Oral sex often a prelude to intercourse for teens

NEW YORK (Reuters Health) – Engaging in oral sex may be a gateway to intercourse for some teens, indirectly raising their risks of sexually transmitted diseases and pregnancy, according to a new study.

California researchers found that only 9 percent of high school students who started having oral sex at the end of ninth grade had abstained from vaginal sex through the end of 11th grade.

Oral sex is the most common sexual activity among teens, with one in five high school freshmen and more than half of 15 to 19-year-olds reporting they've tried it.

Yet many sexual education programs address only abstinence from intercourse or safer sex practices, ignoring the role oral sex plays in teens' sexual behavior, senior researcher Dr. Bonnie L. Halpern-Felsher of the University of California, San Francisco, told Reuters Health in an e-mail.

"In a past publication, we showed that adolescents perceived that oral sex was more acceptable and more prevalent compared to intercourse," she said, "and that adolescents believe that oral sex carries less risk of health consequences -- sexually transmitted infections, HIV and pregnancy -- as well as social and emotional consequences than does vaginal sex."

While teens may be correct that oral sex is somewhat safer than intercourse, it doesn't come without risks, noted the researchers. And the act could carry indirect consequences as well, particularly if it leads teens to participate in more risky acts such as vaginal sex.

In the new study, Halpern-Felsher and Dr. Anna V. Song of the University of California, Merced, followed more than 600 students attending two northern California high schools from 2002 to 2005, in order to better understand the role oral sex has in the progression of teen sexual behavior.

The teens filled out questionnaires every six months between the start of ninth grade and the end of 11th grade.

More than 90 percent of ninth grade students said they had not yet tried vaginal sex, while 40 percent of 11th graders reported the same.

Over the course of the study, most teens first reported having intercourse within or after the same six-month period as their first oral sex experiences. Overwhelmingly they tried oral sex before trying intercourse rather than the other way around.

Further, the researchers found that initiating oral sex in ninth or 10th grade greatly increased the likelihood that a teen would engage in vaginal sex by end of 11th grade. In contrast, the kids who started sexual activity before ninth grade or after 10th grade had a much lower chance of progressing to intercourse by the end of high school. Teens who abstained from oral sex all the way through 11th grade had an 80 percent chance of also avoiding vaginal sex.

There were no differences in the progression of sexual behaviors between boys and girls, or among Hispanic, Asian and white teens, report the researchers in the Archives of Pediatric and Adolescent Medicine.

Halpern-Felsher and Song note that further research is needed to better clarify the relationship between oral and vaginal sex among teens. For example, it might be that early initiation of oral sex acts as a gateway to having intercourse for some individuals, while others may use the behavior to postpone vaginal sex.

"These findings highlight the need for healthcare providers, health educators and parents to include discussions of oral sex within a comprehensive sexual education curriculum," said Halpern-Felsher.

"Teens often do not consider oral sex to be sex," she added, "and thus might discount these messages as not applying or relevant to their own behaviors."