Decision-making in adolescent sexuality

Abstract BACKGROUND: In light of the social and public health consequences of at-risk sexual behavior for adolescents, a great need exists to understand adolescent sexual and reproductive decision-making. Further information can guide medical professionals in the intervention and counseling of this at-risk population. The main objective of this preliminary study is to survey female adolescent gynecological patients about their sexual experiences via questionnaire. Our forty-three question survey focuses on concerns regarding adolescent sexuality: 1) Is there a correlation between features of the first episode of sexual intercourse and future at-risk sexual behavior and decision-making? 2) Is any decision-making involved before adolescents decide to become sexually active? 3) If adolescents decide to postpone sexual intercourse, are they engaging in other at-risk sexual activities? METHODS: Seventy-two (72) female patients aged 12 to 20 years who presented for routine pediatric/adolescent gynecological care and met inclusion criteria were recruited from St. Louis Children's Hospital Pediatric Subspecialty Clinic. Parental consent for minors and patient consent for participants 18-20 years was obtained prior to completion of the anonymous, self-administered surveys in accordance with the Human Studies Committee at Washington University. The data was analyzed with SPSS Windows. RESULTS: The mean age of the participants was 16.01 years (standard deviation 1.72). Demographically, 20.3% were African-American and 75% were Caucasian. Although 44.4% (32/72) had engaged in sexual intercourse, many surveyed adolescents were engaging in other sexual activities before sexual intercourse: 57.5% of “virgins” described breast stimulation; 45% described vaginal stimulation; 22.5% described engaging in cunnilingus; 27.5% described penile stimulation; and 17.5% described engaging in fellatio. There appeared to be racial differences in oral sex participation. African American girls surveyed were significantly less likely to engage in oral sex before sexual intercourse (p = .026). Only 22.2% of surveyed adolescents denied participation in any sexual experiences. Of all participants who had engaged in sexual intercourse, there appeared to be little decision-making. 46.9% indicated that “it just happened” and 28.1% indicated that they decided to have sex during intimacy. The majority of participants did not discuss birth control (68.8%) or STD's (56.3%) with their partner. This lack of discussion was correlated with failure to use an effective birth control method (p = .034) and risk for later contraction of an STD (p = .022) CONCLUSIONS: In this preliminary study, 78.8% of adolescent girls are participating in sexual activities whether or not they have engaged in intercourse. This study supports the hypothesis that clinicians need to be aware that adolescent patients, who deny being “sexually active”, may be engaging in higher-risk sexual activities including oral sex. More directed questions need to be asked to determine the level of sexual activity. Furthermore, 75.0% of the participants reported no discussion or advanced planning prior to their first coital episode. Inadequate decision-making coupled with inadequate communication about birth control and STD's was associated with poor outcomes including pregnancy and STD's.