Teens choosing to wait: Help them maintain
Not every teen is sexually active. In fact, only three in 10 teens ages 13 to 18 reported such experience, according to a recent national survey.1 Sexual intercourse starts to become common for boys when they reach 16 and for girls at 17, survey findings show. Almost half of all teens in the survey say they've decided to delay intercourse.
These trends fall in line with a recent analysis of national statistics released by the Washington, DC-based National Campaign to Prevent Teen Pregnancy.2 In 1995, 50% of girls ages 15 to 19 had had intercourse. This represents a decline from the late 1980s and reversal of a lengthy trend of steady increases in the percent of female teens who are sexually experienced. In 1970, only 29% of teen-age girls had ever had sex, with that figure rising to 36% in 1975, 53% in 1988, and 55% in 1990 before falling to 50% in 1995.
"One of the things that was clear in the [Kaiser Family Foundation/YM magazine] survey is that teens often incorrectly imagine or believe that their friends are more sexually sophisticated than they are," says Felicia Stewart, MD, director of reproductive health programs for Kaiser. "And that, of course, can lead to a sense of needing to catch up or feeling less certain of the reasonableness of their own decision to say, 'It's not time for me yet.'"
Clinicians can counsel teens that while about half of the adolescent population is sexually active, the other half isn't, Stewart says. That fact can alleviate some of the pressure felt by those teens who are choosing to delay intercourse.
Use 'outercourse' strategies
Clinicians can help patients stick with their decision to postpone sexual intercourse, says Liana Clark, MD, clinical assistant professor of pediatrics at The Children's Hospital of Philadel phia. The first step is to replace the word "abstinence" with "outercourse," she says. "The big disconnect in terms of talking about abstinence is that word has so much emotion and connotation associated with it that teens think when you're abstinent that they can do nothing. They think you can't hold hands, you can't look at another person, you can't date."
Clark has a frank discussion about the "bases" and alternatives ranging from mutual masturbation to a "pearl necklace" (placing the penis between the woman's breasts) for teens who want to express their sexuality but avoid intercourse. "I have no room in this day and time of STDs and pregnancies to be embarrassed to talk about this with teens," she says.
Patients need to feel comfortable about their bodies and their sexuality, she says. If teens feel it's "nasty" to touch themselves, they won't feel comfortable with mutual masturbation as an alternative to intercourse. They need to understand that sex is not an all-or-nothing activity, Stewart says. Having intercourse one time doesn't mean they have to do so again. Further sexual activity can be delayed.
"We often treat sexual issues as if sexuality were an on/off switch - once it's turned on, that's it," Stewart explains. "But that isn't the way it is for people. Often, teens will reconsider and decide this initial experience and exploration of the sexual part of life wasn't contributing in a good way to their lives."
References
1. Kaiser Family Foundation. The Kaiser Family Foundation/YM 1998 National Survey of Teens: Teens Talk about Dating, Intimacy and Their Sexual Experiences. Menlo Park, CA; March 27, 1998.
2. Moore KA, Driscoll AK, Lindberg LD. A Statistical Portrait of Adolescent Sex, Contraception, and Childbearing. Washington, DC: The National Campaign to Prevent Teen Pregnancy; March 1998.
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