Rudolph's Pediatrics, 22nd Ed.

CHAPTER 70. Sexual Behavior

Erica B. Monasterio

Sexual behavior during adolescence has decreased over the past 15 years, with fewer adolescents initiating sexual intercourse and more adolescents using effective contraception when they initiate coitus.

The most recent 2005 survey on sexual behavior of youth between the ages of 15 and 19 shows that 46.8% of high school students had experienced coitus at least once. The percentages are somewhat different by race and ethnicity: for blacks, 61% for female and 75% for male teenagers; for Hispanics, 44% for female and 58% for male teenagers; and for whites, 43% for female and 42% for male teenagers. Predictably, the higher the grade in school, the higher the percentage of students reporting sexual intercourse, with 9th graders at 34.3%, 10th graders at 42.8%, 11th graders at 51.4%, and 12th graders at 63.1%.1

Among middle school students, rates of reported sexual intercourse are much lower, with 5.7% of girls and 7.9% of boys reporting having ever had intercourse.2 Of note is the significant increase between 8th and 9th grades, which should encourage pediatricians to discuss sexual activity and risk reduction with their early adolescent patients.

National data related to same-sex sexual activity is not included in the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey, as many states opt out on these questions in their school-based surveys. There is national retrospective data, however, indicating that 4.5% of males and 10.6% of females age 15 to 19 report same-sex sexual contacts in their lifetime.3

Currently, about three quarters of adolescents report using some form of contraception at first intercourse.2 Trends are also positive related to adolescent pregnancy and child-bearing. Pregnancy rates among 15 to 17 year olds decreased 33%, from 80.4 per 1000 females to 53.5 from 1990 to 2000. The birth rate in the same age group declined 42%, from its peak at 38.6 in 1991 to 22.4 in 2003. Abortion rates also declined by more than half between 1987 and 2000, from a peak rate of 30.7 per 1000 to 14.5 per 1000 females ages 15 to 17.4

An estimated 3 million adolescents are diagnosed with a sexually transmitted infection annually.5 Adolescents ages 15 to 19 years consistently demonstrate the highest age-specific rates of Chlamydia trachomatis and Neisseria gonorrhoeae in the United States. Sexually active African American adolescents have much higher rates of chlamydia and gonorrhea than do American Indian/Alaskan Native, Hispanic, white, or Asian/Pacific Islander adolescents.6