New national data in: Oral sex gaining ground among adolescents
About 25% ages 15-19 who haven’t had intercourse report oral sex
You may have heard anecdotes from teen patients or read articles in the popular press, but now clinicians have solid data confirming that oral sex is becoming more commonplace among adolescents. Just-released information from the National Survey of Family Growth (NSFG) shows that almost one in four teens ages 15 to 19 who have not had sexual intercourse report oral sex with an opposite-sex partner. Among those teens who have had sexual intercourse, 83% of females and 88% of males say they also have had oral sex.1
After much anecdotal speculation about teens and oral sex — in particular whether sexually inexperienced teens are "saving" their virginity by having oral sex — doctors and others in the medical profession, parents, educators, and the media now have reliable data on the topic, reports Sarah Brown, director of the Washington, DC-based National Campaign to Prevent Teen Pregnancy, a nonprofit, nonpartisan organization. The campaign performed its own analysis of the NSFG data, which are compiled on a cyclic basis by the National Center for Health Statistics.2 About 12,500 Americans ages 15-44 were surveyed by government researchers in 2002 to conduct the current cycle of the NSFG.3
What is disturbing about the findings is that many teens seem unaware of the health risks associated with oral sex, such as the possibility of contracting sexually transmitted diseases (STDs), including HIV, says Jennifer Manlove, PhD, who directs research on fertility and family structure at Child Trends, a Washington, DC nonprofit, nonpartisan research center.
The center also offered an independent analysis of the NSFG data that specifically focuses on the frequency of oral sex among young people ages 15-19.4 Fewer than one in 10 teens who engaged in oral sex used condoms to protect themselves from STDs, and 9% of males and females reported using a condom the most recent time they engaged in oral sex.4 Parents, health educators, and designers of pregnancy prevention programs need to address these risks, she states.
"While not all teens are having oral sex, a substantial percentage of teens who have not had sexual intercourse are having oral sex and may think of themselves as virgins," says Manlove. "We’re not sure whether these teens who have not had sexual intercourse are engaging in oral sex because they view it as a way to maintain their technical virginity or even because they regard it as an easy’ method of birth control."
Review the data
What about teens who are engaging in oral sex, but who have not had sexual intercourse? According to the Child Trends analysis, among teens ages 15 to 19 who had not had sexual intercourse, no significant gender differences were found in oral sex experience. Almost a quarter of all teens ages 15-19 who had not had sexual experience (24% of males and 22% of females) had engaged in oral sex. Older teens who had not had sexual intercourse were more likely to have engaged in oral sex; among teens ages 18-19 in this category, about a third of males and females reported having ever engaged in oral sex, compared with 21% of males and 18% of females ages 15-17 in the same category.4
Among teens who had not had sexual intercourse, white adolescents were most likely to report experience with oral sex. About one-quarter of white males and females said they had such experience, with fewer numbers reported for Hispanic and black counterparts.4
More research needs to be conducted on the subject, suggests Manlove. It would help to ask follow-up questions in a nationally representative survey about the context of teens’ experiences with oral sex, especially among teens who have not had sexual intercourse, she notes. Manlove says it would be helpful to understand teens’ motivations for engaging in oral sex through answers to such questions as:
- Do teens receive pressure from their partner to be sexually active and decide that oral sex is an alternative way to maintain their "technical virginity"?
- Do teens see oral sex as a way to prevent pregnancy while still being sexually active?
- Do teens see oral sex as "safer sex" or as a way to avoid risks of STDs?
- Do teens engage in oral sex because "everyone is doing it?"
- Is oral sex "casual sex" or a form of intimacy with a regular partner?
- Is oral sex one step on the way to engaging in sexual intercourse with a dating partner?
Is oral sex intimate?
The move to oral sex seems to be a cultural shift for many teens, says Nora Gelperin, MEd, director of training and education at the Network for Family Life Education, a national organization that advocates for comprehensive sexuality education, based in the Center for Applied Psychology at Rutgers University in Piscataway, NJ. The Network’s Teen-to-Teen Sexuality Education Project includes a national newsletter, Sex, Etc., and web site (www.Sexetc.org), written by teens for teens on sexual health, as well as a sexuality education training program for adults who work with young people.
While there is no one generalization that can fit all adolescents, many teens may see oral sex as a behavior that may not be limited exclusively to a romantic partner, says Gelperin.
"I think a lot of kids that I’m in touch with, via our web site and the newsletter that we distribute, really talk about this behavior as something that happens before intercourse," she observes. "A lot of times, I hear something from kids like, This is no big deal. This can’t get me pregnant. I don’t think I can get a disease because in my head I don’t feel like I’m vulnerable to disease. I’m going to be liked by my partner and held in higher esteem by my peer group, so this is great. It’s safer sex.’"
Teens may not necessarily view oral sex as intimate, says Gelperin. The sexetc.org web site, which records 60,000 individual visits each day, polled visitors on their views of oral sex as an intimate act. While about 60% said they did not consider it as intimate as other kinds of behavior such as vaginal sex and anal sex, about 40% said that it was, she says.
"I think that while we are reading the newspaper headlines that all teens think it’s no big deal, I think there are still plenty of teens who feel it is a pretty intense and intimate behavior," says Gelperin.
Use counseling skills
What is the next step clinicians should take once they have reviewed this new information? Be prepared to talk about it in a clear, nonjudgmental manner with adolescents, says Gelperin.
First, acknowledge that talking about sexual matters can be awkward. This alleviates apprehension for both parties involved, she says. Approach the discussion from a pure biological standpoint, and review information on how someone can get and give an infection, Gelperin adds. Make sure that the patient understands that there are risks involved with unprotected oral sex, but do not attach judgment or blame.
Talk about behaviors. Don’t rely on terms such as "virgin," "sexually active," and "abstinent," says Gelperin. If a teen discloses that she or he has had oral sex, consider their reasoning for wanting to engage in this activity, she notes.
If a teen says she is having oral sex to prevent having intercourse, either vaginal sex or anal sex, Gelperin says she would start with a positive affirmation along the lines of, "I think it’s smart of you to think about all the behaviors you can engage in and you’ve chosen one that is less risky [for pregnancy] than vaginal sex or anal sex. But at the same time, I want to make sure you understand some of the risks that are involved with oral sex."
She then would discuss infections that can be transmitted by oral sex. Gelperin would note that while the decision to have oral sex may place the teen in a better place for pregnancy prevention, it is not risk-free. This point in the discussion would include information on using flavored condoms and dental dams. A discussion with a younger teen also would include information on delaying or postponing sexual activity.
Use your role as a health professional to discuss the risks and educate teens on how to protect themselves, says Gelperin. "I think it is important that if teens have told you they are engaged in this behavior, even if they say they have been thinking about it, that they know how to protect themselves right now, today, or in the future," states Gelperin. "Because we know that information is not harmful, it is only helpful."
References
- Mosher, WD, et al. Sexual Behavior and Selected Health Measures: Men and Women 15-44 Years of Age, United States, 2002. Vital and Health Statistics 2005; 362.
- National Campaign to Prevent Teen Pregnancy. Science Says. Teens and Oral Sex. Washington, DC; September 2005. Accessed at: www.teenpregnancy.org/works/pdf/ScienceSays_17_OralSex.pdf.
- Lemonick MD. A teen twist on sex. Time 2005; Sep. 19, 2005. Accessed at: www.time.com/time/magazine/article/0,9171,1106324-1,00.html.
- Child Trends. Oral Sex. Washington, DC; September 2005. Accessed at: www.childtrendsdatabank.org/indicators/95OralSex.cfm.
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