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US teenagers think oral sex isn't real sex

BMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7496.865 (Published 14 April 2005) Cite this as: BMJ 2005;330:865
  1. Janice Hopkins Tanne
  1. New York

    A study of nearly 600 young California teenagers indicates that, having been told to be abstinent and warned of dangers of sex such as pregnancy and sexually transmitted diseases, they have decided that oral sex is the safest choice (Pediatrics 2005;115:845-51).

    Previous studies indicated that many young people choose to have oral sex and don't consider it “real sex.” In 1999 a study in the journal of the American Medical Association showed that US university students didn't think oral sex was real sex (JAMA 1999:281;275-7).

    Publication of that study coincided with the impeachment trial of Bill Clinton, at which he denied sexual relations with Monica Lewinsky, who had performed oral sex on him. Dr George Lundberg, editor of JAMA, was fired for publishing the article (BMJ 1999;318:213).

    The authors of the Pediatrics study say that teenagers see oral sex as a way of preserving their virginity while allowing intimacy and sexual pleasure. “A far greater number of adolescents are engaging in oral sex than vaginal sex and at young ages,” they write. However, teenagers think oral sex is safer than it is.

    The study looked at young teenagers' perceptions of risks and benefits and sexual decision making relating to oral sex and vaginal sex. The lead author, Bonnie Halpern-Felsher, associate professor of paediatrics and adolescent medicine at the University of California, San Francisco, said that parents and health providers who work with young people should be aware that young adolescents are having oral sex or considering it as more acceptable than vaginal sex.

    Her report was part of a two and half year longitudinal study that involved 580 ethnically diverse adolescents at two California high schools in middle class city suburbs. Their mean age was 14.5. With the permission of their parents, the teenagers anonymously answered a questionnaire. It asked about their sexual experiences, their likelihood of experiencing oral or vaginal sex, their attitudes toward it, the outcomes they expected, and how prevalent they thought oral sex and vaginal sex were among their friends.

    The study found that 20% of the teenagers had had oral sex and 14% had had vaginal sex. More participants (32%) thought they might have oral sex in the next six months than vaginal sex (26%). They also thought that their friends were likely to engage in oral sex, thus making it more acceptable to them.

    Oral sex, the teenagers said, was less risky than vaginal sex, considering the health, social, and emotional consequences. They also thought oral sex was more acceptable than vaginal sex for people of their age and was less of a threat to their values and beliefs. They felt that more teenagers will have oral sex and wait to have vaginal sex until they are married.

    “Adolescents in this study believed that they are less likely to get a bad reputation, get into trouble, feel bad about themselves, or feel guilty from having oral as compared with vaginal sex … and [that it is] less of a threat to one's relationship with one's partner,” the authors wrote.

    However, the teenagers underestimated the risk of contracting chlamydia or HIV through oral sex. The authors write that, although low, the risk is not zero, as some adolescents believe.

    The findings are important for parents, public health workers, and healthcare providers, they say. Sex education for teenagers should be broadened to cover what teenagers are actually doing, with screening, counselling, and education about oral sex. Because adolescents are having oral sex at such young ages, sex education should begin before high school—in the United States before the age of about 13, the authors say.