This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

An Unintended Benefit of Same-Sex Marriage?

A new study in JAMA Pediatrics examined adolescent suicide attempts between 1999 and 2015 to see if policies legalizing same-sex marriage had an impact on young people’s mental health. Massachusetts legalized marriage equality in 2003, and more than 30 states followed, either through legislation or court rulings, until 2015 when a U.S. Supreme Court ruling legalized the practice in all 50 states.

The researchers used data from the Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance System (YRBSS), which is given every two years to high school students across the country. Among many questions about everything ranging from nutrition to sexual behavior, the YRBSS asks young people: “During the last 12 months, how many times did you actually attempt suicide?”

The researchers compared the answers of young people in 32 states that had legalized same-sex marriage before 2015 and 15 states that had not (not all states participate in the YRBSS). They also compared responses from all students to those of students identifying as lesbian, gay, bisexual, or “not sure”—though only 25 states ask students about their sexual orientation. In total, the study covered more than 761,000 students, about 231,000 of whom identified as a “sexual minority.”

The research team found a correlation between the passage of same-sex marriage laws and a decrease in attempted suicide. After a state passed such a law, the proportion of high school students who said they’d attempted suicide in the previous 12 months decreased by  7 percent. The effects were even greater among lesbian, gay, and bisexual high school students, who saw a decline in attempted suicide rates equivalent to 14 percent. These declines were not seen in the 15 states that didn’t legalize same-sex marriage before 2015. The researchers estimate that same-sex marriage laws would be associated with 134,000 fewer adolescents attempting suicide each year.

The researchers note that they only showed a correlation and did not prove that same-sex marriage laws reduced teen suicide. Nor did they study the reasons behind the correlation.

Nonetheless, the authors have a number of theories about how same-sex marriage laws could benefit vulnerable teens. First, policies that prohibit same-sex marriage increase the stigma around LGBTQ individuals and deny them equal rights and privileges. Lifting these laws can go a long way toward eliminating this stigma. In addition, there was a lot media attention that came along with a state passing same-sex marriage laws, which could have further decreased stigma and increased the visibility of the LGBTQ community.

Not to oversimplify a complicated issue, but we here at This Week in Sex have another idea about why legalizing marriage equality can help adolescents. Think about sitting in class daydreaming about your future, imagining your wedding, or seeing yourself as part of a happy, married couple. This simple fantasy—one society denied to generations of young people who were questioning their sexual orientation—could go a long way in helping some students make it through their tumultuous teen years.

President Trump and a Dubious Distance Diagnosis of Syphilis

In a February 17 article in the New Republic, Dr. Steven Beutler, an infectious disease specialist in California, speculated that President Donald Trump may be suffering from neurosyphilis—though Trump is not his patient.

Syphilis is an ancient sexually transmitted infection (STI) once known for causing people to deteriorate mentally; an outbreak was reported among French soldiers in the 1400s. Because so many of the symptoms in its early stages mimic common sicknesses like a cold or the flu, syphilis is hard to detect. Neurosyphilis is diagnosed when the syphilis bacterium invades the nervous system, and it causes a wide range of symptoms, including altered behavior, difficulty coordinating muscle movements, paralysis, sensory deficits, and dementia.

Beutler pointed to some of the symptoms when discussing President Trump’s health. He wrote:

Commonly recognized symptoms include irritability, loss of ability to concentrate, delusional thinking, and grandiosity. Memory, insight, and judgment can become impaired. Insomnia may occur. Visual problems may develop, including the inability of pupils to react to the light. This, along with other ocular pathology, can result in photophobia, dimming of vision, and squinting. All of these things have been observed in Trump. Dementia, headaches, gait disturbances, and patchy hair loss can also be seen in later stages of syphilis.

Beutler points to another thing in making his “diagnosis” from a distance: Trump’s STI risk from 30 years ago. Syphilis can surface decades after the initial infection. In the 1980s, Donald Trump was known for leading the lavish lifestyle of a wealthy playboy. Asked by talk show host Howard Stern about how he avoided STIs, he answered: “It’s amazing, I can’t even believe it. I’ve been so lucky in terms of that whole world; it is a dangerous world out there. It’s like Vietnam, sort of. It is my personal Vietnam. I feel like a great and very brave soldier.” Syphilis rates were high during the 1980s and did not begin to decline until the early 1990s (by the late 1990s, it looked like syphilis might be eliminated in this country, but rates have been increasing dramatically in recent years).

These observations about Trump’s alleged symptoms and his own comments form a flimsy and subjective foundation on which to base any claims about his health. While physicians might get clues about a patient’s illness from how they look or act, making even a speculative diagnosis with just this information is not good medicine.

Little is known about the president’s health. Instead of releasing complete medical records during the campaign, Trump presented a gastroenterologist’s letter, which stated that if elected the candidate “will be the healthiest individual ever elected to the presidency.” He released a second document with some additional information but still has said very little about his health. Perhaps it is this lack of transparency that has led so many people—be they doctors, psychiatrists, late night talk show hosts, or other politicians—to talk about the physical and mental issues that could be affecting our new president.

Beutler’s speculation has, in turn, led to debates about how much we should know about our president’s health and whether it is ethical to publicly diagnose anyone without examined them. Doing so might damage the individual’s reputation, especially when that diagnosis is of a stigmatized condition such as an STI. It could also perpetuate stigma against those who have been legitimately diagnosed. After all, everyone who has neurosyphilis doesn’t behave the same way or have the same symptoms. And there can be multiple explanations for President Trump’s sometimes erratic conduct and incoherence, including those unrelated to an underlying medical condition.

But Beutler argues that diagnosing President Trump with neurosyphilis could explain some of his behaviors and put an end to them because the disease is treatable even in late stages. If only it were that easy.