Ninth graders surveyed in two California public schools had more experience with oral than with vaginal intercourse, and their intended behavior in the next six months favored oral sex.¹ The teenagers estimated that they have less chance of becoming pregnant or contracting chlamydia or HIV if they engage in oral sex than if they have vaginal intercourse, as well as less chance of jeopardizing their relationship or their reputation, getting into trouble or feeling guilty about their behavior. Respondents expressed greater acceptance of oral sex than of vaginal intercourse for youth their age, and said that oral sex is the more prevalent behavior among their peers.

The survey was conducted in 2003 as part of a longitudinal study of the relationship between risk and benefit perceptions and sexual activity. In all, 580 ninth graders, with an average age of 14.5 years, completed the self- administered questionnaire; 58% were female and 42% male. Forty percent of respondents were white, 24% Hispanic, 17% Asian and the rest members of other ethnic groups. Roughly equal proportions said that their mothers were college graduates, had some college education and had a high school education or less.

Some 20% of the teenagers said that they had had oral sex, a significantly higher proportion than reported experience with vaginal intercourse (14%). Likewise, a significantly greater proportion intended to have oral sex in the next six months than intended to have vaginal sex (32% vs. 26%). Males and females did not differ in their reports of sexual experiences and intentions.

Participants were asked to estimate their chances of experiencing a variety of health, social and emotional outcomes of oral and vaginal sex, and researchers conducted analyses of variance to compare the responses for the two types of behavior. A substantial minority of the teenagers (13-14%) were unaware that chlamydia and HIV infection can be transmitted through oral sex; the rest perceived the chances of acquiring these infections through oral sex (38% for each) as being lower than the chance associated with vaginal sex (50- 53%). Respondents also considered pregnancy less likely after oral than after vaginal sex (17% vs. 68%). In addition, teenagers thought they had lower chances of having a relationship deteriorate, developing a bad reputation, getting into trouble, feeling bad about themselves and feeling guilty if they had oral sex (36%-63%) than if they had vaginal intercourse (42-71%). They saw both behaviors as equally likely to make them feel good about themselves (40%), increase their popularity (27%) and improve their relationship (40-41%), but they considered vaginal sex more likely to be a pleasurable experience than oral sex (72% vs. 59%). Although some results varied by respondents' sexual experiences or intentions, the teenagers consistently viewed oral sex as less likely than vaginal sex to lead to negative outcomes.

Consistent with the differences in experience, intentions and perceived risks, respondents' attitudes toward the two sexual behaviors also varied. Teenagers agreed more strongly that people their age are too young to have vaginal sex than that they are too young to have oral sex; they also indicated that vaginal intercourse, more than oral sex, is counter to their beliefs. However, for both dating relationships and other types of partnerships, respondents noted greater acceptance of oral than of vaginal sex.

Finally, when asked to estimate the prevalence of behaviors and intentions among youth their age, respondents said they believed that 47% of their peers of had had oral sex, but that only 41% had had vaginal sex. Similarly, they anticipated that in the next six months, a larger proportion will have oral sex than will have vaginal sex (39% vs. 34%), and a smaller proportion will choose not to have oral sex than not to have vaginal intercourse (42% vs. 45%). They thought that 27% will wait until they are married to have oral sex, compared with 31% for vaginal sex.

The researchers acknowledge a number of limitations to their study, notably that the survey defined vaginal but not oral sex for participants, and that the data do not permit an assessment of causal relationships between perceptions and behavior. Nevertheless, they contend that the findings have critical public health implications. They conclude that "to help adolescents make informed sexual decisions, parents, health care providers, and other educators must broaden their clinical and educational efforts"; in particular, these efforts should cover the possible health, emotional and social consequences of all sexual behaviors, coital and noncoital, as well as methods for preventing unhealthy outcomes.

D. Hollander

REFERENCE

1. Halpern-Felsher BL et al., Oral versus vaginal sex among adolescents: perceptions, attitudes, and behavior, Pediatrics, 2005, 115(4):845-851.