Sexuality is an aspect of human development across the lifespan. The rapid biological and psychosocial changes that occur during adolescence enhance the importance of sexuality during this critical period. During puberty, hormones increase adolescents' attraction to potential sexual partners and enables their bodies to reproduce. Psychosocial development enhances teens' abilities to negotiate sexual relationships and to realize that their physically mature bodies encourage adultlike interactions, including romantic relationships and a greater degree of autonomy from parents. This article reviews a number of adolescent sexual issues, including sexual activity, contraception, sexually transmitted infections (STIs), and reproduction. In addition, the issues of substance use, violence, and sexual orientation as related to adolescent sexual behavior are discussed.
Adolescent Sexual Behavior
Overall, fewer high school students are choosing to have sexual intercourse than in the past. The Alan Guttmacher Institute (AGI) reported in 1999 that one in five adolescents (ages fifteen to nineteen) had not had intercourse. Yet, in 1999, 49.9 percent of teens in grades nine through twelve reported ever having had sexual intercourse, a decline from 54.1 percent in 1991. According to the 1999 Youth Risk Behavior Survey (YRBS), produced by the Centers for Disease Control and Prevention (CDC), black students (71.2%) are about 50 percent more likely to be sexually experienced than Hispanic (54.1%) and white students (45.1%). Older students (grades eleven and twelve; 58.7%) were more likely to have had sex than those in ninth and tenth grades (42.7%). Among male and female students, 36.3 percent reported having had sex within the previous three months with higher percentages among black students (53%) and twelfth graders (50.6%).
More than 8 percent of adolescent students (grades nine through twelve) reported having had sexual intercourse before age thirteen. According to the 1999 YRBS, male students (12.2%) were almost three times as likely as female students (4.4%) to have had intercourse before age thirteen. Black students were the most likely to have had sex by that age (20.5%). Males in grades nine and ten also reported initiating sex earlier than their eleventh and twelfth grade peers.
Nationwide figures from the CDC show that 16.2 percent of students (grades nine through twelve) in 1999 reported having had four or more sexual partners, a decline from 18.7 percent in 1991. More male students (19.3%) reported multiple partners than female students (13.1%). Black students (34.4%) more frequently reported sex with multiple partners than Hispanic (16.6%) and white students (12.4%).
Underscoring the importance of contraception is the reality that teens experience a disproportionate share of STIs and unintended pregnancies. In the 1999 CDC survey, 58 percent of students in grades nine through twelve reported that they or their partner used a condom during last sexual intercourse. By gender, 65.5 percent of males and 50.7 percent of females reported condom use. Black students (70%) were more likely to report condom use than Hispanics (55.2%) and whites (55%). From 1991 to 1999, the percentage of teens (grades nine through twelve) that used a condom at last intercourse increased from 46.2 percent to 58 percent. Concerning oral contraception, only 16.2 percent of students reported use of the birth control pill before last sexual intercourse. Overall, white female students in grades eleven and twelve reported the highest use of oral contraception. Yet the 1995 National Survey of Adolescent Males revealed that even adolescents who have successfully used contraception do not use it consistently.
Consequences of Adolescent Sexual Behavior
One sexual encounter can lead to pregnancy or an individual's sexually transmitted infection. AGI finds that every time a teenage woman has sex she has a 1 percent risk of contracting human immunodeficiency virus (HIV), a 30 percent risk of contracting genital herpes, and a 50 percent risk of contracting gonorrhea. The U.S. Department of Health and Human Services (DHHS) reports that although adolescents (ages fifteen to nineteen) represent less than 16 percent of the population of reproductive age (ages fourteen to forty-four), youth account for almost 27 percent of new STI infections (4 million of 15 million new STIs). Based on the 1999 YRBS, female adolescents (ages fifteen to nineteen) had the highest rate of chlamydia (about 2,484 per 100,000) and gonor-rhea infection (534 cases per 100,000) among all U.S. women (404.5 cases per 100,000 and 130 cases per 100,000, respectively).
Sherry Murphy reported that in the United States in 1998, HIV infection was the ninth leading cause of death among persons fifteen to twenty-four years of age. Using YRBS data, the CDC found that although the national number of acquired immunodeficiency syndrome (AIDS) cases diagnosed annually had declined, changes in infection rates among individuals aged thirteen to twenty-four had not followed the same downward trend. By 1999 more than 800 youth (ages thirteen to nineteen) had been diagnosed with AIDS. Adolescent females (64%) and black youth (56%) represented a greater proportion of those diagnosed. Sexually active teenagers face an increased risk for STIs because they often are unable or reluctant to obtain education, birth control, and services for infection screening and treatment.
Among the world's developed countries, the United States has one of the highest teen pregnancy rates—double the rate of France and nine times that of the Netherlands and Japan. In 1994 teenagers aged fifteen to eighteen experienced the highest percentage of unintended pregnancies (71.1%), more than twice that of people aged thirty to thirty-four (33%). According to 1999 YRBS data, 6.3 percent of all sexually active students reported a pregnancy or impregnation of a partner. Female students in grades eleven and twelve (8.1% and 13.8%, respectively) were significantly more likely to have been pregnant than females in lower grades (4.8%). By race, black students (13.4%) were significantly more likely than white students (4.3%) to have been pregnant or to have gotten someone pregnant. AGI found that between 1990 and 1996, the national teen pregnancy rate (among those age fifteen to age nineteen) declined 17 percent, from 117 pregnancies per 1,000 women to 97 per 1,000. By race, however, the figures were not as promising. During the same period, the national pregnancy rate for black teens (ages fifteen to nineteen) decreased from 224 pregnancies per 1,000 to 179 per 1,000, while the Hispanic rate basically stayed the same (163 per 1,000 in 1990; 165 per 1,000 in 1996).
In 1998, 12.3 percent of all U.S. births occurred to teens. This teen birthrate has been decreasing over time. Between 1991 and 1996, the teen birthrate decreased 12 percent, from 62.1 births per 1,000 women to 54.4 births per 1,000, as reported by AGI. Between 1986 and 1996, the proportion of teen pregnancies that ended in abortion fell 31 percent; the number of abortions attributed to adolescent women (ages fifteen to nineteen) declined from 42.3 per 1,000 women in 1986 to 29.2 per 1,000 in 1996. Abortion rates appear to be declining because fewer teens are becoming pregnant and fewer pregnant teens are terminating their pregnancy by abortion.
Other Adolescent Sexuality Issues
Adolescent substance use increases the likelihood of risky adolescent sexual behavior, including multiple sexual partners and early initiation of sexual intercourse. Among students who reported current sexual activity in the YRBS, 24.8 percent had used alcohol or drugs at last sexual intercourse. Male students (31.2%) were more likely to have used such substances than females (18.5%). In examining the data by race, both white male (33.7%) and female students (21.5%) were more likely than Hispanic (male: 30%; female: 14.4%) and black students (male: 26.6%; female: 9.3%) to have combined alcohol or drugs with their last sexual experience.
Substance use has also been associated with sexual violence among adolescents. In 1998, of the almost half million cases of victim-reported rape, 43 percent of the victims reported the offender was under the influence of alcohol and/or drugs. Alcohol has been deemed the chief date-rape drug on U.S. college campuses.
The 1999 YRBS data revealed that 8.8 percent of American students (grades nine through twelve) had been forced to have sexual intercourse against their will. Female students (12.5%) were more than twice as likely to report that they had been victims of sexual aggression than male students (5.2%). By race, black (11.6%) and Hispanic students (10.5%) were more likely to report forced sexual intercourse than white students (6.7%).
A final adolescent sexuality issue that is often ignored is sexual orientation. In 1998 Robert Bidwell wrote that the prevalence of sexual minority youth (e.g., gay, lesbian, bisexual, transgender) was undetermined. Yet it is important to consider sexual orientation in relation to other sexual risk behaviors and adolescent health in general. Sexually active gay adolescents are at particular risk for HIV infection. In 1999, according to the CDC, 46 percent of reported HIV infections among adolescent males (ages thirteen to nineteen) were attributed to male-to-male sexual contact. In addition to medical risks, the DHHS found that lesbian, gay, and bisexual youth face discrimination, hatred, isolation, and an increased risk for suicide.
It is evident that adolescents can and do take a great number of sexual risks. Unprotected intercourse has the ability to create life (pregnancy) or to end life (HIV infection). Fortunately, researchers have found a number of relevant avenues of prevention. These include addressing factors related to neighborhoods (e.g., socioeconomic status, joblessness), peers (e.g., sexually active friends), families (e.g., family instability, single-parent households, sibling sexual activity), and individuals (e.g., academic motivation, depression). Adolescents certainly have much to gain through more comprehensive prevention efforts.
Alan Guttmacher Institute. Sex and America's Teenagers. New York:Alan Guttmacher Institute, 1994.
Alan Guttmacher Institute. Facts in Brief: Teen Sex and Pregnancy. New York: Alan Guttmacher Institute, 1999.
Alan Guttmacher Institute. Teenage Pregnancy: Overall Trends and State-by-State Information. New York: Alan Guttmacher Institute, 1999.
Bidwell, Robert. "Sexual Orientation and Gender Identity." In Stanford Friedman, Martin Fisher, S. K. Schonberg, and E. M. Alderman eds., Comprehensive Adolescent Health Care. St. Louis, MO: Mosby Publishing Service, 1998.
Centers for Disease Control and Prevention. "Fact Sheet: Youth Risk Behavior Trends from CDC's 1991, 1993, 1995, 1997, and 1999 Youth Risk Behavior Surveys." In the Centers for Disease Control and Prevention [web site]. Atlanta, Georgia, 2000. Available from http://www.cdc.gov/nccdphp/dash/yrbs/trend.htm; INTERNET.
Centers for Disease Control and Prevention, Division of STD Prevention. Sexually Transmitted Disease Surveillance, 1999. Atlanta, GA: U.S. Department of Health and Human Services, 2000. Available from http://www.cdc.gov/nchstp/dstd/Stats_Trends/1999SurvRpt.htm; INTERNET.
Centers for Disease Control and Prevention, Division of HIV/AIDSPrevention. Need for Sustained HIV Prevention among Men Who Have Sex with Men. Atlanta, GA: U.S. Department of Health and Human Services, 2000. Available from http://www.cdc.gov/hiv/pubs/facts/msm.htm; INTERNET.
Centers for Disease Control and Prevention, Division of HIV/AIDSPrevention. Young People at Risk: HIV/AIDS among America's Youth. Atlanta, GA: U.S. Department of Health and Human Services, 2000. Available from http://www.cdc.gov/hiv/pubs/facts/youth.htm; INTERNET.
Henshaw, Stanley. "Unintended Pregnancy in the United States." Family Planning Perspectives 30 (1998):24-29.
Murphy, Sherry. "Deaths: Final Data for 1998." National Vital Statistics Report 48, no. 11. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2000. Available from http://www.cdc.gov/nchs/data/nvs48_11.pdf; INTERNET.
U.S. Department of Health and Human Services. Report of the Secretary's Task Force on Youth Suicide. Washington, DC: U.S. Department of Health and Human Services, 1989.
U.S. Department of Health and Human Services. Healthy People 2010: Objective 25: Sexually Transmitted Diseases. Washington, DC: U.S. Department of Health and Human Services, 2000.
Ventura, Stephanie, Joyce Martin, Sally Curtin, T. J. Matthews, and Melissa Park. "Births: Final Data for 1998." National Vital Statistics Report 48, no. 3. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 1998. Available from http://www.cdc.gov/nchs/data/nvs48_3.pdf; INTERNET.