavior," took nearly two years to prepare. The delay fueled doubts among scientists and health professionals that it would ever come out and that it would venture a bold stance in tackling what Dr. Satcher today acknowledged was "the most controversial and sensitive" issue he has faced as surgeon general.
While acting independently, the surgeon general works out of the Department of Health and Human Services. Dr. Satcher, who was appointed by President Bill Clinton, has released other reports in conjunction with President Bush's secretary of health and human services, Tommy G. Thompson, but he issued today's report by himself.
While Mr. Thompson saw the report before it was issued, he made no changes to it. "It's a completely independent work," said Anthony Jewell, a spokesman for Mr. Thompson.
The White House appeared to be distancing itself from the work, although not attacking it. Ari Fleischer, the White House spokesman, noted that the report was commissioned under Mr. Clinton and said that Mr. Bush's "overall approach on these matters focuses on abstinence, abstinence education."
In his report, Dr. Satcher defined sexual health broadly, saying it was not confined to an individual's reproductive years or to having sex, per se. "It includes the ability to understand and weigh the risks, responsibilities, outcomes and impacts of sexual actions and to practice abstinence when appropriate," he wrote. "It includes freedom from sexual abuse and discrimination and the ability of individuals to integrate their sexuality into their lives, derive pleasure from it, and to reproduce if they so choose."
The report, based on a review of hundreds of scientific studies and journal articles, estimated that 45 million people, or one in six Americans, are infected with genital herpes, with a million new cases each year. It said that 22 percent of all women had been raped, and that 104,000 children were sexually abused each year.
While Dr. Satcher said he set out only to establish common ground for discussion in the highly polarized issue of sex education, his report appeared to please scientists and health professionals with his call for frank discussion about sexuality.
Dr. Bruce Bagley, chairman of the board of the American Academy of Family Physicians, which represents 91,000 family physicians, praised Dr. Satcher's message. "Our ability to change society one person at a time is very limited," Dr. Bagley said. "The only way we're going to change approaches to sexual behavior and sexual activity is through school. In school, not only at the doctor's office."
Advocates of abstinence programs were outraged. Peter Brandt, director of issue response at Focus on the Family, a church-based conservative group, called the report "ideology disguised as science from the beginning to the end."
Mr. Brandt disputed the surgeon general's statement that sexual orientation could not be altered through force of will, and said the report "calls severely into question the surgeon general's ability to remain the chief medical officer of the United States." Dr. Satcher's term ends in February 2002.
But rather than appealing to either camp, Dr. Satcher's call could as easily have come from American parents. Several recent opinion polls show the vast majority of parents want schools to urge teenagers to remain virgins, but also to teach them how to protect themselves if they become sexually active.
Drew Altman, president of the Kaiser Family Foundation, a nonprofit research group that has done surveys on sex education, said, "There is nothing in that report that isn't endorsed wholeheartedly in every survey we've done of parents."