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Further information: Adolescent sexuality
The sexuality of US adolescents includes their feelings, behaviors and development, and the place adolescent sexuality has in American society, including the response of the government, educators, parents, and other interested groups.
Teenage pregnancy is four times as prevalent in the US as in the European Union,[1] but has been steadily declining since 1991, reaching a record low in 2012, according to the US Centers for Disease Control and Prevention (CDC), and continuing to decline through 2017.[2][3][4] The CDC said in 2007, 35% of US high school students were currently sexually active and 47.8% of US high school students reported having had sexual intercourse.[5] In 2017, the percentage sexually active was down to 28.7%, and the percentage who had ever had intercourse was 39.5%.[4] According to a 1994 study, every year an estimated one in four sexually active teens contracts a sexually transmitted infection (STI).[6]
In 1999, a Kaiser Family Foundation study found that 95% of public secondary schools offered sex education programs. More than half of the schools in the study followed a comprehensive approach that included information about both abstinence and contraception, while approximately one third of schools provided students with abstinence-only sex education.[7] In 2002, most Americans favored the comprehensive approach.[7] A 2000 study found that almost all schools included information about HIV, the virus that causes AIDS, in their curricula.[7] There have been efforts among social conservatives in the US government to limit sex education in public schools to abstinence-only sex education curricula.[7] The effectiveness of abstinence-only programs has been an issue of controversy.[8][9]
Self-report surveys suggest that half of all 15- to 19-year-olds have had oral sex. That percentage rises to 70% by the time they turn 19, and equal numbers of boys and girls participate.[10] Research indicating that oral sex is less risky to teens' emotional and physical well-being than vaginal sex has been advanced;[11] researchers at the University of California, San Francisco do not believe this conclusion is warranted.[12] They found that oral sex, as well as vaginal sex, was associated with negative consequences.[12] 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.[13] Despite their behaviors, 90% of adolescents "agree that most young people have sex before they are really ready."[14]
The average age of first sexual intercourse in the United States is around 16.8 for males and around 17.2 for females,[15][16] and this has been rising in recent years.[17] For those teens who have had sex, 70% of girls and 56% of boys said that their first sexual experience was with a steady partner, while 16% of girls and 28% of boys report losing their virginity to someone they had just met or who was just a friend.[17]
Teens are using birth control (contraceptives) more today when they lose their virginity than they did in the past, and this is in part due to the AIDS epidemic.[17] Of sexually experienced adolescents, 78% of girls and 85% of males used at least one contraceptive when they lost their virginity.[17] A detailed qualitative study of girls' loss of virginity found that their experiences "were almost all quite negative (and, in some cases, horrific)."[18] Before age 15, "a majority of first intercourse experiences among females are reported to be non-voluntary."[19]
Adolescents who are better students generally initiate sexual activity later than those who are poor students. In addition, among those seventh and eighth graders, those with personal and perceived peer norms that encourage adolescents to refrain from sex are less likely to engage in it.[20]
The percentage of teenagers who report they are currently sexually active has been dropping since 1991.[21] By 2005, the overall percentage of teenagers reporting that they were currently sexually active was down to 33.9%.[5] A lower number of sexually active teens are "quite positive in terms of their health and their well-being."[22]
The condom is the most popular form of contraception used by teenagers.[23] Among sexually active 15- to 19-year-olds, from 2002 to 2010 more than 80% of females and more than 90% of males reported using at least one method of birth control during their last intercourse.[17][24] In 1995, only 71% of girls and 82% of boys reported using contraception the last time they had sex.[17] In 2006–2010, one in five sexually active female teens (20%) and one-third of sexually active male teens (34%) reported having used both the condom and a hormonal method the last time they had sex.[17] Less than 20% of girls at risk for unintended pregnancy were not using any contraceptive method the last time they had sex.[17] Calendar abstinence, or the rhythm method, was used by 17% of female teens in 2006–2008.[23]
Sexual abstinence is the practice of refraining from some or all aspects of sexual activity for medical, psychological, legal, social, financial, philosophical, moral or religious reasons. For the last twenty years, abstinence rates among American adolescents have risen. The percentage of high school students in the US who reported that they have ever had sexual intercourse dropped from 54.1% in 1991 to 47.8% in 2007,[5] 43% in 2011[25] and 39.5% in 2017.[4] A cross-sectional survey 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. Other reasons included a fear of sexually transmitted infections, a lack of desire, being afraid of getting caught, and the belief that sex was not appropriate for someone of their age.[26]
Epidemiologists at the Center for Disease Control emphasize that for sex education to be effective, it should take place before teens become sexually active.[27]
Belief that sex was not right for a person their age
Both adolescents who have never had sex and those who have chosen to become abstinent after engaging in sexual behaviors cite the negative consequences of sex as reasons why they choose not to have sex.[26] Girls of all ages and experience levels were more likely than boys to cite the fear of pregnancy and sexually transmitted diseases.[26] Virgin boys were more likely than girls to say they believed most students did not have sex.[26]
Boys who caused a pregnancy in the past were more than twice as likely to become abstinent after this episode than boys who had not. However, for girls, a past pregnancy had little correlation with secondary abstinence.[26] Fear of pregnancy, wanting to wait until marriage, and not wanting to have sex were cited more often by virgins in the 12th grade than they were by 9th graders.[26] Of the sexually experienced who are now practicing abstinence, girls were more likely than boys to say a lack of desire, fear of STDs, being afraid of getting caught, the belief that sex was not appropriate for someone their age, and that their parents had taught them the advantages of waiting as reasons why they made their decision.[26]
Among young people engaging in some form of sexual activity, definitions of virginity differ. Virginity is usually defined as the state of a person who has never engaged in sexual intercourse, although there are some gray areas. For example, teenagers that engage in oral sex but not penile-vaginal sex may still identify themselves as virgins; this is sometimes termed technical virginity. Of those polled, 70% of adolescents aged 11–16 believed oral sex did not disqualify someone from virginity, and 30% believed they were still abstinent.[29][30]
Of adolescents age 11–16, 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. Additionally, 16% considered themselves virgins after anal 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 one could engage in the former and 12% said one could participate in the latter while still remaining abstinent.
Among those 15–19 years old, those who remain a "technical virgin" are motivated more by the fear of pregnancy or STIs and less by religion and morality.[30]
The American Academy of Pediatrics has identified the sexual behaviors of American adolescents as a major public health problem.[31] The Academy is concerned about the prevalence of sexually transmitted diseases in sexually active teenagers and about the very high rate of teenage pregnancy in the United States compared to other developed countries.
Research into adolescents' sexual behavior in situations outside traditional dating situations, commonly referred to as "hooking up", shows that a large number of adolescents underestimate the risk involved in such situations.[32][33]
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.[6] The 2008 rate was a record low and represented a 42% decline from the peak rate of 117 per 1,000, which occurred in 1990.[17] From 2009 to 2010, the teen pregnancy rate dropped 9%, the biggest one year drop since the 1940s.[34]
Each year, almost 750,000 girls aged 15–19 become pregnant. Two-thirds of all teen pregnancies occur among the oldest teens (18–21-year-olds).[17] Of them, 82% are unplanned, accounting for about 20% of all unintended pregnancies annually.[17] Of pregnancies among 15–19-year-olds girls in 2008, 59% ended in birth, 26% in abortion, and the rest in miscarriage.[17] Overall, 68 pregnancies occurred per 1,000 girls aged 15–19 in 2008. Nearly 7% of 15–19-year-old girls become pregnant each year. Pregnancies are much less common among girls younger than 15. In 2008, 6.6 pregnancies occurred per 1,000 teens aged 14 or younger. In other words, fewer than 1% of teens younger than 15 become pregnant each year.[17] Stillborn and newborn deaths are 50% higher for teen moms than women aged 20–29, and are more likely to have a low birth weight.[35]
Teenage birth rates, as opposed to pregnancies, 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.[34] One in four American women who had sex during their teenage years will have a baby before they are married, compared to only one in ten who wait until they are older.[36] Even more will experience a pregnancy. Of women who have sex in their teens, nearly 30% will conceive a child before they are married. Conversely, only 15% of women who do not have sex in their teens will become pregnant before they are married.[36] Of all women, 16% will be teen mothers.[37]
According to a study, girls who participate in girls-only activities are far less likely to experience a teenage pregnancy and less likely to be sexually active in general.[38] Participating in competitive sports has also shown to have an effect for girls. A study published in 1999 found that female adolescents who participated in sports were less likely than their non-athletic peers to engage in sexual activity and/or report a pregnancy.[39] Males interested in arts are also less likely to be involved in a pregnancy situation. It is unclear whether these correlations are causal or the reflection of the underlying bias of the considered population. The study that reported these findings did not take into account the sexual orientation of the subjects.[39]
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."[40] In another study, teens aged 15–19 accounted for 15.5% of abortions in 2009, and patients aged 20–24 made up 32.7%. Together adolescents aged 15–24 made up just under half (48.2%) of the 784,000 abortions reported to the CDC that year.[41]
According to one study, laws that require parental notification or consent before a minor can obtain an abortion "raise the cost of risky sex for teenagers."[42] The study found that states which have enacted such laws have seen lower gonorrhea rates among teens than states that do not have such laws. The researchers of the study believe these laws lower the gonorrhea rate because teens reduce the amount of sexual activity they have and are more fastidious in their use of birth control.[42] On the contrary, statistics released from the World Health Organization (WHO) indicate that more restrictive laws on abortions do not necessarily mean fewer abortions; the abortion rate one year for Latin America (where, broadly speaking, abortions are generally made illegal) was 32 per 1000 people, whereas the abortion rate for Western Europe (where overall the laws are more relaxed) was 12 in 1000.[43]
Each year, between 8 and 10 million American teens contract a sexually transmitted infection (STI/STD),[note 1] almost half of the 19 million STIs reported for all age groups in the United States.[17][45]
Lloyd Kolbe, director of the Center for Disease Control's Adolescent and School Health program, called the STI problem "a serious epidemic."[46] The younger an adolescent is when they first have any type of sexual relations, including oral sex, the more likely they are to get an STI.[47][48]
HPV (Human papillomavirus) is the most common STI among teens (as well as adults).[49] In a CDC study, 18% of teen girls were infected with HPV.[50] Another study found that HPV infections account for about half of STIs detected among 15- to 24-year-olds each year.[17][51] While HPV infections may not cause any disease and is often asymptomatic, it can cause genital warts and even cancer.
After HPV, trichomoniasis and chlamydia are the most common STI diagnoses among 15- to 24-year-olds; combined, they account for slightly more than one third of diagnoses each year.[17] Genital herpes and gonorrhea together account for about 12% of diagnoses. HIV, syphilis and hepatitis B account for less than 1% of diagnoses,[17] however young people aged 13–24 accounted for about 21% of all new HIV diagnoses in the United States in 2011.[17]
Researchers from the CDC have stated that teenagers often do not understand the risks associated with sexual activity. "Research suggests that adolescents perceive fewer health-related risks for oral sex compared with vaginal intercourse. However, young people, particularly those who have oral sex before their first vaginal intercourse, may still be placing themselves at risk of STIs or HIV before they are ever at risk of pregnancy."[48] "Several studies have documented that oral sex can transmit certain STIs, including chlamydia, genital herpes, gonorrhea and syphilis. Teenagers and young adults engaging in sexual activity are at increased risk of STIs or HIV."[48]
A 2008 study by the CDC found that one in four teen girls, or an estimated 3 million girls, has an STI.[50] 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. This is compared with 20% among both white and Mexican-American teens.[52] 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.[50]
In a 2011 study by the CDC, 7.1% of females and 2.1% of males aged 15–24 were infected with chlamydia,[53]:65 historically the most prevalent of all STIs in the general population (after HPV).
The earlier onset of puberty can produce sexual drives at a time when teens are not yet fully socialized to understand the potential social and emotional consequences of sexual activities.[54][55][56][57][58] Some scholars claim that the risk for depression is "clearly elevated" for the sexually active of either gender.[59]
"We tend to focus on the health consequences of having sex, like pregnancy and STIs, but we also need to talk to [teens] about all the emotional consequences," some experts say.[13]
Some research suggests that two-thirds of sexually active girls wish they had waited longer before having sex.[60] Of seniors in high school, 74% of girls regret sexual experiences they have had.[61]
For girls, even modest involvement in sexual experimentation elevates depression risk.[62] Sexually active teenage girls are more than twice as likely to suffer depression compared to those who are not sexually active.[63]
Sex therapists have found that the roots of sexual issues facing adults often date back to regretful teenage experiences.[13] Research has also found that being abstinent in the teen years was associated with better mental health at age 29.[64] Girls who were virgins at age 18 were also less likely to have a mental illness at age 40.[65]
Girls are "at particular risk for experiencing negative social and emotional consequences of having any type of sex," including oral sex.[12] 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[13] or hookups.[13][66]
In a study of casual sex among adolescents, many girls believed they could have a purely sexual experience with no emotional ties, and they believed it was sexist to assume otherwise. However, the study found that both the girls and the boys who were hooking up often were depressed and didn't feel very good about themselves.[67]
When engaging in sexual acts the body produces oxytocin, a chemical produced in the brain to promote feelings of connection and love. Production of oxytocin increases during the adolescent years. It has a larger effect on girls, suggesting it may make them care more about relationships and feel connections with others more intensely than boys.[68][69]
Teen dating violence is defined as the physical, sexual, psychological or emotional violence within a dating relationship, as well as stalking.[70] This includes electronic forms (e.g., threatening text messages, excessive yelling or cursing at someone in a phone message) as well as face-to-face forms.[70]
Girls who have engaged in sexual intercourse are five times more likely than their virgin peers to be the victim of dating violence.[71] 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."[71] Girls who have been victims are also twice as likely to report high levels of multiple sexual partners.[71]
Sexual assault is any involuntary sexual act in which a person is threatened, coerced, or forced to e
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