Adolescent sexuality in the United States

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Adolescent sexuality in the United States relates to the sexuality of American adolescents and its place in American society, both in terms of their feelings, behaviors and development and in terms of the response of the government, educators and interested groups.

For teenagers, sex is considered an emotionally powerful experience, combined with risks and psychological changes.[1] "All adolescents have sex lives, whether they are sexually active with others, with themselves, or seemingly not at all," and viewing adolescent sexuality as a potentially positive experience, rather than as something inherently dangerous, may help young people develop healthier patterns and make more positive choices regarding sex.[2] According to the US Centers for Disease Control and Prevention, in the year 2007, 35% of US high school students were currently sexually active and 47.8% of US high school students reported having had sexual intercourse.[3] This percentage has decreased slightly since 1991.[4] While some researchers suggest that teens are increasingly engaging in oral sex,[5] other studies indicate that there has been little change in either oral sex or vaginal sex among teen opposite-sex partners over the past decade.[6][7] A minority, 13%, of children aged 15 have experienced vaginal sex.[8]

Every year, an estimated 1 in 4 sexually active teens contracts an STD,[9] and teenage pregnancy is 2 to 10 times more prevalent in the United States than in other similarly developed countries.[10] Among sexually active 15- to 19-year-olds, 83% of females and 91% of males reported using at least one method of birth control during last intercourse.[11] A majority of adolescents have been provided with some information regarding sexuality,[12] though there have been efforts among social conservatives in the United States government to limit sex education in public schools to abstinence-only sex education curricula.[13]

As "teenagers are not mature enough to know all the ramifications of what they're doing,"[14] "early sexual activity - whether in or out of a romantic relationship - does far more harm than good."[15] With all the issues and problems relating to adolescent sex, according to the Medical College of Wisconsin, "Ideally, they won’t be having sex, but if they are or intend to, the next best thing is that they understand the importance of protecting themselves against pregnancy, HIV and STDs."[16]

Contents

Sexual behavior

Sexual intercourse

Percent of teens who claim to have had sex, by age[17]
AgeBoysGirls
147.9%5.7%
1514.6%13.0%
1625.3%26.8%
1739.4%43.1%
1854.3%58.0%
1965.2%70.1%

The average age of first sexual intercourse in the United States is 17.0 for males and 17.3 for females.[18] Most American teenagers are virgins, and the percentage of teens who are virgins has been increasing. 43% of unmarried teenage girls and 42% of unmarried teenage boys have ever had sexual intercourse, according to a 2011 study. In 2002, the last year such a report was published, 46% of girls and 46% percent of boys had had sex by 19.[19] Among younger teens, the majority claim to be virgins, and this percentage has risen over time.[20]

16% percent of adults first had sex before age 15, while 15 percent abstained from sex until at least age 21.[21] Girls will most likely lose their virginity to a boy who is 1 to 3 years older than they are.[17] The same study found that "the likelihood of a first sexual experience happening will increase with the number of hours a day teens spend unsupervised."[22] Surveys indicate that the majority of American teens who have had sex wish they had waited. Among sexually active girls, two-thirds say they didn't want to lose their virginity when they did or that they had mixed feelings about it.[17] "If the sex was not completely wanted or occurred in a traumatic context, it's easy to imagine how that could have a negative impact on how women might feel about relationships, or on relationship skills."[23]

The percentage of teenagers who report they are currently sexually active has also been dropping since 1991. In 1997, 37% of females and 33% of males who reported ever having had sexual intercourse said that they had sex in the past 3 months.[24] By 2005, the overall percentage of teenagers reporting that they were currently sexually active was down to 33.9%.[3] A lower number of sexually active teens is "quite positive in terms of their health and their well-being," said Edward Sondik, director of the National Center for Health Statistics.[25]

Oral sex

The National Center for Health Statistics has reported that half of all 15- to 19-year-olds have had oral sex, with the percentage rising to 70% by the time they turn 19, and equal numbers of boys and girls participating.[26] The data indicates that many teens, particularly those from middle- and upper-income white families, don't consider oral sex to be as significant or meaningful as older generations do.[26] "There is discrepancy when it comes to willingness to perform oral sex [with] 22% of sexually active girls say[ing] their partner never performs oral sex on them, while 5% of boys say their partner never does."[5][12]

Researchers at the University of California, San Francisco believe that some teens, and particularly girls, engage in oral sex as a way to avoid vaginal intercourse.[27] In contrast, author of a study released in 2008 by the Guttmacher Institute, Laura Lindberg, stated that there "is a widespread belief that teens engage in nonvaginal forms of sex, especially oral sex, as a way to be sexually active while still claiming that technically, they are virgins," but that her study drew the conclusion that "research shows that this supposed substitution of oral sex for vaginal sex is largely a myth".[28] However, co-author of the study Dennie Hughes cautions, "We need to move away from the idea that girls who engage in oral sex but not intercourse are 'technical' virgins – that you're not having sex because no one's penetrating you. Let girls know that every time you do something like that, you compromise yourself and give up some of your power."[29]

Contraceptive use

Among sexually active 15- to 19-year-olds, 83% of females and 91% of males reported using at least one method of birth control during last intercourse.[11] Thus, sexually active adolescent girls wishing to avoid pregnancy are less likely than those of other ages to use contraceptives (18% of 15- to 19-year-olds used no contraceptives, versus 10.7% average for women ages 15 to 44), according to an analysis of periodic survey data from the National Center for Health Statistics.[30]

Among adolescents, the most common methods of contraception are birth control pills (used by 43.5% of 15- to 19-year-old women at risk for unintended pregnancy) and condoms (used by 22% of adolescent women).[30] In 2007, 61.5% of high school students reported using a condom the last time they had sexual intercourse, up from 46% in 1991.[3] While 90% of teens surveyed in a poll commissioned by NBC News and People magazine knew they could get an STD from having sexual intercourse, 67% said that they use protection every time they have sex.[12]

Abstinence

For the last 20 years abstinence rates among American adolescents have risen. The percentage of high school students in the U.S. who reported that they have ever had sexual intercourse dropped from 54.1% in 1991 to 47.8% in 2007[3] and to 43% in 2011.[19] A cross-sectional survey 73,464 of adolescents in Minnesota conducted in 1998 found that fear of pregnancy was the most commonly cited reason for choosing abstinence, especially among girls as well as boys who had caused a pregnancy in the past, along with a fear of sexually transmitted infections. Other reasons included a lack of desire, being afraid of getting caught, and the belief that sex was not appropriate for someone of their age.[31]

Adolescents who have received sex education in school or church settings are less likely to be sexually active. For girls, they were 59% less likely and boys were 71% less likely. Epidemiologists at the Center for Disease Control emphasize that for sex education to be effective, it should take place before teens become sexually active.[32]

Most common reasons virgins cite for remaining abstinent[33]
ReasonPercent of 9th grade malesPercent of 12th grade malesPercent of 9th grade femalesPercent of 12th grade females
Fear of pregnancy82%77%
Fear of STDs57%46%75%61%
Decision to wait until marriage43%47%56%58%
Belief that sex was not right for a person their age50%33%70%51%
Parents would object56%43%

Motivation for sexual activity

In a 2003 study, 89% of girls reported feeling pressured by boys to have sex, while 49% of boys reported feeling pressured by girls to have sex. In contrast, 67% of boys felt pressured by other boys, while 53% of girls felt pressured by other girls.[34]

A 2005 poll commissioned by NBC News and People magazine found that, of the teens surveyed, the reasons they had sexual intercourse for the first time were:[12]

Major reasonMinor reasonNot a reason
Met the right person62%20%18%
Were curious36%35%28%
To satisfy a sexual desire34%34%31%
Hoped it would make relationship closer28%28%44%
Pressure from partner15%19%65%
Wanted to be more popular and accepted2%16%81%

The vast majority of 13- to 16-year-olds, 87%, have not had sexual intercourse, and 73% have not been sexually intimate at all. Sexual activity is much more common among 15 to 16 year-olds (41%) than 13 to 14 year-olds (14%)[12]. Three quarters of them have not because they feel they are too young, and just as many say they have made a conscious decision not to.[12] Girls are more likely than boys to say they have made a conscious decision to wait (81% vs. 67%) and are more likely to believe they are too young (82% vs. 67%). Girls who date or hang out with older boys have a higher correlation with substance abuse and a combination of sex and drug use.[35]

Hooking up

Increasingly, teenage sexual encounters in the United States do not occur in the context of a romantic relationship, but in an impersonal, merely sexual "hook up."[15] More than "half of sexually active teens have had sexual partners they are not dating."[12][36] This is a "a genuine and puzzling change in teen sexual behavior"[5] and a "profound shift in the culture of high school dating and sex."[37]

"Casual teen attitudes toward sex — particularly oral sex — reflect their confusion about what is normal behavior... [T]eens are facing an intimacy crisis that could haunt them in future relationships. 'When teenagers fool around before they're ready or have a very casual attitude toward sex, they proceed toward adulthood with a lack of understanding about intimacy.'"[14]

Though a girl is "far more likely to feel used and abused after a typical" hook up,[15] the "impersonality of twenty-first-century adolescent sex victimizes girls" and "plenty of harm" is done to boys as well.[15] When taking part in hookups "the kids don't even look at each other. It's mechanical, dehumanizing. The fallout is that later in life they have trouble forming relationships. They're jaded."[38] James Wagoner, president of Advocates for Youth, worries that "if we are indeed headed as a culture to have a total disconnect between intimate sexual behavior and emotional connection, we're not forming the basis for healthy adult relationships."[14]

The "explosion of sex without meaning" among American teens "is deeply symptomatic. Emotional deadness, disengagement, and constriction are increasingly the norm. (Oral sex is, after all, 'just something to do.') 'Sexual addiction,' [the medical] term for moving from sexual experience to sexual experience without ever being satisfied, is prevalent. Meanwhile, for many kids precocious sexuality represents not freedom and experimentation but is a byproduct frequently seen with sexual trauma: compulsively driven activity that both expresses and aims to manage the effects of chronic intrusion and overstimulation."[39]

Oral sex

Almost half of boys (47%) believe that oral sex is "not a big deal." Slightly more than a third of girls (38%) feel the same way.[12] Despite this, there is a large "discrepancy when it comes to willingness to perform oral sex" with girls giving, and boys receiving. Of sexually active girls, 22% say their partner never performs oral sex on them, while 5% of boys say their partner never does." [12] Oral sex is "now commonly performed by very young girls outside of romantic relationships, casually and without any expectation of reciprocation."[5]

Social aspects

Adolescents with greater academic achievement experience initial sexual activity later than those who do not focus on academics. Similarly, adolescents with personal and perceived peer norms that encourage adolescents to refrain from sex are less likely to engage in it.[40] Despite their behaviors, 90% of adolescents "agree that most young people have sex before they are really ready".[34] Claire Brindis, professor of pediatrics at the University of California at San Francisco, has noted that casual attitudes towards oral sex have made it so common that "we're talking about a major social norm. It's part of kids' lives."[26]

Among young people engaging in some form of sexual activity, definitions of virginity differ. Of adolescents age 12–16, 83% believe a person is still a virgin after engaging in genital touching, and 70% said they believed one retained their virginity after having oral sex. However, 44% believed that one was abstinent after genital touching and 33% believed one could have oral sex and still remain abstinent. Of anal and vaginal sex, 14% believed you could engage in the former and 12% said you could participate in the latter while still remaining abstinent.[41] According to a 2007 study published by the Pacific Institute for Research and Evaluation, "A large proportion of young people believe even an intimate level of sexual contact is abstaining from sex and being a virgin."[42] If an adolescent engaged in a particular behavior they were more likely to believe that they still meet the definition of a virgin.[41]

Physical effects

Pregnancy

Teen pregnancies—defined as pregnancies in women under the age of 20, regardless of marital status—in the United States decreased 28% between 1990 and 2000, from 117 pregnancies per every 1,000 teens to 84 per 1,000.[9] Teenage birth rates peaked in 1991, when there were 61.8 births per 1,000 teens, and the rate dropped in 17 of the 19 years that followed.[43] From 2009 to 2010, the teen pregnancy rate dropped 9%, the biggest one year drop since the 1940s.[43]

Slightly more than half of Hispanic and black women will become pregnant before the age of 20. Asian-Americans have the lowest rate of pregnancy before the age of 20 of any ethnic group.[44] Statistics also vary regionally. A swath of southern states from New Mexico to Mississippi saw rates of more than 50 births per 1,000 teenage girls. In New England, by contrast, most states had less than 20 births per 1,000 girls.[45]

One in four American women who had sex during their teenage years will have a baby before they are married, compared to one in ten who wait until they are older.[23] Even more will experience a pregnancy. Of women who have sex in their teens, nearly 30 percent will conceive a child before they are married. Fifteen percent of women who don't have sex in their teens will become pregnant before they are married.[23] Of all women, 16 percent will be teen mothers.[44]

International comparisons typically place US teen pregnancy and teen birth rates among the highest in the developed world. For example, a 2001 study by UNICEF found that the US teenage birth rate was the highest among 28 OECD nations in the review;[46] in a 1999 comparison by the Guttmacher Institute, U.S. teen pregnancy and teen birth rates were the second-highest among the 46 developed countries studied.[47][48] In 2002, the U.S. was rated 84th out of 170 World Health Organization member countries based on teenage fertility rate.[49]

According to an international comparison by the Guttmacher Institute, teen pregnancy and childbearing levels are higher in the US largely because of differences in contraceptive use. Sexually active teens in the US are less likely to use any contraceptive method and especially less likely to use highly effective hormonal methods, primarily the pill, than their peers in other countries. The research also found that US teens who become pregnant are less likely to choose abortion, whether due to lack of access, higher levels of antiabortion sentiment, or greater acceptance of teen motherhood.[50]

Sexually transmitted infections

Each year, between 8 and 10 million American teens contract a sexually transmitted disease.[51] According to the U.S. Centers for Disease Control, almost half of the 19 million sexually transmitted diseases reported in the U.S. occur in young people, ages 15 to 24.[52] Lloyd Kolbe, director of the CDC's Adolescent and School Health program, called the STI problem "a serious epidemic."[53] The younger an adolescent is when they first have intercourse, the more likely they are to get a STI throughout their teenage years.[54]

Human papillomavirus (HPV) is the most common STI among teens as well as adults.[55] In the CDC study, 18% of teen girls were infected with HPV.[56] Another study found that HPV infections account for about half of STIs detected among 15- to 24-year-olds each year.[57] While most HPV infections cause no disease, HPV does cause genital warts and cervical cancer. An HPV vaccine protects women against two HPV types which cause 70% of cervical cancers as well as two types associated with 90% of genital warts.[52] Ideally the woman should be vaccinated before initial sexual activity, since the vaccine is only effective before exposure to the HPV types.

A 2008 study by the CDC found that one in four teen girls, or an estimated 3 million girls, has an STI.[56] The study of 838 girls who participated in a 2003–04 government health survey found the highest overall prevalence among black girls, nearly half in the study were infected, compared with 20 percent among both whites and Mexican-American teens.[58] The same study found that, among those who were infected, 15% had more than one STI, and 20% of those who said they had only one sexual partner were infected.[56]

In the CDC study, 4% were infected with chlamydia, historically the most prevalent of all STIs in the general population. More than a third of all chlamydia cases occur in those aged 15 to 19.[59] Additionally, 2% were infected with herpes simplex. The herpes infection rate fell between 1988 and 2004 among teens as well as the overall population.[60] Overall, the number of Americans aged 14 to 49 who tested positive for herpes 2 infection fell by a relative rate of 19 percent between 1988 and 2004—from 21 percent in the late 1980s and early 1990s to 17 percent 10 years later, the researchers reported. The number of people aged 14 to 19 who tested positive for new herpes simplex 2 infections dropped from 5.8 percent in a 1988–1994 survey to just 1.6 percent 10 years later.[60]

Psychological effects

For teens, "having sex changes you. It is emotionally powerful and there are risks involved."[1] Those who have first sexual intercourse before 15 have higher rates of mental illness.[61] In one study of 273 sexually active California teens, those studied reported both positive and negative consequences of their sexual activity. According to the paper "We tend to focus on the health consequences of having sex, like pregnancy and STIs, but we also need to talk to them about all the emotional consequences."[62]

According to Harvard Medical School's O'Connell, adolescents "often haven't achieved the emotional, even neurological, maturity necessary for making autonomous and self-aware sexual choices."[39] Emotional, social and cognitive development continues well past adolescence.[63] Dr. Drew Pinsky has also said "All of us want young people to make better choices, to delay their sexual contact, to make sure that they fully understand the implications of those choices -- which of course, they never do..."[64]

As the frontal lobe of the brain, which houses complex thinking, understanding cause and effect, controlling impulses, and judgment, is not fully developed until a person is in their 20s, "teens are less prepared to think about 'if I do this today, what will happen to me tomorrow?'"[1] In one study, among those who had had both oral and vaginal sex, 60% reported at least one negative effect, such as feeling used, getting pregnant, contracting a sexually transmitted infection, or feeling bad about themselves.[62]

Sex for teens is not "without risk. It can take a toll on the soul, dehumanizing unsuspecting students who tumble too soon into the world of hooking up, not knowing enough about sex or themselves to avoid getting hurt," according to educator and psychologist Pat McDonough.[65] Despite "societal shifts in sexual standards, human development remains pretty much the same. Kids are still emotionally vulnerable and volatile – more so if they are sexually active".[65]

Pinsky has said teens are "not in the dark, they're in the dark about the implications of [sexual behavior]. They're in the dark about the emotional reality, they're in the dark about the biological reality, they're in denial about this thing that has become a drug in our culture, rather than an expression about intimate relations."[64] He continued, "It's too far the other way: It's not that they don't know about it, they know everything, but at the same time, they know nothing. And that's the problem. So the human piece is left out, the human reality is taken away, it's all thought of very casually."[64]

Production of oxytocin increases during the adolescent years,[66] and it is key to monogamy and long-term attachment.[67] Oxytocin is "nature's way of weaving people together."[68] Girls have more of it and may be more sensitive to it.[69] Psychologists theorize that oxytocin will make them care about relationships and feel connections with others more intensely than boys.[69] According to Laura Sessions Stepp, this is "a logical explanation for why girls are in turmoil after a hook up and boys are not".[70]

Depression and emotional distress

Longitudinal research has shown "a significant association between teenage sexual abstinence and mental health."[71] In a broad analysis of data from the National Longitudinal Study of Adolescent Health, researchers found that engaging in sex leaves adolescents, and especially girls, with higher levels of stress and depression.[72] "Depression, anxiety and increased stress accompany the abuse of alcohol and drugs also observed in sexually promiscuous teens."[65]

Research has found "a dramatic relationship" between sexual activity among adolescents and "multiple indicators of adolescent mental health. Compared to abstainers, membership in any of the risk clusters was associated with increased odds of depression, serious thoughts about suicide, and suicide attempts."[73] Sexually active girls are more vulnerable to depression, suicidal ideation, and suicide attempt than sexually active boys, but there is little difference between boys and girls who are not sexually active.[73] Risk for depression is "clearly elevated" for the sexually active of either gender.[73]

Doctor of adolescent medicine Meg Meeker writes, “Teenage sexual activity routinely leads to emotional turmoil and psychological distress. [Sexual permissiveness leads] to empty relationships, to feelings of self-contempt and worthlessness. All, of course, precursors to depression.”[74]

Experts recommend that sexually active adolescents be screened for depression and be "provided with anticipatory guidance about the mental health risks of these behaviors."[72][73] Professors at the University of California recommend that parents and health professionals help teens prepare for and cope with the emotions attached to sex.[62]

Researchers at Brown University have found that cutting is linked to higher levels of risky sex among teenagers. Psychologist Lori G. Plante states that "habitual cutting is a way of managing intense emotional distress. It makes sense that the level of impulsivity and risk taking would also be higher in these teens." Plante believes that cutting, even once, is "a warning sign that they are overwhelmed in some way."[75]

Casual sex

Casual attitudes amongst adolescents toward sex and oral sex, in particular, "reflect their confusion about what is normal behavior", according to Sabrina Weill, author of The Real Truth About Teens & Sex.[14] When taking part in hookups, "the kids don't even look at each other. It's mechanical, dehumanizing", according to psychologist Marsha Levy-Warren.[38]

When adolescents engage in casual sexual relationships, they proceed toward adulthood with a lack of understanding about intimacy.[14] James Wagoner, president of Advocates for Youth, worries that "if we are indeed headed as a culture to have a total disconnect between intimate sexual behavior and emotional connection, we're not forming the basis for healthy adult relationships."[14] In US News & World Report, physician Bernadine Healy states, "Both as doctor and mother, I can't help but believe that our anything-goes society, in which impulses are immediately satisfied and sex is divorced from love and bonding, is simply not healthy physically, emotionally, or spiritually."[66]

When girls hook up they "don't count on... oxytocin, a chemical produced in the brain to promote feelings of connection and love. Oxytocin is most commonly associated with breast-feeding; it's what helps a mother bond with her infant."[70] Known as "cuddling hormone" or "hormone of love,"[76] oxytocin is also produced during sex, causing the partners to form emotional attachments with one another. "The more intense the sex, the more oxytocin."[70]

When a man achieves orgasm his oxytocin levels can rise up to 500% of their normal levels.[77] "When "a man ejaculates, he bonds utterly with" his partner.[78] Males also get a bigger dose of testosterone, which suppresses the oxytocin."[70] This is "a logical explanation for why girls are in turmoil after a hook up and boys are not".[70]

Boys are less likely to see sex as connected to an emotional relationship than girls. However, by the time a young man is "in his early twenties, he will rely on his girlfriend or wife to be his primary emotional caregiver.[79] If he can not establish an emotional relationship with a woman, who does view sex as connected to intimacy, then he is more likely to become depressed, commit suicide or die from illness.[80]

Some studies appear to show "what many teens come to find out on their own: Even if sexual activity seems casual, it often is not", according to Bill Albert, deputy director of the nonprofit National Campaign to Prevent Teen Pregnancy. "A casual hookup on a Friday night might not feel that way a month down the road."[62] When having casual sex teens are "pretending to say it's just sexual and nothing else. That's an arbitrary slicing up of the intimacy pie. It's not healthy", according to Paul Coleman, psychologist and author of The Complete Idiot's Guide to Intimacy.[14] Depression, alcohol abuse, anorexia, and emotional disturbance can all afflict adolescents as a result.[70]

Relationships

Even when teens are in a romantic relationship, sexual activities can become the focus of the relationship. Not only are such relationships less sustained, they are often not monogamous and they have lower levels of satisfaction than relationships that do not have sexual activities as their focus, according to W. Andrew Collins, child psychology professor at the University of Minnesota.[14]

David Walsh, from the National Institute on Media and the Family, thinks that when adolescents engage in casual sexual relationships they do not develop skills such as trust and communication that are key ingredients in healthy, long-lasting relationships.[14]

In purely sexual relationships, adolescents pick up "a lot of bad habits" and don't learn "to trust or share or know how to disagree and make up", according to Laura Sessions Stepp, author of Unhooked: How Young Women Pursue Sex, Delay Love, and Lose at Both.[70] They become jaded and as a result later in life, they have trouble forming adult relationships, according to Levy-Warren.[38] "They don't learn to build that emotional intimacy before they get physically intimate. In the long term, that develops bad relationship habits," according to adolescent gynecologist Melisa Holmes, author of Girlology: Hang-Ups, Hook-Ups and Holding Out[81]

Males and females experience sex differently.[82] Males are more able to shrug off a one-night stand, but "girls are more confused afterward... and in general suffer a loss of self- esteem," according to Carrie Lukas of the Independent Women's Forum.[82] However, by the time a young man has reached his early twenties, his girlfriend or his wife will become his primary emotional caregiver.[83] If he cannot establish an emotional relationship with a woman, who does view sex as connected to intimacy, then he is more likely to become depressed, commit suicide or die from illness.[84]

Experts worry that when teens have sex before they're ready then they undervalue the experience and that leads to a cynical view later on. "I think they can develop a kind of negative attitude about life in general, that things aren't that special and they aren't that wonderful and what's the big deal about a lifelong commitment and a family commitment?" said Linda L. Dunlap, a psychology professor at Marist College. "They're disappointed, probably because they weren't mature enough to understand the meaning of it, and it's kind of made them kind of cold to the idea of commitment in other ways."[85]

Oral sex

Teens believe that oral sex is less risky to their emotional and physical well being than vaginal sex,[86] but experts at the University of California do not believe this conclusion is warranted.[27] They found that oral sex, as well as vaginal sex, was associated with negative consequences.[27]

With regards to oral sex, it is almost always the boys who receive it and the girls who give it.[5][12] When girls provide oral sex "they do so without pleasure, usually to please their boyfriend or to avoid the possibility of pregnancy."[87] This paradigm has entitled boys and disempowered girls,[38] putting girls at a disadvantage.[88] Adolescents who engage in oral sex but not intercourse report fewer problems with sexually transmitted diseases, guilt, and their parents, but also less resulting pleasure, self-confidence or intimacy with their partners.[62]

Of adolescents engaging in oral sex only, girls were twice as likely as boys to report feeling bad about themselves and nearly three times as likely to feel used.[62] Boys who engaged in oral sex were more than twice as likely as girls to report feeling more popular and confident.[62]

Psychological effects specific to girls

Researchers at the University of California, San Francisco found that girls are "at particular risk for experiencing negative social and emotional consequences of having any type of sex," including oral sex.[27] According to Healy, "Early sex is a threat, and it remains a greater threat to girls than to boys."[66] "Just because a girl has matured physically, doesn’t mean she’s socially or psychologically mature."[89] Girls are more than twice as likely as boys to say they felt bad about themselves and more than three times as likely to say they felt used as a result of engaging in sex[62][65] or hookups.[15][62]

Some research suggests that females are not biologically or evolutionarily equipped to handle casual sex.[90] The hormone oxytocin, released during sex, affects women differently than men, so that "when women think they can have sex and walk away just like guys do, they're having to suppress thousands of years of evolution that tells them to cuddle, stay in bed, and look forward to tomorrow. When they get up and walk out, they feel depressed and don't know why."[90]

The American Psychological Association task force in 2007 found that an early emphasis on sexuality stunts girls' development in other areas.[91] "When kids are about defining themselves, if you give them this idea that sexy is the be-all and end-all, they drop other things," says Sharon Maxwell, a psychologist who specializes in adolescent sexuality.[91]

Casual sex

Benoit Denizet-Lewis, a fellow at the Alicia Patterson Foundation, found in his study of casual sex among adolescents that many girls believe they can have a purely sexual experience with no emotional ties, and they believed it was sexist to assume otherwise. However, he believes that both the girls and the boys who were hooking up often really were depressed and didn't feel very good about themselves.[92] In his research, Denizet-Lewis found that "all the experts who talk about teen sexuality maintain that... it's impossible" for girls to enjoy meaningless sex as much as boys.[92] Girls will "inevitably regret what they did."[92] Speaking on National Public Radio, Lukas noted that girls "particularly are suffering from the new regime [i.e. casual sex] and are having some lasting problems" as a result of it.[82]

When asked if girls and women really wanted casual sex as much as men did, Dr. Drew Pinsky said he had spoken to them "by the thousands" and that they absolutely did not.[93] The only reason they engaged in it, he said, was because they thought it was what they need to do in order to get the guy. The current paradigm of casual sex has left females "ambivalent, unhappy and uncomfortable."[93]

Emotional effects

While teens may believe that their sexual activities are fine at the time, Lukas cautions that they may feel very differently in time and may regret the choices they made.[82] She points to research that shows 2/3 of sexually active girls wish they had waited longer before having sex.[82] Sex therapists have found that the roots of sexual issues facing adults often date back to regretful teenage experiences.[62] Of seniors in high school, 74% of girls regret sexual experiences they have had.[94]

Girls are more than twice as likely as boys to say they felt bad about themselves and more than three times as likely to say they felt used as a result of engaging in sex.[65] For girls, even modest involvement in sexual experimentation elevates depression risk.[72] Sexually active teenage girls are more than twice as likely to suffer depression compared to those who are not sexually active.[95]

Research has also found that adolescent sexual abstinence was associated with better mental health at age 29.[71] and that girls who were virgins at age 18 were less likely to have a mental illness at age 40.[96]

Dating violence

Girls who have engaged in sexual intercourse are five times more likely than their virgin peers to be the victim of dating violence.[97] Girls who were intentionally hurt by a date in the past 12 months are at a "significantly elevated risk for a broad range of sexual health concerns and for pregnancy."[97] Girls who have been victims are also twice as likely to report high levels of multiple sexual partners.[97]

Other effects

School work

The context of sexual relationships may determine whether the sex is harmful or not to a young person's GPA, as well as to their chances of dropping out of school.[98] University of Minnesota sociologist Eric Grodsky says that, for teens, "sex outside of a romantic relationship may exacerbate the stress youths experience, contributing to problems in school," which prompted sociologist Peggy Giordano of Bowling Green State University to offer "some comfort to parents who may be concerned that their teenage son or daughter is dating" and that teen sex, on its own, is "not going to derail their educational trajectories."[99]

On the other hand students who hook up and have casual sexual encounters are more likely to do poorly in school and get lower grades. They also care less about school and get in more trouble. Boys who hook up have GPAs that are .3 lower than virgins and girls who have casual sex have GPAs that are .16 lower. They also get suspended or expelled more and had lower expectations of going to college.[99]

All kids who have sex, even if they are in a relationship, are more likely to skip school or just drop out altogether.[99] Additionally, adolescents who start having sex before they reach age 16 are much less likely to go to college.[100]

Marriage

Women who first have sex as teenagers are much more likely to divorce, especially if their first time was unwanted or if they had mixed feelings about it.[23] Among sexually active girls, two-thirds say they didn't want to lose their virginity when they did or that they had mixed feelings about it,[17] a condition that is strongly associated with future divorce.[23] Girls who lost their virginity before the age of 16 are also more likely to divorce than those who lose it later.[23]

Of women who had sex for the first time as teens, 30% divorced within five years, and 47% divorced within 10 years of getting married. The divorce rate for women who delayed sex until adulthood was far lower: 15% at five years, and 27% at 10 years.[23] "There are down sides to adolescent sexuality, including the increased likelihood of divorce," according to Anthony Paik, associate professor of sociology at the University of Iowa.[23] Researchers believe "that the early sexual experience leads to the development of behaviors or beliefs that promote divorce."[23]

Legal issues

Age of consent

Each state has its own age of consent. Currently, state laws set the age of consent at 16, 17, or 18. The most common age is 16 (more than half of the states have this age limit); however, the five most populous states all have a higher age of consent (California: 18, Texas: 17, New York: 17, Florida: 18 and Illinois: 17).

Sexting

More than one fifth of teens have sent sexually suggestive text messages or nude photographs of themselves online.[101] Teens who photograph or film themselves or receive photos of others, known as sexting, can be charged with child pornography.[102] Others who post the photos online could also be charged with child pornography and face prison time.[103]

Sexting is linked to psychological distress among teens. Those involved in sexting are more likely to report a suicide attempt, and have twice the odds of reporting depressive symptoms as students who aren't involved in sexting. "For girls who send the sexts... there is a disillusionment and a sense of betrayal when it's posted everywhere. When it gets forwarded to multiple boys at multiple schools and also other girls ... a girl starts getting called names and her reputation is ruined," according to Dr. Jill Murray.[104]

Boys who are victims of sexually predatory teenage girls can also be devastated. Sexually predatory girls will ask a boy, particularly a sexually naive boy, for photos, and "he's sort of flattered and he feels like a big guy and then she sends them around."[104] It can cause lasting harm.

Often girls who take racy photos of themselves "want to be admired, want someone to want them," according to Parry Aftab, an Internet privacy and security lawyer and volunteer for WiredSafety. "A lot of them are lonely and starved for attention. A lot of girls think they have no choice but to pose in this way. And then there are the thrill seekers who do it because it's edgy and cool."[103]

Experts say that sexting poses a serious problem, partly because teens do not understand that the images are permanent and can be spread quickly. “It does not click that what they’re doing is destructive, let alone illegal.”[105] “Once they are out there, it spreads like a virus,” police say.[106]

Outside influences

Media

Researchers remain divided on the role of sexuality in the media on adolescent sexual health. The American Academy of Pediatrics has argued that media representations of sexuality may influence teen sexual behavior.[107] This view is supported by many scholars.[108][109] However some scholars have argued that such claims have been premature.[110] Furthermore, according to US government health statistics, teens have delayed the onset of sexual intercourse in recent years, despite increasingly amounts of sexual media.[111]

Family

Researchers at Boston College have found that teens who frequently did “things like eating dinner together as a family or engaging in fun activities or religious activities together” were less likely to have sex, had fewer sexual partners, and had less unprotected sex.[112][113] One additional family activity per week reduces the likelihood of sexual activity by 9%.[114] Family activities were "centrally important supports for children, providing opportunities for emotional warmth, communication, and transmission of values and beliefs.”[112] However, "negative and psychologically controlling" parenting such as "criticizing the ideas of the adolescents, controlling and directing what they think and how they feel," increased the probability of adolescents having sex.[112]

Researchers at the University of Arizona, University of Texas-Austin and Wake Forest University have found that girls who have positive relationships with their fathers wait longer before they have sex.[115] Other research shows that kids whose dads are involved report less sexual activity than on average,[113] and less risky sexual behaviors when they do.[114]

Girls who grew up in homes without their father are significantly more likely to have premarital sex than girls who are raised by both parents.[116] In addition, teens who lived with stepparents or in a single-parent household had notably higher levels of risky sex behavior than did kids who lived in stable and biological-parent families.[113] At a summit in Detroit on girls and sexual attitudes it was revealed that some "girls in that same age group [13–16] are 'dating' men as old as 30 because the men can give them things – love, money, presents – that their parents cannot."[117]

The Patriot Ledger stated that in current times "Adults condone a variety of sexual misbehaviors, from harassment to assault" which can give a ones daughter or son the wrong idea about what is correct/acceptable and what is not when it comes to sex.[118]

Friends

Both boys and girls feel pressure from their friends to have sex. The perception adolescents have of their best friends' sexual behavior has a significant association with their own sex behavior.[119] Sexually active peers have a negative effect on adolescent sexual delay, however responsive parent-adolescent sex discussions can buffer these effects.[120]

Adolescents who reported sexual activity had high levels of reputation-based popularity, but not likeability among peers; however, sex with more partners was associated with lower levels of popularity.[119]

Sexual education

Two main forms of sex education are taught in American schools: comprehensive and abstinence-only. Comprehensive sex education covers abstinence as a positive choice, but also teaches about contraception and avoidance of STIs when sexually active. A 2002 study conducted by the Kaiser Family Foundation found that 58% of secondary school principals describe their sex education curriculum as comprehensive.[13] The difference between these two approaches, and their impact on teen behavior, remains a controversial subject in the United States.

There have been numerous studies on the effectiveness of both approaches, and conflicting data on American public opinion. Public opinion polls conducted over the years have found that the majority of Americans favor broader sex education programs over those that teach only abstinence, although abstinence educators recently published poll data with the totally opposite conclusion.[121][122][123] The poll sponsored by the National Abstinence Education Association and conducted by Zogby International found that:

When parents become aware of what abstinence education vs. comprehensive sex education actually teaches, support for abstinence programs jumps from 40% to 60%, while support for comprehensive programs drops from 50% to 30%. This sharp increase in support of abstinence education is seen across all political and economic groups. The majority of parents reject the so-called "comprehensive" sex education approach, which focuses on promoting and demonstrating contraceptive use. Sixty-six percent of parents think that the importance of the "wait to have sex" message ends up being lost when programs demonstrate and encourage the use of contraception.[124]

Experts at University of California, San Francisco also encourage sex educators to include oral sex and emotional concerns as part of their curriculum. Their findings also support earlier studies that conclude

that sexual risk-taking should be considered from a dynamic relationship perspective, rather than solely from a traditional disease-model perspective. Prevention programs rarely discuss adolescents’ social and emotional concerns regarding sex.... Discussion about potential negative consequences, such as experiencing guilt or feeling used by one's partner, may lead some adolescents to delay the onset of sexual behavior until they feel more sure of the strength of their relationship with a partner and more comfortable with the idea of becoming sexually active. Identification of common negative social and emotional consequences of having sex may also be useful in screening for adolescents at risk of experiencing more-serious adverse outcomes after having sex.[27]

Comprehensive

The National Association of School Psychologists,[125] the American Academy of Pediatrics,[126] the American Public Health Association,[127] the Society for Adolescent Medicine[128] and the American College Health Association,[128] have all stated official support for comprehensive sex education. Comprehensive sex education curricula are intended to reduce sexually transmitted disease and out-of-wedlock or teenage pregnancies.

Proponents of this approach argue that sexual behavior after puberty is a given, and it is therefore crucial to provide information about the risks and how they can be minimized. They hold that abstinence-only sex ed and conservative moralizing will only alienate students and thus weaken the message.

A report issued by the Department of Health and Human Services has found the "most consistent and clear finding is that sex education does not cause adolescents to initiate sex when they would not otherwise have done so."[129] The same report also found that:

Family life or sex education in the public schools, which traditionally has consisted largely of providing factual information at the secondary school level, is the most general or pervasive approach to preventing pregnancy among adolescents.... Adolescents who begin having sexual intercourse need to understand the importance of using an effective contraceptive every time they have sex. This requires convincing sexually active teens who have never used contraception to do so. In addition, sexually active teens who sometimes use contraceptives need to use them more consistently (every time they have sex) and use them correctly.[129]

Abstinence-only

Abstinence-only sex education tells teenagers that they should be sexually abstinent until marriage and does not provide information about contraception. In the Kaiser study, 34% of high-school principals said their school's main message was abstinence-only. Some Christian organizations advocate abstinence-only sex education because it is the only approach they find acceptable and in accordance with their churches' teachings.

Some organizations promote what they consider to be "sexual purity", which encompasses abstaining from not only intercourse before marriage, but also from sexual thoughts, sexual touching, pornography, and actions that are known to lead to sexual arousal. Advocates of abstinence-only sex education object to comprehensive curricula which fail to teach moral behavior; they maintain that curricula should promote conventional (or conservative) morality as healthy and constructive, and that value-free knowledge of the body may lead to immoral, unhealthy and harmful practices.

A comprehensive review of 115 program evaluations published in November 2007 by the National Campaign to Prevent Teen and Unplanned Pregnancy found that two-thirds of sex education programs focusing on both abstinence and contraception had a positive effect on teen sexual behavior. The same study found no strong evidence that programs that stress abstinence as the only acceptable behavior for unmarried teens delayed the initiation of sex, hastened the return to abstinence, or reduced the number of sexual partners.[130] According to the study author:

"Even though there does not exist strong evidence that any particular abstinence program is effective at delaying sex or reducing sexual behavior, one should not conclude that all abstinence programs are ineffective. After all, programs are diverse, fewer than 10 rigorous studies of these programs have been carried out, and studies of two programs have provided modestly encouraging results. In sum, studies of abstinence programs have not produced sufficient evidence to justify their widespread dissemination."

Extracurricular activities

Girls who participate in athletics, artistic, or academic extracurricular activities are less likely to be sexually active than girls who don't participate in any.[131] Female athletes have "significantly fewer sex partners, engaged in less frequent intercourse... and began having sex at a later age."[131] For boys, those who participate in sports are slightly more likely to be sexually active, and those who are in artistic activities are considerably less likely.[131]

Religion

Religious adolescents lose their virginity 3 years later than the average American.[132] On average, those with strong religious backgrounds become sexually active at age 21.[132] Many studies have found an inverse relationship between religiosity and high-risk adolescent behaviors, including sexual activity.[133]

Sexual minorities

According to a study based on a sampling of teenagers in Massachusetts, sexual minority youth, that is, those who identify as gay, lesbian, or bisexual or had any same-sex sexual contact in their lifetimes, were significantly more likely than other students to report lifetime sexual intercourse (72% vs. 44%).[134] The same study found that sexual minority youth were more likely to report sexual intercourse before age 13 (18% vs. 4%), sexual intercourse with four or more partners in their lifetimes (32% vs. 11%), and recent sexual intercourse (55% vs. 33%). Among students in the Massachusetts study who ever had sexual intercourse in their lifetimes, sexual minority youth were significantly more likely than other students to report "having been or gotten someone pregnant (15% vs. 4%) and having been diagnosed with HIV or another STI (10% vs. 5%)."[134][135]

Several studies have found that gay youths are represented disproportionately among adolescents who drop out of school, run away from home, abuse alcohol and other drugs, engage in prostitution, or attempt, contemplate and successfully commit suicide.[136]

Knowledge of sexuality

Most teens (70%) say they have gotten some or a lot of information about sex and sexual relationships from their parents. Other sources of information include friends at 53%, school, also at 53%, TV and movies at 51% and magazines at 34%. School and magazines were sources of information for more girls than boys, and teens "who were sexually active were much more likely to say they got information about sex from their friends and partners."[12]

Less than half of parents with daughters under 18 talk to their girls about how to say no to boys, and about half talk to them about contraception.[4] While 78% of parents believe that their daughters can talk to them about any topic, only 54% of girls believe they can discuss any topic with them.[137]

Correlation with other risk behaviors

According to a report prepared for the U.S. Department of Health and Human Services,

the younger the age of first sexual intercourse, the greater the risk of unwanted pregnancy and sexually transmitted infections. This is because those who begin having sex at young ages are generally exposed to risk for a longer time, are less likely to use contraception, generally have more sexual partners, and tend to engage in higher risk sexual behaviors such as alcohol or drug use prior to sexual intercourse and having multiple concurrent sexual partners. It must be recognized as well that early intercourse is frequently not voluntary.[129]

Less than 20% of teens become sexually active at 14 years of age or younger; however, if they do, they are six times more likely than their peers that self-identify as a virgin to drink alcohol once a week or more, four times more likely to have smoked marijuana and three times more likely to be regular smokers of cigarettes.[138] Other research also shows that risk behaviors often appear in clusters. If an adolescent is engaging in one risk behavior then there is a strong chance there may be others. For example, many teens are either using drugs or alcohol when they first have sexual intercourse.[139] Students seventh and eighth grade who use drugs and alcohol were more likely than non users to begin having sex.[40]

A survey by the National Campaign to Prevent Teen Pregnancy found that "7% of youth used alcohol the first time they had sex, and 6% used alcohol the most recent time they had sex."[140] Boys will use drugs and alcohol for different reasons than girls. Boys are more likely to use in order to relax and to prevent premature ejaculation.[15] Girls will often become intoxicated before engaging in sexual activities because it "numbs the experience for them, making it less embarrassing and less emotionally painful."[15][141]

Researchers have also found that the younger an adolescent is at the time of their sexual debut, the greater the likelihood that they will engage in delinquent acts later. Adolescents who experience late sexual debut are the least likely to participate in delinquency.[142] According to one of the study's co-authors, Dana Haynie, adolescents who start having sex at a young age may not be prepared to deal with the emotional, social and behavioral consequences of their actions.[143] Study coauthor Stacy Armour theorized that adolescents "who waited longer than average may be developing friendships and relationships that can help protect them from potentially troublesome behaviors as they become young adults...The timing of events such as sexual activity can have profound consequences for adolescents, particularly when they occur prematurely...[T]he timing of sexual initiation does matter. Adolescents need to be at a stage when they are developmentally prepared for it."[143]

Girls who participate in group sex are more likely to smoke cigarettes, get an STD, and be victims of dating violence.[144]

See also

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