The White House Friday signaled President Bush's frustration with Surgeon General David Satcher, a day after the Clinton appointee issued a frank and controversial report on sex education.

"The president understands the report was issued by a surgeon general that he did not appoint, a surgeon general who was appointed by the previous administration," Bush spokesman Ari Fleischer said.

He added that Bush had not read the report, which called for communities to encourage abstinence from sex as well as birth control for those who chose to have it, and it said there's no scientific evidence that abstinence programs are effective. Satcher also said Americans should develop greater understanding toward gays and lesbians.

Fleischer singled out the abstinence issue to explain the chasm. "The president continues to believe that abstinence and abstinence education is the most effective way to prevent AIDS, to prevent unwanted pregnancy," he said.

Satcher's report was the latest in a long history of reports from surgeons general that have rankled the White House. Past surgeons general have issued reports on venereal disease, smoking and AIDS, often to the consternation of the president.

"Only do-nothing surgeon generals are not controversial," said former surgeon general Joycelyn Elders, who was forced to resign in 1994 after suggesting it makes sense to talk about masturbation in schools.

Satcher began his four-year term in 1998 after surviving a confirmation battle in the Senate led by then-Sen. John Ashcroft, R-Mo., now Bush's attorney general. His term expires in February.

Since taking office, Satcher has issued reports on mental health, suicide and other topics, but Thursday's "call to action" on sexuality is easily the most controversial of his tenure.

In his report, Satcher said it's smart to encourage abstinence, but he said schools and communities must also talk about birth control and support health clinics that provide contraception in order to help prevent pregnancy and disease.

But "abstinence-only" education programs, which bar any talk of contraception, are incredibly popular with many conservatives, and Bush has called for increased federal funding of them.

Asked in an interview about the political implications, Satcher said he wasn't taking sides. "We try to make very clear what's needed to improve sexual health and what's supported by the science," he said.

The report also encourages abstinence from sex until one is involved in a "committed, enduring and mutually monogamous relationship." Federal abstinence programs call for abstinence until marriage.

Asked about the difference, Satcher said: "I have to deal with reality because I'm a public health leader. I'm not a political leader or a religious leader."

Conservatives, the core of Bush's political base, complained loudly about the report, and Bush advisers said they are now demanding Satcher's resignation. One senior official, speaking on condition of anonymity, said Bush strongly objected to portions of Satcher's report and had little confidence in him.

Fleischer refused to say whether Bush stood behind Satcher, though he routinely offers endorsements of other personnel.

Officials later said Fleischer was expressing Bush's disappointment in Satcher, though they are not likely to seek his resignation. They couldn't force Satcher to leave even if they wanted to, since he was confirmed to a four-year term.

But Bush could pressure him to resign, just as President Clinton pressed Elders. In an interview Friday, Elders said she left for fear that the administration would take away her staff and her budget, leaving her with little more than a title. And she was at the start of her term, whereas Satcher is nearly done with his.

"I had a long time to go if I was just going to sit there and look out the window," she said.

Administration officials expect that Bush will appoint his own surgeon general when Satcher's term ends next year. For his part, Satcher -- who has been a target of conservatives since his nomination -- has never expected Bush to ask him to stay for a second term.