Identify conflicting messages regarding sexuality and sexual relationships Develop skills to assist students in developing healthy sexuality and reduce health risks associated with sexual behavior Adolescent Sexuality ID: 694555
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Learning Objectives
Describe normal adolescent sexual development
Identify conflicting messages regarding sexuality and sexual relationships
Develop skills to assist students in developing healthy sexuality and reduce health risks associated with sexual behaviorSlide3
Adolescent SexualitySlide4
Sexual Development: Definitions
Sexual identity
Early awareness of being male or female
Gender identity
Sense of oneself as a boy or girl in society
Gender roles/sexual roles
Characteristics, behaviors and interests, defined by cultures, that separate boys and girls
Sexual orientation
Heterosexual, homosexual, bisexual
Consistent pattern of erotic arousal toward persons of the same or opposite sexSlide5
Females start puberty between ages 7 and 13 years
Five stages of pubertal development—Tanner/SMR
Breast development begins at SMR stage 2 – mean age 10.0 years
Early growth spurt in SMR stages 2 to 3
Menarche at SMR stage 4 mean age 12.5 years in US
Body fat ~17% to begin and – ~22% to maintain normal menses
Ovulatory cycles begin within 12 months post-menarche (80%)
Female Pubertal DevelopmentSlide6
Male Pubertal Development
Males start puberty between ages 10 and 13½ years
Five stages of pubertal development – Tanner/SMR
Testicular enlargement begins at SMR stage 2 – mean age 12 years
Voice changes as vocal cords lengthen and thicken in SMR stages 3 to 4
Late growth spurt in SMR stages 4 to 5
Peak muscle mass at SMR stage 5 in response to androgensSlide7
Stages of Sexual Development
Stage I
Preadolescent
Tanner stage I (
prepubertal
)
Low conscious level of mental and physical investment
Collection of information from multiple sourcesSlide8
Stages of Sexual Development
Stage II
Early adolescent
Tanner stage II-III puberty
Exploratory behavior
Concrete thinkingSlide9
Stages of Sexual Development
Stage III
Mid adolescent
Tanner stage IV-V puberty
Group => individual dating
Egocentrism
Experimentation and exploitative behavior
Denial of consequencesSlide10
Stages of Sexual Development
Stage IV
Late adolescent
Tanner stage V puberty
Full
sociolegal
and physical maturation
Object choice consolidated
Expressive behavior – “other directed”Slide11Slide12
Sexual Development
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12
26.7
16.9
28.5
33.2
12.6
17.4
25.1
26.0
30.9
10 15 20 25 30 35
Menarche
Spermarche
First intercourse
First marriage
First birth
Intend no more children
First intercourse
First marriage
First birth
Intend no more children
AGE
14.0
MEN
WOMEN
Guttmacher Institute, 2005Slide13
Adolescent SexualitySlide14
Why don’t the students listen to me?
Why don’t they use contraception?
Why do they keep putting themselves in sexually risky situations?
Why don’t they use condoms?
Why do adolescents/young adults
make “suboptimal” choices in
behavior?Slide15
Transitional Developmental Period
Goal directed behavior:
Finish Job Corps program
Delay pregnancy/parenting
Avoid STI
Requires:
Control impulses
Delay gratification
Control risk taking behaviorSlide16
The Adolescent Brain
The Adolescent Brain; Casey, B.J. et al (2008) Ann NY Acad Sci March; 1122: 111-126Slide17
Brain Function
Impulsivity
Risk taking/sensation seeking
Impatience (immediate reward vs. delayed gratification)Slide18
Impulsivity
Act without thinking
Individual variation (range)
Linear development with increased impulse control with ageSlide19
Sensation Seeking/Risk Taking
Explore novel experiences
Universal in adolescent mammals – encourages leaving family, venturing forth…
Bias in judgment of risk – enjoyed activities perceived as less risky
Lack experience with “adult” behaviorsSlide20Slide21
Impatience
Small reward immediately vs. large delayed reward
Memory and IQ related
Emotional gain may outweigh executive decision makingSlide22
Adolescent SexualitySlide23
Feminine
:
sociability
empathy
passivity
Masculine
:
independence
aggression
assertivenessSlide24
Sociocultural Perspective
“Would you permit your 16 or 17 year-old to spend the night with a
girlfriend or boyfriend in his or her room at home?”
9 out of 10 American parents replied
NO
9 out of 10 Dutch parents replied
YES
Dutch approach: spend less time and effort trying to prevent young
people from becoming sexually active and more time and effort in
educating and empowering young people to behave responsibly
when they do become sexually active.
Dutch youth use contraceptives more frequently and effectively,
have fewer sexual partners, are less likely to contract an STD, and
have lower rates of pregnancy, abortion and childbirth than their
American counterparts.
Amy
Schalet
PhDSlide25
Unintended Pregnancies
49% of pregnancy in U.S. unintended
½ of these are in couples claim to use some form of contraceptionSlide26
Media Influence
Youth spend more than 7 hours per day using media – TV, music, computers, video games, print, moviesSlide27
Group Activity Regarding Media
List 3 behaviors that are shown as norms?
List 3 features of romantic relationships?Slide28Slide29
Media Influence
Youth spend more than 7 hours per day using media – TV, music, computers, video games, print, movies
Media as “
superpeer
” that presents adolescents and young adults with the message that sex is normative and risk free – shapes beliefs about how individuals behave in romantic relationships
Exposure to sexual content linked to:
Rapid progression of sexual activity
Earlier coital behavior
Greater risk of unplanned pregnancy
Greater risk of STD Ref:
Strasburger VC, Pediatrics 2010; 125(4):756-767Slide30Slide31Slide32Slide33
XSlide34
Gender Differences in Sexual Attitudes
Feelings about
first
experience with adolescent
heterosexual intercourse:
Girls
Boys
“Afraid” 63% 17%“Happy/satisfied/thrilled” 13% 43%“Guilty” 36% 3%“Used” 16%
0%“Powerful” 0% 15%
SorensonSlide35
Adolescent Risk Taking Behavior
Adolescents
may
engage in high-risk sexual behaviors
for a variety of reasons,
including:
To meet sexual and emotional needs for intimacy
In an effort to attain peer and partner approval
In an effort to define oneself as mature and adult-like
Developmentally less able to anticipate consequences of risk behaviors compared to adults
Less developed communication skills resulting in poor ability to negotiate condom use and sexual behaviors with partnersInadequate knowledge about the risks of acquiring infections from different sexual behaviors and how to prevent transmission
Concomitant use of alcohol and/or drugs that impair judgment about decisions regarding sexual behaviors, partner choice, and condom use
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Slide36
Influence of Religion/Spirituality
Protective or resilience factor for adolescent sexual health outcomes:
Later sexual debut
Less sexually experienced
Fewer sexual partners
More conservative sexual attitudes
Varies by race and ethnicity
Strongest protective effect for White females
No protective effect for Black males
Not studied in Latinos or Asian AmericansSlide37
Sexuality Education:
What Works?Slide38
The Need for Sexual Education
By the age of 18, 6 in 10 teenage women and nearly 7 in 10 teenage men have had sexual intercourse
A sexually active teenager who does not use contraception has an 85-90% chance of becoming pregnant within a year
In 2000, 48% of all STI infections (9.1 million) were among 15-24 year oldsSlide39
Sexual Health Misinformation
One in five adolescents believe that birth control pills offer protection from STDs
One in five adolescents believe that condoms are “not effective” in preventing STD transmission
One in six adolescents believe that sex without a condom once in awhile is “no big deal”
One in ten adolescents believe that “you do not need to use condoms unless you have a lot of sexual partners”
Half of adolescents believe that raising the subject of condoms raises suspicions about both partners’ sexual history
Ref: Kaiser Family Foundation National SurveySlide40
Main Approaches to Sexuality Education
Abstinence-Only-Until Married Education
Does not discuss the reproduction cycle or other contraceptive methods
Teaches abstinence as the only morally correct option of sexual expression for teenagers
Discusses contraception only in terms of failure rates
Comprehensive Sexuality Education
Urges students to postpone sexual initiation, but also educates them on condoms and other methods of contraception that protect against pregnancy, HIV infection and sexually transmitted infections (STIs), discusses sexual orientation, how to resist peer pressure and how to negotiate contraceptive use with a partnerSlide41
http://nahic.ucsf.edu//downloads/ReproHlth2007.pdfSlide42Slide43
Female Contraceptive Use at First Intercourse by Year of First Premarital Intercourse, NSFG, 2002Slide44
Male Contraceptive Use at First Intercourse by Year of First Premarital Intercourse, NSFG, 2002Slide45
Female Contraceptive Use at Last Intercourse, YRBS, 2003Slide46
Percentage of High School Students Who Drank Alcohol or Used Drugs Before Last Sexual Intercourse,*
by Sex** and Race/Ethnicity,*** 2007
* Among the 35.0% of students nationwide who had sexual intercourse with at least one person during the three months before the survey.
** M > F
*** W, H > B
National Youth Risk Behavior Survey, 2007Slide47
Chlamydia—Age-and Sex-Specific Rates: United States, 2008Slide48
Gonorrhea—Age-and Sex-Specific Rates: United States, 2008Slide49Slide50
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50
Reproductive Health DisparitiesSlide51
Disparities in Pregnancy Rates
Though adolescent pregnancy rates are declining, Black and Hispanic adolescents continue to become pregnant at a rate greater than two times that of White adolescents
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Disparities in Teenage Gonorrhea Rates
Gonorrhea rate (per 100,000) for Black female adolescents (ages 15-19) is 5 to 31 times that of same-age females in other racial/ethnic groups and twice that of same-age Black males
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Disparities in Chlamydia Rates
Black, American Indian, and Hispanic adolescent females have rates 2 to 9 times higher than their White counterparts
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Disparities in Syphilis Rates
Black females ages 15-18 are 7 to 28 times more likely to be infected with Syphilis than same-age females in other racial/ethnic groups
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55
Health Risk Behaviors and Lesbian/Gay/Bi Adolescents
GLB young people are significantly more likely to have a number of serious health risks
Though transgender youth were not included in the study, they remain a high risk populationSlide56
Case 1
A 17-year-old Hispanic student comes into the clinic for her 3
rd
pregnancy test in the past 6 months. You are asked to talk to her after the result shows a negative pregnancy test.
What additional information would be helpful?Slide57
Adolescent Health Care
Reproductive health components
Sexuality education
Pubertal assessment
Consent/confidentiality
Emancipated and mature minors (< age 18 years)
Contraceptive services – female/male
Screening for sexually transmitted infection (STI)
Prevention of STIs – vaccines,
Pregnancy diagnosis and options counseling Screening for intimate partner violenceSlide58
The Provider’s Role in Sex Education
Assess adolescent’s knowledge of reproductive physiology, i.e.,
Puberty, menses, ovulation
Assess knowledge base regarding sex, pregnancy and STI transmission
Discuss myths/rumors and provide factual information
Discuss adolescent’s attitudes towards and experiences with sex and sexuality and pregnancy
Discuss abstinence, safe sex practices including contraception and condoms, self-esteem, communication skills and answer any questionsSlide59
Cues to action
Contraception Cues to
Action
Perceived
Susceptibility:
Knowledge/ belief in ability to bear children
Perceived
Severity:
Emotional, social, financial consequences of pregnancy
Perceived
benefit:
Contraceptive effectiveness, ease of use, other benefits of contraception
Perceived
barriers:
Fear of side effects, cost, desire or ambivalence about being pregnant, partner factorsSlide60Slide61
Assessing Sexual Behavior
Helpful to explain why you are asking such sensitive and specific questions
Asking “Are you currently sexually active?” is unclear in time frame and activity, particularly
Describe specific sexual activities: open mouth kissing, touching genitals over or under clothes, mouth on vagina or penis, penis inside vagina or rectum (may need to interpret street language)Slide62
Case 2
A 20-year-old African American male student comes in requesting screening for gonorrhea and chlamydia. You are asked to see him.
What additional information would be helpful?
Slide63
Case 3
A 19-year-old Caucasian student comes in 2 weeks late for her
depo
shot. You are asked to evaluate her to decide if she can have another shot.
What additional information would be helpful?Slide64
References
Blythe MJ, Rosenthal SL, eds. Adolescent Sexuality. Adolescent Medicine: State of the Art Reviews. 18(3):425-587, 2007 [12 review articles]
Centers for Disease Control and Prevention. Sexual and Reproductive Health of Persons Aged 10–24 Years — United States, 2002–2007. Surveillance Summaries, July 17, 2009. MMWR 2009;58 (No. SS-5806)
Chapman EN, Werner-Wilson RJ. Does positive youth development predict adolescent attitudes about sexuality? Adolescence. 43(171):505-23, 2008
Ponton
LE,
Judice
S. Typical adolescent sexual development. Child & Adolescent Psychiatric Clinics of North America. 13(3):497-511, 2004Slide65
References
Brown et al. Breaking the Barrier: the Health Belief Model and patient perception regarding contraception. Contraception (2011) 83(5): 453-458
Romer
, D. et al. Adolescent Risk Taking, Impulsivity, and Brain Development: Implications for Prevention. Dev
Psychol
(2010) Apr 52(3):263-76
Casey, B.J. et al. The Adolescent Brain. Ann NY
Acad
Sci 2008 March; 1124:111-126