At the Fourth International Congress on School Hygiene in 1913, teachers and medical professionals came together to discuss the health and hygiene of schoolchildren, tackling topics like sanitation, contagious disease reporting, and the purity of fresh milk. However, gynecologist Robert Willson expressed his desire to move beyond health care in the schools and into social hygiene: “It seems a far cry to those of us who were at work in this field twenty years ago to the eager demand for sex instruction and sex knowledge that is heard to-day on every hand from the parents of children. A long hard road has been traveled, the first portion very steep and hazardous, the latter part so easy as almost to appear treacherous.” Little did Willson know how prescient his statement was! The road ahead was indeed treacherous, as social hygienists, who had made deep inroads in the conspiracy of silence, faced new and greater challenges to establishing sex education curricula in the public schools. While many Americans were more accepting of sex in the press and in reform circles, most still were not willing to put it in schools. Willson seemed genuinely surprised that he and his fellow advocates would meet such resistance. Yet that is exactly what happened.

When Willson spoke in 1913, the time seemed ripe for bringing sex to school. Progressive educators recognized that the schools provided merely one of many institutions for social education. Schools necessarily competed with the family, churches, civic organizations, and the state. Across the country, Progressives prompted the formation of institutions such as settlement houses to meet the changing needs of a modern, industrialized nation. Settlement houses provided a wedge to reach people in need, and reformers saw the broader public school system as the ideal habitat for an even larger program of community outreach, reform, and uplift. But during the early years of the twentieth century, public schools began taking over more and more educational responsibilities that had traditionally been in the domain of the home. This involved everything from adult education and citizenship classes for new immigrants to bathing students who did not meet the school's standards of hygiene.