Adolescent Sexuality Article Reference: CMF File 4, 1998; Author: Trevor Stammers Media pundit Dr John Collee expresses this view bluntly -'accept teenage sex as a reality and learn to live with it'. However this implies there is nothing wrong with it. Teenage sex is certainly wide-spread and has become the norm by later adolescence. One in five girls and one in four boys are sexually active before they are 16. By 24 more than half have already had two or more sexual partners. What are the influences leading to early sexual activity? Does starting sexual inter-course early cause any problems? Sex and the law The Sexual Offences Act 1956 states that a male 14 or over who has sex with a girl who is under 13 is committing an absolute offence. Having intercourse with a girl who is between 13 and 16 is still an offence, but the offence is not absolute because the man can claim in his defence that: a) he had reasonable cause to believe that he was validly married to the girl, or b) he had reasonable cause to believe that the girl was 16 or over. This applies only if he is under 24 and has no previous charge of a similar offence. The age of consent for homosexual men is 18 years, though Parliament may reduce this to the age of 16. There is no age of consent for lesbians. The intention of the law is to protect young people from exploitation. It was not designed to punish people who enter mutually consenting relationships. Sexual pressure A combination of biological and social factors exerts enormous pressure on adolescents to start having sex early. Early puberty In boys, testicular enlargement is the first sign of puberty. This starts at about 12 and is normally finished by the age of 14. In girls, breast buds start to develop at 11 years. This is followed some two years later by menarché, the onset of menstrual periods. With puberty comes the capacity for sexual arousal. For most adolescents, the physical ability to make love arrives long before the psychological ability to be a mature, committed and loving partner. Media manipulation Never before have adolescents been exposed to such relentless media pressure to have sex as early as possible. Cinema, television, pop music, the Internet, CD-ROMs, teen novels and magazines all combine to project sex as a status symbol and the primary reason for living. Even a sympathetic reviewer of teen magazines comments, 'Whether they are in a relationship or not, girls reading about boys' obsession with losing their virginity may continue to consider that sex is "the price of going out with a boy".'[1] Contraception The 'pill' arrived in the early 1960s. Since then we have been able to separate sex from reproduction with a high degree of reliability and safety. This has inevitably had a marked effect on sexual behaviour. 'Promiscuity becomes as easy as the next cigarette'[2], was how one early pill user described the transformation of her new-found sexual lifestyle. Sex education There is some evidence that good sex education delays the age of first intercourse[3]. However the majority of sex education programmes in the UK have no more effect than peer group influence, at least for girls[4]. Homosexuality The subject of homosexuality is so politically sensitive that it is difficult to separate myth from fact. The most comprehensive survey of 19,000 UK men showed that 1.1 per cent had sex with homosexual partners within the previous year. The figure rose to 3.6 per cent when asking whether they had ever had a same-sex partner. These findings are similar to recent studies in the US. For women the incidence is even lower at around 1.7 per cent, with well under 1 per cent having had a lesbian partner in the previous five years. So homosexuality in adults is uncommon. In contrast, feelings of same-sex attraction are fairly frequent in adolescence. In the vast majority of cases these feelings do not last and are not an indication of being gay. The prevailing opinion today is to say that sexual orientation doesn't matter. Heterosexual and homosexual behaviour are just variations of the same thing. However two points need to be emphasised: . Homosexual behaviour presents more health risks than heterosexual. One study indicated that the gay male life span is around 30 years shorter than that of straight men[19]. . The pattern of substance abuse in the gay community is also much higher than outside (1.5 times for alcohol, 2.3 for cocaine, 4 for benzodiazepines -tranquillisers such as Valium and 58 times for 'poppers' - nitrates used to relax the anal muscles). Having homosexual feelings does not mean that you have to practise as a homosexual. Many people with homosexual desires have asked for help to change. Although this is never easy, some people do change[20,21]. There are many accounts, by both gays and lesbians, of how their lives have been transformed by the power of Jesus Christ[22]. What God says of sex The Judaeo-Christian tradition sees sexual intercourse as one of God's good gifts. It is only for faithful, loving, committed marriages, which must be heterosexual. A prime source of this ethic is found at the beginning of the Bible: 'For this reason a man will leave his father and mother and be united to his wife, and they will become one flesh'.[5] This key verse is endorsed in the New Testament by both Jesus[6] and one of Jesus' early followers Paul[7]. It shows a clear progression of activity. There is a public move to establish a new family unit. Then comes an exclusive heterosexual commitment to each other. Following this is the joy of becoming 'one flesh', a biblical concept which includes sexual intercourse. The New Testament makes it plain that even when a client has sex with a prostitute an invisible bond is formed. The two become one flesh. For the Bible, there is no such thing as casual sex. A couple may have casual intentions, but there are always consequences. At best sex can result in ecstatic delight and the deepening of faithful love. Without on-going commitment it can lead to guilt, regret and hurt. Masturbation Masturbation is touching or rubbing one's own genitals to give sexual pleasure, usually to orgasm. Over 95 per cent of boys and between 50 and 80 per cent of girls masturbate regularly during adolescence. For many people masturbation is their first sexual experience. Virtually all modern textbooks on sexuality say that it is a totally harm-less way to relieve sexual tension and to enjoy sexual experience on one's own. Many sex therapists regard regular masturbation as a vital way to practise before having sex with a partner. Problems of masturbation are rarely mentioned and indeed their existence is often denied. Some Victorian myths need to be set aside. They claimed that masturbation made you blind or mad. These ideas are mistaken and repressive. However we need to bear in mind that masturbation: is often associated with guilt. This happens in both sexually repressive or liberated homes; is self-centred. This of course does not automatically make it wrong. But being a self-centred activity may not make it a good preparation for love-making, which involves self-giving to one's lover; can lead to a sense of isolation, negative attitudes to members of the opposite sex, and anger about relationships[8]; frequently involves sexual fantasy, often using pornographic material. The Bible calls this 'adultery in the heart'[9]. Pornography can also lead to further problems such as encouraging sexual deviations and even rape[10]; can become compulsive and difficult to control11. Dangers of teenage sex There are still dangerous serpents lurking in the new Eden of adolescent sexual liberation. Sexually transmitted infections Sexually active adolescents are at great risk of getting sexually transmitted infections (STIs). These infections can affect young people for the rest of their lives. For example they can cause infertility. Consequently teenagers may put their entire reproductive future at risk. In addition, the earlier a person's first sexual experience, the greater their risk of acquiring STIs. The prevalence of STIs is often underplayed. One popular book on adolescence mistakenly claims that 'the figures do not support commonly prevailing mythology' that STIs are increasing[12]. But UK doctors treat about 580,000 new cases of STIs every year. The figure has increased 21 per cent since 1981, and 20,000 of these patients are teenagers. Around a third of cases of gonorrhoea in women and an eighth of cases in men occurred in those under 20 years old. A sexually active 15-year-old-girl has ten times the risk of getting pelvic inflammatory disease (PID) than a girl of 23. This is particularly worrying as PID frequently leads to infertility. One fifth of cases of genital herpes and one third of cases of genital warts occur in women under 20. An international conference in New York said that the situation was out of control. 'The 70 per cent of people sexually active by age 19 may have been exposed to a STI and become infected. They could then pass it on without ever feeling ill or knowing they were infected'[13]. It may seem reassuring that teenagers made up only 0.4 per cent of the 218,301 cases of AIDS in the USA in 1992. But 19.5 per cent were aged 20-29. Since AIDS takes about 8 years to develop many would have been infected as teenagers. Teen pregnancy and abortion Denial and a sense of 'I'll be OK' characterise adolescent thinking. One study found that over 70 per cent of teenage girls thought they could not become pregnant[14]. However the sad reality is that each year in the UK, over 8,000 girls under 16 years of age have unplanned pregnancies. More than half these pregnancies are terminated - each year 40,000 teenagers have abortions. The UK has the highest teenage conception rate in Western Europe. The 1995 figures showed a rate of 9.4 per 1,000, a rise of 11 per cent on the previous year's figures. This high rate is blamed on conservative moralists suppressing free availability of contraceptive information to teenagers. However no contraceptive is 100 per cent effective. The hard evidence points to contraceptive failure as a major factor in teenage pregnancy[15]. Cancer of the cervix Cervical cancer kills 1,500 women in the UK each year and it is getting more common. A woman who has sex early in life is at a much greater risk of cervical cancer than one who starts later. Increasing the numbers of sexual partners also increases the risk. The cancer may be related to viral infections such as herpes simplex and genital warts. It's not just promiscuity in women that affects the situation. A promiscuous male partner places any future female partner at a greater risk of cervical cancer. Other risks Sexually active teenagers are more likely to be involved in other risk-taking behaviour than those who remain virgins. Sexual intercourse is often one 'element of a syndrome of problem behaviours that include drug and substance abuse, minor delinquency and school difficulty'[16]. One study found that sexually active girls aged 12-16 were over 6 times more likely to report having attempted suicide[17]. The increasing use of drugs and alcohol is particularly worrying. Intercourse under their influence is much more likely to result in unplanned pregnancy or transmission of STIs. The emotional costs of early intercourse can also be high, especially for girls. The founder of the US Sex Information and Education Council, Dr Mary Calderone, admits that 'No one knows what effect sex precociously experienced will have...Sex experience before confidentiality, empathy and trust have been established can hinder and may destroy the possibility of a solid permanent relationship'[18]. People who become sexually active before 16 express more regret over their actions than those who do not. If you can't be good ...? Most sex educators see contra-ception as the solution to sexual health problems. Certainly if adolescents are going to have sex, then using appropriate contra-ception is better than unprotected sex. However contraception does not solve all the problems. The condom, for example, has a 15 per cent failure rate for protecting against pregnancy even among experienced users. For the prevention of STIs the failure rate is likely to be higher particularly if being used by inexperienced people. Contraception cannot prevent the heartache and anguish (primarily affecting girls), or the cynicism and shallowness (primarily affecting boys), resulting from a sequence of premature sexual relationships. 'If it feels good do it' is the short-term view on adolescent sexuality that appeals to the condom culture. In the long-term, however, the best way is to wait until the degree of sexual involvement mirrors other aspects of the relationship. Sexual intercourse at its best communicates the message 'I am totally yours'. If you are not totally committed to your lover for life, sex will always fall short of the best it can be. Sex in anything less than the total self-giving of marriage is bound to disappoint you. Trevor Stammers is a tutor in General Practice at St George's Hospital Medical School. He is the author of 'The Family Guide to Sex and Intimacy' and 'Love Lies Bleeding - when intimacy turns to abuse'. References Mellanby A. Teen-zine sex is not all it seems. BMJ. 1996 312;451. Vaughan P. The Pill On Trial. Pelican 1972, p185. Mellanby A, Phelps F, Crichton N, Tripp J. School sex education: an experimental programme with educational and medical benefit. BMJ. 1995, 311;414-7. Wellings K, Wadsworth J, Johnson A, Field J, Whitaker L, Field B. Provision of sex education and early sexual experience: the relation ex-amined. BMJ. 1995, 311;417-20. Genesis 2:24. Matthew 19:5,6. 1 Corinthians 6:16. Christensen C. Prescribed masturbation in sex therapy: a critique. Sex and Mar Ther. 1995, 21;87-99. Matthew 5:28. Itzen C (Ed.) Pornography. OUP. 1992. Bancroft J. Human sexuality and its problems. Churchill Livingstone. 1985, p120. Coleman J, Hendry L. The nature of adolescence. Routledge. 1990, p147. Goldsmith M. Silent epidemic of social disease makes experts raise their voices. JAMA. 1989, 261;3509-10. Shah F, Kantner J, Zelnick. Unprotected intercourse amongst unwed teenagers. Fam Plan Perspect. 1975, 7;39-41. Williams ES. Contraceptive failure may be a major factor in teenage pregnancy. BMJ. 1995, 311;807. Orr D. Premature sexual activity as an indicator of psychosocial risk. Paediatrics. 1991, 87;141-7. ibid. Quoted in Collins R. A physician's view of college sex. JAMA. 1975, 232;392. Cameron P, Playfair W, Wellum S. The longevity of homosexuals: before and after the AIDS epidemic. Omega: Journal of death and dying . 1994, 29, 249-271. Mansell Pattison E. Ex-gays: Religiously mediated change in homosexuals. Am J Psych. 1980, 137;1553-62. Green J, Miller D. Male homosexuality and sexual problems. Br J Hosp Med. 1985, 353-355. Davies R, Rentzel L. Coming Out of Homosexuality. Hodder 1995. sexual ethics & relationships index resource centre Copyright ©2002 Christian Medical Fellowship. Comments, suggestions, information: email webmaster@ethicsforschools.org CMF is a registered charity (No 1039823)