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Editorial DECEMBER 2007

Teens and Sex: What’s the Message?

Patricia J. Sulak, MD

What are the facts? Adolescent sexual activity is fraught with multiple health consequences, including sexually transmitted infections (STIs) and their many ramifications (ectopic pregnancy, infertility, recurrent genital sores, dysplasia, emotional issues, partner disruption), teen pregnancy, and socioeconomic detriment. But, it’s “hopeless,” you say. Not so! Unfortunately, many parents and health care providers are not aware of the good news. The Centers for Disease Control and Prevention (CDC) Youth Risk Behavioral Surveillance, conducted every 2 years since 1991, has documented a decrease in sexual intercourse among US high school students (Figure 1).1 So, fewer kids are actually “doing it.”

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FIGURE 1. Decrease in teen sexual activity, 1991-2005. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance, United States, 2005. MMWR. 2006:55(SS-5).

And if fewer kids are having sex, what are the outcomes? That has also been documented. The US teen pregnancy rate has decreased annually since 1991 (Figure 2) to the lowest level since 1946.2 Is this decline due to the decrease in sexual intercourse, or to an increase in contraception? Both factors have contributed, and yet both sides continue to argue (without good data) on which is having the greater impact.

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FIGURE 2. Teen pregnancy rates, 1990-2005. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2005. Health E-Stats. Centers for Disease Control and Prevention, National Center for Health Statistics. Released November 21, 2006.

However, there is no debate that if kids do not have sex, they avoid not only pregnancy, but also STIs. Good news again. The CDC documented a decline in herpes simplex virus type 2, which was attributed to a lower rate in teenagers aged 14 to 19 years—who had an estimated 1 million fewer cases. The CDC in turn attributed this phenomenon to a decrease in the number of teens aged 15 to 19 years who had ever had sexual intercourse from 59.6% (1988 to 1994) to 54.8% (1999 to 2004).3

But, as I am a contraceptive researcher, I must ask where contraceptive information/knowledge comes into the picture. Based on my experience, I believe that teens need all the facts to make informed decisions. Also, adolescent sexual activity should not be treated any differently than other risky behaviors. Avoidance of health risk activities (overeating, sedentary lifestyle, smoking, illicit drug use, early-onset sexual activity, multiple sexual partners) is the primary message. For adolescents who do not avoid such behaviors, risk reduction measures must be implemented—eg, weight-loss programs, smoking cessation, drug rehabilitation, contraception/condoms.

So what is the primary medical message? Adolescent sexual activity and the associated multiple sexual partners are documented health risk behaviors. Any sex education program that does not encourage adolescents to delay sexual activity is not providing medically accurate recommendations. Any sex education program that does not discuss all the ramifications of adolescent sexual activity is also negligent in its duty to promote informed decision-making. Information should not be concealed from adolescents. They must be fully informed, and they need guidance from the adults who interact with them. Providing information on contraceptive methods—including types, side effects, failure rates, and noncontraceptive benefits—is an essential part of sex education. As a contraceptive researcher, I think it is imperative that adolescents know what all of the contraceptive methods can (and cannot) do.

As a health care professional, I was not truly involved in sex education until I had adolescents in my home. I then understood the importance of involvement by all health care providers in this important issue—not only in the office, but in the community as well. Kids need the facts from reliable sources, especially health care professionals. They need accurate information, and they need to know that they are “worth the wait” (www.worththewait.org).

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Patricia J. Sulak, MD, Associate Editor

References

1. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance, United States, 2005. MMWR. 2006:55(SS-5). www.cdc.gov/mmwr/PDF/SS/SS5505.pdf. Accessed September 17, 2007.
2. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2005. Health E-Stats. Centers for Disease Control and Prevention, National Center for Health Statistics. Released November 21, 2006. www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimbirths05/prelimbirths05.htm. Accessed September 17, 2007.
3. Xu F, Sternberg MR, Kottini BJ, et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA. 2006;296(8):964-973.