Adolescents who engage in oral or vaginal sex report a wide range of social, emotional and physical consequences, both positive and negative, according to a survey of California high school students.1 Teenagers who had had only oral sex were less likely than their peers who had had vaginal or both types of sex to experience negative consequences, such as pregnancy and feelings of guilt, but they were also less likely to experience positive outcomes, such as pleasure. Regardless of the type of sex they had had, adolescent males were more likely than their female counterparts to report having experienced only positive consequences and less likely to report having felt used or bad about themselves.

Researchers surveyed 618 ninth graders at two high schools about their sexual history in late 2002 and again at three follow-up assessments conducted at six-month intervals. At each survey, the adolescents indicated whether they had ever engaged in oral sex or vaginal sex, and whether they had experienced various social, emotional and physical consequences. In analyzing the data, the researchers focused on whether respondents had experienced these consequences at the first time point in which they reported sexual activity; they used logistic regression analyses to determine whether the odds of each consequence differed by type of sex or adolescents’ gender.

Overall, 275 adolescents (44%) reported having had oral sex, vaginal sex or both by the final assessment (the spring of 10th grade); this group made up the analytic sample. Slightly more than half of these teenagers (56%) were female; 40% were white, 19% Latino, 17% Asian or Pacific Islander, 4% black and 20% multiethnic or other. Half of sexually experienced respondents had initiated sexual activity by the autumn of ninth grade. Among males, 32% had had only oral sex, 16% had had only vaginal sex, and 52% had had both; among females, 51% had had only oral sex, 15% had had only vaginal sex, and 34% had had both.

Adolescents were more likely to report having had at least one positive consequence from their sexual activity (61–96%, depending on whether they had had oral sex, vaginal sex or both) than having had at least one negative consequence (31–62%). The most common positive consequences were experiencing pleasure (55–96%) and feeling good about oneself (65–83%); adolescents also frequently reported that their relationship with their partner had improved (31–75%) or that they had become popular (8–26%). However, substantial proportions of respondents said that they had felt bad about themselves (34–48%), felt regret (33–53%), felt used (25–54%) or felt guilty (20–46%) after they had had sex. Others said that their relationship with their partner had worsened (10–32%), that they had gotten into trouble with their parents (4–22%) or that they had developed a bad reputation (7–13%). Although adolescents who said they had had only oral sex rarely reported having had an STD (2%) or been involved in a pregnancy (1%), these outcomes were much more common among respondents who reported having had only vaginal sex (5% and 9%, respectively) or both oral and vaginal sex (13% and 14%).

Logistic regression analyses indicated that males were significantly more likely than females to report that they had had only positive consequences (odds ratio, 2.1), become popular (2.1), felt good about themselves (2.5), contracted an STD (4.2) or been involved in a pregnancy (3.6); they were less likely than females to report that they had felt bad about themselves (0.5) or felt used (0.4). The likelihood of consequences also differed by type of sex. Compared with adolescents who had had only oral sex, those who had had vaginal or both kinds of sex had higher odds of having experienced any positive consequences (3.8–12.7) and any negative consequences (3.3–4.1). Specifically, youth who had had vaginal or both types of sex were more likely than those who had had only oral sex to report having experienced pleasure (2.6–20.2), gotten into trouble with parents (4.8–5.6), felt guilty (3.0–3.7) and become or made someone pregnant (10.5–15.2). In addition, respondents who had had both types of sex had an elevated likelihood of having become popular, having had improvement or worsening of their relationship, having felt good about themselves and having felt regretful or used (1.9–6.8), compared with respondents who had had only oral sex.

The researchers note that these results "generally support adolescents’ expectations that oral sex is associated with fewer negative consequences than vaginal sex," although they emphasize that oral sex is "not without negative consequences." Females appear to be especially vulnerable to negative social and emotional outcomes, regardless of the type of sex. The researchers caution that their classifications of consequences as positive or negative may not match the views of adolescents themselves, and the findings may not be widely generalizable. Nonetheless, the data suggest that interventions designed to influence adolescents’ sexual behavior should take into account not only the potential physical consequences of sexual activity, such as pregnancy and STDs, but also the social and emotional consequences—including the positive ones. "Parents and health professionals should talk with adolescents about how they can cope with and reduce the likelihood of experiencing negative physical, social and emotional consequences of having sex, so that decisions to engage in sex are made thoughtfully and are more likely to lead to positive physical and mental health outcomes," the authors conclude. —P. Doskoch

REFERENCE

1. Brady SS and Halpern-Felsher BL, Adolescents’ reported consequences of having oral sex versus vaginal sex, Pediatrics, 2007, 119(2):229–236.