Young Teens: Oral Sex Safer
April 4, 2005

  "It is not considered real sex to teens. They think they are still virgins if they had oral sex compared to vaginal sex."
  Nearly a third of 14-year-olds plan oral sex within six months — and nearly 20 percent say they've already tried oral sex, a California survey shows.
  The survey is not a national sample. The data, while carefully collected, comes from 580 ninth-grade boys and girls at two California schools. But the numbers are in line with — and even a bit lower than — larger studies of American teens' sexual behavior.
  The young teens say oral sex is a safer, more acceptable alternative to vaginal sex. That's true, says researcher Bonnie L. Halpern-Felsher, PhD, of the University of California, San Francisco. Oral sex, by itself, carries no risk of unwanted pregnancy. And some sexually transmitted diseases, such as AIDS, are harder to get from oral sex than from vaginal sex.
  But Halpern-Felsher says the survey shows that many teens don't fully appreciate the very real risks of engaging in oral sex.
  "Yes, risks are less likely to occur with oral sex. The question is, do you think at age 14 you are really ready for this?" Halpern-Felsher tells WebMD. "You are still having intimacy with another person, and there still are possible physical and emotional risks. My concern is the feeling that oral sex is no big deal. It very well might be a big deal."

How Teens See Oral Sex
  Halpern-Felsher's study — published in the April issue of Pediatrics — provides sorely needed data, says youth sexual behavior expert David Landry, senior research associate at the Alan Guttmacher Institute, a nonprofit organization focused on sexual and reproductive health research, policy analysis, and public education.
  "There has been a dearth of information about adolescent oral sex in U.S. survey research," Landry tells WebMD. "A lot of the media reports I've seen about teen oral sex are rather alarmist. But it has been going on for a long time. It is nothing new, as data from 1988 and 1995 show. If anything, this latest research shows an incidence lower than we've seen before. But this is not a national sample."
  Halpern-Felsher notes that her study is the first to gather information from teens as young as 14. The kids enrolled in her ongoing study — with the full consent of their parents — and filled out surveys every six months. The survey questions become more detailed and cover more sexual topics as the children get older.

Oral Sex Is Acceptable Sex
  "We are finding that these ninth-graders — and they are really young — are engaging in thinking about these things," Halpern-Felsher says.
  And what these young teens are thinking may surprise their parents.
  "Young adolescents are perceiving that oral sex is less risky than vaginal sex in terms of health risks — STDs, pregnancy, and HIV," Halpern-Felsher says. "They also see oral sex as having fewer social and emotional risks. They think they are less likely to feel guilty, to get in trouble, to have a bad reputation, or to have a relationship problem. They also felt oral sex is more acceptable. They think more teens are having it, and that it is OK in the context of both a dating and non-dating relationship — a one-night stand in our terms."

Is Oral Sex Really Safer Than Vaginal Sex?
  One finding that worries Halpern-Felsher is that a small but significant proportion of teens think oral sex carries zero physical risk. Fourteen percent of teens said there was zero risk of getting HIV from oral sex, and 13 percent said the behavior carried zero risk of transmitting chlamydia. Only 1 percent and 2 percent, respectively, thought vaginal sex carried zero risk of HIV or chlamydia infection.
  Experts say there is no doubt that oral sex can transmit virtually any sexually transmitted disease — including HIV and chlamydia. The risk of getting most of these infections from oral sex is lower than the risk of getting them from vaginal sex. But the exact risks of oral sex are largely unknown, Landry says.

Oral Sex Doesn't Mean Safe Sex
  "I would say it is encouraging that most adolescents are aware there is a risk of STDs from engaging in oral sex," he says. "This research clearly indicates that most youth also are aware that oral sex is less risky than sexual intercourse. But it is important for them to know that our scientific understanding of risk of STDs from oral sex isn't very well defined. We simply know there is a risk. How much risk we don't reliably know at this time."
  This does not mean that unprotected oral sex is safe sex. Safe oral sex means using barrier protection — condoms or dental dams — to prevent infection. If abstinence is the only safe sex method a person uses, then abstinence must include oral sex as well as vaginal sex.
  "This has to be a consistent message: When people engage in oral sex they should use a barrier method," Landry says. "Unfortunately, in the U.S., fewer and fewer teachers are talking about how condoms can be used to prevent STDs or even pregnancy — let alone how condoms can be used in the context of oral sex."

Is Oral Sex Really Sex?
  Most adults see oral sex as sex. Teens don't.
  "It is not considered real sex to teens," Halpern-Felsher says. "They think they are still virgins if they had oral sex compared to vaginal sex. Oral sex is something else. For teens it is not under the rubric of sex as we know it today."
  This has important implications for every kind of sex education.
  "It is so incredibly important that when people are working with teens they must not just say, 'When you are having sex,' because that won't cover oral sex," Halpern-Felsher says. "We really need to break the barriers and start talking about all the things we consider to be sexual experiences."

When To Have The Big Talk
  Since oral sex is already prevalent at age 14, these conversations have to take place before a child reaches puberty.
  "There is no data on exactly how young you should start — maybe at age 10 or 11, but we have no evidence," Halpern-Felsher says. "But regardless of the child's age, don't hide from the conversation. We do know that parents who have complete conversations with their children about sex have kids who make wiser decisions about these issues."
  Halpern-Felsher and Landry say the "big talk" isn't as effective as more frequent, more casual conversations. There are many opportunities for such discussions.
  "Instead of just one big talk, you absolutely need ongoing conversations," Halpern-Felsher says. "There are many teachable moments when we parents can discuss issues of sexuality with our children, especially as our culture is awash with sexuality. It is important to seize those moments rather than to let them pass by. It is important to be open and honest and have clear consistent messages with youth. The frequency and openness of conversations is important. It has effects both on delaying sex and on using protection when sex occurs."
  These conversations aren't all teens need.
  "The bottom line is that youth need accurate information to make responsible decisions about sexual activity — and that includes all forms of sex they might engage in," Landry says. "Unfortunately, in the U.S. we have been pulling back in school-based education to provide that info. Fewer students get information on how to protect themselves."

Sources: Halpern-Felsher, B.L. Pediatrics, April 2005; vol 115: pp 845-851. Remez, L. Family Planning Perspectives, November/December 2000; vol 32: pp 298-304. Bonnie L. Halpern-Felsher, PhD, associate professor of pediatrics, University of California, San Francisco. David Landry, senior research associate, Alan Guttmacher Institute, New York.