Teen Sexual Development, Sexual Behavior and Decision Making Its more than just plumbing

Carol E. Peterson, MS, RN Nurse Consultant Wyoming Health Council

Why should adults discuss teens & sex?

   

Human beings are sexual beings. Most people become sexually active at some point in their lives. Sexual development and some sexual exploration are normal parts of adolescence. Adolescents need to be allowed opportunities to understand what is happening with their bodies, minds and emotions. They need to be provided with useful information and skills so that they can be prepared to make healthy decisions as teens and so that they can become sexually healthy, sexually responsible adults.

Presentation Overview
           

Teens & Sex: Complex Factors At Play Sexual Development Adolescent Brain and Cognitive Development Stages of Cognitive Development Psychological/Emotional Development Romantic Attachments Sexual Decision Making, Sexual Behavior But its not sex. LGBTQ Youth Other Factors to Consider Characteristics of Sexually Healthy Adolescents Implications for Adults

Teens & Sex: Complex Factors At Play

     

No clear age at which adolescence begins or ends (as early as 7/9 to maturity at 19/23). Age at which puberty begins has been getting earlier. Early puberty is associated with early initial sexual intercourse. Adolescents experience a strong drive for intimacy. Tobacco, alcohol, drug and sexual experimentation is common. Sexual activity among teens increases when they perceive that their peers are also sexually active.

Teens & Sex: Complex Factors At Play



During adolescence teens attempt to separate from their parents and identify more closely with their peers; become self centered. Discussion of sensitive subjects with teens is difficult and there is often lack of communication between parents and teens. Media plays a very strong role in adolescents concept and view of sexuality (TV, music, music videos, radio, the internet, movies, magazines, etc.). Sex is used to sell almost everything in our society! Parents can play a role in prohibiting or promoting sexual activity.

Teen Sexual Development



  

1955 Dr. J.M. Tanner developed in-depth description of development of the reproductive system during puberty. Tanner Stages 1-5 for female breast, male genitalia, and pattern/ distribution of male and female pubic hair. Stage 1 / pre-puberty through Stage 5 / sexual development complete. Some variation in speed of progression normal; can go from Stage 1 to 5 in two to five years. Body odor - an early sign that puberty is about to begin! See www.4parents.gov for detailed information on normal teen physical sexual development.

Teen Sexual Development



 

Growth spurt accounts for 20-25% of adult height. Begins 1 to 2 years earlier in females than males, but females peak at end of Stage 3 while in males it continues through Stage 5. Arms and legs grow more rapidly than the trunk = spindly look. Feet grow first; sudden increase in shoe size often first sign child is about to enter puberty. Weight gain accounts for half of adult ideal body weight. Females experience a greater increase in adipose mass while males experience a significant increase in lean mass.

Teen Sexual Development

 

Estrogen and testosterone cause the physical sexual changes noted during puberty. Male Development: Average age of onset of puberty in males (Stage 2) is 9 to 9 . First sign of male puberty in usually onset of testicular enlargement. Ejaculation usually begins in Stage 3 with fertility (sperm production) in Stage 4 (ranges from age 12 to 16). Stage 4 voice deepens; Stage 5 facial hair thickens.

Teen Sexual Development: Females



Average age of onset of puberty in females (Stage 2) is 11.2 (range 9 -13 ), however 7 is the accepted lower level of normal timing of start of breast development. First signs of female puberty downy pubic hair and development of breast bud (glandular tissue can be palpated). Average age of menarche (menstruation and egg production) in the U.S. has declined. Usually occurs at end of Stage 3/start of Stage 4. Has been decreasing over the years: late 1800s = age 16/17, 1954 = age 13 , now average age is 12 with normal range of 12 to 16.

The Brain and Cognitive Development

 

Until recent years scientists believed the brain was largely a finished product by age 12. According to Piaget the highest rung on the ladder of cognitive development was achieved at 12 with formal operations. Use of the MRI has paved the way in attempting to answer questions about brain development and in providing new insights into patterns of brain activity. Not only is the adolescent brain not mature, but both gray and white matter undergo extensive structural changes well past puberty, even into the late 20s!

The Brain and Cognitive Development



Brain development follows a set plan; cues are pre-programmed into the genes while other subtler changes (in gray matter) reflect experience and environment. These structural brain changes and the accompanying psychological changes account for typical teen behaviors: emotional outbursts, risk taking, rule breaking, impassioned pursuit of sex, drugs, rock & roll. Brain overproduces neurons in utero to first 18 months of life, followed by a period of pruning.

The Brain and Cognitive Development



Second surge in neuron development - bushier neurons/thickening of gray matter (ages 6-12) followed by severe pruning at start of puberty; gray matter is thinned at rate of 0.7% a year & tapers off in early 20s. At same time white matter thickens (fatty myelin sheath) - makes neurons signal transmission faster & more efficient. Development proceeds from back of brain to front: Cerebellum Back/base of the brain: coordinates both physical & mental activities is particularly responsive to environment & experience grows into early 20s.

The Brain and Cognitive Development

Amygdala Center of the brain: emotional center of the brain Frontal lobe Front of the brain: center of cognitive skills, planning, impulse control and reasoning. Because of this pattern of brain development teens will appear more mature in one area of behavior while seem to be lagging behind in other areas. For example, while older teens do gain mature language and spatial functions, the area of brain that controls the executive functions of decision making and risk management are not fully developed until early adulthood (age 25-30).

Hormones & Brain Activity

 

At the same time as the brain switches from proliferation to pruning - the hormones kick in! The intense emotional changes seen in teens are often attributed to hormones - however this is probably due to a combination of hormones and structural brain changes. Hormone production by the adrenal glands also increases and these are extremely active on the brain; attach to receptors and directly influence neurochemicals that regulate mood and excitability.

Hormones & Brain Activity



Parts of the brain responsible for sensation seeking & excitement are turned on at the same time as the parts for exercising judgment are still under construction. Like turning on the engine of a car and putting a unskilled driver at the wheel! Dopamine - hormone involved with motivation and reinforcing behavior is abundant & active in teen years; may influence experimentation & risk taking. Melatonin signals body to begin shutting down for sleep; daily levels take longer to rise in teens (so they want to go to bed later and get up later).

Stages of Cognitive Development



Early Adolescence (ages10/12 to 14) Begins use of formal logic operations in school work. They are egocentric, concrete thinkers. Begin to form and verbalize own thoughts and views on many topics. Opinions, choices and decisions about home, school, peers, and intimate relationships begin to surface.

Stages of Cognitive Development



Middle Adolescence (ages 14 to 17) Surge in complex thinking processes; many changes occurring. Focus on expanding beyond individual concerns becomes more philosophical and futuristic. Increased challenging of authority and analysis of issues and concerns. Develops individual code of ethical behavior. Thinks in the long term, but often makes choices and decisions based on urgency and impulsivity! Demonstrates ability to engage in in-depth discussions.

Stages of Cognitive Development



Late Adolescence (ages 17 to 19/23): Complex thinking processes. Focus less on self-centered concepts. Increased personal decision making. Interest in more global concepts such as justice, history, politics, patriotism, etc. Engages in debate with peers and parents; often intolerant of opposing views Focused on making career decisions.

Stages of Cognitive Development

Cognitive development is: 1. Linked to brain (structural) development, 2. Reflected in psychological/emotional development and sexual decision making, 3. Observable in age related sexual behaviors, 4. Ongoing until the late 20s.

Psychological/Emotional Development


 

Critical psychological task is development of identity (Erickson); period when they define themselves. Time of storm & stress for teens and parents. In general, adolescents have lots of doubts; about their body image and appearance, who they are, their sexual identity, goals in life, etc. Moodiness, conflict and distancing occur within the family.

Psychological/Emotional Development
  

They over identify with those around them. Love at this stage is an attempt to further define the self. Important period in life as it is the transition from childhood to adulthood and is the testing ground for much of what we come to believe as adults!

Early Adolescence (12-14)

 

Independence initial movement toward independence. Emotions & Affect mood swings; return to childish behaviors at times (e.g. want to sit on parents lap, play with dolls, etc.) often express emotions with actions; lots of risk taking. Relationships - close friendships become important; less attention shown to parents; lots of conflict; same sex friends and group activities; travel in groups.

Early Adolescence (12-14)



Physical Appearance & Body group influences clothing, makeup, hair. Pre-occupied with their physical appearance. School, Work & Career Interests not important; focus on present & near future (here & now).

Middle Adolescence (14-17)



 

Sexuality & Romantic Attachments girls and boys enter puberty; shyness, blushing, modesty, interest in privacy; masturbation; concerns about normal development; sexual curiosity. Independence self-involvement; alternate between unrealistically high expectations and poor self-concept. Emotions & Affect periods of sadness and emotional withdrawal from parents; use diaries. Relationships protest parental involvement; lowered opinion of parents; high degree of conflict; parents dont know anything; peer group and youth culture very important.

Middle Adolescence (14-17)



Physical Appearance & Body extremely focused and concerned with own appearance; sense of being a stranger in their own body. School, Work & Career Interests intellectual interests gain importance; greater capacity for setting goals. Sexuality & Romantic Attachments concerns about sexuality and sexual attractiveness; increased interest in opposite sex; frequently changing short-term relationships; emotional connections expressed as love and passion.

Late Adolescence (17-19/23)

 

 

Independence ability to make independent decisions; self-reliant. Emotions & Affect ability to delay gratification is a key developmental milestone; more developed sense of humor; ability to gain insight into own emotions and behaviors. Relationships greater concern for others; recognition of parents as a resource. Physical Appearance and Body sexual development complete comfortable in own skin.

Late Adolescence (17-19/23)



School, Work & Career Interests ability to process ideas and express them in words; ability to compromise; increased level of concern for the future; ability to set goals and follow through. Sexuality & Romantic Attachments concern with developing serious relationships; capacity for sensitivity, caring and sensual love.

Romantic Relationships/Attachments
  

 

Early interactions among opposite sex occur in the context/safety of larger peer groups. Romantic Relationships (RRs) are often superficial and short lived. RRs may be crucial to identity formation, transformation of family relationships, ability to develop close relationships with peers, sexual identity and academic success. However, they can become the focal point of an early adolescents daily life. They imagine an ideal partner/ideal romance and real life relationships may pale in comparison; confusing media representations can lead to inevitable disappointment.

Romantic Relationships/Attachments


RRs can impact mental health, school and family life and other aspects of teen life such as college and career plans. Adults should not take RRs lightly! If they dismiss these relationships as minor they may alienate teen and block communications, also occasionally a teen may take this so seriously that they might become suicidal when it does not work out. Teens may spend great deal of time with partners and distance self from other friends and family: need adults help them to keep a balance! Positive RRS can offer needed positive support and healthy companionship.

Sexual Decision Making



Adolescent decision making differs from adult decision making; depends on the stage of cognitive, emotional and social development However, for the most part emotions rule! Decisions regarding initiation of sexual intercourse, use of birth control, and consent issues can have a significant impact on the health and well-being of an adolescent. Situations concerning sexual decisions (consenting to have sex or using contraceptives) are flooded with passionate emotions; important decisions often made in the heat of the moment.

Sexual Decision Making



Teens will state that it is important for them to wait for the right person or until they reach a certain age, but during the passion of the moment they may make a different decision; they need to develop skills and have a plan so they can be prepared, in advance, for the moment. Psychological changes (personality type/traits, self-esteem, internal or external locus of control, etc.); social factors (religious & moral beliefs, influence of media, etc.); developing sex drive; developing autonomy; knowledge and skills; all play roles in the sexual decisions teens make.

Sexual Decision Making



Elements of Decision Making Cognitive Development may not be refined enough to allow for realistic cost-benefit analysis. Dependant on:
Capacity (ability to use cognitive resources)  Knowledge (acquisition of information),  Skills (assessment of odds, confidence, etc.).


Emotional Development Hot Emotions (strong undercurrents dependant on the situation) vs. Cold Emotions (rely on basic values and cognitive skills).

Sexual Decision Making

Social Development includes learning the norms, attitudes, and values of ones group and observing others and learning from experience. Knowledge alone does not change behavior. Peer influence is very powerful (i.e. teens whose friends rarely used condoms 3x more likely to engage in risky behaviors). Difficult situation because teens have a biological/psychological urge for sexual activity accompanied by a sense of invulnerability to harm from STIs, pregnancy, etc.

 

Sexual Behavior


Normal progression of behavior relates to age/developmental stage: Early adolescence (9-14): postponement & abstinence, experimentation with nonintercourse sexual behavior is common Middle adolescence (13-17): more frequent experimentation and first intercourse for some Late adolescence (17 and older): initiation of sexual activity/intercourse; sexuality often associated with commitment and future goals

Sexual Behavior


 

2005 Wyoming Youth Risk Behavior Survey (YRBS): valuable data about teen sexual activity (as well as many other health related behaviors such as substance abuse and depression also some local/district level data is also available): 15.5% or middle school students (6th-8th grade) report ever having sexual intercourse. 47.1% of high school students (9th -12th grade) report ever having had sexual intercourse; increases to 61% for all 12th graders. Of those high school students who report having sexual intercourse in the past three months, 64.9% reported using a condom.

Sexual Behavior


Sexual Debut most people become sexually active before adulthood; debut rarely planned in advance; median age for first intercourse in U.S. is 16 . Sexual Desire & Sexual Response Females: discussion often in context of ruining reputation or staying pure Males: Discussion in context of sexual appetite as the underlying evil that gets them (and girls) into trouble Teens often frightened and ashamed by desire and sexual response; shrouded in misinformation; adults rarely engage in honest conversations with teens about these normal responses.

But its not sex .

 

Young people have redefined sexual behavior in large part because of media messages! Consider themselves virgins even if they are sexually active and engaging in mutual masturbation, oral sex, or anal intercourse. Risk of pregnancy may be reduced, but not the risk of HIV (with anal sex) and STIs (oral and anal); teens need to know this! 12 & 13 year olds do not truly understand the implications of oral sex; may see it as less intimate than intercourse.

But its not sex

  

Girls agreeing for ridiculous reasons (e.g. so boys will like them). Often dont see forced oral sex as rape Most information about incidence is anecdotal, from school nurses and other clinicians (linked to increases in stomach aches & sore throats). One national study reported that as many as 50% of students will have tried oral sex by the time they graduate from high school. Other risky behaviors: hooking-up, friends with benefits

LGBTQ Teens


Identifying or being perceived as LGBT or queer is commonly associated with internalized and externalized stigmatization, victimization and resultant negative mental and physical outcomes. LGBT Identity Development LGBT youth must accomplish the same developmental milestones and processes as other youth but also are trying to come to terms with their difference as LGBT. LGBT adolescents are commonly left isolated without healthy, socially acceptable venues for exploring their sexual feelings.

LGBTQ Teens
Process of Self Identifying Has Four Stages: 1. Acknowledges being or feeling different as child/early teen; 2. Identity confusion (non-heterosexual but not sure if LGBT); 3. Identity assumption (self identifies & comes out); 4. Commitment stage (identifies as LGBT in all aspects of life)

LGBTQ Teens


Common Safety/Health Care Concerns with LGBT Adolescents Involved in fights; increased injuries; increased skipping school because of feeling unsafe; increased rates of attempted suicide. HIV/AIDS & Hepatitis, substance abuse, emotional stress/depression/anxiety disorder Need for harm reduction counseling. Establish Safe Settings for LGBT Youth pink triangles, rainbow flags, items with pictures of same sex couples, use gender neutral language. They are our children and they need information and resources to help them reduce their risks.

Many Other Factors/Issues to Consider

 

Lots of other factors to consider! Environmental Factors - single parent home, lack of healthy adult male or female role models, too much unstructured/unsupervised time, etc. Legal Issues: Confidentiality/Right to Privacy, Minors and Consent/ Right to Access Reproductive Health Care without Parental Consent Access to and availability of reproductive health care; not always there or may not know how to access it. No health insurance (Kidcare/SCHIP covers till age 19)

Many Other Factors/Issues to Consider

  

 

Previous STI or pregnancy. Non-Consensual Sex: coercion, abuse, rape Mental Illness may engage in more risky behaviors; may be a significant factor if there is promiscuity, behavior that is out of character; teens who report they feel out of control with respect to their sexual behavior. Chronic Illnesses sex education and reproductive health needs are often overlooked. Physical & Developmental Disabilities often are victimized; need sensitive, developmentally appropriate sex ed; they encounter unique barriers to obtaining reproductive health care.

    

  

Characteristics of Sexually Healthy Teens Appreciates and values own body. Takes responsibility for own behaviors. Is knowledgeable about sexuality issues. Communicates effectively with family about many issues, including sexuality. Seeks and understands information about parents values and considers them when forming own values. Interacts with both genders in appropriate and respectful ways. Expresses love and intimacy in developmentally appropriate ways. Able to evaluate personal readiness for mature sexual relationships.

Implications for Adults

 

 

Talk with teens about the many factors that contribute to early sexual activity Research shows that if teens think that most other teens are having sex, they may be more likely to be sexually active. Many teens regret becoming sexually active at a young age. Teens often lack honest and accurate information about contraceptives and the long term consequences of STIs. Teens have an unrealistic idea of what it is like to parent a child.

Implications for Adults

 

 

Teens can have an unrealistic idea of what the future might hold for their child. Teens may be unclear about the financial responsibilities that come with pregnancy and raising a child. Teens need help to plan their future and need opportunities to discuss birth control options. Teens need to have hope for the future a real problem in parts of WY because of limited opportunities for good jobs! Teens thrive when involved in the world around them; they need healthy outlets such as music, art, drama, sports, debate team, etc.

Implications for Adults



Assisting teens to meet their sexual/reproductive health needs provides an excellent opportunity to help them begin to develop health literacy the ability to understand, gain access to and use health information and services a skill many adults lack! Teens are usually healthy so there are limited opportunities to help them gain this skill sexual/reproductive health is something they are already interested in! Clinicians should allow teens opportunities for decision making and assist them to plan ahead at routine health care visits.

Implications for Adults

Provide an environment where open discussion is allowed Encourage teens to share their ideas & thoughts. Allow them to think independently. Teach them skills that allow them to become comfortable with this own bodies: self breast exams, testicular self exams. Recognize and praise teens for well-thoughtout, responsible decisions Assist adolescents in reevaluating decisions that have negative consequences. (How might you do this differently next time?)

Implications for Adults



It is crucial to address reproductive anatomy and physiology, human sexuality, and sexual decision making throughout adolescence once is not enough! Different programs, approaches needed at different stages of adolescence one two week class in 7th or 8th grade is not sufficient! Programs must be appropriate for teens developmental levels and based on their individual needs (e.g. non-sexually active 13 year olds vs. sexually active 17 year olds need different programs and services).

Implications for Adults



Support age/developmentally appropriate sex education in their communities:

Abstinence-Only: can help to delay initiation of sexual activity in young teens (Jr. High) for up to 18 months however after that STI rates are equal to those who have never had any sex ed.; they need more information as they get older. Abstinence-Based: teaches facts about HIV/STIs and unintended pregnancy and teaches valuable communication and refusal skills that can be transferable to other situations (e.g. when offered drugs); appropriate for Jr. & Sr. High Comprehensive Sexuality Education: best for Sr. High; a must for high risk and sexually active teens, incarcerated youth and college students.

In Conclusion.


In order to effectively assist teens with their own sexuality adults must first: Identify their own sexual views and values. Support teens autonomy when possible. Show empathy and be good listeners. Familiarize themselves with available programs and resources for teens. Know when, how, and where to make referrals for teens who are already sexually active, high risk teens, teens in abusive situations, teens with mental health issues, substance abuse issues, etc.

In Conclusion.


Parents, youth serving organizations, churches, educators, public health and family planning entities may have different opinions about teen sexuality but we can and must work together because we do have a common goal: To assist all teens to avoid unintended pregnancy and STIs and to help them to become sexually healthy /sexually responsible adults.

References


 

California Family Health Council. (2002). Reducing Teen Pregnancy: Helping Teens Make Healthy Decisions. Campbell, CA. Erickson, E.H. (1968). Identity, youth and crisis. New York: Norton Gaffney, D.A. and Roye, C. (2003). Adolescent sexual development and sexuality: Assessment and interventions. Kingston, NJ: Civic Research Institute Hall, P.A., Holmquest, M., Sherry, S.B., (2004). Risky adolescent sexual behavior: A psychological perspective. Topics in Advance Practice eJournal 4(1).

References


 

Neistein, L.S. (1996). Adolescent health care: A practical guide. Baltimore, MD: Williams & Wilkerson. Piaget, J. (1972). Intellectual evolution from adolescence to adulthood. Human Development, (15). Time Magazine. (2004). Secrets of the teen brain. Pg. 56-65. Issue: 5/10/2004. www.time.com Federal web site for parents: www.4parents.gov Youth Risk Behavior Survey (2005). Wyoming Department of Education, Health and Safety Unit. www.K12.wy.us/HS/yrbs/yrbs.asp

Contact Information
Carol E. Peterson, MS, RN Nurse Consultant Wyoming Health Council 2120 ONeil Ave. Cheyenne, WY 82001 E-mail: carol@wyhc.org Phone: 307-632-3640 Fax: 307-632-3611 Web: www.wyhc.org