Sexuality is a birthright, fundamental to being human, but -- as anyone who has dabbled in romance knows -- building healthy, fulfilling sexual relationships requires the development of a set of skills. Exploring sexuality is an important part of adolescent development.
In adolescence, our romantic and sexual attractions intensify. We begin to learn how to manage and express our feelings and desires, and how to negotiate new romantic relationships. As the teen years progress, this exploration can include a range of normal sexual behaviors, from masturbation to kissing, touching through clothes, genital touching, oral sex, and anal and vaginal intercourse. When the supports we need for sexual health are present -- positive relationships; access to health care, including condoms; and the knowledge, attitudes, and skills needed to protect health -- any of these behaviors can be healthy. However, when these supports are missing or inadequate, engaging in some of these behaviors increases a person's risk of unintended health consequences, including STDs and pregnancy.
In this section, we outline the risks associated with specific sexual behaviors. Of course, it is important to keep in mind that sexual decision making happens within a complex context: it is driven not only by the passion of the moment, strong as that may be, but by risk and protective factors at the societal, family, peer, couple, and individual levels. This means that community approaches to adolescent sexual health are vital to improving young people's health.
Sexual Behaviors and Risk
For statistics on adolescents and sexual behaviors, visit Demographics: Sexual Health.When considering relative risk, it's important to remember that even a single exposure to HIV or other STDs can result in transmission. Many factors beyond the type of behavior have an impact on the risk of HIV and other STDs. Condoms, when used correctly and consistently, help to protect against pregnancy as well as STDs.
Oral Sex (on a penis, vagina, or anus)
- Oral sex (without condoms or dental dams) carries some risk of HIV exposure, though much less than anal or vaginal intercourse. Where HIV is concerned, the riskiest form of oral sex is ejaculation of semen into the mouth. The risk of HIV exposure through vaginal oral sex is very low.
- Herpes, chlamydia, gonorrhea, syphilis, and hepatitis A and B can all be transmitted through unprotected oral sex. Hepatitis C can also be transmitted if blood is present.
Vaginal Intercourse
- Vaginal intercourse without condoms puts females and males at risk of STDs.
- The risk of HIV transmission through penile-vaginal intercourse is roughly twice as high for the female/receptive partner as for the male/insertive partner.
- Teen girls are at higher risk of HIV transmission because the vaginal tissue is more fragile at this age.
- Some STDs, such as syphilis, chlamydia, gonorrhea, HSV, HPV, and HIV, can be passed to a baby during pregnancy and/or childbirth.
- Without contraception, a sexually active girl has a 90% chance of pregnancy within a year.
Anal Intercourse
- For both men and women, receptive anal sex carries the highest HIV and STD risk of any sexual behavior -- much higher than receptive vaginal intercourse.
- While condoms offer protection, especially when used with lubrication, they break more frequently during anal sex.
Additional Risk-Related Activities
- Having multiple partners is associated with elevated risk of HIV and other STDs.
- First sexual intercourse at an early age (often defined by researchers as under 16) is less likely to be wanted or consensual, and less likely to involve contraception, than sexual initiation at later ages. Having sex at an early age is associated with a greater number of sexual partners and with having concurrent partners. Youth who started having sex at an early age are more likely to use alcohol and other drugs when they have sex.
- Skin-to-skin contact and sharing sex toys can lead to the transmission of certain STDs, such as genital warts (HPV), herpes (HSV), and trichomonas vaginalis.
- Any sexual behavior that causes bleeding or cuts in the vagina or anus increases the risk of HIV and other STD transmission.
- Bisexual behavior is associated with higher levels of risk behavior: sex at an early age, multiple partners, decreased condom use (among boys), higher numbers of male partners (among girls).
- Most studies show that youth who combine sex with the use of alcohol or other drugs are more likely to have multiple partners. (Studies are mixed with respect to an association between substance use and unprotected sex.)
Sexual Networks and Risk
In sexual networks where there is a high prevalence of an STD or HIV, the risk of contracting disease is higher even if behaviors are the same as those in low prevalence networks. For example, young black men who have sex with men have a high prevalence of HIV. When their sexual partners come from that same group, as is often the case, they face greater odds of exposure, even when engaging in the same behaviors as men whose sexual partners come from lower risk networks.References
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Centers for Disease Control and Prevention. (2014, November). CDC Fact Sheet: Information for Teens: Staying Healthy and Preventing STDs.
Centers for Disease Control and Prevention. (2013, March). Condom Fact Sheet in Brief.
Centers for Disease Control and Prevention. (2015, April). HIV Among African American Gay and Bisexual Men.
Centers for Disease Control and Prevention. (2014, May). Oral Sex and HIV Risk.
Guttmacher Institute. National Reproductive Health Profile: Adolescents.
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
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Office on Women's Health, U.S. Department of Health and Human Services. (2012, July). WomensHealth.gov: Lesbian and Bisexual Health Fact Sheet.
Schantz, K. (2015). Pregnancy risk among bisexual, lesbian, and gay youth: What does research tell us? (PDF). ACT for Youth.
Schantz, K. (2012). Substance use and sexual risk taking in adolescence (PDF). ACT for Youth.