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Adolescent Sexuality What’s normal, what’s not normal, what to ask and how to ask...

Adolescent Sexuality What’s normal, what’s not normal, what to ask and how to ask. Preeti Matkins, MD. Adolescent Sexuality. Physical development Sexual development Psychosocial development CONFLICT / TURMOIL / ANGST !!!!. Adolescent Sexuality Mixed Messages. Media

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Adolescent Sexuality What’s normal, what’s not normal, what to ask and how to ask...

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  1. Adolescent SexualityWhat’s normal, what’s not normal, what to ask and how to ask... Preeti Matkins, MD

  2. Adolescent Sexuality • Physical development • Sexual development • Psychosocial development • CONFLICT/TURMOIL/ANGST!!!!

  3. Adolescent SexualityMixed Messages • Media • Average teen sees>14,000 images of sexuality on television/year • About 150 show any responsibility, family discord or bad outcome of the sexual experience • Parents • 20%-80% of parents “talk” about sexuality with their children • only 20% do more than say “don’t do it”

  4. Early Adolescence (age 11-14) • breaking away • narcissistic • lower self-esteem • impulsive • same sex confidantes • concrete

  5. Middle Adolescence (age 15-17) • idealistic and fatalistic • risk takers • peer group attachment • parental conflict • emerging sexuality

  6. Late Adolescence (age 18-22) • realistic self identity • realistic sexual identity • future thought • abstract thought

  7. Female Pubertal Growth and Development

  8. Male Pubertal Growth and Development

  9. Normative Sexual Behavior in 10-12 year old BoysFriedrich, et al., Pediatrics, 101 (4):e9

  10. Normative Sexual Behavior in 10-12 year old GirlsFriedrich, et al., Pediatrics, 101 (4):e9

  11. Adolescent SexualitySame Sex InterestRyan and Fullermann Adol Med:State of Art Review 8:2 June 1997 • many adolescents experiment sexually (4%) • experimentation does not predict future behavior • sexual activity is not the same as sexual orientation • behavior vs. identity

  12. Adolescent SexualityNon Intercourse Sexual Activity • Continuum • perceived as less risky • “still a virgin” • “not really sex” (ala Clinton)

  13. Adolescent SexualityReasons for Intercourse • please partner • partner will love more • curiosity • expected • pressure from same sex peers • non consensual

  14. Relationship between Pubertal Development and Sexual ActivityDoyle, et al. Adol Ped Gyn 1988;1:252 • n=116 adolescents at gyn clinic • 17% began sex act year of menarche • 38% began sex act second year • 20% began third year after menarche

  15. Sexual Activity in AdolescentsSchuster, Am J Pub Health 1996;86:1570

  16. Adolescent Sexual Activity Rates1995 National survey of Family Growth 1995 National Survey of Adolescent Males

  17. Adolescent Condom Use during Last Intercourse (self report)Rosentraub, Child Health USA: 1996-1997

  18. Adolescent Contraceptive Use(The Alan Guttmacher Institute, 1999) • Teen fecundity rate 90% within one year • Contraceptive Use at First Intercourse • early 80’s 48% • late 80’s 65% • 1995 78% (26% condoms) • Contraceptive Methods • OCP 44% • condom 38% • injectable 10% • withdrawal 4% • implant 3%

  19. Adolescent SexualityRisk Taking Behaviors • Psychological development • Alcohol, illicit drugs increase risky behavior • No perceived negative effects • KnowledgeMAY NOTchange behavior

  20. Teen Pregnancy Rate(The Alan Guttmacher Institute, 1999) • 10% of women age 15-19, 19% of sexually active women age 15-19 become pregnant • 78% are unplanned • 60% occur in 18-19 year olds

  21. Teen Pregnancy Rate(The Alan Guttmacher Institute, 1999) • US Teen Pregnancy Rate (17% decline) • 1990 117 per 1000 • 1996 97 per 1000 • Twice the rate of England,Canada • Nine times the rate of Japan, Netherlands • 20% of decline due decreased sexual activity • 80% of decline due to more effective contraception

  22. Teen Birth Rates 1998 (per 1000 women age 15-19)(Advocates for Youth, 2000)

  23. Teen Birth Rates 1998 (per 1000 women age 15-19)(Advocates for Youth, 2000)

  24. Adolescents Report of Clinician CounselingSchuster et al, Arch of Adol and Ped Med 150(9):906-913 Sept 1996

  25. GAPS Recommendations • Health guidance on development during each stage of Adolescence • physical • sexual • emotional • Annual Guidance • physical growth • psychosocial development • psychosexual development • responsible behaviors • STD • contraception

  26. Patient Scenario • 4.5 yo male • mother pregnant • Should he take showers with me?

  27. Patient Scenario • 13 yo girl • mother is 27 • patient is not sexually active, premenarchal, good student • first boyfriend • mom wants pt on Depo

  28. Patient Scenario • 5 yo girl and 4.5 yo boy neighbor • found mom’s feminine hygeine products • put them all over the dog

  29. Patient Scenario • 9 yo girl • mom is pregnant • what do we tell her?

  30. Patient Scenario • 13 yo boy • 50% ht/wt • breast development

  31. Patient Scenario • 14 yo boy • likes cooking, art • doesn’t like sports • CC: is something wrong with him?

  32. Patient Scenario • 22 mo girl • stays with dad this summer • CC: touching herself all the time

  33. Patient Scenario • 11 yo girl • mom worried she’s getting “fat” and sleeps all the time • not really sexuality

  34. Patient Scenario • 16 yo girl • going to marry boyfriend of 6 weeks • grades slipping • What should we do?

  35. Patient Scenario • 12 yo girl • spends all her time on the phone/e-mail • talks about boys constantly

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