Youth Statistics: Sexual Health

Sexual Orientation Overview

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].

A large, anonymous survey of U.S. high school students (Youth Risk Behavior Survey) found that in 2019 [4]:

• 84% of students identified with the term "heterosexual (straight)."
• 2.5% identified as "gay or lesbian."
• 9% identified as "bisexual."
• 4.5% indicated they were not sure of their sexual identity.

Most lesbian, gay, bisexual, and/or transgender students experience harassment at school [5]. In 2019, 69% of LGBTQ middle and high school students reported verbal harassment, 26% physical harassment, and 11% physical assault [6]. About half (52%) had heard homophobic remarks from teachers or other school staff [6]. Boys who are perceived to be gay are especially likely to face bullying [5]. The presence of Gay-Straight Alliance / Gender Sexuality Alliance (GSA) clubs within a school setting has been demonstrated to foster a safer environment, but 38% of LGBTQ students reported that their school did not have a GSA [6].

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

Generally speaking, sexual exploration is common in adolescence. About half (54%) of adolescents age 15-19 have had some type of sexual experience [2]. However, adolescents are having less sex today than they were a decade ago. An analysis of the 2009 and 2018 waves of the National Survey of Sexual Health and Relationships found that solo masturbation, partnered masturbation, oral sex, and anal and vaginal intercourse all decreased among adolescents age 14-17 [10]. Analysis of the NSFG confirms a decline in most sexual behaviors among teens (with the exception of same-sex partnered behaviors) [2].

Masturbation

Masturbation is common, though incidence has decreased [10]. One nationally representative study found that in 2018, 40% of teens age 14-17 reported masturbating within the last year; in 2009 the number was 56% [10].

Vaginal Intercourse / "Sexual Intercourse"

An analysis of the 2015-2019 NSFG found that by age 19, about 70% of youth have had penile-vaginal intercourse [2]. Rates of vaginal intercourse have declined for both females and males since 1988 [11]. In the 2019 Youth Risk Behavior Surveillance survey, 38% of high school students reported having had "sexual intercourse" at some point in their lives (30% in New York State) [4]. Over one in four students were currently sexually active (had sexual intercourse at least once in the three months before taking the survey) [4]. Note that "sexual intercourse" was not defined in the survey. Higher percentages of lifetime sexual intercourse are seen among students who identify as bisexual (46%) [4]. Asian high school students are less likely to have had intercourse (16%) or be currently sexually active (10%) than are students who are Black, Latinx, multiple race, or White [4]. In New York State, about one in five high school students (22%) were currently sexually active [4].

Most people who identify as lesbian, gay, or bisexual (79% women and 55% men) have had penile-vaginal sex, typically earlier than their first same-sex experience [12].

About one in three adolescents has had penile-vaginal intercourse by age 16 [2].

On average, rural women experience heterosexual vaginal sex earlier than urban women [13].

Heterosexual Oral Sex and Anal Sex

• Among young people age 15-19, about 44% have had oral sex with a different-sex partner [2].
• Just under one in ten teens age 15-19 has had anal sex with a different-sex partner [2].

Same-Sex Experiences

• Among young women age 15-19, 15% have had a sexual experience with a same sex partner (11% age 15-17 and 19% age 18-19) [2].
• Among young men age 15-19, 3% have had a sexual experience with a same-sex partner [2].

For people identifying as lesbian or gay, the mean age of first sexual experience with a same-sex partner is nearly 19 [12]. For bisexual women, first same-sex experience typically occurs later at age 20; for bisexual men, the mean age is slightly earlier at 18 [12].

Condoms and Contraceptives

Among sexually active high school students, condom use at most recent sexual intercourse has declined from the recent high of 63% in 2003 to 54% in 2019 [14]. One study of teen males who have sex with women (MSW) identified a decline in condom use specifically among males with additional STI risk factors [15].

Most teens use a condom or other form of contraception the first time they have sexual intercourse (78% of sexually experienced females, 89% of males) [11]. In 2019, 9% of sexually active students reported using condoms together with another form of birth control [4].

According to the 2015-2017 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 (65%) and the pill (53%). Young women also indicated having at some point used the following contraceptive drugs or devices: injectables such as Depo-Provera (used by 19% of sexually experienced women age 15-19), fertility awareness methods (11%), emergency contraception (19%), the contraceptive patch (1%), and long-acting reversible contraception (20%) [11]. Current use of long-acting reversible contraceptives (IUDs and implants, also known as LARCs) remains low at 6% of contraceptive-using women age 15-19 [16].

Access to Services

Among teen women age 15-17, 31% receive contraceptive services [17]. The proportion of teens receiving services has been stable, but the source has changed: While nearly half (47%) used publicly funded clinics in 2002, only about one in four used clinics in 2011-2015 [17]. Instead, teens are increasing relying on private physicians, reflecting either an increase in private insurance coverage or a greater willingness to use private insurance [17].

Risky Behaviors

Sexual exploration is a natural part of adolescent development. Certain behaviors, however, do increase risk of acquiring sexually transmitted infections (STIs) and/or pregnancy.

For statistics on dating violence, see Youth Statistics: Health.

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, 10% of males and 7% of girls report having four or more sexual partners in their lifetime (including 16% of male and 15% of female high school seniors) [4].

Condomless Sex and Condom Breakage/Slippage

Defective condoms are rare, but condoms do fail when users don't fully understand how to handle them correctly. Although it carries an especially high level of risk for HIV and STIs, anal sex among adolescents is often unprotected [18, 19] as is (lower risk) oral sex [18, 20].

One study of condom-using high school students found [21]:

• 71% did not squeeze the tip of the condom.
• 25% did not roll the condom all the way down the penis.
• 49% did not hold the condom at the base of the penis when pulling out.
• 37% reported condom breakage or slippage.

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 [22].
• YMSM are less likely to use condoms with older partners, though HIV is more prevalent among older MSM [22].
• Half of sexual minority male teens (age 14-19) who are sexually active did not use a condom at last sex, and 44% had anal sex without a condom within the last six months [23].
• 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 [4].

Adolescent Pregnancy, Abortion, and Birth Rates

The unintended pregnancy rate among women age 18-19 declined by 20% from 2008 to 2011, while the rate among women age 15-17 declined 44% [24]. When women who are not sexually active are excluded from the analysis, the highest rates of unintended pregnancy are among teens age 15-19, followed by young adult women in their early twenties [24]. Women of color also experience disproportionately high rates of unintended pregnancy, but pregnancy rates among Black and Latinx teens are declining steeply [25].

Between 1990 and 2013, the pregnancy rate among women age 15-19 declined dramatically to a rate of 101 pregnancies per 1,000 sexually experienced teen women [25]. The rate more commonly cited includes all female teens, not just those who have had sex. In 2017, that rate fell to its lowest recorded level: 14 per 1,000 for teen women age 15-17 and 57 per 1,000 for those age 18-19 [26]. Among teens, 18-19 year old women have disproportionately high rates of pregnancy [25]. Teens who identify as lesbian, gay, or bisexual have higher rates of pregnancy involvement than heterosexual teens [27].

From 2010-2019, the teen abortion rate declined 50% to a rate of 5.8 abortions per 1,000 women age 15-19 [28]. 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 racial/ethnic groups [29]. Between 1991 and 2020, birth rates declined 75% among teens age 15-19 (to 15.4 births per 1,000), with an 8% drop between 2019 and 2020 alone [29]. In 2015, 17% of births to teens were to women who had previously given birth [30].

Across New York State, the 2019 pregnancy rate was 4.6 per 1,000 females under age 18 and 39.8 per 1,000 teens age 18-19 [31]. In New York State outside of NYC, the rates were 3.7 (for females under 18) and 32.4 (for females age 18-19), while in NYC the corresponding rates were 5.9 and 53 [31]. The highest rate for the 18-19 year old age group across the state is in Jefferson County (112.1), followed by Fulton (81.8) [31]. In New York State in 2019, there were 6,652 births to females under age 19 [32]. About half (56%) of pregnancies to New York State teens age 15-19 ended in abortion in 2013 [25].

Sexually Transmitted Infections (STIs) and HIV

Of the roughly 26 million new STI infections reported every year, nearly half are found among young people (ages 15-24) [33]. The most common STI is human papillomavirus, which is contracted at some point by nearly every unvaccinated sexually active person [34]. In 2020, rates of gonorrhea and syphilis increased compared to 2019 [35].

Black adolescents and young adults age 13-24 account for over half of HIV diagnoses in their age group [36]. One out of four youth living with HIV are Latinx and 18% are White [36].

Gay, bisexual, and other men who have sex with men are at high risk. In 2018, 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 86% of diagnoses. Among teens with an HIV diagnosis, 85% are male and 15% are female [36].