Uticopa Blog

There has been a tide of media interest in young people recently - from fathers at thirteen, to earlier and earlier sex-education in schools, to the cervical infections surrounding the tragic Jade Goody.

Sex is once again in the news, if ever it really left.

The sexual conduct of young people has long been vigorously debated, but what of the inevitable mental health issues that are caused by such behaviour?

The UK again features high in its rate of teenage pregnancies and there is an increasing prevalence of sexually-transmitted infections. When questioned, many teenagers later say that they had sexual intercourse "too early". Has the time come when our doctors should be advising young teenagers to abstain from sex completely - not merely due to moral reasons, not even just to reduce the high rates of cervical diseases and unwanted pregnancies, but also now because of rising levels of consequent depression and even suicide?

Trevor Stammers, who is a tutor in general practice and an author and broadcaster on sexual health, and Roger Ingham, who has done research on sexual conduct and sex education in Britain and other countries, have been considering the whole issue of whether advice on abstinence is effective enough.

Recent trends in adolescent sexual health in the UK are certainly cause for concern. In 1997 in England alone, almost 90,000 teenagers became pregnant. Slightly fewer than 7,700 of these girls were younger than 16 years old, and about half had abortions. In this same period, the rate of increase in gonorrhoea among 16-19 year olds was 45%. This was the highest increase seen in any age group. During the same period and in the same age group, the incidence of chlamydia rose by 53% and that of genital warts by 25%.

Consequent psychological effects have also been recorded. Early intercourse often leads to subsequent regret: only two fifths of respondents in a recent study indicated that first intercourse occurred "at about the right time"; 45% of girls and 32% of boys indicated that it had happened too early or should never have happened at all. Sexually-active teenagers are more likely to be emotionally hurt and have an increased risk of depression and suicide.

Many doctors say that they have never seen a single case of unplanned pregnancy resulting from ignorance about, or unavailability of, contraception. Up to 80% of unplanned pregnancies result from failed contraception. The younger the age of first intercourse, the greater the risks involved. Early teenage sex is associated with poor use of contraception as well as multiple sexual partners and increased rates of depression and suicide, and it is often part of a wider spectrum of harmful behaviour that includes substance abuse, smoking, and excessive alcohol consumption. As in the case of the much-publicised father at 13, young people who start having intercourse before they are 16 are three times more likely to become teenage parents than those who wait.

It is widely recognised that delaying the onset of intercourse is an important objective in assessing the effectiveness of sexual health promotion and sex education programmes. It is clear that abstinence in adolescents is also helpful in avoiding mental health issues at a time when they are struggling to learn who they are and where their life is leading.

However, most adolescent sexual activity is about the expression of non-sexual needs. First intercourse is rarely about love; it is often about peer pressure and the need to conform to it. The strongest predictor of frequency of sexual intercourse among teenagers is the influence of peers. Effective promotion of abstinence involves equipping teenagers to resist such pressure.

Parents should talk with their children about sex and be able to recommend resources to help them to do so. Parents in the Netherlands communicate much more with their children about sex, and this may contribute as much to teenage sexual health there as the more usually cited school sex education. It would certainly be interesting to see whether Dutch children have fewer mental health issues because of the way they are brought up.

Teenagers need to understand why there is ultimately no such thing as casual sex. It may be casual in intent but never in its consequences. Sex education should have its prime focus not on contraceptives but rather on sex as a means of communication, and thereby on becoming a well-balanced adult.

It is clear that the medical profession as a whole - encompassing physical as well as mental health - has a duty to encourage adolescents to avoid early sexual intercourse so that they can enjoy better long term sexual and mental health.  By so doing, not only will there be a decrease in sexual diseases and unplanned pregnancies but also in such things as childhood depression and angst leading to adolescent suicide.