ACT for Youth Center of Excellence

Demographics: Sexual Health

For background and context, see Understanding Sexual Development and Sexual Health. Sexual Identities Among High School Students

Sexual Orientation

Awareness of romantic attraction typically begins prior to puberty [1]. Sexual attraction, behavior, and identity are not always aligned: a person primarily attracted to women may also have sexual contact with men and may or may not identify as gay, bisexual, or straight. This fluidity may be true of both adolescents and adults, and is reported more frequently by females [2, 3].

Among youth age 15-19, according to data from the 2006-2008 National Survey of Family Growth (NSFG) [4]:

  • 11% of girls have had a same-sex partner in their lifetime, and 10% report having had a same-sex partner within the last year.
     
  • 5% of boys have had a same-sex partner in their lifetime, and 4% report having had a same-sex partner within the last year.
Among youth age 18-19 [4]:
  • 82% of women described themselves as attracted only to the opposite sex, 9% mostly to the opposite sex, 5% equally to both, 1% mostly to the same sex, and 1% only to the same sex, with 1% unsure.
     
  • 90% of women identified with the term "heterosexual or straight"; 2% "homosexual, gay, or lesbian"; and 6% "bisexual."
     
  • 92% of men described themselves as attracted only to the opposite sex, 6% mostly to the opposite sex, 1% mostly to the same sex, and 1% only to the same sex, with less than 1% unsure.
     
  • 97% of men identified with the term "heterosexual or straight"; nearly 2% "homosexual or gay"; and 1% "bisexual."
More recently, a large, anonymous survey of U.S. high school students (Youth Risk Behavior Survey) found that in 2015 [5]:
  • 89% of students identified with the term "heterosexual (straight)."
     
  • 2% identified as "gay" or "lesbian."
     
  • 6% identified as "bisexual."
     
  • 3% indicated they were not sure of their sexual identity.

Most lesbian, gay, bisexual, and/or transgender students experience harassment at school. In 2015, 85% of LGBTQ middle and high school students reported verbal harassment, 27% physical harassment, and 13% physical assault. Over half (56%) had heard homophobic remarks from teachers or other school staff [6]. Boys who are perceived to be gay or feminine are especially likely to face intense stigma [4]. The presence of Gay-Straight Alliance clubs within a school setting has been demonstrated to foster a safer environment [2, 6].

Most lesbian, gay, and bisexual youth achieve health and well-being at levels similar to those achieved by heterosexual youth, though many face higher risks for violence and rejection [2].

Romantic Relationships and Sexual Experience

About one in three 13-year-olds has had a romantic relationship (not necessarily sexual), and the number naturally increases with age: By age 17, 70% report having had a special romantic relationship within the last 18 months [7]. Despite relatively high levels of conflict in adolescent romantic relationships, most youth report a sense of equal power, decision making, and emotional support within their relationships [7].

Interest in romantic and sexual contact typically begins around age 11-14 [8]. Adolescent sexual behaviors most often occur within romantic relationships [7], or with friends or ex-partners [9]. Sexual activity that goes beyond kissing and other "light" behaviors may be associated with depression and other problems in early adolescence when these behaviors are uncommon. However, these problems are not associated with sexual activity in late adolescence within the context of a romantic relationship [7].

Sexual Behaviors

Masturbation

Masturbation is common. One nationally representative study of teens age 14-17 found a lifetime prevalence of 80% for boys and 48% for girls [10].

Sexual Initiation

In one nationally representative study, "having sex" was defined as including vaginal, anal, or oral sex. With that inclusive definition, the researchers found the median age of sexual initiation to be 16 years for both males and females. By age 19, 75% of youth have had vaginal, anal, and/or oral sex [3].

Vaginal Intercourse

An analysis of the 2011-2015 NSFG found that among youth age 15-19, 42% of females and 44% of males have had heterosexual vaginal intercourse [11]. In 2015, 41% of high school students reported having had sexual intercourse at some point in their lives (30% in New York State), and 30% were currently sexually active (had sexual intercourse at least once in the three months before taking the survey) [12]. In New York State, about one-fourth of high school students (28%) were currently sexually active [12]. On average, youth in the U.S. first have sexual intercourse at age 17 [13], and most people (55% females and 55% males) have had penile-vaginal intercourse by age 18 [11]. Over 80% of adolescent women age 15-21 who report lesbian/bisexual identities or same-sex attractions report having had sex with men [4].

Heterosexual Oral Sex [4]

  • Among young women age 15-19, 45% have had oral sex with a male.
  • Among young men age 15-19, 48% have had oral sex with a female.

Anal Sex

  • Among teens age 14-17, nearly 5% of males and 5.5% of females have had anal sex [10]
  • Among young women age 15-19, 11% have had anal sex with a male. [4]
  • Among young men age 15-19, 10% have had anal sex with a female. [4]

Same-Sex Oral or Anal Sex [4]

  • Among young women age 15-19, 11% have had "oral sex or any sexual experience" with a female.
     
  • Among young men age 15-19, 3% have had oral or anal sex with a male.
Youth who are white or have a higher socio-economic status are more likely to engage in heterosexual oral or anal sex than are youth of other groups [14].

Condoms and Contraceptives

Among sexually active students, condom use at most recent sexual intercourse increased from 46% in 1991 to 63% in 2003, falling to 57% by 2015 [15]. Most teens use a condom or other form of contraception the first time they have sexual intercourse (81% of sexually experienced females, 84% of males) [11]. Among sexually active students nationally, in 2015, black males reported the highest levels of condom use (74% at last sex) [12]. In 2015, 9% of sexually active students reported using condoms together with another form of birth control [12].

According to the 2011-2015 NSFG, the most popular form of birth control among teen women age 15-19 is the condom (used at least once by 97% of sexually experienced females), followed by withdrawal (60%) and the pill (56%). Young women also indicated having at some point used the following contraceptive drugs or devices: injectables such as Depo-Provera (used by 17% of sexually experienced women age 15-19), fertility awareness methods (12%), emergency contraception (23%), the contraceptive patch (2%), the contraceptive ring (5%), the IUD (3%), and implants (3%) [11].

Use of long-acting reversible contraceptives (LARCs) -- IUDs and implants -- has increased among teen women who use contraception, but remains low at 4% [13].

Access to Services

Among sexually experienced young women (age 15-24), use of family planning services increased between 1995 and 2002, then declined for several years. Rates were more stable in the period 2006-2010, but did not return to the utilization levels seen in 2002 [16]. Only 37% of school-based health centers offer contraceptives to students [13].

Risky Behaviors

Sexual exploration is a natural part of adolescent development. Certain behaviors, however, do increase risk of acquiring sexually transmitted diseases (STDs) and/or unwanted pregnancy. Early initiation of sexual intercourse, multiple sex partners, sex without a condom, and incorrect use of a condom increase the risk of poor outcomes. Male adolescents are more likely than females to be exposed to or engage in certain risky sexual behaviors.

Early Initiation of Sexual Intercourse

First penile-vaginal intercourse at an early age -- often, though not always, defined by researchers as younger than 16 -- is less likely to be consensual, and less likely to involve contraception, than sexual initiation at later ages [17]. It is also a risk factor for teen pregnancy [17]. Having vaginal intercourse at an early age is associated with a greater number of sexual partners, having concurrent partners [17], and using alcohol and other drugs with sex [18].

  • Males are more likely than females to begin having sexual intercourse before age 13 (as reported by high school students: 6% males and 2% females in 2015) [12].
     
  • Among high school students, black males are more likely to have had sex before age 13 than other groups [12].
     
  • One study found that lesbian-identified girls were more likely to begin having sex (penile-vaginal, penile-anal, oral, penetration with finger or sex toy) at an early age than were heterosexual- or bisexual-identified girls [19].

Multiple Sex Partners

Sexually experienced youth age 14-19 are quite likely to report having had at least three lifetime sexual partners (when sex is defined broadly as including oral, anal, and vaginal sex); just under half of females (45%) and just over half of males (55%) have had three or more partners [3].

  • Among high school students, 14% of males and 9% of girls report having four or more sexual partners in their lifetime [12].
     
  • Black males are more likely to have had four or more partners (28%); however, as noted above, they are more likely to use condoms [12].

Condom Inconsistency, Breakage, and Slippage

Defective condoms are rare, but condoms do fail when users don't fully understand how to handle them correctly. Though more likely than adults to use condoms, adolescents are also more likely to experience condom failures [20]. (See "Condoms and Contraceptives" above for additional statistics on sex without a condom.) Although it carries an especially high level of risk for HIV and STDs, anal sex among adolescents is often unprotected [21] as is (lower risk) oral sex [22].

To give an example of condom problems, one (non-representative) study of a group of primarily African American girls age 14-17 found [23]:

  • Condoms were used in only one-third of incidents of vaginal intercourse.
     
  • Condoms were used in about half of incidents of anal sex.
     
  • Problems with condoms breaking or slipping were reported in about 10% of incidents of vaginal intercourse.
     
  • Problems with condoms were reported in about 55% of incidents of anal intercourse.
Studies of LGB youth and young men who have sex with men (YMSM) have found:
  • YMSM are less likely to use condoms during anal sex with a serious partner than with a casual partner [24].
     
  • YMSM are less likely to use condoms with older partners, though HIV is more prevalent among older MSM [24].
     
  • Among high school students, sexually active students who identify as LGB are less likely than heterosexual students to have used a condom during last sexual intercourse [5].
For more information on sexual behaviors and risk, see Sexual Behaviors and Health in Adolescence.

Adolescent Pregnancy, Abortion, and Birth Rates

Adolescent pregnancies are largely, but not entirely, unplanned: 75% are unintended [13]. The unintended pregnancy rate among teens age 15-19 declined by 28% from 2008 to 2011 [25]. The highest rates of unintended pregnancy are among young adult women in their early twenties [25]. Women of color also experience disproportionately high rates of unintended pregnancy, but pregnancy rates among black and Hispanic teens are declining steeply [26].

Between 1990 and 2011, the pregnancy rate among women age 15-19 declined dramatically to a rate of 117.8 pregnancies per 1,000 sexually experienced teen women, the lowest rate in over 30 years [26]. The rate more commonly cited includes all female teens, not just those who have had sex -- that rate fell to 52 per 1,000 in 2011 [27]. About 5% of all females in this age group became pregnant [26]. Among teens, 18-19 year old women have disproportionately high rates of pregnancy [26]. Teens who identify as lesbian, gay, or bisexual have higher rates of pregnancy involvement than heterosexual teens [2].

Most pregnancies among teens end in birth (60%), while 26% end in abortion and 14% in miscarriage (2011 data) [25]. The teen abortion rate (14 abortions per 1,000 women age 15-19 in 2011) declined by 66% between 1988 and 2011 [26]. While most women (including teens) who have abortions do so in the first trimester of pregnancy, teens are overrepresented among women who have abortions at 13 weeks or later [28].

Birth rates among teens have fallen steeply since 1991, and are now at historic lows for all age and racial/ethnic groups [29]. Between 1991 and 2015, birth rates declined 64% among teens age 15-19 (to 22 births per 1,000), with a 16% drop between 2014-2015 alone [29]. In 2015, 17% of births to teens were to teen women who had previously given birth [30].

In New York State in 2015, there were 8,933 births to women age 15-19. Most births in this group were to Latinas (3,643), followed by non-Hispanic white teens (2,718) [31]. In New York City, the pregnancy rate for teens 15-19 is 44 per 1,000, with the highest rate (63.5) among non-Hispanic black teens [32]. In New York State outside of NYC, the pregnancy rate for teens age 15-17 is 11 per 1,000, while the rate for teens age 18-19 is 36 [33].

Sexually Transmitted Diseases (STDs) and HIV

Of the roughly 20 million new STD infections reported every year, half are found among young people (ages 15-24), although this age group makes up only 25% of people who are sexually experienced [34]. The most common STD is human papillomavirus, which is contracted at some point by nearly every sexually active person [35]. Teens age 15-19 accounted for 18% of gonorrhea and 26% of chlamydia cases reported in 2015 [36].

Over one million people in the U.S. are living with HIV, and 7% of these are youth age 13-24 [37]. In 2014, while only 14% of youth age 13-19 were black, black youth accounted for approximately 63% of HIV diagnoses in their age group [38]. The same was true among young adults (age 20-24): while 15% of youth age 20-24 were black, black youth carried 55% of the burden of HIV diagnoses.

Gay, bisexual, and other men who have sex with men are at high risk. In 2015, among males age 13-19, male-to-male sexual contact accounted for 93% of HIV diagnoses. Among females in the same age group, heterosexual contact accounted for 87% of diagnoses. Among teens with an HIV diagnosis, 85% are male and 15% are female [38].

Endnotes

[1]   McClintock, M. K., & Herdt, G. (1996). Rethinking puberty: The development of sexual attraction. Current Directions in Psychological Science, 5. Retrieved July 27, 2017, from
homepage.univie.ac.at/Michael.Berger/lit/McClintock.pdf
 
[2]   Saewyc, E. M. (2011). Research on adolescent sexual orientation: Development, health disparities, stigma, and resilience. Journal of Research on Adolescence, 21, 256-272. doi:10.1111/j.1532-7795.2010.00727.x
 
[3]   Liu, G., Hariri, S., Bradley, H., Gottlieb, S. L., Leichliter, J. S., & Markowitz, L. E. (2015). Trends and patterns of sexual behaviors among adolescents and adults aged 14 to 59 years, United States. Sexually Transmitted Diseases, 42(1), 20-26.
doi.org/10.1097/OLQ.0000000000000231
 
[4]   Chandra, A., Mosher, W. D., Copen, C., & Sionean, C. (2011). Sexual behavior, sexual attraction, and sexual identity in the United States: Data from the 2006-2008 National Survey of Family Growth. National Health Statistics Reports, 36. Retrieved July 27, 2017, from
permanent.access.gpo.gov/gpo21173/nhsr036.pdf
 
[5]   Kann, L., Olsen, E. O., McManus, T., et al. (2016). Sexual identity, sex of sexual contacts, and health-related behaviors among students in grades 9-12 - United States and selected sites, 2015. Morbidity and Mortality Weekly Report Surveillance Summary 65(No. SS-9). Retrieved July 27, 2017, from CDC website:
cdc.gov/mmwr/volumes/65/ss/ss6509a1.htm?s_cid=ss6509_w
 
[6]   Kosciw, J. G., Greytak, E. A., Giga, N. M., Villenas, C., & Danischewski, D. J. (2016). The 2015 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation's schools. Retrieved July 27, 2017, from the Gay, Lesbian & Straight Education Network website:
glsen.org/article/2015-national-school-climate-survey
 
[7]   Collins, W. A., Welsh, D. R., & Furman, W. (2009). Adolescent romantic relationships. Annual Review of Psychology, 60, 631-652. doi:10.1146/annurev.psych.60.110707.163459
 
[8]   Smiler, A. (2013). Young men's sexuality: What's typical? ACT for Youth Center of Excellence.
actforyouth.net/resources/rf/rf_young-men_0913.pdf
actforyouth.net/resources/rf/rf_young-men_0913.cfm (accessible format)
 
[9]   Tolman, D. L. & McClelland, S. I. (2011). Normative sexuality development in adolescence: A decade in review, 2000-2009. Journal of Research on Adolescence, 21(1), 242-255. doi:10.1111/j.1532-7795.2010.00726.x
 
[10]   Fortenberry, J. D., Schick, V., Herbenick, D., Sanders, S. A., Dodge, B., & Reece, M. (2010). Sexual behaviors and condom use at last vaginal intercourse: A national sample of adolescents ages 14 to 17 years [Abstract]. The Journal of Sexual Medicine, 7 Suppl 5, 305–314.
doi.org/10.1111/j.1743-6109.2010.02018.x
 
[11]   Abma, J. C., &Martinez, G. M. (2017, June). Sexual activity and contraceptive use among teenagers in the United States, 2011-2015. National Health Statistics Reports. Retrieved July 27, 2017, from Centers for Disease Control and Prevention website:
cdc.gov/nchs/data/nhsr/nhsr104.pdf
 
[12]   Kann, L., McManus, T., Harris, W. A., et al. (2016, June 10). Youth risk behavior surveillance - United States, 2015. Morbidity and Mortality Weekly Report, 65(6). Retrieved July 27, 2017, from
cdc.gov/mmwr/volumes/65/ss/ss6506a1.htm

For another way to access YRBS data, see the interactive database Youth Online at https://nccd.cdc.gov/youthonline/App/Results.aspx
 

[13]   Guttmacher Institute. (2016, August). Fact sheet: American teens' sexual and reproductive health. Retrieved July 27, 2017, from
guttmacher.org/fact-sheet/american-teens-sexual-and-reproductive-
health

 
[14]   Lindberg, L. D., Jones, R., & Santelli, J. S. (2008). Non-coital sexual activities among adolescents [Electronic version]. Journal of Adolescent Health. Retrieved July 27, 2017, from
guttmacher.org/pubs/JAH_Lindberg.pdf
 
[15]   Centers for Disease Control and Prevention. (n.d.). Trends in the prevalence of sexual behaviors and HIV testing, national YRBS: 1991-2015. Retrieved July 27, 2017, from
cdc.gov/healthyyouth/data/yrbs/pdf/trends/2015_us_sexual_trend_yr
bs.pdf

 
[16]   Hall, K. S., Moreau, C., & Trussell, J. (2012). Continuing social disparities despite upward trends in sexual and reproductive health service use among young women in the United States. Contraception, 86(6), 681-686.
 
[17]   Heywood, W., Patrick, K., Smith, A. M. A., & Pitts, M. K. (2015). Associations between early first sexual intercourse and later sexual and reproductive outcomes: A systematic review of population-based data. Archives of Sexual Behavior, 44, 531-569. doi:10.1007/s10508-014-0374-3
 
[18]   Schantz, K. (2012). Substance Use and Sexual Risk Taking in Adolescence
actforyouth.net/resources/rf/rf_substance_0712.pdf
actforyouth.net/resources/rf/rf_substance_0712.cfm (accessible format)
 
[19]   Ybarra, M. L., Rosario, M., Saewyc, E., & Goodenow, C. (2016). Sexual behaviors and partner characteristics by sexual identity among adolescent girls. Journal of Adolescent Health, 58(3), 310–316.
doi.org/10.1016/j.jadohealth.2015.11.001
 
[20]   Schantz, K. (2016). The case for condom education
actforyouth.net/resources/pm/pm_condom_0316.pdf
actforyouth.net/resources/pm/pm_condom_0316.cfm (accessible format)
 
[21]   Dake, J. A., Price, J. H., McKinney, M., & Ward, B. (2010). Midwestern rural adolescents' anal intercourse experience. Journal of Rural Health, 27(2). doi:10.1111/j.1748-0361.2010.00330.x
 
[22]   Halpern-Felsher, B., Cornell, J., Kropp, R., & Tschann, J. (2005). Oral versus vaginal sex among adolescents: Perceptions, attitudes, and behavior. Pediatrics, 115(4), 845-851. doi:10.1542/peds.2004-2108
 
[23]   Hensel, D. J., Selby, S., Tanner, A. E., & Fortenberry, J. D. (2016). A daily diary analysis of condom breakage and slippage during vaginal sex or anal sex among adolescent women. Sexually Transmitted Diseases, 43(9), 531–536.
doi.org/10.1097/OLQ.0000000000000487
 
[24]   Newcomb, M. E., & Mustanski, B. (2016). Developmental change in the effects of sexual partner and relationship characteristics on sexual risk behavior in young men who have sex with men. AIDS and Behavior, 20(6), 1284–1294.
doi.org/10.1007/s10461-015-1046-6
 
[25]   Finer, L. B., & Zolna, M. R. (2016). Declines in unintended pregnancy in the United States, 2008-2011. New England Journal of Medicine, 374. doi: 10.1056/NEJMsa1506575
 
[26]   Kost, K., & Maddow-Zimet, I. (2016, April). U.S. teenage pregnancies, births and abortions, 2011: National trends by age, race and ethnicity. Retrieved July 27, 2017, from
guttmacher.org/report/us-teen-pregnancy-trends-2011
 
[27]   National Campaign to Prevent Teen and Unplanned Pregnancy. (n.d.). Teen pregnancy rate comparison, 2011. Retrieved July 27, 2017, from
thenationalcampaign.org/data/compare/1678
 
[28]   Jones, R. K. & Finer, L. B. (2011). Who has second-trimester abortions in the United States? Retrieved July 27, 2017, from
contraceptionjournal.org/article/S0010-7824(11)00625-1/pdf
 
[29]   National Campaign to Prevent Teen and Unplanned Pregnancy. (n.d.). National & state data. Retrieved July 27, 2017, from
thenationalcampaign.org/data/landing
 
[30]   Dee, D. L., Pazol, K., Cox, S., et al. (2017, April 28). Trends in repeat births and use of postpartum contraception among teens - United States, 2004–2015. Morbidity and Mortality Weekly Report, 66. Retrieved July 27, 2017, from
cdc.gov/mmwr/volumes/66/wr/mm6616a3.htm?s_cid=mm6616a3_e
 
[31]   New York State Department of Health. (n.d.). Table 6a: Live births by race/ethnicity, birthweight and mother's age, New York State 2015. Retrieved July 27, 2017, from
health.ny.gov/statistics/vital_statistics/2015/table06a.htm
 
[32]   Li, W., Sebek, K., Huynh, M., et al. (2017, April). Summary of vital statistics 2015: The City of New York. New York City Department of Health and Mental Hygiene. Retrieved July 27, 2017, from
www1.nyc.gov/assets/doh/downloads/pdf/vs/2015sum.pdf
 
[33]   New York State Department of Health. (n.d.). Table 27: Total pregnancy rate by age and resident county New York State exclusive of NYC - 2015. Retrieved July 27, 2017, from
health.ny.gov/statistics/vital_statistics/2015/table27.htm
 
[34]   Centers for Disease Control and Prevention. (n.d.). Sexually transmitted diseases: Adolescents and young adults. Retrieved July 27, 2017, from
cdc.gov/std/life-stages-populations/adolescents-youngadults.htm
 
[35]   Centers for Disease Control and Prevention. (n.d.). Genital HPV infection - Fact sheet. Retrieved July 27, 2017, from
cdc.gov/std/hpv/stdfact-hpv.htm
 
[36]   Centers for Disease Control and Prevention. (2015, November). Reported STDs in the United States: 2015 national data for chlamydia, gonorrhea, and syphilis. CDC Fact Sheet. Retrieved July 27, 2017, from
cdc.gov/nchhstp/newsroom/docs/factsheets/STD-Trends-508.pdf
 
[37]   Centers for Disease Control and Prevention. (2012, November). HIV among youth in the U.S. Retrieved July 27, 2017, from
cdc.gov/vitalsigns/hivamongyouth/
 
[38]   Centers for Disease Control and Prevention. (n.d.). HIV surveillance in adolescents and young adults [Slide set]. Retrieved July 27, 2017, from
cdc.gov/hiv/library/slideSets/