Are Teens Really Engaging In More Oral Sex?

There seems to be a belief that teens are participating in more oral sex than ever before, possibly to avoid emotional involvement, vaginal sex and pregnancy risk, partially because some teens do not think of oral sex as "real" sex, therefore do not consider themselves sexually active if they are only participating in oral sex.

A recent study by Duberstein Lindberg and Santelli, "Non-coital sexual activities among adolescents," suggests it might be true. These authors used the 2002 National Study of Family Growth data from 2,271 teens aged 15 to 19 to report that oral sex was much more common than vaginal sex, but both seemed to occur for the first time within six months.

Their results suggest that slightly more than half of the teens had engaged in oral sex, and in fact, more had participated in oral sex than vaginal sex, but their evidence suggests that female teens who are having oral sex, have only done so with one partner.

These results suggest it is very important that teens be provided education and risk counseling about the sexually transmitted infection risks associated with both vaginal and oral sex. By ignoring oral sex in sexuality education, we are allowing teens to believe they are "safe" if they are only having oral sex.

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Labels: Healthline, Sexuality, Teen Health

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A Global Perspective on Teen Sex Habits

There is some good news about teen sex habits. The Journal of Pediatrics & Adolescent Medicine published a study and editorial suggesting that teenage sexual activity does not always have serious short-term and long-term health-compromising consequences, particularly in countries that are strongly accepting of teenage contraceptive use and are insuring adolescent access to contraception and sex education. Lest you are wondering, the authors were NOT talking about the United States.

The study reports data collected in 2002 from 33,943 adolescents from 24 European and North American countries, the majority of whom are protected against pregnancy (about 82%). The percentage of 15-year-olds who reported having had sexual intercourse ranged from 14% in Croatia to 38% in England, with boys reporting more sexual activity than girls. Condoms were the most popular contraceptive method and use varied between 53% in Sweden to 89% in Greece. Bummer for them though, condoms have a first-year failure rate of about 15% for teenagers when used alone, but on the bright side, they do help protect against sexually transmitted infections.

Contraceptive pills were the second most common contraception method used and ranged from 3% in Croatia to 48% in Flemish Belgium and the Netherlands. Dual use - using condoms and the pill - which is the best way to prevent pregnancy and sexually transmitted infection was only reported by 29% of teens in Canada - GO CANADA!

These results leave a lot of room for improvement though and suggest that there is still a high proportion of poorly protected and unprotected sexual activity going on and we can do a better job developing policies that encourage contraceptive use among sexually active youth.

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Labels: Healthline, Sexuality, Teen Health

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Literature for Transgender Youth

There may be up to 3 million transgender people in the United States (according to the National Center for Transgender Equality) which suggests that there are youth in every community who defy gender norms. It is universal, and although the 21st century is probably the most tolerant time in history, there are still youth who need the support of adults when questioning their gender identity because they are bullied at school or not accepted at home. Transgender youth tend to be invisible and may not know where to find support and resources.

Luckily, there are some great books that high school teachers can keep in their classrooms and libraries that will help questioning youth understand they are not alone.

Here is a list of five of them:

• Freak Show (2007) by James St. James, Dutton. A story about a teenage drag queen at an uptight private academy who wants to be not only accepted, but homecoming queen!
• Parrotfish (2007) by Ellen Wittlinger, SImon & Shuster. Did you know parrotfish can change gender? This is an idea that appeals to awkward Angela who wants to be accepted as Grady, and finds support in some unlikely places.
• Luna (2006) by Julie Anne Peters, Little Brown. Luna is a great story about Liam who transforms himself into Luna every night with the help of his sister's clothes and make-up, but wants to stop hiding.
• Choir Boy (2005) by Charlie Anders, Soft Skull Press. Berry loves to sing and when puberty threatens to change his voice, this young man decides castration or hormones may be the answer.
• Morgan in the Mirror (2004) by C.C. Saint-Clair, BookMakers Ink. Morgan is a trans man who decides to make a full transition to female.

Teachers are frequently seen as "safe" and therefore the adults that students first come to with questions about their gender or sexuality, and the best thing teachers can do is know about some of these books and resources to point the kids to. Libraries may not be able to include these books because of local politics, but classrooms can usually keep books under the radar. I have to warn you though, these books, along with books about homosexuality may never be officially checked out, but will disappear quickly, so check your stock frequently and be prepared to replace them on a regular basis.

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Labels: Book Review, GLBT, Sexuality, Teen Development

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But What is Hooking Up?

Warning - this post is not for the faint at heart or those people who believe "denial" is a form of birth control and safer sex.

Hooking up. I hear this term everywhere - from teens, professionals, parents, and in the media - but what exactly are the behaviors being referred to, and how dangerous are they from a sexually transmitted infection, point of view? What behaviors are teens participating in, how much fluid exchange is there, and do they understand how sexually transmitted infections can be transmitted via oral sex and even skin-to-skin in the case of herpes and HPV?

From what I had heard, and from the questions submitted at We're Talking Teen Health, I surmised that hooking up can mean getting together to hang out, or it may mean having sexual contact with a person they know, or just met, and that the sexual contact could include behaviors ranging from making out, petting (for us old folks), oral sex, fingering, anal sex, or vaginal intercourse. I was curious, so I asked the teens working with me this summer to explain what it meant. When they were done squirming, the consensus of these teens, ranging in age from 15 to 20, was that teens use the slang term "hooking up," to refer to everything short of sexual intercourse, but in college, when people are more likely to be having sexual intercourse, it can mean that, too.

What I admit surprised me, was that the "everything" short of sexual intercourse included not only making out (kissing, rubbing, touching, with or without clothes), but also oral sex and fingering, which were perceived as less sexually intimate than vaginal intercourse. It seems the current generation of teens are far more comfortable sharing their bodies with each other than we, as parents and professionals, may understand. Sadly, I admit that my generation is more likely to perceive oral & anal intercourse, as well as fingering, things that are more sexually intimate than vaginal intercourse, which suggests we are out of touch and that our "sex talks" may not be preparing teens for the sexual pressure or expectations they may encounter when they are out in the real world.

The teens reported that oral sex, and "fingering" (a partner inserting one or more fingers into a vagina), were just an extension of making out and considered "no big deal." In fact, they were likely behaviors that "just happened" before any discussion about potential risk occurred, and not even likely to be perceived as "sexual activity" that would require a conscious decision or any preparation.

I explained that what was concerning me was that so many girls were submitting questions on We're Talking Teen Health wondering if they had been exposed to a sexually transmitted infection by not using a condom for oral sex, or why they were bleeding or swollen after having been "fingered," by a partner. These teens seemed to have no concept that they were likely bleeding because their hymen, or the delicate vaginal tissue, had been torn, and swollen because there was likely not enough lubrication or too much friction, both things that suggest the experience was far from satisfying.

All-in-all, these scenarios did not sound to me like they were sexually pleasurable in the way my (granted middle-aged) brain thinks they should have ben, in order to justify the risk. I am left wondering why these young women are participating in a behavior that leaves them bleeding and hurt, or exposed to infection, and how they are participating in these activities without forethought about the consequences.

What this conversation suggested to me was that parents need to have a chat with their teens about the sexual experiences "their friends" might be having, and the risks and benefits associated with those behaviors. Just asking if friends are having sex, and breathing a sigh of relief when the answer is "no," is too easy (what a surprise). Finding out that teens are actually having oral sex and that fingering is seen as a safe and not sexually intimate activity, may require another, more uncomfortable conversation.

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Condoms Prevent STDs: Duh!

A recent study reported in the American Journal of Public Health (2007; 97(6):1090-1095) found that adolescents who use condoms the first time they have sexual intercourse are less likely to have chlamydia and gonorrhea seven years later, and were no more likely to have more sexual partners than adolescents who did not use condoms at first intercourse.

The study including more than 4,000 teenagers who completed interviews about their sexual behavior over a 6-to-8 year period. Participants were also tested for chlamydia and gonorrhea seven years into the study. Of those teens who were sexually active during the study, 62% reported using a condom the first time they had sexual intercourse and those who used a condom were half as likely to have a sexually transmitted disease seven years later. All sexually active teens reported approximately five different sexual partners during that 6-to-8 year period.

These results support, as health change behavioral theory would suggest, that teens who protect themselves with condoms the first time they have sex, are more likely to maintain healthy, STD and pregnancy preventing habits through their teen and young adult lives. With sexually transmitted infection and pregnancy rates being the highest among 15-25 year olds, it is extremely important that parents, teachers, and peers encourage teens to protect themselves and "not just let sex happen."

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Labels: Chlamydia, Sexuality

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Book Review: Unhooked: How Young Women Pursue Sex, Delay Love, and Lose at Both (2007)

This book, by Laura Sessions Stepp suggests that sex on college campuses for young women today means joyless encounters devoid of pleasure, leading to cynical and depressed young women. Her conclusions are supported by interviews with young women and stories about nine girls over the period of one year. The thing that all of these young women have in common is that none of them seem happy, fulfilled, or even very much in touch with what it would mean to have an intimate relationship. As I read this book I was profoundly sad, for the young women, for the mothers of the young women, and finally, for the author, who listened to tales of sadness, anorexia, depression, binge drinking, and rape.

I think every parent with teenage daughters should read this book, to remind ourselves about what we need to be talking about with our kids, and how to prepare them for college, particularly if the scenario described by this author is one that they will find themselves facing. Ms. Sessions Stepp seems to suggest that the sex education our children are not getting, along with messages from parents that downplay intimate relationships in exchange for competition, good education, and career goals, is creating a generation of young women who not only feel entitled to immediate gratification, but are trying to pursue love through sex, and failing miserably.

The young women having multiple sexual partners were getting sexually transmitted infections, but there is very little mention of how often they were being tested, using birth control and/or using condoms. In addition, maybe the most disturbing part of the book for me, was how little these women expected from their sexual partners, how little "getting to know you" time was expected, and how poorly they allowed men to treat them. We as parents are failing miserably if we are not giving our daughters the skills to identify disrespectful, emotionally abusive, and unfulfilling relationships, as well as the understanding that their bodies are their own and no one can enter their bodies without being invited, under any circumstance.

I was also struck by the fact that these young women seem to be approaching everything in their lives with the same "lack of self-reflection." Their work ethics, sports, bodies, friendships, school performance, family connection, and sexuality seem to all be missing a depth and sense of connection to the world around them that may be indicative of a much larger social ill - a lack of connection, in exchange for control, physical sensation and monetary gain, that would make true satisfaction, with any aspect of their lives, impossible.

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GLBT Movies to Share With Your Teens

The social construction of sexuality in our country has mostly ignored the reality of gay and lesbian adolescents. Until into the 70’s the psychiatric profession regarded homosexuality as an illness, and well into the 80’s, gay youth were treated as if they were a distinct category from “normal” and almost a separate species.

In the 80’s and 90’s gay adolescents were characterized with a “suffering suicidal” script and the social expectation was that they could expect injustice and discrimination.

The early 2000’s have opened up the possibility that gay adolescents might include resilient, proud and adaptive individuals. In the future, I am hoping that “gay” adolescence will not exist and that same-sex-attracted individuals will be found to be quite ordinary, neither better or worse off than other adolescents.

Talking about GLBT issues can be hard for parents, but it is an important conversation to have, so your teens know they can talk with you about anything they ar thinking about. Below are movies with GLBT themes that you may want to watch with your teens - as a way to open up conversation about GLBT issues in your home. Have fun!

• In & Out (1997)
• But I’m a Cheerleader (1999)
• Hedwig & the Angry Inch (2001)
• Better than Chocolate (2002)
• Treading Water (2002)
• My Life on Ice (2002)
• Saved! (2003)
• The Trip (2003)
• Inescapable (2004)
• Mysterious Skin (2004)
• Saving Face (2004)
• Brokeback Mountain (2005)
• Transamerica (2005)
• Breakfast on Pluto (2005)
• Kinky Boots (2006)

Links to previous posts: Gay Teens, Gay Teen Suicide Risk
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Labels: GLBT, Sexuality

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Cybering - Scary or Safe?

Cybersex, computer sex, or Internet sex describes a shared sexual experience between two people (or more) connected via the Internet. I guess this is the next generation of phone sex. This experience, sort of like a fantasy, can be verbal, visual, or written, and include pictures, webcams, the use of avatars, or actual masturbation while participating. These experiences could be within intimate relationships, like lovers separated geographically, or with strangers within chat rooms or via instant messaging.

The safer part is there is no sharing of body fluids, and no disease or pregnancy risk. I suppose we should actually consider this is as alternative to early sexual participation given the only risk is getting attached emotionally to a stranger, but I have trouble imagining that I could encourage emotionally detached sexual expression for teens.

The scary part is that the participants are sharing very sexually explicit words, images, and in some cases vivid fantasies and role-playing situations that may be "beyond their years." The use of web cams also may give a sexual predator clues about identity.

Another great reason to keep computers in public spaces!

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Labels: Media, Sexuality

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Loose Women on Campus?

"Hooking up" means having some form of sex, ranging from petting to intercourse, with someone who may or may not know well, usually without much thought. The point may be pleasure, because hookups take less time than dating, or to get social status, or even stress. The sex may be consensual, or if the young woman has been drinking, she may not even remember it. The sex may also be protected, but given the sexually transmitted infection rates on college campuses, it is probably not. In theory, the cultural support of hooking up seems to give women the same freedom that men have always enjoyed - sex without emotional ties. Unfortunately, women rarely do things that do not have emotional ties, and the "pleasure" from a hookup, may not be worth the emotional let down when the hookup fails to be "Mr.Right."

According to a new book by Laura Sessions Stepp called "Unhooked: How Young Women Pursue Sex, Delay Love, and Lose at Both," sex on college campuses for young women today means joyless encounters devoid of pleasure, leading to cynical and depressed young women. She reports her conclusions are supported by interviews with "dozens" of young women that resulted in the book, which is a story about nine girls over the period of one year.

I am pretty ambivalent about this and think a lot more research and interviews need to be completed before I buy the dismal conclusions. I look forward to your comments!

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Labels: Sexuality

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Speaking Out About Adolescent Sexuality

The Reverend Debra Haffner is talking about adolescent sexuality again, and I love it! The Center for American Progress published an article recently in which Reverend Haffner talks about the fact that parents in the United States seem to be raising some of the most sexually confused adolescents in the world. While our movies, advertising, Internet, music, and TV give the message that "everyone is doing it," the federal government and 46 states have policies endorsing abstinence-only until marriage, in spite of the fact that the majority of people have been having sex before marriage for decades. In addition, today's teens reach puberty earlier and marry later than any other generation in history.

The article discusses the "Open Letter to Religious Leaders on Adolescent Sexuality" just released by the Religious Institute on Sexual Morality, Justice, and Healing recognizes the fact that sexuality in most religious communities remains shrouded in silence but that adolescents have the right to full, accurate sexual health information and to be accepted within the faith community regardless of the sexual decisions they have made. The letter also lays out specific actions that faith communities need to take in order to support those rights, which include:

• Supporting parents in teaching children and teens about sexuality;
• Creating an honest, and open environment for discussion of sexuality issues, including age-appropriate sexuality education in the context of faith values;
• Collaborating with community organizations to promote adolescent sexual health; and
• Recognizing the sexual diversity of adolescents in their congregations, including those who are sexually active and those who are gay and lesbian.

Reverend Haffner is calling for religious leaders to accept their responsibility to speak out against educational programs that deny young people the medically accurate information they need to protect themselves and others from sexually transmitted infections and unwanted pregnancy. She also encourages religious leaders to oppose parental notification and consent laws that restrict teens' access to life-saving reproductive health services. She acknowledges that this commitment will be tough for many clergy who have not received any training during their seminary time to address human sexuality issues, but struggle is not new to the church!

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Labels: Sexuality

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Suicide Risk and Gay, Lesbian and Bisexual (GLB) Youth

Every time I hear about a teen suicide that no one can explain, my heart breaks. You know the stories in the paper that report that a healthy, happy, athletic, beautiful, popular, and smart student has taken his (or her) own life and no one understands why. I always fear that the student had a secret that they believed would make them unlovable, and sadly, sometimes that secret is their sexual orientation.

The November 2006 issue of the Journal of Adolescent Health included an article about what protects GLB youth from suicide risk. The research suggested that gay, lesbian and bisexual (GLB) youth are particularly vulnerable to suicidaal feelings, although family connectedness, teacher caring, other adult caring, and school safety all protect youth from suicide attempts.

Data for the article came from the 2004 Minnesota Student Survey of 9th and 12th grade students in which 21,927 sexually active youth were grouped according to the gender of their sex partner(s) into GLB and non-GLB groups. Four protective factors and suicidal ideation and attempts were compared across groups. The results reported that:

• 2,255 respondents had same-gender experience;
• over half of GLB students had thought about suicide;
• and 37.4% reported a suicide attempt.

GLB youth reported significantly lower levels of each protective factor than their non-GLB peers, suggesting that suicidal ideation and attempts could be reduced if GLB youth perceived more support from their families and schools.

Do me a favor and tell your kids - in whatever way you can - that you love them unconditionally, and that you love them no matter what their sexual orientation is or will be. Be clear - say the words - "you know that I love you more than anything in the world, and that I would love you just as much if you were gay, lesbian, or bisexual, too!" Don't let your teens have a secret that could kill them!

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Labels: GLBT, Sexuality, Suicide

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It's a Whole New World: Relationships and Sex in the 21st Century

Information about Teen Sexual Behavior Let me first say, that although we were all teenagers once, our experience was so different than what our teens are experiencing today, that we cannot assume to know anything – and applying the way our parents parented us, or our experiences – is a wasted effort.

Today’s teens have access to more information about relationships and sex, and at younger ages, than we could ever have imagined. They are also better prepared to handle that level of information then we would have been. The world has changed – the Internet has brought the world to our kids before we are ready!

What kids are the most in need of – is us. Research study after research study documents the fact that teens nationwide are suffering from a lack of honest communication from their parents and other pivotal adults around them… They do not have the information they need about their bodies, and their hearts.

I know that is true because at the Palo Alto Medical Foundation we get more than 350 anonymous questions a month submitted on the We're Talking Teen Health web site – most are related to sexuality and relationships.

The good news is that research shows talking to kids about sexuality does not make them have sex earlier! In fact, it protects them from situations in which “sex just happens” and the consequences that follow, including sexually transmitted infections and pregnancy.

In addition, the Centers for Disease Control and Prevention (CDC) suggests:

• youth are having less intercourse;
• using more contraception, and
• that there was 30% less teen pregnancy between 1994 and 2004.

Now the bad news!

• Nationally, 63% of high school students have had sexual intercourse before they graduate from high school;
• The average age of first sexual intercourse, and first oral sex, is 15;
• 70% of teens say their first sexual experience was not planned;
• 80% of teen sex happens at home; and
• Only 60% of youth who are sexually active used a condom the last time they had sex.

What can we do?
Teens need to know that 66% of teens and 81% of 12 – 14 year olds regret their first sexual experience and adults need to make sure that teens have the knowledge and strength to “make good decisions.”

Parents being “in denial” will not help and it will undermine our relationships and make them superficial. Having an open relationship means that your kids tell you things! Sifting through their emails or reading a diary or blog is a major invasion of privacy and it will ruin your relationship. Do not do it!

Parents need to talk honestly with their children about sexual rights, pleasure, and risk. All teens need to know the danger signs of abusive relationships and that feeling all “tingly and floaty” does not mean they are in love – it means they are sexually excited.

Teens need to know that it feels good to be excited, but that sexuality should be protected, consensual and planned with someone they love or, it is not going to feel great, and there are life threatening consequences.

Take Home Messages From the Teens
Preparing for a recent talk I asked several teens what they hoped their parents would get from my talk, and these are some of the things they said:
FIRST, “Being open matters. The people I know who can tell their parents anything are much safer, and much smarter, than those whose parents are disapproving or just awkward.”

SECOND, “Please respect our relationships – we know we are not likely to marry our teen sweetheart, but what we are experiencing in our relationships is very real to us.” And I would like to add – the first time teens experience things – whether it is love or sex, - is likely to be the most intense – and one they remember forever – help them savor it – do not blow it off.

Initiating Good Communication
There are rules for good communication with your child on any subject. For example, it’s best to start early. Waiting until your child is 12 years old to discuss important issues is not a good idea. Kids are hearing about and forced to cope with tough issues, such as alcohol, drugs and peer pressure, at increasingly younger ages. There is a lot to discuss with your child about these complex topics, and the lessons should be gradual. Also, it’s important to tailor communication to the age of the child and add more information as your child grows. If you start communicating about everything when your child is 10, rather than beginning the conversations when he or she is younger, it may feel very intrusive to your child.

Initiate Conversations
Begin to have conversations with your child about a variety of topics. While some kids will ask you questions, others need you to start the conversation. This does not mean that you should start a conversation out of the blue; it means be aware of naturally occurring moments. For example, when something on TV or the radio mentions kissing, take the opportunity to ask your child what he or she knows about the topic, or if he or she has any questions. Listening to what the kids talk about in the car may provide other opportunities. Jump right in when you can.

Create an Open Environment
Children are constantly bombarded with images and messages through television, radio and the Internet. At no other time in history have children been exposed to so much information, and they need to know they can ask you anything. When they do ask you, ask what they really want to know, and answer as clearly and honestly as you can. Admit if you do not know something, and look for the answer together, or tell your child that you will find out the answer and let them know.

Communicate Your Own Values
Share your values with your children. Do not simply assume that they understand your family’s values just because they live in the same house. Clearly communicate what you believe in and explain why you have the values you do and why you encourage them to share your values.

Listen to Your Child
If you really listen, your children will feel more comfortable talking to you and coming to you with questions. They will know that their opinions and concerns are important because they have your undivided attention, and that you are committed to understanding their feelings and providing information.

Try to Be Honest
Whatever your children's age, they deserve honest answers; it strengthens their ability to trust. If you do not give them complete answers, they might make them up, which may be more frightening than the truth. Remember, the most difficult questions also give you a chance to communicate your values.

Be Patient
Let your child ask the whole question, and ask for the story that explains why he or she wants to know. This will help you give the correct answer without overwhelming them with too much information. In most cases, kids are not asking for the complex answer you might be tempted to give.

Talk About it Again and Again
If your child asks the same question several times, maybe over several days or weeks, be tolerant and give the answer, over and over again. Chances are good that your child is taking in some of the answer, processing it and then coming back for more information when they are ready. Persistence is a valuable character trait.

Ask for Feedback
Let a little time pass after an important conversation and then ask your child to tell you what he or she remembers from the conversation. Also ask what he or she understood, or thought you were saying. Try asking your child what you said -- the answer may surprise you. More importantly, it gives you an opportunity to repeat what you believe.

Resources
Web Sites
Talking with Kids About Tough Issues is a national campaign by Children Now and the Kaiser Family Foundation with tips, resources, and facts about sex, HIV & AIDS, violence and drugs.

The National Campaign to Prevent Teen Pregnancy seeks to improve the well-being of children, youth, and families by reducing teen pregnancy. The Campaign's goal is to reduce the teen pregnancy rate by one-third between 1996 and 2005.

Planned Parenthood is the world's largest and oldest voluntary family planning organization. Planned Parenthood is dedicated to the principles that every individual has a fundamental right to decide when or whether to have a child, and that every child should be wanted and loved.

Books
PAMF has a resource list on the preteen site.

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Labels: Sexuality

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Good Sex = Good Communication

Ask any adult woman if communication matters to sex and you will get a clear answer - YES! Ask a teenager, and you are likely to get many different answers.

A recent research study by Widman, Welsh, McNulty & Little published in the Journal of Adolescent Health explored communication and contraceptive use in adolescent couples. Their results suggested that open sexual communication is important to contraception, and specifically:

• 30% of the couples did not use contraception during first intercourse;
• Almost 50% of couples did not use contraception every time they had sex;
• Open sexual communication meant more contraceptive use; and
• Teens who reported being more satisfied with their relationship reported more open sexual communication.

So, the take home message is - teens who talk about sex are happier in their relationships and more likely to use contraception - translating to parents as follows:

• Talk to your teens about sex and protection;
• Clearly state your expectation that before they have sex they need to be able to talk about sex with their partner - about protecting themselves from HIV and other sexually transmitted diseases and deciding on a reliable method of birth control to protect themselves against unwanted pregnancy; and
• make sure they know where to obtain condoms and birth control.

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Labels: Sexuality

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The Incredible Melting Condom

As I hope you know, HIV infection rates are growing among women as heterosexual transmission becomes more common, and there are places in the world where up to 74% of the new cases each year are in females. Biology is part of the problem. The skin lining the vaginal tract contains immune-system cells that fight infection and are the same cells that HIV infects. Social customs that allow older men to have multiple sexual partners and take younger partners are also a problem, as is the fact that most countries do pretty poor sexuality education.

This places a huge burden on women to prevent infection, especially since the best prevention, male condoms, require male cooperation. One proposed answer is vaginal microbicides that are virus-killing gels and creams that a woman can use without male permission, but they have to be inserted 1-2 hours before sex, and they "leak" out. There are at least five products in testing now.

However, in December there were several news articles about a proposed better way for women to protect themselves from HIV. One was in the Economist, that described a squishy microbicide-containing lining for the vagina from Patirck Kiser and colleagues at the University of Utah.

Talk about magic - this "molecular condom" starts off as a liquid that a woman can insert into her vagina, where her body temperature and the acidity of her vagina turn the liquid into a gel. The gel stays in her vagina until the alkalinity of semen turns the gel back into a liquid, releasing antimicrobial drugs that kill HIV. How cool would that be?

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Youth Risk Behavior Surveillance - United States, 2005

In the United States, 71% of all deaths among people 10 to 24 years old result from four causes - motor vehicle crashes, unintentional injuries, homicide and suicide. In 2005 the National Youth Risk Behavior Survey (YRBS) data indicated that during the 30 days preceding the survey, many high school students engaged in behaviors that increased their likelihood of death from these four causes:

• 9.9% had driven a care or other vehicle after drinking alcohol;
• 18.5% had carried a weapon;
• 43.3% had drunk alcohol;and
• 20.2% had used marijuana.

In addition, in the 12 months preceding the survey:

• 35.9% of high school students had been in a physical fight;
• 8.4% had attempted suicide;
• 46.8% reported ever having sexual intercourse; and
• 37.2% had not used a condom at last sexual intercourse.

Among adults over 25 years old, 61% of all deaths result from cardiovascular disease and cancer, and we know that many habits that contribute to those causes of death start during adolescence. In particular, results show that in 2005 a total of 23% of high school students had smoked cigarettes during the 30 days preceding the survey and 80% had not eaten at least five servings of fruits or vegetables during the previous week, and 13% were over weight.

Every other year the Centers for Disease Control and Prevention collects YRBS data from a scientifically sound sample of all public and private schools in all 50 states and the District of Columbia. In 2005 that sample included 13,953 questionnaires from 159 schools with grades 9-12. It is clear that our youth need additional support developing habits that will help them stay healthy in adulthood.

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Labels: Sexuality

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What Motivates Teens to Have Sex

A recent article in Perspectives on Sexual and Reproductive Health (2006) by Ott, Millstein, Ofner, & Halpern-Felsher, explored relationship goals and positive expectations about sex with 637 ninth graders. These researchers concluded that the youth valued intimacy the most, then social status, and finally, sexual pleasure.

With all the focus on the risk of sexually transmitted infection including HIV associated with sexual behavior, there has been plenty of research about adolescent perception of the negative consequences of sex, but little about what motivates teens to engage in sexual behavior in the first place. If the sexuality education teens are receiving focuses only on the risks, ignoring the reasons they engage in sex, I would expect that the education is destined to fail.

Sexual behavior can be motivated by perceived benefits including, the desire for excitement or pleasure, intimacy, or peer approval or respect (social status). The teens in this study expected sexual behavior to bring intimacy, pleasure and increased social status, but there were gender differences as well as differences based on sexual experience.

Not surprisingly these researchers found that girls in their sample valued intimacy significantly more and sexual pleasure less than males. Sexually inexperienced females thought that having sex would bring them more social status than did sexually experienced girls. Males reported higher mean expectations that sex would result in pleasure and social status than did females. Females and sexually inexperienced youth reported lower expectations that sex would meet their goals than did males and sexually experienced youth.

It would seem to me that if male and female teens are looking for intimacy and social status, we, the adults in their lives, need to help them identify non-sexual ways to achieve those goals. Especially in the case of girls, who seem to understand that becoming sexual may be a social liability, adults need to provide more discussion about how their expectations may differ from reality. The results in this article also would suggest that our stereotypes about males being motivated by pleasure may be inaccurate.

As parents, educators, and clinicians, it is important to be aware of the expectations teens have for sexual involvement and provide frank discussions and skills to help teens achieve intimacy, social status and even sexual pleasure, without sexual risk. It makes perfect sense to me that teens are looking for connection and closeness in our culture, I think we all are.

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Teens and Single Sex Education: Is it Good for Their Health?

Why does the concept of single-sex education continue to be considered? There are many people on both sides of the argument about whether single-sex education is beneficial for children and teens, and you can find research to support both perspectives.

On one hand, advocates say that students in same-sex schools are less distracted by the opposite sex, girls demonstrate more interest in math than their co-educated peers do, and students in same-sex schools score significantly better on cognitive tests. This would suggest that individuals focus on schoolwork more or have a broader range of interests available to them and that the academic options are less gendered-limited.

The other side of the argument includes concerns that if teaching patterns are altered to "fit" one gender, stereotypes will be reinforced and the differences between the genders will be enhanced, ignoring individual difference. This perspective is related to the fear that in a same sex educational setting each gender will reinforce the cultural expectations they perceive - girls becoming solely concerned with their looks and boys becoming solely concerned with their strength.

We do know that any education must be well-implemented, take into account individual differences, and "engage" students at many levels. Whether that education is public or private, same sex or coed, seem to be less important than how motivated students are to participate in the education provided. There are poor schools everywhere.

Having two daughters in a single sex school I have to admit I have a pretty strong bias, but I also see a tremendous amount of difference between the coeducational elementary school education they received and the single-sex middle and high school educations they are currently receiving. Walking around campus after school the difference is particularly striking. There are groups of girls preparing for, or competing in, sports, there are practices in progress for plays, orchestra, and academic competitions, as well as clubs meeting, community service activities, and grabbing an occasional nap. The clubs include subjects that are definitely not gender-determined. The include subjects as diverse as robotics, manga/anime, knitting, trivia, and garage bands. The girls excel at many different things, none limited by their sex.

This same sex environment encourages these girls to try everything and not be afraid to fail at anything. Just that ability to try something new promotes health and wellness in many ways. Physically, kids who do not fit the social "norm" of attractiveness are less focused on their appearance then they might be in a coeducational setting, and much more likely to participate in sports. Academic kids are able to excel as well, finding they are less concerned by being called "nerds." Kids in same sex schools also tend to be more comfortable with their bodies, as well, allowing more open discussion about the changes associated with puberty and growing into adults.

Nothing fixes everything, but I suspect that same sex schools support student health a little bit more than coed schools, particularly if classes are smaller and there are counseling and support services available.

You can find more information about same sex education at:
The National Association for Single Sex Public Education (NASSPE)
A recent article by Meghan O'Rourke, in Slate.

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Religion and Teen Sexual Behavior

The Journal of Adolescent Health included a recent article entitled "The role of parent religiosity in teens' transitions to sex and contraception" exploring the associations of parent and family religiosity with the timing of sexual initiation or use of contraception at first sex.

The researchers analyzed a sample of sexually inexperienced adolescents aged 12–14 years in the 1997 National Longitudinal Survey of Youth (NLSY97) to test the association between multiple dimensions of parent and family religiosity and the transition to first sexual experience and contraceptive use at first sex during the teen years. They assessed the association between parent and family religiosity and the timing of adolescent sexual experience and examined contraceptive use separately by gender and race/ethnicity.

Among all sub-populations except African American adolescents, more frequent parental religious attendance was found to be associated with delayed first sex. An important predictor of delayed sexual initiation among teens was engaging in religious activities on a daily basis. Unfortunately, strong religious beliefs and more frequent participation in family religious activities was associated with males being LESS likely to use contraception at first sex.

The authors concluded that more frequent parental religious attendance and family religious activities are related to a delay in sexual initiation, however, stronger family religiosity does not translate into improved contraceptive use.

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Is it Consensual Sex or Rape?

The Washington Post recently published a story that disturbed me deeply. The story "Court Says Consensual Sex Can't Become Rape" by Ernesto Londono reported about a Court of Special Appeals in Maryland that overturned a rape conviction based on a legal view that "a woman cannot be raped after she has agreed to have sex."

According to this story, the issue was that at some point during a sexual encounter the female asked the male to stop, and he did not. His defense is "she had started to have sex," so it was consensual. Her perspective is that she did not feel she could say no and when she experienced pain during intercourse, she told him to stop, and he did not. The legal issue at hand is the difference between rape and sexual assault.

As a parent, I want to be able to teach my children that "no means no" and that they can stop any behavior, at any time, and have the right to expect the person they are with to respect their decision and choice. As a health educator, we are teaching sexuality education classes that include the message that if a sexual partner refuses to use a reliable method of birth control or a barrier method to prevent HIV, or if there is a perceived sexually transmitted infection, or the intercourse is rough or includes violence or coercion, a person can say "stop." Do we need to add the caveat, "unless you already consented?"

But what is "consent to have sex?" According to RAINN (Rape, Abuse, & Incest National Network) consent must be explicit. A prior or current relationship or previous acts of intimacy are insufficient indicators of consent and verbal consent must be obtained both in each instance of sexual intimacy and as the level of sexual intimacy increases (e.g., moving from kissing to petting, from petting to oral sex, from oral sex to intercourse, etc...). Wouldn't that suggest that at any point in a sexually intimate encounter, a person can withdraw their consent, and the other person would be expected to stop?

As a community, including the courts, medical professionals and parents, we need to be clear - rape is sexual contact that occurs against a person's will by means of force, violence, duress, or fear of bodily injury. How hard is that to understand?

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Abstinence in the news

Two items about abstinence caught my eye this week. The first was an interesting article in a recent Journal of Adolescent Health (Vol. 39(2), p. 192-198) by Ott, Pfeiffer & Fortenberry describing abstinence according to the wisdom of 42 adolescents aged 11-17 recruited from primary-care clinics. Researchers found marked confusion about the term "abstinence," but found the concept "choosing not to have sex" was relevant for teens. Participants in this research saw sex as a powerful transition to adulthood that occurred when the "right" person or a "committed relationship" suggested it.

The second was a statement from the Government Accountability Office (GAO) reminding the Department of Health and Human Services (HSS) that STD prevention materials distributed by federally funded abstinence programs must "contain medically accurate information on condom effectiveness."

In 2006 abstinence-based sexuality education programs received around $170 million dollars, and have routinely exaggerated condom failure rates. This reminder from the GAO would suggest that abstinence-based sexuality education should be required to use something like a CDC fact sheet which states: "For persons whose sexual behaviors place them at risk for STDs, correct and consistent use of the male latex condom can reduce the risk of STD transmission. However, no protective method is 100% effective. When used correctly, condoms are highly effective in preventing HIV and can reduce the risk of transmission of gonorrhea, chlamydia, and trichomoniasis."

Together these articles reminded me that teens need to be engaged in conversations about the "choice" to be sexual, with the right person, protecting both partners from the risk of an unwanted pregnancy or sexually transmitted infection, including HIV, and avoiding any coercion or pressure to participate in activities that are not consensual.

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Sexuality Education is Failing Miserably

Recently there was a great story in the Washington Post article by Laura Sessions Stepp, staff writer and author of "Our last best shot: Guiding our children through early adolescence." I loved her book, and the title of the article, "Beyond the Birds and the Bees," was right up my alley, so I read it. The article is about a well-loved professor at the University of Maryland who teaches sexuality to college students, most of them suffering from a serious lack of sexuality education. It was very distressing to me that college students are asking questions about birth control, and that only 50% of the sexually active students are using condoms, meaning the other half of them are at risk for unwanted pregnancy and/or contracting a sexually transmitted infection, including HIV. And yet, I bet every one of them has had their meningitis vaccine, which is good, but so illogical.

As a society, our sexual phobias are putting our children at risk, and I think we should be extremely concerned that college students need sexuality education. This generation has experienced more media, seen more sexual innuendo, and probably experienced more oral sex than any previous generation, and yet, they actually kno