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Home , Birth control, Sexual intercourse

FACT SHEET

Adolescent Sexual and in the

Sexuality is a fundamental aspect of ■■ In 2013–2015, 90% of adolescents reported ever having had anal with being , and sexual activity is a aged 15–19 identified as straight or a different-sex partner. basic part of human development for heterosexual, while 5% of males and young people in the United States. As 13% of reported their sexual ■■ Overall, the share of 15–19-year-olds they develop, adolescents and young orientation as , , bisexual or that has had has adults need access to evidence-based, something else. remained steady in recent years. But holistic and nonstigmatizing information, among the narrower of high and services that support their ■■ is a common behav- school students, there was a decline lifelong sexual and reproductive health ior during ; in a national in 2013–2017 in the proportion that and well-being. The findings included in sample of young people aged 14–17, had ever had sexual intercourse—from this fact sheet about adolescent sexual reports of ever having masturbated 47% to 40%. and reproductive health in the United increased with age and more males States are the most current available, reported masturbation than females ■■ The proportion of young people who drawn primarily from recent nationally (74% vs. 48%). have had sexual intercourse increases representative surveys. Although these rapidly as they age through adoles- data have limitations (see accompanying Sexual intercourse cence. In 2013, about one in five box), they still provide important insights ■■ Partnered sexual activity may include a 15-year-olds and two-thirds of 18-year- into young people’s experiences and range of behaviors. In 2015–2017, 40% olds reported having had sex (Figure 1). needs. of adolescents aged 15–19 reported ever having had penile-vaginal inter- ■■ Among adolescents aged 15–19 Sexual development course (commonly referred to as “sex- in 2015–2017 who had had penile- ■■ During adolescence, many young peo- ual intercourse”), 45% had had vaginal sex, 75% of females and ple engage in a range of sexual behav- with a different-sex partner and 9% 48% of males reported that their first iors and develop romantic and intimate relationships. SEXUAL INTERCOURSE AMONG YOUNG PEOPLE IN THE U.S. ■■ In 2013–2014, 20% of 13–14-year-olds Sex is a natural part of being human, and 65% of 18–year- and 44% of 15–17-year-olds reported that they had ever had some type olds and 93% of 25–year-olds have had sexual intercourse of romantic relationship or % of individuals who have had sexual intercourse, by age experience. 100

Age 25 80 Limitations

Data are a powerful tool, but available 60 Age 18 data are not without their limitations. The national survey data from which this resource draws cannot fully represent 40 the context in which a young person’s health behavior and decision making occurs. In addition, not all 20 are included or appropriately represented in the available data. This fact sheet presents the best available data on this 0 issue. 10 15 20 25 30 35 40

SEPTEMBER 2019

100% 97% 98% 99% 93% age 25 80 79%

60 65% age 18

40

20 22%

0 1%

10 15 20 25 30 35 40 STATE LAWS ON MINORS’ ACCESS TO CONTRACEPTIVES Access to services Twenty-one states and D.C. explicitly allow minors to obtain ■■ Adolescents and young adults need access to confi- contraceptive services without a parent’s involvement. dential sexual and reproduc- tive health care services.

■■ Many health care provid- ers do not talk with their adolescent patients about sexual health issues during primary care visits. When these conversations do D.C. occur, they are usually brief; in one study of visits in 2009–2012, sexual health conversations with patients aged 12–17 lasted an aver- age of 36 seconds.

■■ Despite guidance recogniz- ing young men’s needs for sexual and reproductive health services in recent State laws allow years, many gaps remain. All minors to In a 2018 study of male patients aged 15–24, only Some minors to consent one in 10 received all of the No policy recommended sexual and reproductive health services.

intercourse was with a .There is no first time they had sexual ■■ Queer young people need steady partner. one best contraceptive intercourse. access to health care ser- method for every adoles- vices that are inclusive of ■■ As of 2015–2017, among cent. Decision making about ■■ Older adolescents are more their identities and experi- young people aged 18–24 method choice should likely to use prescription ences, including clinicians who have had penile-vaginal reflect individuals’ needs methods of contraception, who are well trained in dis- sex, 71% of men described and priorities. and use becomes cussing and addressing the their first sexual experience less common with age. particular health concerns of as wanted, as opposed to ■■ Most adolescents use members of these groups. unwanted (4%) or that they contraceptives at both first ■■ Adolescents aged 14 or had mixed feelings (25%). sex and most recent penile- younger at first sex are less Contraceptive services One-half of young women vaginal sex. In 2015–2017, likely than older adolescents ■■ In 2019, federal law requires said they had mixed feelings 89% of females and 94% of to use contraceptives at first health plans (51%), while 45% said first males aged 15–19 reported sex. to cover the full range of sex was wanted and 4% that they or their partner contraceptive meth- said it was unwanted. had used contraceptives the ■■ Adolescents’ nonuse of con- ods, including counseling last time they had sexual traceptives may be driven and related services, with- ■■ Among young people aged intercourse, and 77% of by many factors, including out out-of-pocket costs. 18–24 in 2015–2017, 13% females and 91% of males lack of access, the need However, some young of females and 5% of males reported contraceptive for confidential care and people may not use insur- reported that they had ever use the first time they had low-cost services, a belief ance to access reproductive been forced to have vaginal sexual intercourse. that they are unlikely to get health services because sex. pregnant and poor partner they are not aware that ■■ The condom is the con- negotiation skills. In addi- these services are covered Condom and other traceptive method most tion, some adolescents may or because of confidentiality contraceptive use commonly used among not be using contracep- concerns.The U.S. Supreme ■■ Use of and other adolescents. In 2015–2017, tives because they want to Court has ruled that minors’ contraceptives reduce 63% of females and 82% of become pregnant. privacy rights include the adolescents’ risk of preg- males aged 15–19 reported right to obtain contraceptive nancy and HIV and STI having used a condom the services.

GUTTMACHER INSTITUTE ■■ No state explicitly requires the last year; about one- parental consent or notifica- quarter of both age-groups The majority of adolescents receive formal tion for minors to obtain had received this care from contraceptive services. publicly funded clinics and instruction about how to say no to sex and However, two states (Texas the rest from private health about . and Utah) require parental care providers. consent for contraceptive % of females and males aged 15–19 100 services paid for with state ■■ Nearly one million women funds. younger than age 20 % of females who received instruction about birth control received contraceptive 80 84 % of females who received instruction about birth control ■■ Twenty-one states and the services from publicly 82 District of Columbia (DC) supported 60 % of males aged 15_19 who received formal instruction about how to say no to sex explicitly allow minors to centers in 2014. These ser- 60 55 obtain contraceptive ser- vices helped adolescents to 40 vices without a parent’s prevent 232,000 pregnan- involvement. Another 25 cies that they wanted to 20 states have affirmed that postpone or avoid. right for certain classes of minors (e.g., a married or Prevention and 0 minor), while four treatment of HIV and Received formal instruction Received instruction about about how to say no to sex birth control states do not have a statute other STIs and related or policy on the subject. services Female Male ■■ All 50 states and DC explic- ■■ Even when parental consent itly allow minors to consent is not required for contra- to STI services without ■■ The Centers for Disease ■■ HPV vaccinations are cur- ceptive services, concerns parental involvement. Thirty- Control and Prevention rently available to prevent about confidentiality may two states explicitly allow (CDC) report that young the types of infections most limit adolescents’ access to minors to consentof and to Male HIV people aged 15–24 account likely to to cervical can- or use of contraceptive or testing and treatment. for half of the 20 million cer and are recommended other reproductive health new cases of STIs in the by the CDC for all adoles- services. Among females ■■ Young people aged 13–24 United States annually, cents starting at age 11. aged 15–17 who had ever accounted for about 21% which reflects biological had sex in 2013–2015, of all new HIV diagnoses in differences as well as likely ■■ HPV vaccination coverage those who reported con- the United States in 2016. age-based disparities in has been improving and as cerns about confidentiality Young black and Hispanic accessing preventive infor- of 2017, 69% of females were significantly less likely gay, bisexual or other men mation and services. and 63% of males aged to have received a contra- who have sex with men are 13–17 had received one or ceptive service in the previ- disproportionately affected. ■■ accounts for more doses of the vaccine. ous year than those who did nearly 20% of all STI diag- not have these concerns. ■■ Pre-exposure prophylaxis noses each year among ■■ Numerous studies have (PrEP), a daily pill that pro- 15–24-year-olds.NOTE: Numbers Genital may not add to totalsconfirmed because of r ounding.that increases in ■■ In 2011–2015, 31% of tects against HIV, gained herpes, and HPV vaccinations result in females aged 15–17 and FDA approval for use among together significant declines in HPV 56% of those aged 18–25 adolescents in May 2018. account for about 11% of infections and related nega- reported having received diagnoses. HIV, and tive health outcomes. contraceptive services in are estimated to account for fewer than 1% Sexual health of diagnoses. information and education Support for Comprehensive ■■ Two-thirds of STIs diag- ■■ Young people need and Sex Education nosed among 15–24-year- have the right to accurate, olds each year are human comprehensive, inclusive Leading public health and medical professional organizations— papillomavirus (HPV) infec- information and education including the American Medical Association; the American tions.These infections to support their healthy Academy of Pediatrics; the American College of Obstetricians are often asymptomatic sexual development and and Gynecologists; the American Public Health Association; and generally harmless lifelong sexual health and the Health and Medicine Division of the National Academies but, if left undetected and well-being. of Science, and Medicine (formerly the Institute untreated, can lead to cervi- of Medicine); and the for Adolescent Health and cal and other . Medicine—support comprehensive sex education.

GUTTMACHER INSTITUTE ■■ States and local school ■■ Parents are another pos- SOURCES districts play a large part in sible source of sexual health These data are the most determining what is taught information for young peo- current available. References at their schools. ple. In 2011–2013, 70% of are available in the HTML males and 78% of females version: https://www. guttmacher.org/fact-sheet/ ■■ Twenty-two states and DC aged 15–19 reported having american-teens-sexual-and- mandate both sex educa- talked with a parent about at reproductive-health tion and HIV education. Two least one of six sex educa- states mandate sex educa- tion topics: how to say no to tion only, and 12 mandate sex, methods of birth con- HIV education only. trol, STIs, where to get birth control, how to prevent HIV ■■ In 2011–2013, 82% of infection and how to use a females and 84% of males condom. aged 15–19 received formal instruction about how to ■■ Digital media offer opportu- say no to sex, and 60% of nities for youth to confiden- females and 55% of males tially search for information received instruction about on sensitive topics and birth control methods. increasingly are being used to provide sexual health ■■ In 2016, the median share interventions for young of schools in each state that people. provided instruction on all 19 topics that the CDC con- siders essential to sexual health education was 38% of high schools and only 14% of middle schools.

■■ The share of schools provid- ing sexual health education declined between 2000 and 2014, across many topics.

■■ As of 2017, fewer than 7% of queer students aged 13–21 reported that their school health classes had included positive repre- sentations of LGBT-related topics.

Good reproductive health policy starts with credible research 125 Maiden Lane New York, NY 10038 212.248.1111 [email protected] www.guttmacher.org

GUTTMACHER INSTITUTE SEPTEMBER 2019