Pregnancy Rates per 1, Females Age 15 to 19 Years Sexual Orientation Self-definition of sexual orientation can predate sexual activity or may come after sexual debut. Particularly in adolescence, sexual and affectational preference may not be the same.
Gender identity is separate from sexual orientation. The range of sexual orientation spans from heterosexual primarily attracted to the opposite sex to bisexual attracted to both males and females to gay or lesbian primarily attracted to the same sex. Studies of adolescent sexuality often are limited by the questions asked. In addition, teens who eventually identify as gay, lesbian, or bisexual will not always do so during adolescence.
Many young people who engage in some sort of same-sex experience are not gay, and many gay teens have never had sex with someone of the same sex. The British Columbia Adolescent Health Survey representing , British Columbus students enrolled in public schools has collected detailed data on sexual orientation. A Massachusetts study 24 found that 2. While struggling to figure out how to meet someone who they might be interested in or how to introduce a sexual element to the relationship, these teens may turn to the Internet to meet partners, without understanding the possible risks.
A history of heterosexual activity does not rule out eventual self-identification as lesbian or gay. There are societal pressures on young people to be heterosexual, and youth who disclose homosexual feelings may be told that they cannot know that they are gay until they have had unsatisfying heterosexual sex.
Heterosexual sex also may occur to camouflage a gay orientation. Several studies have shown that, while in the process of coming out, young people are as likely to have heterosexual intercourse as those who identify as heterosexual. The premise is not consistent with known scientific evidence on homosexual development and should not be supported by health-care professionals, according to a report by the American Psychological Association.
Saewyc, PhD, RN, personal communication, Pubertal development can be affected by a medical condition or disability in either direction: The fatigue that is a part of many conditions may interfere with sexual desire and activity. Anything that makes an adolescent look different from his or her peers including skin diseases, short stature, and facial differences can interfere with finding a partner.
Even with a totally invisible condition, however, adolescents often worry that there is something unusual or deficient in their sexual functioning but are reluctant to ask a health-care provider about this concern. It is equally normal for caregivers and health-care providers to struggle to find ways to present complex information in a way that is understandable to young people who have cognitive delays; it is also normal for these caregivers and providers to have concerns about sexual exploitation and pregnancy in this population.
But that designation does not necessarily mean that the young person is emotionally or sexually at a first grade level. This counseling should be done in small, understandable pieces. Explaining the anatomy of what is visible is much more important than focusing on the invisible. Early in puberty, young people should be told that, for girls, menstruation and breast development are expected and, for boys, that erections and ejaculation similarly are normal.
Using concrete examples, pictures, or models can be very helpful in these early conversations and when discussing more complex topics, such as figuring out who to trust, how to flirt, and how to develop a relationship. A strong desire to have an infant is often encountered.
The clinician can let the young person know that there are a number of skills she needs to master to prepare for parenthood. With the young person, break down these skills into a list of tasks that can be tackled one at a time. Sexual Health Education All sectors, including parents, schools, community agencies, religious institutions, media, business, health-care providers, and policy makers, have a responsibility to promote healthy sexuality.
Strong evidence suggests that comprehensive approaches to sex education help adolescents withstand the pressures to have sex too soon. This approach encompasses education about all aspects of sexuality, dating and relationships, decision-making, communication, birth control methods, STIs, and pregnancy prevention. Comprehensive sexual education also encourages adolescents to cultivate healthy, responsible, and mutually protective relationships whenever they decide to become sexually active.
The appropriate type of formal school-based sexual education has continued to be an ongoing topic for discussion.
Thirty-six states require abstinence education, with 27 requiring that abstinence be emphasized, and 9 require that abstinence be included as a part of the instruction. Eighteen states and the District of Columbia require that sex education programs include information on contraception; however, no state requires that contraception be emphasized. Forty-eight comprehensive programs were studied, and the two thirds that supported both abstinence and safer sex for sexually active teens had positive behavioral effects.
To date, there is no evidence to support the belief that abstinence-only-until-marriage education delays sexual debut. More importantly, studies have shown that abstinence-only strategies may deter contraceptive use among sexually active teens, consequently increasing their risk of unintended pregnancy and STIs. Parents In a Canadian study of high school youth, those who had sexual intercourse before age 14 years reported lower connectedness to their mother and father figures than youth who did not have these experiences.
Although the majority of teens claimed to be knowledgeable about sexuality and sexual health, they lacked knowledge about STIs and their consequences. Many adults acknowledge the challenges inherent in engaging in discussions about adolescent sexuality and sexual health. Many adults will deny or express disapproval of adolescent sexuality. Adolescents are aware of this disapproval and may be willing to risk STIs and pregnancy rather than talk with a parent or other adult about their sexual behavior.
Sexual health education can be provided by parents primarily through discussion and by modeling an approach to discussions of sexuality. Open communication in the home typically creates an environment in which teens may behave more responsibly, learn from their mistakes, and accept their feelings around sexuality. Parents of adolescents who are sexually healthy tend to value, respect, and accept their children, model sexually healthy attitudes in their own relationships, maintain a nonpunitive approach toward sexuality, discuss sexuality, and provide information about contraception, STIs, and relationships.
Media Youth now get much of their information and exposure to sexual content on the Internet, which is even less regulated than television. Sixty-four percent of online teens age 12 to 17 years have created and posted a wide range of content on the web. They also engage in online activities, such as games that include text and voice interaction with other players.
Social networking is the most popular online activity. This availability may result in more exposure to sexual content at more times of the day and in more contexts than with traditional media. A number of studies describe the sexual content found in newer forms of media, but very few studies of new media effects have been conducted.
The effects of new media may differ from those of traditional media, although empirical evidence on this topic is lacking. The Guidelines for Adolescent Preventative Services, published by the American Medical Association, 44 and Bright Futures, published by the American Academy of Pediatrics, 45 can be used to help health-care clinicians deliver adolescent-friendly services appropriately.
Both supply a comprehensive set of recommendations, thus providing a framework for the organization and content of adolescent preventive services. According to these recommendations, all adolescents and young adults age 11 to 21 years should have an annual preventive service visit. These visits should address biomedical and psychosocial aspects of health.
Adolescents should be provided with guidance on sexuality and sexual decision-making. If sexual health education has been a regular part of visits in early years with discussions of pubertal changes or sexual content viewed on television and the Internet , it may be more comfortable to embark on more detailed discussions with a young person.
Adolescents should be engaged in a nonjudgmental, nongendered, and confidential discussion regarding sexual health concerns within the context of a comprehensive clinical encounter.
Standards of practice should be reviewed, and the development of clear and concise office protocols for confidentiality should be developed for staff, patients, and parents. These policies should include guidelines for when confidentiality must be breached, as well as policies for medical record access and information disclosure.
Office staff must be sensitive to the importance of delivering confidential health services. Family involvement should be encouraged; however, this involvement should be discussed with the adolescent.
Respectfully disengaging the parent so that the adolescent can be interviewed alone is crucial. Clinicians should reinforce confidentiality, because this approach will likely help the adolescent to disclose sensitive information.
Throughout the clinical encounter, it is important to avoid assumptions, such as what sexual behaviors have or have not taken place or the sexual orientation of the adolescent.
Adolescents tend to respond honestly to open-ended questions; this approach allows the clinician to obtain a thorough sexual history and to establish a rapport with the patient. The patient's history should include information regarding attitudes and knowledge about sexual behavior and the degree of involvement in sexual activity. The five Ps include: Partners, sexual Practices, Past history, Pregnancy, and Protection.
When you think about who you are attracted to, do you think about boys, girls, or both? Are you currently spending time with someone special? Do you consider this individual your boyfriend or girlfriend? How old is he or she? When inquiring about Practices and Past history, the clinician can ask: There are different ways people have sex.
Have you ever had oral sex or vaginal or anal intercourse? Are you now or have you ever had sex with males, females, or both? When was the last time you had sex? How many sexual partners have you had? How old were you when you first had sex?
The clinician should address Pregnancy and Protection: Have you ever been worried that you were got someone pregnant? Have you ever been got someone pregnant? Have you ever had a termination? Have you ever had an STI? The clinician should always address safety: Have you ever traded money or drugs for sex?
Has anyone ever touched you in a way you did not want to be touched? Has anyone forced you to do something you did not want to do sexually? It is important to address these issues in a manner that does not stigmatize lesbian, gay, bisexual, and transgendered youth. The clinical encounter should be used as an opportunity to provide resources with accurate information.
Ending the encounter with questions leaves room for the adolescent to open up regarding a possible concern that may not have been addressed. Latex condoms to prevent STIs, including HIV infection, and appropriate methods of birth control should be made available, as should instructions on how to use them effectively.
For sexually active adolescents who are using contraception, the role of the clinician is to support adherence, manage adverse effects, change the method of contraception as circumstances require, and provide referrals and frequent follow-up with periodic screening for STIs. Pediatricians can help adolescents identify their own goals for safe and responsible sexual behavior. Issues of health concerns and individual risk assessments may lead to appropriate discussions between the adolescent and clinician.