Notes from an emergency room doctor: There are certain words that you can’t say in the media. Despite the fact that it’s in all too common usage in daily language, you can’t say the “F” word. Not even if you’re Madonna on Letterman. Now it seems that the “M” word has dire consequences too. The “M” word is masturbation.

Dr. Jocelyn Elders, President Clinton’s recent and former surgeon general was fired for mentioning the “M” word. Dr. Elders’ dismissal came because of comments she dared to make during the World AIDS Day Conference at the United Nations in 1994. “Masturbation,” she said, “is something that is a part of human sexuality and it is part of something that perhaps should be taught.”

The furor and firing that followed seems more consistent with age old phobias about masturbation than the real issues. Certainly Dr. Elders angered many people with her voice, often strident and uncompromising, in pursuit of an agenda encouraging early sex education, distribution of birth control materials and condoms in schools, and promotion of Medicaid funding for abortions. Any efforts she might have made to encourage parental guidance and self-restraint were not well publicized or perhaps were subordinate to her other goals.

But the issues she raised and tried to deal with – the problem of teen sex, teen births, and AIDS – can only be addressed from two spectrums. The political left would say the problem could best be solved by school sex education programs and the easy availability of birth control and condoms. The political right would oppose that solution and call for a renewal of “family values” and “abstention.”

But teen pregnancies and the spread of sexually transmitted diseases will not be subdued simply by the tactics of fear education about AIDS and pregnancy, or by a plea for “righteousness.” Dr. Elders’ remarks about masturbation were more on the mark of how to deal with the diseases and excesses of sexuality in America than most of her previous policy statements. Despite the fact that the “M” word is distasteful and embarrassing to many, its importance as part of sexuality and part of the process of preventing disease and pregnancy ought to be discussed.

Perhaps the next surgeon general will be able to combine political tact with political courage and renew the debate about masturbation and sex education.

If we are to reduce unwanted pregnancies and sexually transmitted diseases, we ought not to just advertise birth control or condoms versus abstinence as options; we ought to advertise the following facts:

Masturbation is having sex with the only person whose sexual history you can completely trust.

And, if you must have sex with a partner, mutual masturbation is the safest sex of all.

Dr. Elders’ mention of the “M” word was embarrassing and distasteful to many people. But prudishness ought to have no part in the public discussion of a serious issue.

During the 19th century, masturbation was considered a disease. Doctors described its neurologic consequences as epilepsy, blindness, headaches, and memory loss. At one time it was even considered a virulent disease. Two patients were admitted to New Orleans Charity Hospital, one in 1872 and the other in 1887, for treatment of masturbation. Both died there. The cause of death was listed as masturbation.

Today, hospitals have other lists of sexually related deaths – due to AIDS, teen pregnancies, and premature births by teenage mothers. Perhaps Dr. Elders, with her departing comments, was right in encouraging more educational options for our sexually active youth. We ought to encourage abstinence. We ought to encourage safe sex. And, yes, we ought to talk about masturbation during sex education. The “M” word is, perhaps, the most practical of all.