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Adolescent sexuality

INTRODUCTION

From Aristotle's early treatises on sexual desire to Sigmund Freud's theories of psychosocial development, adolescent sexuality has been a controversial topic for virtually every generation. As the 21st century unfolds, society will continue to be challenged by adolescent sexual behavior and its consequences. Although medical providers often discuss adolescent sexuality in terms of "risk", it is important to remember that sexuality, sexual behaviors, and sexual relationships are an important and necessary part of human development. Responsible sexual behavior (eg, delaying initiation of sexual intercourse, choosing caring and respectful partners, increasing the use of condoms, and using effective contraception) is an important public health issue. The United States Healthy People 2020 goals include improved pregnancy planning and spacing; prevention of unintended pregnancy; promotion of healthy sexual behaviors; and increased access to quality services to prevent sexually transmitted diseases and their complications [1,2]. The World Health Organization and other agencies interested international health also identify adolescent-friendly health services as a worldwide priority [3,4], with 70 percent of more than 1 billion youth (10 to 19 years) living in developing countries [5].

Among adolescents in the United States:

  • Young women reach puberty and sexual maturity (eg, breast development, menarche) at earlier ages than ever [6]. (See "Normal puberty" and "Definition, etiology, and evaluation of precocious puberty".)
  • Approximately one-half of high school youth report having had sexual intercourse, and one-third report being currently sexually active [7]. Prevalence of sexual activity increases with age, rising from 33 percent in 9th graders to 63 percent in 12th graders [8].
  • Trends (from 1991 to 2011) in the Youth Risk Behavior Survey indicate that [8]:

  • Rates of sexual activity have decreased (54 to 47 percent)
  • Rates of sex with more than four persons have decreased (19 to 15 percent)
  • Rates of condom use at last intercourse increased from 1991 to 2003 (46 to 63 percent) but remained stable from 2003 to 2011 at 60 percent

  • Despite increases in the rate of condom use by teens in the 1990s, one-fourth of sexually transmitted infections (STI) each year occur in young people aged 15 through 24 years; youth are over-represented, accounting for almost one-half of new infections [9]. Human papillomavirus (HPV), Chlamydia, and trichomoniasis, account for almost 90 percent of STIs in this age group [9]. One in four young women ages 14 to 19 is infected with at least one of four STI (HPV, Chlamydia, herpes simplex virus (HSV), and trichomoniasis) [10].
  • Approximately 5 percent of teens identify as lesbian, gay, or bisexual [10]. Over 10 percent of females and between 2 and 6 percent of males report having participated in same-gender sexual activity [7]. Adolescents' uncertainty about their sexual orientation decreases with age, from 26 percent of 12-year-old students to 5 percent of 17-year-olds [11]. Adolescents with both male and female sexual partners have higher rates of unprotected sex, teen dating violence (TDV), and forced sex [12]. Gender variant adolescents seem to experience similar difficulties including higher risks of bullying, social isolation, and suicidality.

                                

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Literature review current through: Jun 2014. | This topic last updated: Jun 26, 2013.
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References
Top
  1. Healthy People 2020. Family Planning. http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=13 (Accessed on September 19, 2011).
  2. Healthy People 2020. Sexually Transmitted Diseases. http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=37 (Accessed on September 19, 2011).
  3. Adolescent Friendly Health Services: An Agenda for Change. The World Health Organization 2004. www.who.int/child_adolescent_health/documents/fch_cah_02_14/en/index.html (Accessed on September 28, 2009).
  4. Mbizvo MT, Zaidi S. Addressing critical gaps in achieving universal access to sexual and reproductive health (SRH): the case for improving adolescent SRH, preventing unsafe abortion, and enhancing linkages between SRH and HIV interventions. Int J Gynaecol Obstet 2010; 110 Suppl:S3.
  5. UNFPA. Generation of Change: Young People and Culture, Youth Supplement: State of World Population 2008, UNFPA, New York 2008.
  6. Euling SY, Herman-Giddens ME, Lee PA, et al. Examination of US puberty-timing data from 1940 to 1994 for secular trends: panel findings. Pediatrics 2008; 121 Suppl 3:S172.
  7. Chandra A, Mosher WD, Copen C, Sionean C. Sexual behavior, sexual attraction, and sexual identity in the United States: data from the 2006-2008 National Survey of Family Growth. Natl Health Stat Report 2011; :1.
  8. Eaton DK, Kann L, Kinchen S, et al. Youth risk behavior surveillance - United States, 2011. MMWR Surveill Summ 2012; 61:1.
  9. Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004; 36:6.
  10. Kann L, Olsen EO, McManus T, et al. Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9-12--youth risk behavior surveillance, selected sites, United States, 2001-2009. MMWR Surveill Summ 2011; 60:1.
  11. Remafedi G, Resnick M, Blum R, Harris L. Demography of sexual orientation in adolescents. Pediatrics 1992; 89:714.
  12. Pathela P, Schillinger JA. Sexual behaviors and sexual violence: adolescents with opposite-, same-, or both-sex partners. Pediatrics 2010; 126:879.
  13. Adolescent Health Updated Editorial Board. Use a strengths-based approach to adolescent preventive care. AAP News 2009; 30:13.
  14. Brown RT. Adolescent sexuality at the dawn of the 21st century. Adolesc Med 2000; 11:19.
  15. Cohen-Kettenis PT, Gooren LJ. Transsexualism: a review of etiology, diagnosis and treatment. J Psychosom Res 1999; 46:315.
  16. Levine DA, Committee On Adolescence. Office-based care for lesbian, gay, bisexual, transgender, and questioning youth. Pediatrics 2013; 132:e297.
  17. Meyer W, Bockting WP, Cohen-Kettenis E, et al. The Harry Benjamin International Gender Dysphoria Association: Standards of care for gender identity disorders. Int J Transgender 2001; 5.
  18. Transgender Health Program, Guidelines for Transgender Care. Vancouver Coastal Health. http://transhealth.vch.ca/resources/careguidelines.html (Accessed on June 24, 2011).
  19. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, et al. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2009; 94:3132.
  20. Zucker KJ, Cohen-Kettenis PT. Gender identity disorder in children and adolescents. In: Handbook of Sexual and Gender Identity Disorders, Rowland DL, Incrocci L. (Eds), Wiley, Hoboken, NJ 2008. p.376.
  21. Committee On Adolescence. Office-based care for lesbian, gay, bisexual, transgender, and questioning youth. Pediatrics 2013; 132:198.
  22. Igartua K, Thombs BD, Burgos G, Montoro R. Concordance and discrepancy in sexual identity, attraction, and behavior among adolescents. J Adolesc Health 2009; 45:602.
  23. McCabe J, Brewster KL, Tillman KH. Patterns and correlates of same-sex sexual activity among U.S. teenagers and young adults. Perspect Sex Reprod Health 2011; 43:142.
  24. Kinsey AC, Pomeroy WB, Martin CE. Sexual behavior in the human male, WB Saunders, Philadelphia 1948.
  25. Moore RE. Normal childhood and early adolescent sexuality. A psychologist's perspective. Semin Adolesc Med 1985; 1:97.
  26. Savic I, Garcia-Falgueras A, Swaab DF. Sexual differentiation of the human brain in relation to gender identity and sexual orientation. Prog Brain Res 2010; 186:41.
  27. Strasburger VC, Jordan AB, Donnerstein E. Health effects of media on children and adolescents. Pediatrics 2010; 125:756.
  28. Rideout VJ, Foehr UG, Roberts DF. Generation M2: Media in the lives of 8- to 18-Year-Olds, Kaiser Family Foundation, Menlo Park, CA 2010.
  29. Kunkel D, Eyal K, Finnerty K, et al. Sex on TV 4: A Biennial Report to the Kaiser Family Foundation, Kaiser Family Foundation, Menlo Park, CA 2005.
  30. Kunkel D, Eyal K, Donnerstein E, et al. Sexual socialization messages on entertainment television. Media Psychol 2007; 9:595.
  31. Braun-Courville DK, Rojas M. Exposure to sexually explicit Web sites and adolescent sexual attitudes and behaviors. J Adolesc Health 2009; 45:156.
  32. Stern S. Sexual selves on the World Wide Web: Adolescent girls' home pages as sites for sexual self-expression. In: Sexual Teens, Sexual Media: Investigating Media's Influence on Adolescent Sexuality, Brown JD, Steele JR, Walsh-Childers K. (Eds), Lawrence Erlbaum Associates, Inc., Mahwah, NJ 2002. p.265.
  33. Moreno MA, Parks MR, Zimmerman FJ, et al. Display of health risk behaviors on MySpace by adolescents: prevalence and associations. Arch Pediatr Adolesc Med 2009; 163:27.
  34. National Campaign to Prevent Teen and Unplanned Pregnancy, 2008. Sex and Tech: Results from a survey of teens and young adults http://www.thenationalcampaign.org/sextech/pdf/sextech_summary.pdf (Accessed on July 15, 2011).
  35. Hatzenbuehler ML. The social environment and suicide attempts in lesbian, gay, and bisexual youth. Pediatrics 2011; 127:896.
  36. Eisenberg ME, Resnick MD. Suicidality among gay, lesbian and bisexual youth: the role of protective factors. J Adolesc Health 2006; 39:662.
  37. Rew L, Whittaker TA, Taylor-Seehafer MA, Smith LR. Sexual health risks and protective resources in gay, lesbian, bisexual, and heterosexual homeless youth. J Spec Pediatr Nurs 2005; 10:11.
  38. The Guidelines for Comprehensive Sexuality Education: Grades K-12. Sexuality Information and Education Council of the United States. www.siecus.org/_data/global/images/guidelines.pdf (Accessed on July 15, 2011).
  39. Song AV, Halpern-Felsher BL. Predictive relationship between adolescent oral and vaginal sex: results from a prospective, longitudinal study. Arch Pediatr Adolesc Med 2011; 165:243.
  40. Biddlecom AE. Trends in sexual behaviours and infections among young people in the United States. Sex Transm Infect 2004; 80 Suppl 2:ii74.
  41. Turner CF, Ku L, Rogers SM, et al. Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology. Science 1998; 280:867.
  42. Hewitt M. Attitudes toward interview mode and comparability of reporting sexual behavior by personal interview and audio computer-assisted self-interviewing: analyses of the 1995 National Survey of Family Growth. Sociol Methods Res 2002; 31:3.
  43. Fu H, Darroch JE, Henshaw SK, Kolb E. Measuring the extent of abortion underreporting in the 1995 National Survey of Family Growth. Fam Plann Perspect 1998; 30:128.
  44. DiClemente RJ, Sales JM, Danner F, Crosby RA. Association between sexually transmitted diseases and young adults' self-reported abstinence. Pediatrics 2011; 127:208.
  45. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health 2006; 38:90.
  46. Frost JJ, Darroch JE. Factors associated with contraceptive choice and inconsistent method use, United States, 2004. Perspect Sex Reprod Health 2008; 40:94.
  47. Sheeder J, Teal SB, Crane LA, Stevens-Simon C. Adolescent childbearing ambivalence: is it the sum of its parts? J Pediatr Adolesc Gynecol 2010; 23:86.
  48. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 392, December 2007. Intrauterine device and adolescents. Obstet Gynecol 2007; 110:1493.
  49. Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59:1.
  50. Forhan SE, Gottlieb SL, Sternberg MR, et al. Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States. Pediatrics 2009; 124:1505.
  51. Institute of Medicine (IOM). Adolescent Health Services: Missing Opportunities, The National Academies Press, Washington, DC 2009.
  52. Henry-Reid LM, O'Connor KG, Klein JD, et al. Current pediatrician practices in identifying high-risk behaviors of adolescents. Pediatrics 2010; 125:e741.
  53. Teten AL, Ball B, Valle LA, et al. Considerations for the definition, measurement, consequences, and prevention of dating violence victimization among adolescent girls. J Womens Health (Larchmt) 2009; 18:923.
  54. Miller E, Decker MR, Raj A, et al. Intimate partner violence and health care-seeking patterns among female users of urban adolescent clinics. Matern Child Health J 2010; 14:910.
  55. Cutter-Wilson E, Richmond T. Understanding teen dating violence: practical screening and intervention strategies for pediatric and adolescent healthcare providers. Curr Opin Pediatr 2011; 23:379.
  56. Coker TR, Austin SB, Schuster MA. The health and health care of lesbian, gay, and bisexual adolescents. Annu Rev Public Health 2010; 31:457.
  57. Kalichman SC, Benotsch E, Rompa D, et al. Unwanted Sexual Experiences and Sexual Risks in Gay and Bisexual Men: Associations among Revictimization, Substance Use, and Psychiatric Symptoms. J Sex Res 2001; 38:1.
  58. Halpern CT. Same-sex attraction and health disparities: do sexual minority youth really need something different for healthy development? J Adolesc Health 2011; 48:5.
  59. Constantine NA. Converging evidence leaves policy behind: sex education in the United States. J Adolesc Health 2008; 42:324.
  60. Kohler PK, Manhart LE, Lafferty WE. Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. J Adolesc Health 2008; 42:344.
  61. Eisenberg ME, Bernat DH, Bearinger LH, Resnick MD. Support for comprehensive sexuality education: perspectives from parents of school-age youth. J Adolesc Health 2008; 42:352.
  62. Ott MA, Santelli JS. Approaches to adolescent sexuality education. Adolesc Med State Art Rev 2007; 18:558.
  63. Kirby D, Laris BA. Effective curriculum-based sex and STD/HIV education programs for adolescents. Child Dev Perspect 2009; 3:21.
  64. Kantor L, Santelli J, Teitler J, Balmer R. Abstinence-Only Policies and Programs: An Overview. Sex Res Soc Pol 2008; 25:6.
  65. Johnson BT, Scott-Sheldon LA, Huedo-Medina TB, Carey MP. Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: a meta-analysis of trials, 1985-2008. Arch Pediatr Adolesc Med 2011; 165:77.
  66. Shepherd J, Kavanagh J, Picot J, et al. The effectiveness and cost-effectiveness of behavioural interventions for the prevention of sexually transmitted infections in young people aged 13-19: a systematic review and economic evaluation. Health Technol Assess 2010; 14:1.
  67. Kirby D. Research Findings on Programs to Reduce Teen Pregnancy, The National Campaign to Prevent Teen Pregnancy, Washington, DC 2001.
  68. Inman DD, van Bakergem KM, Larosa AC, Garr DR. Evidence-based health promotion programs for schools and communities. Am J Prev Med 2011; 40:207.
  69. Rupp R, Rosenthal SL. Parental influences on adolescent sexual behaviors. Adolesc Med State Art Rev 2007; 18:460.
  70. Council on Communications and Media. American Academy of Pediatrics. Policy statement--sexuality, contraception, and the media. Pediatrics 2010; 126:576.
  71. Strasburger VC. Adolescents, sex, and the media: ooooo, baby, baby-a Q & A. Adolesc Med Clin 2005; 16:269.
  72. Bleakley A, Hennessy M, Fishbein M, Jordan A. How sources of sexual information relate to adolescents' beliefs about sex. Am J Health Behav 2009; 33:37.
  73. Schuster MA, Corona R, Elliott MN, et al. Evaluation of Talking Parents, Healthy Teens, a new worksite based parenting programme to promote parent-adolescent communication about sexual health: randomised controlled trial. BMJ 2008; 337:a308.
  74. Bailey JV, Murray E, Rait G, et al. Interactive computer-based interventions for sexual health promotion. Cochrane Database Syst Rev 2010; :CD006483.
  75. Gold J, Lim MS, Hellard ME, et al. What's in a message? Delivering sexual health promotion to young people in Australia via text messaging. BMC Public Health 2010; 10:792.
  76. Gold J, Lim MS, Hocking JS, et al. Determining the impact of text messaging for sexual health promotion to young people. Sex Transm Dis 2011; 38:247.
  77. Kavanaugh ML, Schwarz EB. Counseling about and use of emergency contraception in the United States. Perspect Sex Reprod Health 2008; 40:81.
  78. Brown JD, Strasburger VC. From Calvin Klein to Paris Hilton and MySpace: adolescents, sex, and the media. Adolesc Med State Art Rev 2007; 18:484.
  79. Tylee A, Haller DM, Graham T, et al. Youth-friendly primary-care services: how are we doing and what more needs to be done? Lancet 2007; 369:1565.
  80. Ogle S, Glasier A, Riley SC. Communication between parents and their children about sexual health. Contraception 2008; 77:283.
  81. The Health of Lesbian, Gay, Bisexual, and Transgender People Building a Foundation for Better Understanding. Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. Board on the Health of Select Populations. Institute of Medicine of the National Academies. htttp://www.nap.edu/openbook.php?record_id=13128&page=R1 (Accessed on July 24, 2011).
  82. East JA, El Rayess F. Pediatricians' approach to the health care of lesbian, gay, and bisexual youth. J Adolesc Health 1998; 23:191.
  83. Diamant AL, Schuster MA, McGuigan K, Lever J. Lesbians' sexual history with men: implications for taking a sexual history. Arch Intern Med 1999; 159:2730.
  84. Marrazzo JM, Koutsky LA, Kiviat NB, et al. Papanicolaou test screening and prevalence of genital human papillomavirus among women who have sex with women. Am J Public Health 2001; 91:947.
  85. Saewyc EM, Bearinger LH, Blum RW, Resnick MD. Sexual intercourse, abuse and pregnancy among adolescent women: does sexual orientation make a difference? Fam Plann Perspect 1999; 31:127.
  86. Bailey JV, Farquhar C, Owen C. Bacterial vaginosis in lesbians and bisexual women. Sex Transm Dis 2004; 31:691.
  87. Greydanus DE, Omar HA. Sexuality issues and gynecologic care of adolescents with developmental disabilities. Pediatr Clin North Am 2008; 55:1315.
  88. Ward KM, Bosek RL, Trimble EL. Romantic relationships and interpersonal violence among adults with developmental disabilities. Intellect Dev Disabil 2010; 48:89.
  89. Tice CJ, Hall DM. Sexuality education and adolescents with developmental disabilities: assessment, policy, and advocacy. J Soc Work Disabil Rehabil 2008; 7:47.
  90. Rew L. Sexual health of adolescents with chronic health conditions. Adolesc Med State Art Rev 2007; 18:519.