Sexual Orientation OverviewAwareness of romantic attraction typically begins prior to puberty . Sexual attraction, behavior, and identity are not always aligned: a person primarily attracted to women may also have sexual contact with men and may or may not identify as gay, bisexual, or straight. This fluidity may be true of both adolescents and adults, and is reported more frequently by females [2, 3].
Among youth age 15-19, according to data from the 2006-2008 National Survey of Family Growth (NSFG) :
- 11% of girls have had a same-sex partner in their lifetime, and 10% report having had a same-sex partner within the last year.
- 5% of boys have had a same-sex partner in their lifetime, and 4% report having had a same-sex partner within the last year.
- 82% of women described themselves as attracted only to the opposite sex, 9% mostly to the opposite sex, 5% equally to both, 1% mostly to the same sex, and 1% only to the same sex, with 1% unsure.
- 90% of women identified with the term "heterosexual or straight"; 2% "homosexual, gay, or lesbian"; and 6% "bisexual."
- 92% of men described themselves as attracted only to the opposite sex, 6% mostly to the opposite sex, 1% mostly to the same sex, and 1% only to the same sex, with less than 1% unsure.
- 97% of men identified with the term "heterosexual or straight"; nearly 2% "homosexual or gay"; and 1% "bisexual."
- 84% of students identified with the term "heterosexual (straight)."
- 2.5% identified as "gay or lesbian."
- 9% identified as "bisexual."
- 4.5% indicated they were not sure of their sexual identity.
Most lesbian, gay, bisexual, and/or transgender students experience harassment at school. In 2019, 69% of LGBTQ middle and high school students reported verbal harassment, 26% physical harassment, and 11% physical assault. About half (52%) had heard homophobic remarks from teachers or other school staff . Boys who are perceived to be gay or feminine are especially likely to face intense stigma . The presence of Gay-Straight Alliance clubs within a school setting has been demonstrated to foster a safer environment, but 15% of LGBTQ students reported that schools would not allow them to form or promote such a club [2, 6].
Most lesbian, gay, and bisexual youth achieve health and well-being at levels similar to those achieved by heterosexual youth, though many face higher risks for violence and rejection .
Romantic Relationships and Sexual ExperienceAbout one in three 13-year-olds has had a romantic relationship (not necessarily sexual), and the number naturally increases with age: By age 17, 70% report having had a special romantic relationship within the last 18 months . Despite relatively high levels of conflict in adolescent romantic relationships, most youth report a sense of equal power, decision making, and emotional support within their relationships .
Interest in romantic and sexual contact typically begins around age 11-14 . Adolescent sexual behaviors most often occur within romantic relationships , or with friends or ex-partners . Sexual activity that goes beyond kissing and other "light" behaviors may be associated with depression and other problems in early adolescence when these behaviors are uncommon. However, these problems are not associated with sexual activity in late adolescence within the context of a romantic relationship .
Masturbation is common. One nationally representative study of teens age 14-17 found a lifetime prevalence of 80% for boys and 48% for girls .
In one nationally representative study, "having sex" was defined as including vaginal, anal, or oral sex. With that inclusive definition, the researchers found the median age of sexual initiation to be 16 years for both males and females. By age 19, 75% of youth have had vaginal, anal, and/or oral sex .
Vaginal Intercourse / "Sexual Intercourse"
An analysis of the 2015-2017 NSFG found that among youth age 15-19, 42% of females and 38% of males have had heterosexual vaginal intercourse . Rates of vaginal intercourse have declined for both females and males since 1988, though since 2006 the rate of intercourse has declined for males and been more stable for females . In 2019, 38% of high school students reported having had "sexual intercourse" at some point in their lives (30% in New York State), and 27% were currently sexually active (had sexual intercourse at least once in the three months before taking the survey. Note that "sexual intercourse" is not defined in the survey.) . Higher percentages of lifetime sexual intercourse are seen among students who identify as bisexual (46%) . Asian high school students are less likely to have had intercourse (16%) or be currently sexually active (10%) than are students who are black, Latinx, multiple race, or white . In New York State, about one in five high school students (22%) were currently sexually active . Most people (55% females and 55% males) have had penile-vaginal intercourse by age 18 . Over 80% of adolescent women age 15-21 who report lesbian/bisexual identities or same-sex attractions report having had sex with men .
Heterosexual Oral Sex
- Among young people age 15-19, 45% have had oral sex with a different-sex partner .
- Among teens age 14-17, nearly 5% of males and 5.5% of females have had anal sex .
- Among teens age 15-19, 11% have had anal sex with a different-sex partner .
Same-Sex Oral or Anal Sex
- Among young women age 15-19, 11% have had "oral sex or any sexual experience" with a female .
- Among young men age 15-19, 3% have had oral or anal sex with a male .
Condoms and ContraceptivesAmong sexually active high school students, condom use at most recent sexual intercourse has declined from the recent high of 63% in 2003 to 54% in 2019 . Most teens use a condom or other form of contraception the first time they have sexual intercourse (78% of sexually experienced females, 89% of males) . In 2019, 9% of sexually active students reported using condoms together with another form of birth control .
According to the 2015-2017 NSFG, the most popular form of birth control among teen women age 15-19 is the condom (used at least once by 97% of sexually experienced females), followed by withdrawal (65%) and the pill (53%). Young women also indicated having at some point used the following contraceptive drugs or devices: injectables such as Depo-Provera (used by 19% of sexually experienced women age 15-19), fertility awareness methods (11%), emergency contraception (19%), the contraceptive patch (1%), and long-acting reversible contraception (20%) . Current use of long-acting reversible contraceptives (LARCs) -- IUDs and implants -- has increased among teen women who use contraception, but remains low at 8% of youth age 15-19 .
Access to Services
Among teen women age 15-17, 31% receive contraceptive services . The proportion of teens receiving services has been stable, but the source has changed: While nearly half (47%) used publicly funded clinics in 2002, only about one in four used clinics in 2011-2015 . Instead, teens are increasing relying on private physicians, reflecting either an increase in private insurance coverage or a greater willingness to use private insurance .
Sexual exploration is a natural part of adolescent development. Certain behaviors, however, do increase risk of acquiring sexually transmitted diseases (STDs) and/or unwanted pregnancy. Early initiation of sexual intercourse, multiple sex partners, sex without a condom, and incorrect use of a condom increase the risk of poor outcomes.
For statistics on dating violence, see Youth Statistics: Health.
Early Initiation of Sexual Intercourse
First penile-vaginal intercourse at an early age -- often, though not always, defined by researchers as younger than 16 -- is less likely to be consensual, and less likely to involve contraception, than sexual initiation at later ages . It is also a risk factor for teen pregnancy . Having vaginal intercourse at an early age is associated with having a greater number of sexual partners and having concurrent partners .
Multiple Sex Partners
Sexually experienced youth age 14-19 are quite likely to report having had at least three lifetime sexual partners (when sex is defined broadly as including oral, anal, and vaginal sex); just under half of females (45%) and just over half of males (55%) have had three or more partners . Among high school students, 10% of males and 7% of girls report having four or more sexual partners in their lifetime (including 16% of male and 15% of female high school seniors) .
Condomless Sex and Condom Breakage/Slippage
Defective condoms are rare, but condoms do fail when users don't fully understand how to handle them correctly. Though more likely than adults to use condoms, adolescents are also more likely to experience condom failures . (See "Condoms and Contraceptives" above for additional statistics on sex without a condom.) Although it carries an especially high level of risk for HIV and STDs, anal sex among adolescents is often unprotected [13, 19] as is (lower risk) oral sex [13, 20].
To give an example of condom problems, one (non-representative) study of a group of primarily African American girls age 14-17 found :
- Condoms were used in only one-third of incidents of vaginal intercourse.
- Condoms were used in about half of incidents of anal sex.
- Problems with condoms breaking or slipping were reported in about 10% of incidents of vaginal intercourse.
- Problems with condoms were reported in about 55% of incidents of anal intercourse.
- YMSM are less likely to use condoms during anal sex with a serious partner than with a casual partner .
- YMSM are less likely to use condoms with older partners, though HIV is more prevalent among older MSM .
- Half of sexual minority male teens (age 14-19) who are sexually active did not use a condom at last sex, and 44% had anal sex without a condom within the last six months .
- Among high school students, sexually active students who identify as LGB are less likely than heterosexual students to have used a condom during last sexual intercourse .
Adolescent Pregnancy, Abortion, and Birth RatesThe unintended pregnancy rate among women age 18-19 declined by 20% from 2008 to 2011, while the rate among women age 15-17 declined 44% . When women who are not sexually active are excluded from the analysis, the highest rates of unintended pregnancy are among teens age 15-19, followed by young adult women in their early twenties . Women of color also experience disproportionately high rates of unintended pregnancy, but pregnancy rates among black and Hispanic teens are declining steeply . Between 1990 and 2013, the pregnancy rate among women age 15-19 declined dramatically to a rate of 101 pregnancies per 1,000 sexually experienced teen women . The rate more commonly cited includes all female teens, not just those who have had sex -- that rate fell to 43 per 1,000 in 2013, the lowest it has been in at least 80 years . About 5% of all females in this age group became pregnant . Among teens, 18-19 year old women have disproportionately high rates of pregnancy . Teens who identify as lesbian, gay, or bisexual have higher rates of pregnancy involvement than heterosexual teens .
The teen abortion rate has reached its lowest point since legalization  at 6 abortions per 1,000 women age 15-19 in 2016; this rate represents a 56% decrease from 2007 to 2016 . While most women (including teens) who have abortions do so in the first trimester of pregnancy, teens are overrepresented among women who have abortions at 13 weeks or later [26, 27].
Birth rates among teens have fallen steeply since 1991, and are now at historic lows for all age and racial/ethnic groups . Between 1991 and 2018, birth rates declined 72% among teens age 15-19 (to 17.4 births per 1,000), with a 7% drop between 2017 and 2018 alone . In 2015, 17% of births to teens were to teen women who had previously given birth .
Across New York State, the 2017 pregnancy rate was 12.2 per 1,000 teens age 15-17 and 42.8 per 1,000 teens age 18-19 . In New York State outside of NYC, the rates are 9.2 (for 15-17 year olds) and 33.7 (for 18-19 year olds), while in NYC the corresponding rates are 16.7 and 58.4 . The highest rate for the 18-19 year old age group across the state is in Jefferson County (108.3), followed by Schuyler County (89.8) and Montgomery County (83.5) . In New York State in 2017, there were 7,453 births to women age 15-19 . About half (56%) of pregnancies to New York State teens age 15-19 ended in abortion in 2013 .
Sexually Transmitted Diseases (STDs) and HIVOf the roughly 20 million new STD infections reported every year, half are found among young people (ages 15-24), although this age group makes up only 25% of people who are sexually active . The most common STD is human papillomavirus, which is contracted at some point by nearly every sexually active person . In 2018, rates of chlamydia increased slightly, gonorrhea was stable, and primary and secondary syphilis increased considerably compared to 2017 rates .
Gay, bisexual, and other men who have sex with men are at high risk. In 2018, among males age 13-19, male-to-male sexual contact accounted for 93% of HIV diagnoses. Among females in the same age group, heterosexual contact accounted for 86% of diagnoses. Among teens with an HIV diagnosis, 85% are male and 15% are female .
McClintock, M. K., & Herdt, G. (1996). Rethinking puberty: The development of sexual attraction. Current Directions in Psychological Science, 5.
Saewyc, E. M. (2011). Research on adolescent sexual orientation: Development, health disparities, stigma, and resilience. Journal of Research on Adolescence, 21, 256-272. doi:10.1111/j.1532-7795.2010.00727.x
Liu, G., Hariri, S., Bradley, H., Gottlieb, S. L., Leichliter, J. S., & Markowitz, L. E. (2015). Trends and patterns of sexual behaviors among adolescents and adults aged 14 to 59 years, United States. Sexually Transmitted Diseases, 42(1), 20-26.
Chandra, A., Mosher, W. D., Copen, C., & Sionean, C. (2011). Sexual behavior, sexual attraction, and sexual identity in the United States: Data from the 2006-2008 National Survey of Family Growth. National Health Statistics Reports, 36.
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2020, August 21). Youth Risk Behavior Surveillance - United States, 2019. MMWR Supplement, 69(1). For another way to access YRBS data, including state and regional results, see the interactive database Youth Online at:
Kosciw, J. G., Clark, C. M., Truong, N. L., & Zogrone, A. (2020). The 2019 National School Climate Survey: The experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation's schools.
Collins, W. A., Welsh, D. R., & Furman, W. (2009). Adolescent romantic relationships. Annual Review of Psychology, 60, 631-652. doi:10.1146/annurev.psych.60.110707.163459
Smiler, A. (2013). Young men's sexuality: What's typical? ACT for Youth.
actforyouth.net/resources/rf/rf_young-men_0913.cfm (formatted for screen readers)
Tolman, D. L. & McClelland, S. I. (2011). Normative sexuality development in adolescence: A decade in review, 2000-2009. Journal of Research on Adolescence, 21(1), 242-255. doi:10.1111/j.1532-7795.2010.00726.x
Fortenberry, J. D., Schick, V., Herbenick, D., Sanders, S. A., Dodge, B., & Reece, M. (2010). Sexual behaviors and condom use at last vaginal intercourse: A national sample of adolescents ages 14 to 17 years [Abstract]. The Journal of Sexual Medicine, 7 Suppl 5, 305-314.
Abma, J. C., & Martinez, G. M. (2020, May). Sexual activity and contraceptive use among teenagers aged 15-19 in the United States, 2015-2017. National Health Statistics Reports.
Guttmacher Institute. (2019, September). Adolescent sexual and reproductive health in the United States [Fact sheet].
Habel, M. A., Leichliter, J. S., Dittus, P. J., Spicknall, I. H., & Aral, S. O. (2018). Heterosexual anal and oral sex in adolescents and adults in the United States, 2011-2015. Sexually Transmitted Diseases, 45(12), 775-782.
Centers for Disease Control and Prevention. (n.d.). Trends in the prevalence of sexual behaviors and HIV testing, national YRBS: 1991-2019.
Daniels, K., & Abma, J. C. (2018, December). Current Contraceptive Status Among Women Aged 15-49: United States, 2015-2017. NCHS Data Brief No. 327.
Frost, J., & Lindberg, L. (2018). Receipt of contraceptive services among young women in the United States. Journal of Adolescent Health, 62(2), S75.
Heywood, W., Patrick, K., Smith, A. M. A., & Pitts, M. K. (2015). Associations between early first sexual intercourse and later sexual and reproductive outcomes: A systematic review of population-based data. Archives of Sexual Behavior, 44, 531-569. doi:10.1007/s10508-014-0374-3
Schantz, K. (2016). The case for condom education. ACT for Youth.
actforyouth.net/resources/pm/pm_condom_0316.cfm (formatted for screen readers)
Samuel, K. (2019, May 3). How does condom use change over time as young MSM get older?
Holway, G. V., & Hernandez, S. M. (2017). Oral Sex and Condom Use in a U.S. National Sample of Adolescents and Young Adults. Journal of Adolescent Health.
Hensel, D. J., Selby, S., Tanner, A. E., & Fortenberry, J. D. (2016). A daily diary analysis of condom breakage and slippage during vaginal sex or anal sex among adolescent women. Sexually Transmitted Diseases, 43(9), 531-536.
Newcomb, M. E., & Mustanski, B. (2016). Developmental change in the effects of sexual partner and relationship characteristics on sexual risk behavior in young men who have sex with men. AIDS and Behavior, 20(6), 1284-1294.
Valencia, R., Wang, L. Y., Dunville, R., Sharma, A., Sanchez, T., & Rosenberg, E. (2018). Sexual risk behaviors in adolescent sexual minority males: A systematic review and meta-analysis. The Journal of Primary Prevention, 39(6), 619-645.
Guttmacher Institute. (2019, January). Unintended pregnancy in the United States.
Kost, K., Maddow-Zimet, I., & Arpaia, A. (2017, September). Pregnancies, births and abortions among adolescents and young women in the United States, 2013: National and state trends by age, race and ethnicity.
Jatlaoui, T. C., Eckhaus, L., Mandel, M. G., Nguyen, A., Oduyebo, T., Petersen, E., & Whiteman, K. (2019). Abortion Surveillance--United States, 2016. MMWR Surveillance Summaries, 68(11), 1-41.
Jatlaoui, T. C., Boutot, M. E., Mandel, M. G., Whiteman, M. K., Ti, A., Petersen, E., & Pazol, K. (2018). Abortion surveillance - United States, 2015. MMWR Surveillance Summaries, 67(13), 1-45.
Power to Decide. (n.d.). National & state data.
Dee, D. L., Pazol, K., Cox, S., et al. (2017, April 28). Trends in repeat births and use of postpartum contraception among teens - United States, 2004-2015. Morbidity and Mortality Weekly Report, 66.
New York State Department of Health. (n.d.). Table 27: Total pregnancy rate by age and resident county New York State 2017.
New York State Department of Health. (n.d.). Table 6a: Live births by race/ethnicity, birthweight and mother's age, New York State 2017.
Centers for Disease Control and Prevention. (n.d.). Sexually transmitted diseases: Adolescents and young adults.
Centers for Disease Control and Prevention. (n.d.). Genital HPV infection - Fact sheet.
Centers for Disease Control and Prevention. (2019, October). STDs in Adolescents and Young Adults - Sexually Transmitted Diseases Surveillance 2018.
Centers for Disease Control and Prevention. (n.d.). HIV surveillance in adolescents and young adults 2018 (preliminary) [Slide set].
Page last updated November 4, 2020