The first nationally representative survey of teenage boys' sexual practices confirms what had been a powerful hunch among public-health experts: Significant numbers of teenagers are engaging in non-coital sex such as oral sex and anal sex.
The study, conducted by the Washington, D.C.-based Urban Institute researchers and published last month by the Alan Guttmacher Institute in its Family Perspectives journal, has sounded an alarm for public-health experts and sex educators who fear that teenagers are exposing themselves to sexually transmitted diseases by engaging in unprotected, risky behaviors under the belief that they are "safe."
"This study provides documentation for what a number of people who have worked in the field have strongly suspected," said Robert W. Blum, director of the Adolescent Health Program at the University of Minnesota. "It shows that there is substantial evidence that we have much more young people involved in sexual behaviors that pose health risks than we thought."
In the study, which included 1,297 heterosexual 15- to 19-year-olds, 55% reported having engaged in vaginal intercourse, 53% said they had been masturbated by a female, 49% had received oral sex, 39% had performed oral sex and 11% had engaged in anal sex. Although 22% reported using condoms during vaginal intercourse, there was no complete data on condom use during oral and anal sex.
Responses were compared with a 1988 survey of 1,880 male teens. The results showed an increase in the proportion of teenager males who reported having been masturbated by a female (from 44% in 1988 to 53% in 1995). Oral sex figures were similar for both years, except for black teenage males, whose levels more than doubled (from 25% to 57%), bringing them closer to those of Latino and white boys (50% and 45% respectively).
What concerns public-health experts most is that teenagers appear to be engaging in high-risk sexual practices without caution and with alarming casualness.
"When you put this study together with other studies about what kids call sex, most kids do not call oral sex and anal sex 'sex,' " said Blum, who called the study's report of more than one in 10 teenagers having had anal intercourse "surprising and quite high."
In a separate, earlier study of undergraduates at a Midwestern university, more than half did not consider oral sex "sex," and 19% felt the same about anal sex. In another survey of college undergraduates, more than half said oral sex did not qualify as "sex," numbers which increased when oral sex was specified as not producing orgasm.
Yet another study of college freshmen and sophomores in the South found that 61% considered mutual masturbation to be abstinent behavior; 37% described oral sex as abstinence; and 24% thought the same of anal sex.
"Among many kids, there is this mythology that [non-coital sex] is safer or not a risk behavior," said Blum. "Most of that focus in this country since 1996 has been on abstinence. The implicit message in abstinence is abstinence from penile-vaginal intercourse. Teenagers see non-coital sex as protective because it protects against pregnancy." But sexual practices such as oral and anal sex are risky. A health-screening project for meningitis among middle-school students in Georgia found that several girls' throat swabs revealed they had pharyngeal gonorrhea. Anal sex is particularly risky for young women and is a major transmitter of HIV, the virus that causes AIDS.
Many sexually transmitted diseases including herpes, hepatitis B, gonorrhea, syphilis and chlamydia can be transmitted orally and genitally, unless partners use condoms or dental dams. Although HIV is not easily transmitted through oral sex, physicians warn that transmission can occur.
"In every study I have seen that asks about anal intercourse, some significant number of adolescents are engaging in it," said Dr. Mark Schuster, director of UCLA/Rand Center for Adolescent Health Promotion and author of a 1996 study of L.A. high school students' sexual practices in which 12% reported having had heterosexual anal intercourse in the prior year.
"It may be possible that young men are engaging in it because young women want to preserve their virginity," said Schuster. "But parents, physicians, and health educators need to know that some adolescents are engaging in anal intercourse. We need to know if we need to test for STDs and what risk reduction advice we need to be giving." Teenagers are ignorant about STD transmission, said Schuster, because of lack of information.
Most adults are uncomfortable talking about oral sex and anal sex with teenagers, said Nancy Sasaki, president and chief executive of Planned Parenthood Los Angeles. "We don't talk specifically about oral and anal sex when we do sex-education outreach programs," she said. "Those are difficult topics for us also because we need parent support in raising those issues."
Freya L. Sonenstein and Gary Gates, co-authors of the Urban Institute study, agree. "Both parents and educators may be having difficulty imparting information about the riskiness of oral sex and anal sex," said Sonenstein, director of the Population Studies Center at the Urban Institute. "What we hope our study does is show that even though they are not talking about these behaviors with their kids, their kids are engaging in these behaviors."
Next week: Public-health experts, psychologists and physicians weigh in on potential solutions.