SPECIAL REPORT Oral Sex Among Adolescents: Is It Sex or Is It Abstinence? By Lisa Remez ver the past few decades, nation- p a red with private households, become stinence. All of this leaves health profes- ally re p resentative surveys have even more inflamed when the questions sionals and policymakers without the Oaccumulated a wealth of data on go into behaviors “beyond” intercourse. means to effectively address these issues. levels of adolescent sexual activity. Thanks Another reason is the federal govern- The tendency to equate “sex” with in- to such surveys, we know how the pro- ment’s reluctance to sponsor such con- te r course alone rep r esents long-standing portion of 15–19-year-olds who have ever t roversial re s e a rch into the full range of cultural norms of acceptable sexual be- had intercourse has changed over the noncoital behaviors among adolescents.* havior and certainly applies to adults as years. Similar data exist on age at first in- For example, the highly charged political well as to adolescents. It also reflects a t e rcourse, most recent sexual interc ou r s e debate in 1992 over federal financing of deeply rooted ambivalence about talking and current contraceptive use. c o m p rehensive sexuality studies had a about sex. Recent press reports, however, Yet all of these measures focus on—or chilling effect on adolescent sexuality re- a re forcing a reappraisal of the implica- relate to the possible results of—vaginal se a rc h . 1 The Senate’s decision, prom p t e d tions of this exclusive focus on coitus for in t e r course. This is natural, given that at- by pre s s u re from a small group of con- re s e a rch and data collection efforts, for tention to adolescent sexual activity aros e servative senators, to deny funding for the STD prevention and treatment, and for the initially out of concerns over the far-re a c h - American Teenage Study of adolescent framing and interpretation of abstinence ing problems associated with teenage sexual behavior still reverberates in the and risk-reduction messages. p regnancy and childbearing. More re- scope of re s e a rch on teenagers. (An This special report draws on interviews c e n t l y, infection with sexually transmit- amendment sponsored by Sen. Jesse and correspondence with roughly two ted diseases (STDs), particularly with HIV, Helms [R.-NC] prohibited the funding of dozen adolescent and health profession- has fueled further public and scientific in- that survey, along with one of adults, “in als, including res e a r chers, psychologists, terest in teenage sexual behavior. fiscal year 1992 or any subsequent fis c a l abstinence program coordinators and But to what extent does adolescent sex- ye a r. ” 2 Despite warnings that ideology evaluators, sexuality educators and epi- ual activity consist of noncoital behav- was dictating science, the conservative demiologists, to explore some of these iors—that is, mutual masturbation, oral leadership succeeded in casting these en- consequences. The report concentrates on sex and anal intercourse—that are not deavors as “re p rehensible sex surveys” oral sex, as opposed to other noncoital be- linked to pregnancy but involve the risk only undertaken “to legitimize homosex- haviors, because it is currently the subject of STDs? Some of these activities may also uality and other sexually pro m i s c u o u s of public debate in the media and in many be precursors to vaginal intercourse. Yet, lifestyles.”3) schools. It reviews the limited information health professionals and policymakers It has become increasingly clear, how- on adolescents’ experience with oral sex, know very little about their pre v a l e n c e e v e r, that the narrow focus on sexual in- and looks at the even smaller body of ev- among teenagers. t e rcourse in re s e a rch that does get fund- idence on what young people consider to There are several explanations for this ed is missing a major component of early be sex or abstinence. dearth of information. One is the per- sexual activity. There is growing evidence, ceived difficulty of getting parents to con- although still anecdotal and amassed Anecdotal Reports in the Media sent to surveys on the sexual activity of la r gely by journalists, not res e a r chers, that The first hint in the popular press of a new their minor children (generally aged 17 adolescents might be turning to behaviors “ t rend” in sexual activity among young and younger). Another is a generalized that avoid pregnancy risk but leave them people appeared in an April 1997 article fear that asking young people about sex vulnerable to acquisition of many STDs, in The New York Ti m e s.4 That article as- will somehow lead them to choose to have including HIV. serted that high school students who had sex. The conflicts and passions usually The reports in the popular press that come of age with AIDS education con- surrounding the appropriateness of ask- oral sex has become widespread among si d e r ed oral sex to be a far less dangerou s ing young people about sex, especially in adolescents cannot be confirmed or re- alternative, in both physical and emo- public settings such as schools as com- futed because the data to do so have never tional terms, than vaginal intercourse. By been collected. Moreo v e r , adults do not re- Lisa Remez is associate editor of Family Planning Per - ally know what behaviors teenagers con- *The exceptions are the National Survey of Adolescent sp e c t i v e s . The preparation of this special report was made Males, which asked 15–19-year-old males about their ex- possible by a grant from the Marion Cohen Memorial sider to be “sex” and, by the same token, perience with oral and anal sex, and other studies that Foundation. what they consider to be its opposite, ab- were not national in scope. 298 Family Planning Perspectives 1999, the press reports started attributing For example, according to Kathleen son asked. Some say they have seen no this behavior to even younger students. Too m e y , director of the Division of Public change in STDs acquired noncoitally, A July Washington Post article described Health in Georgia’s Department of Human while others report that they are seeing an “unsettling new fad” in which subur- Re s o u r ces, “anecdotal evidence and some both new types of infections and new ban middle-school students were re g u- recent data suggest that teenagers are en- types of patients—i.e., teenagers who have larly engaging in oral sex at one another’s gaging in oral sex to a greater degree than not yet initiated coitus but who come in homes, in parks and even on school we had previously thought, but whether with fears and anxiety over having ac- g rounds; this piece reported an oral sex this re p resents a true increase is diffic u l t quired an infection orally. p revalence estimate, attributed to un- to say, since we have no baseline data for Linda Dominguez, assistant medical di- named counselors and sexual behavior re- co m p a r i s o n . ” 9 Susan Rosenthal, a prof e s - rector of Planned Parenthood of New s e a rchers of “about half by the time stu- sor of pediatrics and a pediatric psychol- Mexico and a nurse practitioner with a pri- dents are in high school.”5* ogist at Cincinnati Children’s Hospital vate practice, reports that at patients’ re- Other stories followed, such as a piece Medical Center, notes that in her clinical quests, she is performing more oral swabs in Tal k magazine in February 2000 that re- practice, “girls are clearly talking about and throat inspections now than in the ported on interviews with 12–16-year- oral sex and masturbation (of their part- p a s t .1 6 She affirms that “I have more pa- olds. These students set seventh grade as ners or by their partners) more freq u e n t - tients who are virgins who report to me the starting point for oral sex, which they ly than I used to hear about, but whether that they are worried about STDs they claimed begins considerably earlier than this is because they talk more openly about may have gotten by having oral sex. There i n t e rcourse. By 10th grade, according to it or are doing it more is unclear.” 10 De b o - are a lot of questions and concerns about the rep o r t e r , “well over half of their class- rah Haffn e r , a sexuality educator and for- herpes, since they seem to know that there mates were involved.”6 This article laid mer president of the Sexuality Information is some risk of ‘top and bottom’ herpes, as part of the blame on dual-care e r, over- and Education Council of the United States one of my patients put it.” worked “parents who were afraid to par- (SIECUS), dismisses the press reports of Sharon Schnare, a family planning cli- ent,” and also mentioned that young ado- oral sex among middle-school–aged ado- nician and consultant in Seattle, remarks lescents were caught between messages lescents as largely media hype, saying that that she now sees many teenagers with about AIDS and abstinence on the one only a very small number of young peo- oral herpes.