Every couple of years, the Centers for Disease Control and Prevention asks middle and high school students to fill out surveys in class for the Youth Risk Behavior Surveillance System. If students are sexually active, it asks for the age of first sexual intercourse, which is an important milestone.
From a public health point of view, sexual intercourse initiates young people into certain kinds of risk, notably pregnancy and sexually transmitted infection. In those terms, what is called early sexual initiation — that is, intercourse before the age of 13 — is well-known as a marker for other kinds of risk, in both girls and boys, including binge drinking and having multiple sexual partners.
These are associations, not cause-and-effect explanations. There are many factors that go into individual trajectories, including the individual child’s physical and emotional development; the home environment and parental supervision practices and the local culture and standards in the child’s community, school and circle of friends.
But kids who start having sex early are kids we should be worrying about, kids at risk.
In April, the journal JAMA Pediatrics published a study of early sexual initiation among males in the United States. The researchers combined data from three different survey years of the Youth Risk Behavior Surveillance System, giving them information from 19,916 male students.
The article also reports data from another very large and reputable survey, the National Survey of Family Growth, which gave them information on 7,739 males who had been 15 to 24 years old when they were interviewed.
Of the high school boys in the Youth Risk Behavior Surveillance System, 8 percent reported sexual initiation before they were 13, and so did 4 percent of the 15- to 24-year-olds in the National Survey of Family Growth. That survey specifically asks about the age of first heterosexual intercourse, while the Youth Risk Behavior Surveillance System doesn’t specify the gender of the partner.
The researchers found striking geographical variations in the percent of young men reporting early sexual initiation, with some cities, such as Memphis, Milwaukee and Chicago, reporting much higher percentages. Of the males from Memphis, 25 percent reported early initiation, while in San Francisco, only 5 percent did.
They also found higher rates among non-Hispanic black and Hispanic males, and lower rates among those whose mothers had college degrees.
Any survey about sexual behavior raises the question of whether the respondents are answering accurately; Dr. Lee M. Sanders, the chief of the division of general pediatrics at Stanford, suggested that in some communities and neighborhoods, reporting early initiation may be a social expectation, while in others it may be loaded with stigma.
The majority of boys in the United States don’t get comprehensive sex education before they are sexually active, said Dr. Arik V. Marcell, an associate professor of general pediatrics and adolescent medicine at Johns Hopkins Children’s Center, who was one of the authors of the study. If that is true for boys who start sexual activity in high school, he said, the gap is even more significant for those who become sexually active at these young ages.
“I don’t want to perpetuate the double standard that it’s O.K. for boys to start having sex,” Dr. Marcell said. “How can we think about addressing potential vulnerabilities, especially if those experiences were not wanted?”
In fact, of those who were 18 to 24 at the time of the survey who reported having initiated sexual activity before the age of 13, 8.5 percent characterized it as unwanted, choosing the response: “I really didn’t want it to happen at the time,” and 54.6 percent as wanted, responding, “I really wanted it to happen at the time,” while 37 percent “had mixed feelings” about it. Interestingly, those percentages were similar for those who began having intercourse when they were 13 or older.
The study was accompanied by a commentary which pointed out that only 13.9 percent of the adolescents in the latest National Survey of Family Growth cohort reported having had any education about saying no to sex by sixth grade, and called for “medically accurate, developmentally appropriate sex education starting in elementary school,” as is also recommended by the Future of Sex Education Initiative.
Dr. David L. Bell, an associate professor of pediatrics at Columbia University Irving Medical Center, and the first author on the commentary, said, “Parents and pediatricians need to help our young men navigate their sexual lives by communicating with them, having open dialogues with them about many different aspects of having sexual relationships.” That includes conversations about consent.
In talking about sexual activity with his patients, Dr. Sanders said, “I’ve gotten really careful about using exactly the same language with boys and girls.” He starts with the question, are you dating. And then, whether they say yes or no, “I will ask if they’ve had sex, and whether they were pressured to have sex, and if they’ve had sex I will ask, was it consensual.”
Boys as young as 12 may not have the opportunity to have confidential conversations without their parents in the room, or be asked routinely by their pediatricians about any of this. Dr. Bell’s editorial called on clinicians to start these conversations earlier, not just in asking about activity, but in opening up conversations about “relationships and sexual decision making.”
In his own clinic for young men, many of the youngest come in with their parents, and he starts by asking them what they’ve heard about puberty, and who it is they go to when they have questions, he said, “letting them know that as their pediatrician, I’m also available to have conversations about how to think about their future in that space.”
The average age of first intercourse also gives public health experts (and educators and politicians and pundits) a way to track changes in social norms, and perhaps to look at the effects of sex education and guidance, which tends to recommend waiting and making good decisions, and the countereffects of media and a highly sexualized environment.
And overall, the public health news has been good: for both males and females, that age has actually been moving older in the United States, and is now at about 17, just as teenage pregnancy rates have declined steeply in recent decades.
It’s very hard not to slip into double standards where adolescents and sex are concerned. It’s easy to look at girls as victims and boys as perpetrators.
“We don’t really have a lot of information about what’s the context of these early sexual experiences for young people in general at ages 12 or younger,” Dr. Marcell said. “The next steps involve understanding a bit more about that.” Because some of this is reported by adults reflecting back, he said, research closer in time to the event might help in understanding young people’s feelings and the longer term consequences of early sexual experience.
“Our culture is always afraid that by talking about something, it encourages something,” Dr. Bell said. “It’s not true about sex. It doesn’t encourage them to have sex, it encourages them to be thoughtful.”
