Why is Teen Sex a Problem?

All of a sudden the phone rang alerting the nurses to an imminent arrival and, minutes later, a couple of paramedics wheeled in a young girl in active labour. Five minutes afterwards, with the help of two nurses, I delivered the first baby of my career. The young mother, who had no family or friends with her, turned out to be twelve years old.

Over the next few days, I spent a lot of time talking to this young teen. I found out that she had become pregnant when she was eleven; the baby's father was a fourteen-year-old boy who had since found another girlfriend. The young mother steadfastly insisted that she wanted the baby and was not interested in giving the infant up for adoption. I wondered how this young girl with minimal life experience and no apparent family support could possibly raise a child. Although at that point in my career I did not know the facts and the figures related to teen pregnancy, I was struck by the phenomenon of 'children having children' and I wondered what the future held for this twelve-year-old and her tiny infant.

Although not the topic of this book, unintended teen pregnancy is a monumental problem for our society. According to an article in the prestigious journal, Adolescent Medicine, "adolescent girls who become mothers are more likely to drop out of school and have low educational attainment; to face unemployment, poverty, and welfare dependency; to experience more rapid repeat pregnancy; to become single mothers; and to experience divorce, if they marry."(2) The cycle of difficulties continues as the children of teen mothers have a much higher incidence of a variety of problems including prematurity, infant death, developmental problems and behavioral difficulties. (2,3)

In addressing the American Academy of Paediatrics, a former U.S. Surgeon General, Dr. M. Jocelyn Elders stated that preventing teen pregnancy was her top priority: "eighty percent of our poverty is related to unplanned, unwanted pregnancies" and "ninety per cent of the young men in prison between [ages] 19-35 were born to teenaged mothers."(4) While on an individual basis, I have seen teen moms who find their motherhood to be an unexpected motivation to seek further education and strive to do their very best, the challenges faced by these young mothers are frequently overwhelming.

What we know: Most people know that unplanned teen pregnancy is a big problem . . . however, most people are completely unaware of the devastating results of STDs and of the huge number of young people who suffer from them.

Most people are aware that teen pregnancy often leads to problems and challenges. I have heard many parents express concern about their teenagers becoming pregnant. I recall hearing a mother comment "I just want to make sure that neither of my daughters get pregnant and that my son doesn't get some girl in trouble!" Most people, however, are completely unaware of the devastating results of STDs and of the overwhelming number of sexually active teenagers and adults who suffer from these very common infections. While an unplanned pregnancy becomes rapidly evident, many of the consequences of having an STD do not show up immediately and some may not be apparent for years.

What we know: The unrealistic view that one can have risk-free sexual liaisons is rampant in North America and many other parts of the world.

I was only a few weeks into my specialist training when I began to encounter young patients who were suffering from the results of STDs. I remember being called to the emergency department in the middle of the night to see a fourteen-year-old who had experienced ten days of severe pain in her lower abdomen. After completing the medical history and physical examination, it was evident that this girl was suffering from Pelvic Inflammatory Disease (P.I.D.), an inflammation of her reproductive organs resulting from a sexually transmitted infection. (P.I.D. is commonly caused by gonorrhoea or chlamydia). When I discussed the situation with the teen and her mother, I was told that, in an attempt to be responsible, they had together visited a birth control centre and, in order to prevent an unintended pregnancy, the daughter had started taking the birth control pill. Neither the mother, nor the teenaged girl, said that they had ever heard of P.I.D., and they certainly did not have any idea that such a serious medical condition might be the direct result of having sex. In view of the potential consequences of this severe pelvic infection (many people are subsequently unable to have children), it was troubling to me that neither this teenager nor her mother had ever considered STDs before this teen began having sex.

Despite the fact that many teenagers do not perceive that they are at risk for sexually transmitted infections, the incidence of certain STDs is so high that some researchers have concluded that contracting a common, potentially cancer-causing STD like human papillomavirus "should now be considered an inevitable consequence of sexual activity."(5) Teens and young adults have become the population group at greatest risk for acquiring STDs. (6,7)

Although in the last five years individuals and medical professionals have increasingly realized that even condom use does not make sex 'safe,' the unrealistic view that one can have risk-free sexual encounters is still rampant in North America and many other parts of the world. I recently saw a young, professional woman who was plagued by recurrent herpes sores acquired when she was a teenager. Her partner at that time had been checked out at a medical clinic and was told that he was infection free. Unfortunately, he was not informed, that many STDs have no signs or symptoms in the early stages and that there are no simple and available tests to detect some of the viral STDs in the early phases of the infection. My patient did not, as a teenager, understand the risks of this sexual relationship and she contracted herpes from this first sexual partner.

Because of ongoing problems with spreading herpes sores, this woman sought advice from a public health provider in order to determine how to minimize the risk of transmission to her current husband. She was told that he only needed to wear a condom to prevent catching herpes. This advice was given despite the fact that her sores were located all over her genital area and not just at sites where a condom would prevent skin-to skin contact. Unfortunately, this woman's spouse subsequently became infected with genital herpes.

What we know: Those who start having sex at earlier ages tend to have a higher number of sexual partners over their lifespan ... this results in an increased risk for STDs.

It is important to point out that this is not an uncommon scenario. Teenagers are frequently misinformed or misunderstand the life-long risks that early sexual involvement exposes them to. Over the last couple of decades there has been a disturbing trend toward initiation of sexual activity at very young ages. (8 9) In 1995, one study noted that "more than twice as many females ages 14, 15, and 16 are sexually active now, compared with young women of the same ages just 15 years ago." (11) The documented result has been that those who start having sex at earlier ages tend to have a higher number of sexual partners over their lifespan.(11,13,15,16,18,21) And, increasing the number of life-time sexual partners inevitably results in an increased risk of becoming infected with an STD.(13) Earlier sexual involvement, therefore, clearly means that the individual will have a much higher chance of catching an STD at some point in their life.

Teen Trends over the last 35 years (8-23) Percentage of teens involved in sexual activity has nearly doubled Average age that teens begin having sex has decreased Physicians are seeing more 12 and 13 year olds who are sexually active Average number of sexual partners during teen years has increased Sex with high-risk partners, such as injecting drug users and people with HIV, has increased Illegal drug use in teens has escalated Ø Rate of infection with STDs has increased substantially Teen pregnancy has increased

While there are many common STDs, none has attracted so much attention in the last ten years as HIV/ AIDS. This infection is the second leading cause of serious sickness and disability in the world (24) and is contracted most commonly by young people, aged 15 to 25. (25) With an estimated 14,000 people infected every single day, an article published in the British Medical Journal in 2002 stated "despite the impressive advances in medicine since [the 14th century], HIV/AIDS is likely to surpass the Black Death as the worst pandemic ever." (26) The Black Death was the most severe plague in history, it ravaged Asia and Europe, and it significantly impacted both social life and national economies. (26,27)

Just as previous epidemics have affected social and economic life, the current consequences of teen sex are having a profoundly negative impact both on the lives of individuals as well as on national health care expenditures. In the United States alone the economic cost for dealing with problems related to teen sex are tens of billions of dollars annually. (2,28) As health care is a primary concern for politicians and citizens all over the world, the economics and the sustainability of public health care is yet another reason that the issue of teen sex needs to be addressed.

What we know: HIV/AIDS is likely to surpass the Black Death, the most severe plague in history, and become the worst epidemic ever.

Many well-meaning educators are concerned about burdening teens with the uncomfortable and even threatening reality of STDs. They are also struggling with the idea that in order to present non-judgemental information, they should not directly endorse one behavior over another. This has sometimes resulted in a hesitancy to directly encourage teenagers to make decisions and choose behaviours that will effectively minimize risk and enhance life-long well-being. Unfortunately, however, STDs are such a serious problem that they demand attention. Considering the serious risks, it is crucial that teens begin to learn the comprehensive facts related to sexual behavior and STDs and that they are encouraged to make health-oriented decisions.