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 .
Among adolescents in the United States:
- Young women reach puberty and sexual maturity (eg, breast development, menarche) at earlier ages than ever . (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 . Prevalence of sexual activity increases with age, rising from 33 percent in 9th graders to 63 percent in 12th graders .
- Trends (from 1991 to 2011) in the Youth Risk Behavior Survey indicate that :
- 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 . Human papillomavirus (HPV), Chlamydia, and trichomoniasis, account for almost 90 percent of STIs in this age group . 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) .
- Approximately 5 percent of teens identify as lesbian, gay, or bisexual . Over 10 percent of females and between 2 and 6 percent of males report having participated in same-gender sexual activity . Adolescents' uncertainty about their sexual orientation decreases with age, from 26 percent of 12-year-old students to 5 percent of 17-year-olds . Adolescents with both male and female sexual partners have higher rates of unprotected sex, teen dating violence (TDV), and forced sex . Gender variant adolescents seem to experience similar difficulties including higher risks of bullying, social isolation, and suicidality.