Friday, March 25, 2016

Teen Girls 30% Less Likely Than Boys to Use Protection During First Sexual Encounter: Does Sex Ed Increase Safe Teen Sex?

Nicole Weller, a doctoral candidate at Arizona State, performed an analysis of data from the National Survey of Family Growth, in which she looked at responses from 5,012 adolescents aged 11 to 19. Some of what she found may not surprise us, but her research does confirm a sad reality about the impact of early sexual health education.

Weller found that regardless of what type of sex-ed they received, teen girls were 30% less likely than teen boys to use protection during their first sexual encounter. She also found that black teens were 40% less likely than white teens to use protection the first time they had sex. 
For both young women and African Americans, Weller found no association between the type of sexual health education they got and their risk of sexually transmitted infection (STI) or use of contraception.

Conclusions about the relation of sex education and sexual activity? Allow me to state the results:
  • Sex education does seem to delay the age at which teens first have sex: previous studies show that 42% of teenage girls and 43% of teenage boys now have their sexual debut at an average age of 17.5 years — later than they did 10 years ago, when the average age of first sex was 15.
  • But sex education doesn’t appear to increase safe sex once teens begin having sex. According to a 2009 study in Pediatrics, 38% of 14-to-19-year-old girls who were sexually active were diagnosed with at least one of the five most common STIs in 2009. Weller asserts that the similar age of sexual debut and infection shows that contracting STIs often happens soon after first sex.
  • Although people disagree about what type of sexual education children and teenagers should receive, 90% of Americans want some kind of sex ed for teens. Understanding how adolescents interact with information about sex may help improve the quality of education they receive.
Weller’s findings are preliminary and will require follow-up, though a study from Indiana University corroborates her findings: “while 80% of 14-to-17-year-old boys used condoms during the last 10 times they had sex, only 58% of their female counterparts reported the same.”

(Maredith Melnick. “Study: Teen Girls More Likely to Have Risky Sex Than Teen Boys.”  
Time. November 09, 2010.)


My Take

Weller's research is deeply disturbing in that young women – for whatever reason – view protection as less important than do young men, and disturbing in that sex education – by formal instruction or with parental guidance – fails to promote safer sex with proper methods of contraception.

Why are teens, especially girls reluctant to use contraception? 
Perhaps a study from Europe will help illuminate the answer. Interviews conducted with women between the ages of 16 and 20 attending a day unit at a hospital in England who were due to have, or had recently had, a surgical abortion were conducted. The young women were asked about their knowledge of and views on contraception, sex education, and sexual health services.. The conclusions were published in The European Journal of Contraception and Reproductive Health Care.

The interviews revealed that lack of knowledge about sex and contraception, and access to sexual health services did not play a major role in unintended pregnancies among these young women. “Much more significant were the decision-making processes around choosing (or not) to use contraception.”

Researchers found that young people do not use contraception consistently and do not always think about it until after they become sexually active. Sex was often unplanned, and this lack of planning lessened the likelihood of contraception being used, especially where alcohol was involved. The study shows that a combination of factors – alcohol lessening inhibitions, being “in the moment,” and being too embarrassed to discuss condom use – was likely to result in unprotected sex despite young people being knowledgeable about contraception and aware of how to access it.
A very important determinant of contraceptive use was communication, or lack thereof, with a partner. A key finding of this study is that “lack of communication plays a major role, with few respondents feeling comfortable about discussing condom use in particular. This was compounded by what was perceived to be young men's reluctance to use condoms, and assumptions about responsibility for contraceptive use. The evidence suggests that those in short-term relationships or engaging in 'one night stands' were much less likely to use contraception because sex was unplanned, but those in a long-term relationship where sex was planned, were likely to have discussed it with their partner.” 

(Sally Brown and Kate Guthrie “Why don't teenagers use contraception? A qualitative interview study.” Wolfson Research Institute. The European Journal of Contraception and Reproductive Health Care. June 2010.)

Another study puts a great deal of blame on parents.
A recent survey by The National Campaign to Prevent Teen and Unplanned Pregnancy. (2015) discovered 68% of teens said they agreed with this statement: “The primary reason why they don't use birth control or protection is because they're afraid their parents will find out.”

That's nearly seven out of 10 teens who say fears about what their parents might think or say are pushing them not to protect themselves when and if they have sex.

Now, I do understand that this “fear of parents” is very illogical, but so are teenagers, especially during times when floods of hormones encourage them to take new risks and adventures. And, isn't it true that parents calmly preach protection while being much more judgmental when faced with the actuality of discovering that their own children use birth control?

Bill Albert, chief program officer for The National Campaign to Prevent Teen and Unplanned Pregnancy said teens consistently say that their parents, not peers, partners or popular culture, most influence their decisions about sex, but birth control seems to be a "profound exception" to this rule.

Many parents say they want their kids to be using birth control or protection if they are having sex, but they just don't feel comfortable being the ones sharing that information, he said.

"Because somehow that implies to many parents we've talked to that it's almost like implicit tacit approval, like, 'You want to have sex. You go right ahead. Just be protected. You'll be fine.' That's not the view of most parents."

What's also at play, said Albert, is the feeling of many parents that they don't believe they can be influential when it comes to the topic of birth control.

"But that's simply not the case," said Albert.

(Kelly Wallace. “Survey says teens skip birth control because they fear parental judgment. CNN. May 07, 2015.)

What To Do?

Suggestions to change the reality about sexual risks include the following advice for parents: start early with conversations about sex and birth control, be sure “the talk” is not a one-time conversation, consistently offer helpful advice on sex, and use an anatomy book for better instruction.

When discussing the topic of sex, whoever gives proper sex education instruction to girls must be obliged to inform them that boys are not the only participants responsible for understanding and using birth control. Also, girls must understand that boys who beg them to have sex au naturel present great risks. One study found a quarter of teen girls who didn't use birth control say they didn't because their partner didn't want them to. 
Of course, boys need to learn that trying to talk someone into risking their partner's health and future because sex without protection feels “awesome” is totally irresponsible.

Ignorant beliefs in myths such as these also contribute to risky sexual behavior:

I've heard that if you pee after sex, you wash out all of the sperm.”
I'm pretty sure you can't get pregnant the first time you have sex.”
I think I'll use a plastic bag instead of buying condoms.”
I'm going to have sex in a special position to avoid getting pregnant.”
My boyfriend says he'll just pull his penis out before anything happens.”

We all understand that it's never too late to talk about abstinence – how it can relate to values and hopes for the future. Abstinence is also the only way to prevent teen pregnancy and STIs, such as chlamydia, gonorrhea, human papillomavirus (HPV), herpes and HIV.

We still must look at the fact that many teens – of ages 13 to 19 – engage in sexual activities. As responsible adults, we must educate young people about risks and contraception. Here is a respected report of the facts:

Fewer than 2% of adolescents have had sex by the time they reach their 12th birthday. But adolescence is a time of rapid change. Only 16% of teens have had sex by age 15, compared with one-third of those aged 16, nearly half (48%) of those aged 17, 61% of 18-year-olds and 71% of 19-year-olds. There is little difference by gender in the timing of first sex.”

(L.B. Finer and J.M. Philbin. Sexual initiation, contraceptive use, and pregnancy among young adolescents.” Pediatrics. 2013.) 


The Mayo Clinic Staff believes understanding birth control methods is an important life skill for everyone. They conclude it is important to be sure teens know how to prevent pregnancy and protect themselves from sexually transmitted infections.That information includes the following:


Stress the importance of always using condoms during sex, even if your teen is using a second form of contraception.
  • Consistent and correct use of condoms is the most effective way for sexually active teens to protect themselves from sexually transmitted infections. 
  • Condoms help prevent pregnancy. 

Prescription birth control

Various prescription contraceptives can help prevent teen pregnancy. The American College of Obstetricians and Gynecologists encourages adolescents to consider long-acting reversible contraception first — including intrauterine devices and contraceptive implants — as these options are highly effective with little thought required.
Prescription birth control options that help prevent teen pregnancy include:
  • Intrauterine devices (Mirena, Skyla, Paragard)
  • Contraceptive implants (Implanon, Nexplanon)
  • Combination birth control pills
  • The contraceptive patch (Ortho Evra)
  • The vaginal ring (NuvaRing)
  • The contraceptive injection (Depo-Provera)
Your teen will need to see a doctor to get a prescription for these types of contraceptives. Before scheduling the appointment, ask your daughter if she would prefer to see a female physician.
Explain to your teen that the doctor will:
  • Review her medical history.
  • Conduct a pelvic exam.
  • Go over the risks and benefits of different types of birth control. For instance, Depo-Provera generally isn't recommended for young teens because it may affect bone mass.
Make sure your teen understands that prescription birth control isn't a replacement for condoms. Prescription birth control helps prevent pregnancy, but it doesn't offer protection from sexually transmitted infections.

Emergency birth control

Explain to your teen that it's always a good idea to make a decision about birth control before having sex. However, emergency contraception — such as the morning-after pill levonorgestrel Plan B One-Step, Next Choice One Dose) or ulipristal (ella) — can help prevent pregnancy if your teen doesn't plan ahead or contraception fails.
  • Plan B One-Step is available over-the-counter without a prescription.
  • Next Choice One Dose is available over-the-counter for women age 17 and older and by prescription for those younger than age 17.
  • Ella is available only with a prescription from your doctor or health care provider.
Make sure your teen understands that emergency contraception must be started as soon as possible after unprotected intercourse. The sooner the pills are taken, the more likely they are to be effective, though they may be taken up to 120 hours after unprotected intercourse.

(Staff. “Teens and sex: Protecting your teen's sexual health.” Mayo Clinic. 2016)

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