Lawrence S. Neinstein, M.D., F.A.C.P.
Professor of Pediatrics and Medicine
USC Keck School of Medicine
Executive Director
University Park Health Center
Associate Dean of Student Affairs
   

 

 

Sexuality - Overview(B3)

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It is not always comfortable for a clinician to deal with sexual issues of adolescents. Suddenly the 6 or 8 year old child that has been coming in for ear infections or rashes is turning into an adult. In the process the teen is developing both physical changes but is becoming much more interested and involved in their sexual identity and relationships. An additional part of this is dealing with the consequences of sexual behaviors including sexually transmitted diseases and pregnancy. However, clinicians must be aware that all teenagers are sexual beings whether or not they are sexually active and also that teens engage in sexual activities other than vaginal intercourse. The reality is that sexual development and behavior does not start during adolescence or adulthood, but with childhood sexual curiosity. It is critical for health-care providers caring for adolescents to understand sexuality during the teenage period and to be familiar with ways to deal with teenagers' questions, feelings, and problems.

A FEW DEVELOPMENTAL ISSUES

Preadolescent period:

Biological sex is determined based on chromosomes, gonads, and hormones. In general, gender identity or sense of masculinity and femininity is established during this period also. During this period there is low physical and mental time spent on sexuality issues.

Early Adolescence

This period is characterized by:

  • Early pubertal developmental changes
  • Curiosity and concern over one's body and one's peers
  • Sexual fantasies are common as well as beginning of masturbation activity
  • Most sexual activity is nonphysical such as phone conversations
Middle Adolescence

This period is characterized by:

  • Full physical maturation including menstruation in females
  • High sexual energy with more emphasis on physical contact
  • Sexual exploration activity including dating, kissing, casual relationships of both coital and noncoital nature
  • Denial of consequences of sexual behaviors
Late Adolescence

This period is characterized by:

  • More expressive and less exploitative sexual behaviors
  • More intimate sharing relationships

Adolescents are filled with questions about their sexuality including?

  • Am I normal?
  • Is masturbation ok?
  • Am I ready for a sexual relationship or intercourse?
  • How do I say no?
  • What is safe sex?
  • What is contraception?
  • Am I gay?

SEXUAL BEHAVIORS

The following web sites have the most information about sexual behaviors on U.S. adolescents.

Other web sites with a more international focus include:

www.ippf.org
International Planned Parenthood Federation (IPPF) . Links family planning associations in over 150 countries worldwide.

www.paho.org
Pan American Health Organization (PAHO). . Addresses the health of adolescents and youth within the context of their social and economic environment.

www.popcouncil.org
The Population Council. . Organization conducts reproductive health research and policy work worldwide. Publications cover a range of reproductive health topics, including adolescent health.

http://www.siecus.org
Sexuality Information and Education Council of the U.S. , SIECUS Home Page . 2000, SIECUS. SIECUS develops, collects, and disseminates information, promotes comprehensive education about sexuality, and advocates the right of individuals to make responsible sexual choices.

http://www.unescobkk.org/education/ict/ict-in-education-projects/other-projects/unesco-projects/adolescent-reproductive-and-sexual-health/
UNESCO ( Bangkok office). /. The Adolescent Reproductive and Sexual Health section includes demographic profiles of adolescents in Asia and the Pacific, advocacy and IEC strategies for adolescent-oriented programs, reproductive and sexual health information, publications and resources, links and news.

Given the need, do physicians address issues of adolescent sexuality?

In a recent CDC news release (PACT5, December 8, 2000) it was found that in a survey of 15,000 high school students from the U.S., only 43% of teenage females and 26% of teenage males discuss pregnancy or sexually transmitted infections with their physicians during routine exams.

UNWANTED SEXUAL EXPERIENCES

Unfortunately not all adolescent sexual involvement is consensual.

  • Over 80% of females in grades 8-11 and over 2/3 of males experienced unwanted sexual comments or actions in 1993.
  • Sexual intercourse in young adolescents in particular may not be voluntary. Data presented by the Alan Guttmacher Institute indicates that about 74% of women who had intercourse before age 14 and 60% of those who had sex before age 15 report having had sex involuntarily (Alan Guttmacher Institute, 1994

Suggestions to help adolescents better deal with their sexuality include:

  • Listening to teen's feeling and concerns and tempering ones own reactions.
  • Parents can exert a strong positive influence, not through moralizing, lecturing, or invasion of privacy, but through helping the adolescent in his or her decision-making process.
  • Timing: Because sexuality begins in childhood, it is important to treat sexuality as a natural part of life from birth onward. Given this perspective, it is much less awkward to have discussions about sexuality when children grow up.
  • Education: Adolescents should be informed and knowledgeable -with the aid of parents, school, or community resources in areas including basic reproductive anatomy and physiology, basic sexual functioning, health consequences of sexual intercourse, decision making skills
  • Avoid joking about sexuality
  • Admit personal discomfort
  • Have available resources including books and pamphlets or web sites.
  • Respect the adolescent's privacy
  • Be aware of community resources.

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Web Sites

Sites for Teenagers and parents

www.goaskalice.columbia.edu
Go Ask Alice ! . Source of general health and sex information maintained by Columbia University health educators. Most questions answered are submitted by high school and college-aged people.

www.iwannaknow.org
This web page is specifically designed for teenagers to find answers to their questions about their bodies, sex, and sexual feelings, and to provide them with “responsible educational information in a relaxed, safe, and fun environment.”

http://www.teenwire.com/index.asp
TeenWire. Sponsored by the Planned Parenthood Federation of America . Provides teens with unbiased, uncensored sexuality and sexual health information.

www.unicef.org/voy
Voices of Youth. UNICEF. Designed for youth worldwide as a venue to share ideas.

www.ippf.org
International Planned Parenthood Federation (IPPF) . Links family planning associations in over 150 countries worldwide. Provides information to a number of other sites.

www.paho.org
Pan American Health Organization (PAHO). . Address the health of adolescents and youth within the context of their social and economic environment.

http://www.plannedparenthood.org
Planned Parenthood Federation of America .

www.popcouncil.org
The Population Council. . Organization conducts reproductive health research and policy work worldwide. Publications cover a range of reproductive health topics, including adolescent health.

http://www.siecus.org
Sexuality Information and Education Council of the U.S. , SIECUS Home Page . 2000, SIECUS. SIECUS develops, collects, and disseminates information, promotes comprehensive education about sexuality, and advocates the right of individuals to make responsible sexual choices.

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References

Committee on Communications, American Academy of Pediatrics. Sexuality, contraception, and the media. Pediatrics 1995;95:298.

Eyre SL, Read NW, Millstein SG. Adolescent sexual strategies. Journal of Adolescent Health 1997;20:286.

Miller KS, Kotchick BA, Dorsey S et al. Family communication about sex: what are parents saying and are their adolescents listening? Family Planning Perspectivess 1998;30:218.

Neinstein LS: Adolescent Health: A Practical Guide, 4 th Edition, Chapter 39: Neinstein LS, Anderson MM. Adolescent Sexuality, Lippicott Williams and Wilkins, Philadelphia , 2002.

Santelli JS, Lindberg LD, Abma J et al. Adolescent sexual behavior: Estimates and trends from four nationally represented surveys. Family Planning Perspectives 2000;32:156.

Schoen C, Davis K, DesRoches C, Shekhdar A. The health of adolescent boys: Commonwealth Fund survey findings. The Commonwealth Fund. http://www.commonwealthfund.org/Content/Publications/Fund-Reports/1998/Apr/The-Health-of-Adolescent-Boys--Commonwealth-Fund-Survey-Findings.aspx

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Copyright (©) 2004-2013 Lawrence S. Neinstein, University of Southern California . All rights reserved. Republication or redistribution of the text, table, graphs and photos is expressly prohibited. The University of Southern California shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.