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Teens may be saying they aren’t having sex. But does their definition of "sex" include noncoital behavior, such as oral sex? Such a distinction is important, as oral sex can be a risk factor for HIV and other sexually transmitted diseases (STDs).
Adolescents are a high-risk group for STDs; about one-quarter of the estimated 15 million new cases of STD each year occur to 15- to 19-year-olds.1 Despite the risks, however, a national survey of U.S. adolescents now shows that one in five teens considers oral sex as "safe sex."2
"Teens are using oral sex as safe sex,’ and it isn’t," says Willa Brown, MD, director of personal health services in the Howard County Health Department in Columbia, MD. "We see teens who have acquired STD infections though oral sex."
Measuring the number of teens who are participating in such risky behavior is difficult, given a lack of solid national data. A new report from the New York City-based Alan Guttmacher Institute takes an in-depth look at the subject and concludes that the lack of information leaves parents, educators, health professionals, and policy-makers at a disadvantage for addressing the issue.3
What are teens doing?
Given the apparent levels of sexual risk taking occurring among teen-agers, there is a need for better data about how frequently teens are engaging in a broad range of sexual behaviors, not just vaginal intercourse, says Freya Sonenstein, PhD, director of the Population Sciences Center at the Washington, DC-based Urban Institute.
"We also need to know whether they understand the risks they are taking and what they are doing to protect themselves," observes Sonenstein. "Collecting these data, in both qualitative and quantitative studies, will be a challenge."
More representative information on the range of sexual behaviors in which adolescents are engaging is essential, states Lawrence Finer, PhD, assistant director of research at the Alan Guttmacher Institute in New York City.
"So far, nationally representative data are available only on heterosexual penile-vaginal intercourse," Finer comments. "On any behaviors other than this, what we have are small-scale and anecdotal studies."
A study that does look at a range of heterosexual activity is an analysis of teen-age boys aged 15-19 who were interviewed in 1988 and 1995 as part of the National Survey of Adolescent Males.4 In 1995, 49% said they had ever received oral sex, and 39% reported they had ever given oral sex. More than three-quarters of males who had had vaginal intercourse noted experience with masturbation or oral sex by a female.
Magazines published for teens offer another insight into adolescent behavior. According to a survey of teens ages 15-19, 49% consider oral sex "not as big a deal as intercourse," and 40% did not consider it as "sex."5 A summer 2000 Internet survey conducted by Twist magazine revealed that 18% of girls ages 13-19 believe that oral sex is a safe substitute for intercourse.6
Noncoital sexual behavior also is often a precursor to intercourse and can therefore shed light on patterns of sexual progression, notes Finer. In addition, research indicates that precocious sexual behavior is often linked to risk behaviors such as drug use and delinquency,7 he adds.
"If, for example, noncoital sexual behavior generally leads to intercourse, then individuals who begin noncoital behaviors at early ages could be considered at risk for these other kinds of risk behavior," states Finer. "But without data on the range of sexual behavior, there is no way to know either the relationship between noncoital and coital behavior or the groups or individuals at greatest risk."
Defining what it’ is
Adults are behind the curve on when it comes to assessing the level of oral sex in the adolescent population, says Linda Dominguez, RN-C, NP, assistant medical director of the Albuquerque-based Planned Parenthood of New Mexico. Teens are doing it’; it’s just a new it’ for adults to consider, she contends.
"Today’s parents grew up in an era when oral sex was considered beyond getting a home run,’ where oral sex was perceived to be reserved for a long-term, safe, and trusting relationship," explains Dominguez. "For kids today, it is part of the game, the warm up, the supposedly safe practice swings."
The time to start talking to adolescents about the full range of risk behaviors is now, states Dominguez. Numerous studies has demonstrated that oral sex can result in the transmission of HIV and other STDs.8
"The health of our kids and our nation is at risk until here in the United States we adopt an approach that recognizes that sexual health is part of overall health and should be treated in the same manner, with information, education, and prevention," she asserts. (Obtain tips on how to talk with teens in the story below.)
1. Kaiser Family Foundation and American Social Health Association. STDs in America: How Many Cases And At What Cost? Menlo Park, CA; December 1998.
2. Kaiser Family Foundation and Seventeen magazine. National Survey of Teens: Safer Sex, Condoms, and the Pill. Menlo Park, CA; November 2000.
3. Remez L. Oral sex among adolescents: Is it sex or is it abstinence? Fam Plann Perspect 2000; 32:298-304.
4. Gates GJ, Sonenstein FL. Heterosexual genital sexual activity among adolescent males: 1988 and 1995. Fam Plann Perspect 2000; 32:295-297, 304.
5. News release. Seventeen news. National survey conducted by Seventeen finds that more than half of teens ages 15-19 have engaged in oral sex. Feb. 28, 2000.
6. Birnbaum C. The love and sex survey 2000. Twist Oct./Nov. 2000; 54-56.
7. Jessor R, ed. New perspectives on adolescent risk behavior. New York: Cambridge University Press; 1998.
8. Centers for Disease Control and Prevention. Preventing the Sexual Transmission of HIV, the Virus that Causes AIDS. What You Should Know About Oral Sex. Atlanta; December 2000.
For more information on the risks of oral sex, contact:
• Lawrence Finer, PhD, The Alan Guttmacher Institute, 120 Wall St., New York, NY 10005. E-mail: email@example.com.
• Linda Dominguez, RN-C, NP, Planned Parenthood of New Mexico, 719 San Mateo N.E., Albuquerque, NM 87108. Telephone: (505) 265-5976.