9.10: Sexual Health

By the end of high school, more than half of boys and girls report having experienced sexual intercourse at least once, though it is hard to be certain of the proportion because of the sensitivity and privacy of the information. (Center for Disease Control, 2004; Rosenbaum, 2006).

Teen Pregnancy

Although adolescent pregnancy rates have declined since 1991, teenage birth rates in the United States are higher than most industrialized countries. Teen birth rates continued to decline from 17.4 per 1,000 females in 2018 to 16.7 per 1,000 females in 2019.  This is another record low for US teens and a decrease of 4% from 2018. Birth rates fell 7% for females aged 15 to 17 years and 4% for females aged 18 to 19 years. (Centers for Disease Control, 2021)

Figure \(\PageIndex{1}\): Birth Rates for Females Aged 15 to 19 Years, by Race and Hispanic Origin of Mother: United States, 2018 and 2019. From https://www.cdc.gov/teenpregnancy/about/index.htm Data source: Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep. 2021;70(2):1–50.

Figure \(\PageIndex{1}\): United States map with state teen birth rates (births per 1,000 females ages 15-19) by quartile. https://www.cdc.gov/teenpregnancy/about/alt-text/map-state-text.htm (page last updated Oct 2018)

Risk Factors for Adolescent Pregnancy

Miller, Benson, and Galbraith (2001) found that parent/child closeness, parental supervision, and parents' values against teen intercourse (or unprotected intercourse) decreased the risk of adolescent pregnancy. In contrast, residing in disorganized/dangerous neighborhoods, living in a lower SES family, living with a single parent, having older sexually active siblings or pregnant/parenting teenage sisters, early puberty, and being a victim of sexual abuse place adolescents at an increased risk of adolescent pregnancy.

Consequences of Adolescent Pregnancy

Figure \(\PageIndex{3}\): Teenage pregnancy can lead to academic education being interrupted, health risks, maternal mortality, and stillbirth.[2]

Sexually Transmitted Infections

Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) or venereal diseases (VDs), are illnesses that have a significant probability of transmission by means of sexual behavior, including vaginal intercourse, anal sex, and oral sex. It’s important to mention that some STIs can also be contracted by sharing intravenous drug needles with an infected person, through childbirth, or breastfeeding. Common STIs include:

• chlamydia;
• herpes (HSV-1 and HSV-2);
• human papillomavirus (HPV);
• gonorrhea;
• syphilis;
• trichomoniasis;
• HIV (human immunodeficiency virus) and AIDS (acquired immunodeficiency syndrome).

According to the Centers for Disease Control and Prevention (CDC) (2014), there was an increase in the three most common types of STDs in 2014. The reporting of STI incidences were impacted in many ways by COVID 19 and the resulting lockdowns, access to testing, healthcare and so on.  For example, in March and April of 2020, incidences of gonorrhea and syphilis dropped but began to increase after that throughout the rest of the year (CDC, 2023)  Those most affected by STDS include younger, gay/bisexual males, and females. The most effective way to prevent transmission of STIs is to practice abstinence, (not participating in sexual intercourse), safe sex, and to avoid direct contact of skin or fluids which can lead to transfer with an infected partner. Proper use of safe-sex supplies (such as male condoms, female condoms, gloves, or dental dams) reduces contact and risk and can be effective in limiting exposure; however, some disease transmission may occur even with these barriers.[3]

Practicing safe sex is important to one’s physical health.

Contraceptive Methods and Protection from Sexually Transmitted Infection

There are many methods of contraception that sexually active adolescents can use to reduce the chances of pregnancy.

Table \(\PageIndex{4}\): Reversible Methods of Birth Control[4]

Method	Description	Failure Rate
Intrauterine Contraception (IUD)	An IUD is a small device that is shaped in the form of a “T” placed inside the uterus	0.1-0.8%
Implant	A single, thin rod that is inserted under the skin of a woman’s upper arm.	0.01%
Injection	Injections or shots of hormones to prevent pregnancy are given in the buttocks or arm every three months.	4%
Oral contraceptives	Also called “the pill,” contain the hormones to prevent pregnancy. A pill is taken at the same time each day.	7%
Patch	This skin patch is worn on the lower abdomen, buttocks, or upper body and releases hormones to prevent pregnancy into the bloodstream. A new patch once a week for three weeks and then left off for a week.	7%
Hormonal vaginal contraceptive ring	The ring is placed in the vagina and releases the hormones to prevent pregnancy. It is worn for three weeks. A week after it is removed a new ring is placed.	7%
Spermicide	These kill sperm and come in several forms—foam, gel, cream, film, suppository, or tablet. They are placed in the vagina before intercourse.	21%
Diaphragm or cervical cap	A cup that is placed inside the vagina to cover the cervix to block sperm. It is inserted with spermicide before sexual intercourse.	17%
Sponge	This contains spermicide and is placed in the vagina where it fits over the cervix.	14-27%
Male condom	Worn (single use) by the man over the penis to keep sperm from getting into a woman’s body.	13%
Female condom	Worn (single use) by the woman inside the vagina to keep sperm from getting into a woman’s body.	21%
Natural Family Planning	During a regular menstrual cycle, fertile days can be predicted. Sexual intercourse can be avoided on those days.	2-23%
Copper IUD	Can be inserted up to 5 days after sexual intercourse	<1%[5]
Emergency contraceptive pills	Can be taken up to 5 days after sexual intercourse and may be available over-the-counter.	1-10%[6]

In choosing a birth control method, dual protection from the simultaneous risk for HIV and other STIs also should be considered. Although hormonal contraceptives and IUDs are highly effective at preventing pregnancy, they do not protect against STIs, including HIV. Consistent and correct use of the male latex condom reduces the risk for HIV infection and other STIs, including chlamydial infection, gonococcal infection, and trichomoniasis.

Figure \(\PageIndex{4}\): There are many types of birth control methods - natural family planning, female and male condoms, injectibles, IUDs, oral contraceptive pills, contraceptive patch, and vaginal ring.[7]

References:

Centers for Disease Control (2023). Impact of COVID 19 on STDs. Sexually transmitted disease surveillance, 2021.

Attributions:

Child Growth and Development by Jennifer Paris, Antoinette Ricardo, and Dawn Rymond, 2019, is licensed under CC BY 4.0

[1] Lifespan Development: A Psychological Perspective by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0

[2] Image by Ian Joslin is licensed under CC BY 4.0

[3] Lifespan Development: A Psychological Perspective by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0

[4] Contraception by the CDC is in the public domain

[5] How effective is emergency contraception? (2016). Retrieved from https://www.nhs.uk/conditions/contraception/how-effective-emergency-contraception/

[6] David G. Weismiller M.D., Sc.M (2004). Emergency Contraception. Retrieved from https://www.aafp.org/afp/2004/0815/p707.html

[7] Image by rexchimex is licensed under CC BY 4.0