4/22 Adolescent Sexuality Flashcards
In terms of sexuality development, what are teens doing as pre-adolescents?
Gender identity and gender roles
They will start identifying genders
What boys and girls are “supposed” to do
In terms of sexuality development, what are teens doing as early adolescents (ages 10-13)?
Going through early pubertal changes
having sexual fantasies and masturbation
First crushes
In terms of sexuality development, what are teens doing in middle-adolescence (ages 14-16)?
Physical maturity reached
Early sexual exploration, coital and non-coital
In terms of sexuality development, what are teens doing in late adolescence (ages 17+)?
adult, intimate sharing relationships
Biologic sex: define
Gender identity: when can kids identify this?
Gender roles: when can kids identify this?
Sexual orientation: what % of teens question?
Sexual behavior: aligned with sexual orientation?
Biologic sex: interplay of chromosomes & hormones
Gender identity: kids can identify by age 2 or 3
Gender roles: kids can identify really early
Sexual orientation: 15% of teens question, 5% identify as gay/les
Sexual behavior: may or may not align with sexual orientation
What behaviors and situations are LGBTQ youth at increased risk for?
- Suicide (33%)
- Homelessness
- Substance abuse
- Violence, victimization
- STIs (HIV rising for young MSM)
What % of high schoolers have had sex at least once?
what % are currently sexually active (past 3m)?
50% of 9th-12th graders have been SA at least once
33% within past 3m
median age of sexual debut?
17
what correlates with a younger age of sexual debut?
The younger the age of sexual debut, the more likely they were to have been coerced
What % of all STIs are diagnosed in patients aged 15-24?
What % of teen pregnancies are unplanned?
50% all STIs = in ages 15-24
80% teen pregnancies are unplanned
Since the 1990s, has the % of HS students who have had sex gone up or down?
What about condom usage?
What about “safer” sex (ie BC method + condom)?
-What about alcohol/drug use before sex?
Since the 1990s:
- % of HS students who have had sex: decreased
- condom usage: increased
- “safer” sex (ie BC method + condom): trend unknown, currently 9% total
- alcohol/drug use before sex? increased then decr: about the same now
Do virginity pledges work?
Um, no.
- 5 yrs later, 82% denied that they ever pledged.
- Fewer pledgers than nonpledgers used birth control and condoms in the past year and birth control at last sex
- 10% of self-reported abstinent youth had STIs
Screening recommendations for PAP smears?
Begin screening at age 21.
Define:
Age of majority
Emancipated minor
Mature minor doctrine
Age of majority: age of full decision making capacity (generally 18)
Emancipated minor: Legal definition. Achieved “adult” milestones including military service, marriage, parenthood, independent financial status
_Mature minor doctrine: _Based on context. common-law rule that allows an adolescent who is mature to give consent for medical care
What determines Confidentiality when it comes to adolescents?
Adolescents are protected by what laws?
Confidentiality is state-dependent
Adolescents are protected by:
minor consent laws
HIPAA
State Medical Privacy Laws
What are some limitations to confidentiality laws?
- Emergency care
- Reproductive care (pregnancy, contraception, STI testing/tx)
- Mental health care
Local regulations for NH/VT:
Minor til what age?
Confidential STD testing/tx at what age?
Parental notification for abortion?
Sex ed requirements?
VT:
Minor til 18
Confidential STD testing at 12; parents notified for treatment
Parental notification for abortion: no requirement for parental notification or judicial involvement; Medicaid pays; no waiting period
Sex ed: required; must state that abstinence is only way to prevent pregnancy/STD
NH
Minor til 18
Age 14 for reproductive health care
Abortion: no requirement for parental notification or judicial involvement; Medicaid does not pay except for rape or incest; no waiting period
Sex ed not mandatory in NH; if taught must state that abstinence is only way to prevent pregnancy
Define age of consent.
What is it in NH/VT?
Age of consent = minimum age to legally have sex
In NH/VT the age of consent and minimum age to (legally) have sex is 16
What are Biological risk factors for STIs in adolescents?
- Immature cervix with ectopy (columnar cells exposed to the vag environment, more easily colonized with CT)
- Naive immunity
- Higher risk for forced sexual activity
What are some developmental risk factors for STIs in adolescents?
-Concrete thinking /Don’t plan ahead…
- Difficulty assessing risk: they are egocentric & invincible, they think that the partner is a good person therefore no STI’s)
- Higher number of sexual partners
- Risk of coerced sex
- Concomitant substance use
STI rate of CT in adolescents compared to general population?
GC?
CT: 5x the rate of the general population
GC: Age 15-24 = 4x the rate of the general population
Screening recommendations for sexually active adolescents - for CT/GC? HIV?
CT/GC: urine based testing yearly
HIV: consider Rapid HIV screening
What is the relative rate of HPV and cervical dysplasia in adolescents? Why is the recommendation to start screening at age 21?
Higher prevalence of HPV infection and cervical dysplasia (due to immature cervix) in the adolescent population
but most HPV infection will spontaneously resolve in 1-2 years and true cervical cancer is very rare.
Prevention strategies?
Immunizations (HPV, Hep B)
Condoms
Education
