Advancing Sexual and Reproductive Health and Rights
Perspectives on Sexual and Reproductive Health
Volume 40, Number 4, December 2008

A Majority of Teenagers Who Have Had Intercourse Also Have Had Oral Sex

Some 55% of adolescents have had oral sex, and 11% have had anal sex, according to an analysis of data from a nationally representative sample of 15–19-year-olds.1 A large majority of youth who have recently initiated vaginal sex have also engaged in oral sex; in contrast, only a small minority of the newly sexually experienced have engaged in anal sex, but the proportion increases steadily with time. Teenagers have elevated odds of engaging in oral sex if they have been sexually experienced for more than a few months, have a high socioeconomic status or are 18 or 19 years old; in contrast, they have reduced odds if they are nonwhite or consider nonmarital sex before age 18 inappropriate. Time since first vaginal intercourse and socioeconomic status are also positively associated with the likelihood of engaging in anal sex, whereas black race is negatively associated with the odds of this behavior.

To ascertain levels and determinants of heterosexual oral sex and anal sex among adolescents, researchers analyzed data from the 2002 National Survey of Family Growth, in which behavioral and demographic data were collected by in-person interviews and computer-assisted self-administered questionnaires. Analyses were based on 1,505 women and 1,121 men aged 15–19. Some 50% had engaged in vaginal sex (i.e., were sexually experienced), 55% had engaged in oral sex and 11% had engaged in anal sex.

Bivariate analyses revealed that larger proportions of sexually experienced youth than of their sexually inexperienced peers had engaged in oral sex (87% vs. 23%) and anal sex (21% vs. 1%). In addition, larger proportions of 18–19-year-olds than of 15–17-year-olds had engaged in oral sex (71% vs. 43%) and anal sex (17% vs. 7%). Adolescent women were more likely than their male counterparts to report having given oral sex (44% vs. 39%); however, in stratified analyses, this gender difference persisted only among sexually experienced youth. Similar proportions of women and men reported having received oral sex (50–52%).

The temporal pattern of oral sex and anal sex differed among sexually experienced youth. Eighty-two percent of adolescents who had initiated vaginal intercourse in the preceding six months had also engaged in oral sex, and the value was only modestly higher—92%—among those who had initiated vaginal intercourse more than three years earlier. In contrast, 6% of teenagers who had begun having vaginal sex in the preceding six months had engaged in anal sex, but the proportion was substantially higher—28%—among those who had done so more than three years ago.

At the multivariate level, sexually experienced adolescents had higher odds of engaging in oral sex than their sexually inexperienced counterparts, and the differential increased with time since first vaginal intercourse: Odd ratios climbed from 9.5 for those who had been sexually experienced for no more than six months to 32.8 for those who had first had vaginal sex more than three years earlier. In addition, 18–19-year-olds were more likely to have engaged in oral sex than were 15–17-year-olds (1.4), and teenagers whose socioeconomic status was categorized as medium or high had greater odds of reporting this behavior than did their peers with a low socioeconomic status (2.2–2.9). On the other hand, relative to white youth, youth who were black, Hispanic or of other races had lower odds of having had oral sex (0.4–0.6), and youth who did not believe that sex among unmarried teenagers was appropriate had lower odds relative to those who believed it was or were neutral on the topic (0.4).

Time since first vaginal intercourse also was a key predictor of anal intercourse. (This analysis excluded sexually inexperienced teenagers, because reports of anal intercourse were uncommon in this group.) Compared with youth who had initiated vaginal sex within the previous six months, those who had done so 7–12 months earlier had more than four times the odds of reporting anal sex (odds ratio, 4.4), and the difference was even higher for those who had done so more than three years earlier (6.1). Other predictors of this behavior were having a medium socioeconomic status (1.6) and being black (0.6).

Two-thirds of sexually inexperienced adolescents who had engaged in oral sex reported having had only a single sex partner. The proportion was similar among sexually experienced youth who had never had oral sex. In sharp contrast, more than two-thirds of sexually experienced youth who had engaged in oral sex had had multiple partners; in fact, more than one-third reported having at least four.

The study’s findings, the researchers assert, suggest that vaginal and oral sex are “closely related” for many teenagers; in contrast, the pattern observed for anal sex is more consistent with that for a “taboo” behavior. They also note that the results do not support contentions that adolescents engage in oral sex instead of vaginal sex as a means of reducing their risk. “Adolescents need education and counseling about the [STD] risks from both coital and noncoital sex,” the researchers recommend.

The author of an accompanying editorial questions whether oral sex in fact has any net benefit relative to vaginal sex among adolescents and whether it constitutes a gateway behavior to vaginal sex.2 On the latter topic, she notes that studies based on cross-sectional data have had conflicting results and leave unresolved issues of whether oral sex coincides with or delays the onset of vaginal sex, and whether adolescents’ initiation of one type of sex increases their likelihood of initiating others. “Sorely needed are prospective, longitudinal studies that can address these remaining queries,” the editorialist concludes.


1. Lindberg LD, Jones R and Santelli JS, Noncoital sexual activities among adolescents, Journal of Adolescent Health, 2008, 43(3):231–238.

2. Halpern-Felsher B, Oral sexual behavior: harm reduction or gateway behavior? editorial, Journal of Adolescent Health, 2008, 43(3):207–208.