Cheryl Onwuchuruba, M.D.
If you have ever roamed the halls of the labor and delivery suites of your school’s hospital, it is not hard to notice how young the mothers seem to be. If you were to go a step further and examine the histories of these birthing mothers, you would learn that it is not unusual to find the average age of your patients between 17 and 19 years of age. Many of these girls are having their second or third child and the father may or may not be involved. At the end of the day, you may wonder how so many teens are going through the acts of childbirth before ever crossing the stage to accept their high school or college diplomas. Research now shows us that in the United States, nearly half of high school students have reported being sexually active, with the highest rates among black males at 74.6%. The average age of first sexual intercourse continues to decline with each generation with nearly 15% of adolescents having greater than four partners by the age of 19.
Some might wonder why there is so much concern surrounding adolescent sexual behavior but the reality is that 18 million new sexually transmitted infections are occurring each year in the U.S. with half of those individuals between the ages of 15-24. Adolescents have higher rates of high risk sexual behaviors leading to high rates of reinfection among this age group. Often adolescents have no understanding about the possible sequela of their actions. Adolescents are leading in chlamydial reinfections which are associated with higher rates of HIV infection and subsequent pelvic inflammatory disease. It has been shown the younger the age at first intercourse the poorer the outcomes, such as high pregnancy rates, higher likelihood of depression, and early or problematic use of alcohol or other drugs. The underlying issue here is determining what influences adolescents to enter into sexual intercourse so early and what strategies we can employ as physicians to help adolescents understand the associated risks.
A paper was recently published in the Journal of Adolescent Health that interviewed sexually active females between the ages of 14-19 to determine their perceptions of their first sexual experience. Overall the paper revealed that the younger the girls were at the time of their first sexual experience, the more likely they were to regret the experience, to not complete school, and were less likely to live with both biological parents. Several of the girls cited curiosity as the reason for engaging in sexual activity, often spurred on by conversations from their peers. Many of the girls felt pressured by their peers and saw themselves as outcasts if they were not sexually active. Some saw sex as a rite of passage, and in retrospect many of these girls felt that they had grown up too fast. For many of the girls they felt as though having sex under the influence of alcohol made it easier for them to have sex for the first time. Only a minority of the girls decided to wait until they felt ready to have sex; these girls were usually older and in committed relationships where they had communicated with their partners about sex before engaging in any sexual acts. The one common thread between all of these girls was that the perception of control over the factors leading to their first sexual intercourse had an important bearing on how adolescents reflected on their first experience and the meanings that they ascribed to it.
Adolescents currently receive the majority of their information about sex from their friends and from the media. It is estimated that adolescents between the ages of 8-18 are exposed to approximately six hours of media. Nearly 80% of all media has some form of sexual content and adolescents of middle and high school age cite movies and television as main sources of information. However, adolescents receive the most amount of information from their peers. Adolescents tend to follow the example set forth by their peers; if their peers are practicing safe sex they are more likely to as well. Within each peer group, once an adolescent’s friends become sexually active there is an increased likelihood that the adolescent will become sexually active within the next 12 months.
It has been shown that the top five sources of information regarding sex in descending order are friends, teachers, mothers, media and doctors. Nearly half of all adolescents receive their information regarding sexual activity from their physicians. As we emerge as the future doctors it is up to us to have these conversations with our patients. We may be the only accurate source of information that our adolescents have in regards to sexual activity. It is important to talk to our patients in non-judgemental atmospheres without the presence of their parents. While we can not force our patients to do what we would like them to do, many studies have shown decreases in sexually transmitted infections, teen pregnancy and other adverse outcomes in adolescents who have received some sort of sexual education. Lastly, it is important to offer testing for sexually transmitted infections to adolescent patients, particularly those who may be suspected of high risk behavior. As physicians we have the unique opportunity to be able to reach many people who might otherwise have no other credible source for their healthcare needs. As physicians it is as important to practice preventative medicine as it is to identify and treat the disease at hand.
This article first appeared in the Winter 2009 issue of the JSNMA, Volume 15, Number 1
Filed Under: Lifestyles
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