Learning Objectives

2. Learning Objectives • Describe normal adolescent sexual development • Identify conflicting messages regarding sexuality and sexual relationships • Develop skills to assist students in developing healthy sexuality and reduce health risks associated with sexual behavior

3. Adolescent Sexuality

4. Sexual Development: Definitions • Sexual identity • Early awareness of being male or female • Gender identity • Sense of oneself as a boy or girl in society • Gender roles/sexual roles • Characteristics, behaviors and interests, defined by cultures, that separate boys and girls • Sexual orientation • Heterosexual, homosexual, bisexual • Consistent pattern of erotic arousal toward persons of the same or opposite sex

5. Female Pubertal Development • Body fat ~17% to begin and – ~22% to maintain normal menses • Ovulatory cycles begin within 12 months post-menarche (80%) • Females start puberty between ages 7 and 13 years • Five stages of pubertal development—Tanner/SMR • Breast development begins at SMR stage 2 – mean age 10.0 years • Early growth spurt in SMR stages 2 to 3 • Menarche at SMR stage 4 mean age 12.5 years in US

6. Male Pubertal Development • Males start puberty between ages 10 and 13½ years • Five stages of pubertal development – Tanner/SMR • Testicular enlargement begins at SMR stage 2 – mean age 12 years • Voice changes as vocal cords lengthen and thicken in SMR stages 3 to 4 • Late growth spurt in SMR stages 4 to 5 • Peak muscle mass at SMR stage 5 in response to androgens

7. Stages of Sexual Development • Stage I • Preadolescent • Tanner stage I (prepubertal) • Low conscious level of mental and physical investment • Collection of information from multiple sources

8. Stages of Sexual Development • Stage II • Early adolescent • Tanner stage II-III puberty • Exploratory behavior • Concrete thinking

9. Stages of Sexual Development • Stage III • Mid adolescent • Tanner stage IV-V puberty • Group => individual dating • Egocentrism • Experimentation and exploitative behavior • Denial of consequences

10. Stages of Sexual Development • Stage IV • Late adolescent • Tanner stage V puberty • Full sociolegal and physical maturation • Object choice consolidated • Expressive behavior – “other directed”

12. Sexual Development Intend no more children First intercourse Spermarche First marriage First birth MEN 33.2 26.7 14.0 28.5 16.9 AGE 10 15 20 25 30 35 30.9 25.1 26.0 17.4 12.6 WOMEN Menarche First intercourse Intend no more children First marriage First birth Guttmacher Institute, 2005

13. Adolescent Sexuality

14. Why don’t the students listen to me? • Why don’t they use contraception? • Why do they keep putting themselves in sexually risky situations? • Why don’t they use condoms? Why do adolescents/young adults make “suboptimal” choices in behavior?

15. Transitional Developmental Period • Goal directed behavior: • Finish Job Corps program • Delay pregnancy/parenting • Avoid STI • Requires: • Control impulses • Delay gratification • Control risk taking behavior

16. The Adolescent Brain The Adolescent Brain; Casey, B.J. et al (2008) Ann NY Acad Sci March; 1122: 111-126

17. Brain Function • Impulsivity • Risk taking/sensation seeking • Impatience (immediate reward vs. delayed gratification)

18. Impulsivity • Act without thinking • Individual variation (range) • Linear development with increased impulse control with age

19. Sensation Seeking/Risk Taking • Explore novel experiences • Universal in adolescent mammals – encourages leaving family, venturing forth… • Bias in judgment of risk – enjoyed activities perceived as less risky • Lack experience with “adult” behaviors

21. Impatience • Small reward immediately vs. large delayed reward • Memory and IQ related • Emotional gain may outweigh executive decision making

22. Adolescent Sexuality

23. Feminine: sociability empathy passivity Masculine: independence aggression assertiveness

24. Sociocultural Perspective “Would you permit your 16 or 17 year-old to spend the night with a girlfriend or boyfriend in his or her room at home?” • 9 out of 10 American parents replied NO • 9 out of 10 Dutch parents replied YES Dutch approach: spend less time and effort trying to prevent young people from becoming sexually active and more time and effort in educating and empowering young people to behave responsibly when they do become sexually active. Dutch youth use contraceptives more frequently and effectively, have fewer sexual partners, are less likely to contract an STD, and have lower rates of pregnancy, abortion and childbirth than their American counterparts. Amy Schalet PhD

25. Unintended Pregnancies • 49% of pregnancy in U.S. unintended • ½ of these are in couples claim to use some form of contraception

26. Media Influence • Youth spend more than 7 hours per day using media – TV, music, computers, video games, print, movies

27. Group Activity Regarding Media • List 3 behaviors that are shown as norms? • List 3 features of romantic relationships?

29. Media Influence • Youth spend more than 7 hours per day using media – TV, music, computers, video games, print, movies • Media as “superpeer” that presents adolescents and young adults with the message that sex is normative and risk free – shapes beliefs about how individuals behave in romantic relationships • Exposure to sexual content linked to: • Rapid progression of sexual activity • Earlier coital behavior • Greater risk of unplanned pregnancy • Greater risk of STD Ref: Strasburger VC, Pediatrics 2010; 125(4):756-767

33. X

34. Gender Differences in Sexual Attitudes Feelings about first experience with adolescent heterosexual intercourse: GirlsBoys • “Afraid” 63% 17% • “Happy/satisfied/thrilled” 13% 43% • “Guilty” 36% 3% • “Used” 16% 0% • “Powerful” 0% 15% Sorenson

35. Adolescent Risk Taking Behavior • Adolescents may engage in high-risk sexual behaviors for a variety of reasons, including: • To meet sexual and emotional needs for intimacy • In an effort to attain peer and partner approval • In an effort to define oneself as mature and adult-like • Developmentally less able to anticipate consequences of risk behaviors compared to adults • Less developed communication skills resulting in poor ability to negotiate condom use and sexual behaviors with partners • Inadequate knowledge about the risks of acquiring infections from different sexual behaviors and how to prevent transmission • Concomitant use of alcohol and/or drugs that impair judgment about decisions regarding sexual behaviors, partner choice, and condom use

36. Influence of Religion/Spirituality • Protective or resilience factor for adolescent sexual health outcomes: • Later sexual debut • Less sexually experienced • Fewer sexual partners • More conservative sexual attitudes • Varies by race and ethnicity • Strongest protective effect for White females • No protective effect for Black males • Not studied in Latinos or Asian Americans

37. Sexuality Education: What Works?

38. The Need for Sexual Education • By the age of 18, 6 in 10 teenage women and nearly 7 in 10 teenage men have had sexual intercourse • A sexually active teenager who does not use contraception has an 85-90% chance of becoming pregnant within a year • In 2000, 48% of all STI infections (9.1 million) were among 15-24 year olds

39. Sexual Health Misinformation • One in five adolescents believe that birth control pills offer protection from STDs • One in five adolescents believe that condoms are “not effective” in preventing STD transmission • One in six adolescents believe that sex without a condom once in awhile is “no big deal” • One in ten adolescents believe that “you do not need to use condoms unless you have a lot of sexual partners” • Half of adolescents believe that raising the subject of condoms raises suspicions about both partners’ sexual history Ref: Kaiser Family Foundation National Survey

40. Main Approaches to Sexuality Education • Abstinence-Only-Until Married Education • Does not discuss the reproduction cycle or other contraceptive methods • Teaches abstinence as the only morally correct option of sexual expression for teenagers • Discusses contraception only in terms of failure rates • Comprehensive Sexuality Education • Urges students to postpone sexual initiation, but also educates them on condoms and other methods of contraception that protect against pregnancy, HIV infection and sexually transmitted infections (STIs), discusses sexual orientation, how to resist peer pressure and how to negotiate contraceptive use with a partner

41. http://nahic.ucsf.edu//downloads/ReproHlth2007.pdf

43. Female Contraceptive Use at First Intercourse by Year of First Premarital Intercourse, NSFG, 2002

44. Male Contraceptive Use at First Intercourse by Year of First Premarital Intercourse, NSFG, 2002

45. Female Contraceptive Use at Last Intercourse, YRBS, 2003

46. Percentage of High School Students Who Drank Alcohol or Used Drugs Before Last Sexual Intercourse,* by Sex** and Race/Ethnicity,*** 2007 * Among the 35.0% of students nationwide who had sexual intercourse with at least one person during the three months before the survey. ** M > F*** W, H > B National Youth Risk Behavior Survey, 2007

47. Chlamydia—Age-and Sex-Specific Rates: United States, 2008

48. Gonorrhea—Age-and Sex-Specific Rates: United States, 2008

50. Reproductive Health Disparities