The start of sexual maturation (puberty) typically is accompanied by an interest in sexual anatomy, which may be a source of anxiety. As adolescents mature emotionally and sexually, they may begin to engage in sexual behaviors. Masturbation is common among adolescents. Sexual experimentation with a partner often begins as touching or petting and may progress to oral, vaginal, or anal sex. By late adolescence, sexuality may shift from experimentation to being an expression of intimacy and sharing.
Ideally, adolescents have access to an appropriate adult (such as a parent, teacher, or health care professional) they feel comfortable with and who they can turn to for answers to questions about worries or misunderstandings regarding sexuality. Other topics adolescents may want to talk about include body image, anatomy, menstruation, masturbation, erections, nocturnal emissions (also known as wet dreams or sleep orgasms), orgasms, and sexual practices. These discussions can be reassuring if adolescents feel embarrassed or are wondering whether they are normal.
Adolescents need trustworthy sources of information about sexual health. They need counseling and guidance about how to form healthy relationships and avoid risky situations. Issues regarding sources of sexual health information, relationships, or experiences include the following:
Promoting healthy sexual attitudes and relationships
Recognizing and avoiding misleading or potentially harmful sources of information (for example, some social media or internet sources or pornography)
Communicating and meeting with potential sexual predators
Feeling coerced into sharing or accidentally sharing sexual images of themselves (sexting)
Feeling coerced into sexual activity
Psychological, physical, or sexual intimate partner violence
Sexual abuse by someone they know or a stranger
Health care professionals should provide appropriate advice on safe sex practices as part of routine health care and should screen all sexually active adolescents for sexually transmitted infections. They should also provide information about contraception and pregnancy.
Few elements of the human experience combine physical, cognitive, and emotional aspects as thoroughly as sexuality and all the feelings and experiences that go along with it. Helping adolescents put sexuality, sexual orientation, and gender identity into a healthy context through sex health education and discussion is extremely important. Parents should share their values and expectations openly with their adolescents and be receptive and supportive as their child’s sexual and gender identities develop.
Sexual Orientation and Gender Identity in Adolescents
Sexual orientation and gender identity are a focus for many adolescents.
Some definitions regarding gender identity include the following:
Sex refers to biological characteristics, such as genitals, chromosomes, and hormones, used to categorize a person as male or female sex. (Rarely, people are born with ambiguous genitals that include both male and female characteristics, which is called intersex.) When a person is transgender, a phrase used to refer to their birth sex is "sex assigned at birth." A person may be assigned male at birth (AMAB) or assigned female at birth (AFAB).
Gender identity is how people see themselves, whether as masculine, feminine, or some other gender identity, which may or may not correspond to the sex they were assigned at birth. Examples of gender-diverse identities include transgender, genderqueer, gender nonbinary, and other gender identities.
Gender expression is how people present themselves in public in terms of gender. It may include the way people dress, speak, or wear their hair.
Gender incongruence is a marked and persistent experience of incompatibility between a person's gender identity and the gender expected based on sex assigned at birth.
Gender dysphoria is diagnosed when a person with gender incongruence experiences significant psychological distress (such as depression or anxiety) or functional impairment associated with the gender incongruence.
Sexual orientation is a pattern of emotional, romantic, and/or sexual attractions that people have toward others.
Gender identity starts to develop early on, often before adolescence. For some children and adolescents, the sex they were assigned at birth does not match their gender identity. This mismatch can cause considerable mental distress known as gender dysphoria. Treatment for gender dysphoria can include psychotherapy, hormones, and surgery.
Some adolescents feel comfortable exploring their sexual orientation and gender identity, whereas others are uncertain about and may be afraid to reveal their sexual orientation or gender identity to friends or family members. They may be unsure of what they are feeling, and it is common for adolescents to be attracted to or have sexual thoughts about people of the same sex and people of the opposite sex.
Homosexuality, bisexuality, and asexuality are normal variations of human sexuality.
Some adolescents may face challenges as their sexual and gender identities develop. They may fear they will not be accepted. Such fears (especially during a time when social acceptance is critically important) can cause severe distress. Fear of abandonment by parents, sometimes real, may lead to dishonest or at least incomplete communication between adolescents and their parents. In some cases, these adolescents are bullied by peers. Threats of physical violence should be taken seriously and reported to school officials or other authorities. The emotional development of adolescents is best helped by a supportive community that includes friends and family members.
Sexually Transmitted Infections (STIs) in Adolescents
In the United States, rates of certain STIs are higher among adolescents and young adults. For example, rates of chlamydia and gonorrhea are highest among females during their adolescent and young adult years, and many people acquire human papillomavirus (HPV) infection during that time.
Adolescents who start having sex early in adolescence are at higher risk of STIs. Other adolescents at higher risk of STIs include the following:
Those living in a detention facilities
Those receiving services at STI clinics
Those who are sex workers or who use sex as a means of survival and exchange sex for drugs, money, food, or housing
Young males who have sex with males (YMSM)
Youths who are transgender
Youths with disabilities, substance misuse, or mental health issues
Those having unprotected sex
Additional risk factors include multiple sex partners, lack of education about safe sex practices, unprotected sex (not using condoms consistently and correctly), lower socioeconomic status, and lack of access to health care. (See also Overview of Sexually Transmitted Infections (STIs).)
Health care professionals can provide adolescents with information about how to identify, prevent, and treat STIs. They also screen adolescents for STIs.
