Managing the Risks: Birth Control, Sexually Transmitted Diseases, & Social, and Personal Risks, Part 3

Must Sex Equal Sex?

As of late, technical virginity, if not sexual abstinence, is presumed to be in vogue among teens and young adults, or at least that is the expectation of their parents and older generations. Teens wishing to avoid pregnancy are presumed to see a benefit to technical virginity and abstinence. The social pressure to remain a virgin is expected to result, at least for girls, in teens engaging in non-coital sexual activities for a period of time prior to engaging in vaginal intercourse. Even then, virgin girls are believed to permit sexual activity only so as not to appear prudish, and to prevent their partner from seeking out a relationship with someone else*. While this may be the social presumption and expectation, the reality is otherwise.

“Slightly more than half (55%) of 15–19-year-olds have engaged in heterosexual oral sex, 50% have engaged in vaginal sex and 11% have had anal sex, according to a new Guttmacher Institute study. However, both oral and anal sex are much more common among teens who have already had vaginal intercourse than among those who have not, suggesting that teens initiate a range of sexual activities around the same time, rather than substitute one for another.

"There is a widespread belief that teens engage in nonvaginal forms of sex, especially oral sex, as a way to be sexually active while still claiming that technically, they are virgins,” says study author Laura Lindberg. “However, our research shows that this supposed substitution of oral sex for vaginal sex is largely a myth. There is no good evidence that teens who have not had intercourse engage in oral sex with a series of partners.

"Some teens may first experience oral sex immediately prior to vaginal intercourse, while others may initiate vaginal intercourse shortly before having oral sex. While only one in four teen virgins (26%) have engaged in oral sex, once teens have had vaginal intercourse, the proportion increases incrementally. By six months after first vaginal sex, more than four out of five adolescents (81%) have also engaged in oral sex, and by three years after first intercourse, nine in 10 (92%) have done so.” Source

"Among technical virgins—teens who have never had vaginal sex—23 percent have had oral sex." Source

I must admit, I have held the false presumption that teenagers and young adults engage in "foreplay" as a means of delaying their first experience of vaginal intercourse. Foreplay, in all its various forms, is suppose to allow them to express their sexual interest and desire without the risk of unwanted pregnancy. The reality is, even if they do use foreplay as a means of postponing intercourse, it doesn't appear to do so for long. Perhaps, as eluded to above, because once sexual interaction has begun, and sexual desire and arousal are experienced, the word "no" is much less appealing to both men and women. Of course, calling it "fore-play" probably doesn't help matters at all, as it implies the activity is meant to lead to something else, sex.

Frequency of Oral and Vaginal Sex Men aged 15 to 19

Frequency of Oral and Vaginal Sex Girls aged 15 to 19

Source CDC

The graphs presented above indicate that at the age of 15, boys are nearly twice as likely to be engaging in vaginal intercourse than only oral sex, and girls are more than three times as likely to be doing the same. I would presume this means, some girls are performing oral sex on more than one boy, and once girls begin engaging in partnered sex, intercourse is soon to follow. Girls under the age of 20 are also more likely to be engaging in vaginal intercourse than boys their own age; perhaps indicating their partners are older and/or boys who have engaged in vaginal intercourse are more likely to have done so with more than one partner. If there is a period of time during which oral sex and other forms of foreplay are more common than vaginal intercourse, it is prior to the age of 15, but this occurrence seems very unlikely.

The evidence is that we, young and old, still consider "sex" to be penile-vaginal intercourse, and well, everything else is not sex. During the 1990s, the Lewinsky scandal revealed that most college students didn't consider oral sex to be "sex," and in 2003 this was still true amongst at least one high school population. Oral sex may not be considered "sex" by teens because if it were, you couldn't claim to be a virgin after participating in the activity, which would limit the sexual options available to virgins.

In the past, oral sex was considered a form of sodomy, hence was illegal in many areas, and as a result was not socially condoned. Legally, penile-vaginal intercourse was the only form of sex many if not most American couples could engage in. This prior morality is still very evident in our society today; foreplay is acceptable, but engaging in intercourse is still a significant measure of adulthood. This morality obviously creates a challenge when trying to prevent unplanned pregnancies and transmission of STD's.

How do we prevent the undesired consequences if we insist on engaging in the very activity that creates that risk? Are we a society of risk takers? Is society the cause, or biology? Based on the evidence presented above, despite changing social morality, biology always seems to be a major influence, at least that is my hypothesis. Society also appears to be reluctant to allow us to acknowledge why we may accept these risks, but then condemns the consequences of accepting those risks. Yes, society delays sexual activity to some extent, but the final conclusion is always the same. I'm not suggesting we throw in the towel, but we, especially teens and young adults, should be fully aware of all the forces at play in their decisions and actions. This knowledge "may" prepare them for making better choices, as forcing their heads into the sand, i.e. censoring their knowledge, surely hasn't worked.

* In practice this has come to mean, either be the sexual woman or lose your partner to a sexual woman, which puts pressure on all young women to engage in partnered sex.

Pregnancy Rates for Different Birth Control Methods

Another unfortunate reality is, birth control isn't as effective in use as the advertising often implies. Lets face it, teens and young adults probably don't have a lot of experience using birth control, probably never had someone demonstrate the correct use, and in the case of birth control pills, a girl's family and peers probably aren't working together to ensure she takes it at the appropriate time each day, though perhaps they should. And as strange as it made sound, there is no one ensuring couples are using birth control correctly during sex, even though they are usually supervised quite closely when first demonstrating non-sexual skills. You have to have demonstrate proficiency to drive a car, but not to have partnered sex and potentially produce a baby. Now add in raging hormones, peer and social pressures, the possibility for drugs and alcohol use, and we have a very hazardous combination.

The following information is from the FDA website [referenced webpage has been removed from FDA website].

See Table 6

Sex With Decreased Risk of Pregnancy - Alternatives to Reproductive Sex

Here is a website that presents alternative forms of "sex".

Feminist Women's Health Center: Sex With Less Risk of Pregnancy

Personal and Social Risks

Women are likely aware of these risks as an innate component of their personal identity, and while they may not have physical properties, they often have physical implications. These risks manifest themselves in terms of peer approval, labeling, reproductive responsibility (consequences of conception), and social marginalization. Traditionally, and to varying degrees today, women are not permitted to be sexual, so there were and are negative consequences to being a sexual woman. Even if women are permitted to be sexual, they are often left to address the consequences of their sexuality alone, and indeed in this manner their sexuality can serve to isolate them from their partner, family, friends, peers, and community. Perhaps the most common demonstration of this fact is the way women are treated when confronted with a teenage pregnancy or a pregnancy outside of marriage.

Information About Birth Control & Contraceptives

Birth Control Comparisons

FDA: Birth Control Guide (PDF File)

FDA: Birth Control

Planned Parenthood: Birth Control

Avert.org: Birth Control & Contraception for Teenagers

Medline Plus: Birth Control

Wikipedia: Birth Control

FamilyDoctor.org: Birth Control Options

MedicineNet.com: Birth Control

WebMed.com: Birth Control Overview

KidsHealth.org: About Birth Control What You Need to Know