Sexuality in Adolescents

Children exposed to sexual activity in adults, nudity, less overall privacy, and bathing without privacy are more likely to exhibit sexual behaviors. If parents knowingly expose their child to harmful sexual media or pornography, this is abnormal and requires social services referral. Parents should expect the highest degree of overt sexual behavior in the three to five-year-old, which should decrease with age until puberty.

In looking at sexual behavior problems in children, one needs to look at their developmental age. Sexual contact with others and sex with other people are less likely to be normative. Children with intellectual disabilities can display what is considered abnormal behaviors because of their younger developmental age.

Sexual behavior problems in children include the following:

• Self-penetration of their anus or genitals with objects or fingers

• Persistent or frequent sexual activity

• Sexual behaviors involving another who is more than three years in age apart from them

• Any type of coercive sexual activity

• Explicit imitation of adult sexual behaviors

• Asking adults for sex

• Oral to genital contact

There is a higher than average risk of ADHD, conduct disorder, and oppositional defiant disorder among children who have problem sexual behaviors. These are children who externalize their emotional problems and who often need to have other things addressed besides their sexual behavior issues. There is also a high risk of abuse of all types in children who have sexual behavior problems.

SEXUALITY IN ADOLESCENTS

Sexuality changes in adolescence but is intensified by puberty and the onset of puberty. Adolescents engage in kidding, flirting, masturbation, and sex with others. As with children, there are social influences on what is acceptable in adolescents as far as

sexuality is concerned. There are also different laws as to when the age of consent is for adolescence. This is a time when things like unintended pregnancy and sexually transmitted infections increase. The brain is not fully mature in adolescence, which influences control over sexual behaviors.

Thoughts about sex and sexual interests change and increase with puberty. Hormones influence these things to a great degree and, as already discussed, the secondary sexual characteristics are matured.

Studies on sexual activity in teens show that fewer girls report sexual activity than boys. Girls also indicate less pressure to have sex from peers, while boys have increased social pressure. Boys see sex and having sex as a positive link to their social standing, which is not a phenomenon in girls. Boys are less concerned about the risks of sex itself and more interested in the perceived social risks of being abstinent.

More teens turned to oral sex after programs were initiated in the US about the risks of sexual intercourse. About a third of adolescents see oral sex as being the same thing as abstinence. Girls see their virginity as a gift and something special so they expect some type of intimacy if they are going to “give away” or give up their virginity. Many do not feel they have gotten this from their sexual partner when the do lose their virginity. Boys are more likely to be stigmatized around still being virgins. They are more likely to see a loss of virginity as a good thing.

Among teens who are sexually active use birth control of some type at a rate exceeding 80 percent. Most of the time, girls make use of combination estrogen and progestin birth control pills, while some use progestin-only pills or non-oral forms of hormonal contraception. There is a much higher risk of depression related to the use of hormonal birth control in girls. Much of the risk is associated with progestin use rather than estrogen use.

Studies of older adolescents show no differences between the genders and sexual satisfaction or sexual problems. The most common problem in older teen males was anxiety around sexual performance, followed by premature ejaculation. In females, the most common problem was difficulty in attaining an orgasm, followed by lack of sexual interest, poor vaginal lubrication, anxiety, and painful sex.

Those that had more sex were more likely to enjoy sexual pleasure. Sexual difficulties often lead to sex avoidance, although many will still have regular sex even if they have a decreased libido. Pain with sex was higher in those who had low arousal levels. Girls have increased social pressure to be “good girls” and are more often to think their sexual desires are bad. This can increase sexual problems.

Same-sex attraction in adolescents depends on their social surroundings. Those who hide their feelings to the greatest degree are those in girls’ schools that prohibit samesex attraction and girls belonging to conservative religious communities. Schools in general place a greater emphasis on girls to date boys with a high emphasis on heterosexuality. Male gender role expectations can inhibit boys from expressing their attraction to the same sex. There is less flexibility around same-sex attraction in boys than there is in girls.

Adolescents have the highest risk of getting an STI compared to adults. They are more likely to have sex with an infected person and often do not believe they will contract an infection. They are less likely to seek healthcare when infected and are less likely to be compliant with treatment efforts. They are more likely to have more than one infection at the same time.

Media in general and exposure to sexuality on television shows do not necessarily affect adolescent sexual behavior but the type of messages they receive does have an influence. Sexual scenes with typical gender stereotypes do affect sexual behavior to a greater degree, with girls getting messages that they are not in control of their sexuality. Settings where girls are less submissive are empowering to girls. Boys seem to be less influenced by these things.

Teen girls can get pregnant after menarche. There are increased pregnancy and childbirth risks in pregnant teens, especially if under 15 years or if they live in a developing country. There are, of course, socioeconomic problems associated with teen pregnancy and an increased risk of low birth weight. The rates of teen pregnancy is higher in some parts of the world, such as sub-Saharan Africa, and lower in places like industrialized countries in Asia. In developed countries, teen pregnancy is often found

outside of marriage and social stigma is common. This is not the case in developing countries.

Sexual contact prior to the age of consent with adults is illegal in all countries, while sex outside of marriage at all in Islamic countries is illegal. If teens are close in age, this is generally not prohibited. The average age of consent in the world is 16 years of age. This may or may not correlate with the age of majority or the age of legal marriageability. Statutory rape is sex between an adult and a child under the age of consent.

It is important to develop a sexual self-concept in the adolescent years. Unfortunately, societal influences have led girls to objectify their bodies and to be unattached to their own sexual feelings. Adolescents in general must learn to understand their personal motivations for sexual behavior. This affects their later relationship development. Sexual self-concept development begins before sexual experiences in some cases. The media and sex education can help modify a teen’s sexual self-concept.

Boys tend to have greater sexual anxiety and lower self-esteem around their sexuality. They are also less likely to resist having sexual activity, while girls are trained to do this to a greater degree. There are hyper-masculine ideals that contribute to a boy’s sexual inadequacies. Older teen girls have greater comfort with sexuality and experience less anxiety.

Sex education is an avenue for schools, parents, and public health campaigns to teach the important issues regarding sex for teens and pre-teens. It is not taught in the same way in every country with some European countries having sex education in schools since about 1970. In the US, parents are the major sex educators of their teens, although the school system can also be involved. Schools are more likely to be objective in teaching sex than parents. While many schools place an emphasis on abstinence, it is believed to have no positive effect on teen behavior. More than 95 percent of Americans have sex before marriage, often in the teen years. Religious programming can also involve sex education. Lack of access to sex education has a negative impact on teen health.