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
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
And what these young teens are thinking may surprise their
"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
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
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.