Non-Coital Behaviors That Put Teens at Risk for HIV and Other STDs

An article in the November/December issue of Family Planning Perspectives reviews the limited information and research on adolescents' experience with oral sex. It draws on interviews and correspondence with roughly two dozen adolescents and health professionals, including researchers, psychologists, abstinence program coordinators and evaluators, sexuality educators, and epidemiologists.


What is Sex?

  • Of roughly 600 students surveyed at a Midwestern university in 1991, 59% did not believe that oral sex would qualify as "sex" and only 19% thought anal sex would qualify as "sex." Of these same students, females (62%) were more likely than males (56%) to assert that cunnilingus and fellatio were not "sex."

  • Among college undergraduates who were asked to comment on hypothetical scenarios in 1998, 54% reported that men would not consider fellatio to be "sex" and 59% reported that women would not consider cunnilingus to be "sex." These proportions were even higher once it was specified that the hypothetical oral sex had not resulted in orgasm.

  • A fall 1999 survey of 15 to 19 year olds conducted by Seventeen Magazine found that 49% of respondents considered oral sex to be "not as big a deal as sexual intercourse." Further, 40% of respondents said it did not count as "sex."

  • A 2000 Internet survey of 13 to 19-year-old girls conducted by Twist magazine found that 18% of respondents said that oral sex was something that you did with your boyfriend before you are ready to have "sex." The same proportion of respondents also stated that oral sex was a substitute for sexual intercourse.

What is Abstinence?

  • In a 1999 E-mail survey of 72 health educators, 30% of respondents stated that oral sex was abstinent behavior. A similar proportion (29%), however, asserted that mutual masturbation would not qualify as abstinence.

  • In 1994-95 data collected from college freshman and sophomores in the South, 61% of respondents considered mutual masturbation (to orgasm) to be abstinent behavior, 37% described oral intercourse as abstinence, and 24% described anal intercourse as abstinence. However, nearly one-quarter labeled kissing and bathing or showering together as "not abstinent."

Historical Perspective

  • Of 1,067 teens aged 13 to 18 surveyed by Douglas Kirby in the early 1980s, roughly one-fifth said they had ever had oral sex. Further, only 16% of the young women who had performed fellatio reported that they had never had vaginal-penile intercourse.

  • Among non-virgin college undergraduates surveyed in 1994-96, 70% of males and 57% of females reported having performed oral sex at least once before their first sexual intercourse.

  • In 1992, data collected from 9th through 12th graders indicated that 29 to 31% of those respondents who were virgins had engaged in masturbation with a partner. Further, 9 to 10% of those who have not yet had intercourse had nonetheless had oral sex.

  • In a 2000 survey by the Kaiser Family Foundation, 24% of male respondents and 19% of females respondents reported that oral sex is "safe sex."

Notes from the Field

  • A sexuality educator in Baltimore asserts that "middle school girls sometimes look at oral sex as an absolute bargain -- you don't get pregnant, they think you don't get diseases, you're still a virgin and you're in control since it's something that they can do to boys whereas sex is almost always described as something boys do to girls."

  • The director of the National Campaign to Prevent Teen Pregnancy suggests what some adolescents might be thinking: "Okay, we get it. You adults really don't want us to have sexual intercourse, and you're probably right because of AIDS and pregnancy. But we're still sexual and we're going to do other things."

  • A doctor quotes her adolescent patients as thinking "if you're going to avoid intercourse, you're going to resort to oral sex. You're going to do something that is sexual, but in some ways emotionally safer, before you give the big one away."

  • A pediatric psychologist notes that in her clinical practice "girls are clearly talking about oral sex and masturbation (of their partners and by their partners) more frequently than I used to hear about, but whether this is because they talk more openly about it or are doing it more is unclear."

  • The assistant medical director of Planned Parenthood of New Mexico reports that, at patients' request, she is performing more oral swabs and throat inspections now than in the past. She affirms that "I have more patients who are virgins who report to me that they are worried about STDs they may have gotten by having oral sex."

The authors conclude that evidence of early oral sexual behavior has implications for education, research and evaluation, and clinical care. First, teachers and parents need to do a better job helping young people interpret the messages about sexuality that they are bombarded with everyday. Further, they need to help adolescents set the criteria and develop the skills they need to decide when to abstain and/or when to participate across the full continuum of sexual behaviors.

Second, broadening the range of behaviors asked about in surveys of sexual activity can enable researchers to identify individuals whose behaviors place them at risk, as well as help develop more appropriate programs and policies. Finally, there is widespread agreement that oral STD risk in adolescent populations has yet to be adequately screened and measured. This situation is exacerbated by the fact that many of the adolescent patients involved have not yet initiated coitus and, thus, are unlikely to visit a family planning or STD clinic. Practitioners need to hone their skills at communicating with their young clients about sexual activities other than penile-vaginal intercourse -- and to do so they need more information.

For more information: L. Remez, "Oral Sex Among Adolescents: Is It Sex or Is It Abstinence?" Family Planning Perspectives_, 32(6), pp. 298-304._

See also our article on the New CDC Fact Sheet on Oral Sex.