Why is Teen Sex a Problem?

STEPHEN AND SHELAGH GENUIS

On my first day of training to become a specialist physician, I could hardly contain my

excitement and arrived at the hospital two hours early. I knew no one, as I had arrived from
another part of the country on the preceding day, but I introduced myself to the nurses on the
maternity ward and looked around at what would be my training ground for the next few months.
All of a sudden the phone rang alerting the nurses to an
imminent arrival and, minutes later, a couple of
paramedics wheeled in a young girl in active labour.
Five minutes afterwards, with the help of two nurses, I
delivered the first baby of my career. The young
mother, who had no family or friends with her, turned
out to be twelve years old.

Over the next few days, I spent a lot of time talking to

this young teen. I found out that she had become
pregnant when she was eleven; the baby's father was a
fourteen-year-old boy who had since found another
girlfriend. The young mother steadfastly insisted that
she wanted the baby and was not interested in giving
the infant up for adoption. I wondered how this young
girl with minimal life experience and no apparent family support could possibly raise a child.
Although at that point in my career I did not know the facts and the figures related to teen
pregnancy, I was struck by the phenomenon of 'children having children' and I wondered what
the future held for this twelve-year-old and her tiny infant.

Although not the topic of this book, unintended teen pregnancy is a monumental problem for our
society. According to an article in the prestigious journal, Adolescent Medicine, "adolescent girls
who become mothers are more likely to drop out of school and have low educational attainment;
to face unemployment, poverty, and welfare dependency; to experience more rapid repeat
pregnancy; to become single mothers; and to experience divorce, if they marry."(2) The cycle of
difficulties continues as the children of teen mothers have a much higher incidence of a variety
of problems including prematurity, infant death, developmental problems and behavioral
difficulties. (2,3)

In addressing the American Academy of Paediatrics, a former U.S. Surgeon General, Dr. M.
Jocelyn Elders stated that preventing teen pregnancy was her top priority: "eighty percent of our
poverty is related to unplanned, unwanted pregnancies" and "ninety per cent of the young men in
prison between [ages] 19-35 were born to teenaged mothers."(4) While on an individual basis, I
have seen teen moms who find their motherhood to be an unexpected motivation to seek further
education and strive to do their very best, the challenges faced by these young mothers are
frequently overwhelming.
 What we know:

Most people know that unplanned teen pregnancy is a big problem . . . however, most
people are completely unaware of the devastating results of STDs and of the huge number
of young people who suffer from them.
Most people are aware that teen pregnancy often leads to problems and challenges. I have heard
many parents express concern about their teenagers becoming pregnant. I recall hearing a mother
comment "I just want to make sure that neither of my daughters get pregnant and that my son
doesn't get some girl in trouble!" Most people, however, are completely unaware of the
devastating results of STDs and of the overwhelming number of sexually active teenagers and
adults who suffer from these very common infections. While an unplanned pregnancy becomes
rapidly evident, many of the consequences of having an STD do not show up immediately and
some may not be apparent for years.

What we know:
The unrealistic view that one can have risk-free sexual liaisons is rampant in North
America and many other parts of the world.
I was only a few weeks into my specialist training when I began to encounter young patients who
were suffering from the results of STDs. I remember being called to the emergency department
in the middle of the night to see a fourteen-year-old who had experienced ten days of severe pain
in her lower abdomen. After completing the medical history and physical examination, it was
evident that this girl was suffering from Pelvic Inflammatory Disease (P.I.D.), an inflammation
of her reproductive organs resulting from a sexually transmitted infection. (P.I.D. is commonly
caused by gonorrhoea or chlamydia). When I discussed the situation with the teen and her
mother, I was told that, in an attempt to be responsible, they had together visited a birth control
centre and, in order to prevent an unintended pregnancy, the daughter had started taking the birth
control pill. Neither the mother, nor the teenaged girl, said that they had ever heard of P.I.D., and
they certainly did not have any idea that such a serious medical condition might be the direct
result of having sex. In view of the potential consequences of this severe pelvic infection (many
people are subsequently unable to have children), it was troubling to me that neither this teenager
nor her mother had ever considered STDs before this teen began having sex.

Despite the fact that many teenagers do not perceive that they are at risk for sexually transmitted
infections, the incidence of certain STDs is so high that some researchers have concluded that
contracting a common, potentially cancer-causing STD like human papillomavirus "should now
be considered an inevitable consequence of sexual activity."(5) Teens and young adults have
become the population group at greatest risk for acquiring STDs. (6,7)

Although in the last five years individuals and medical professionals have increasingly realized
that even condom use does not make sex 'safe,' the unrealistic view that one can have risk-free
sexual encounters is still rampant in North America and many other parts of the world. I recently
saw a young, professional woman who was plagued by recurrent herpes sores acquired when she
was a teenager. Her partner at that time had been checked out at a medical clinic and was told
that he was infection free. Unfortunately, he was not informed, that many STDs have no signs or
symptoms in the early stages and that there are no simple and available tests to detect some of
the viral STDs in the early phases of the infection. My patient did not, as a teenager, understand
the risks of this sexual relationship and she contracted herpes from this first sexual partner.

Because of ongoing problems with spreading herpes sores, this woman sought advice from a
public health provider in order to determine how to minimize the risk of transmission to her
current husband. She was told that he only needed to wear a condom to prevent catching herpes.
This advice was given despite the fact that her sores were located all over her genital area and
not just at sites where a condom would prevent skin-to skin contact. Unfortunately, this woman's
spouse subsequently became infected with genital herpes.

What we know:
Those who start having sex at earlier ages tend to have a higher number of sexual partners
over their lifespan ... this results in an increased risk for STDs.
It is important to point out that this is not an uncommon scenario. Teenagers are frequently
misinformed or misunderstand the life-long risks that early sexual involvement exposes them to.
Over the last couple of decades there has been a disturbing trend toward initiation of sexual
activity at very young ages. (8 9) In 1995, one study noted that "more than twice as many
females ages 14, 15, and 16 are sexually active now, compared with young women of the same
ages just 15 years ago." (11) The documented result has been that those who start having sex at
earlier ages tend to have a higher number of sexual partners over their lifespan.
(11,13,15,16,18,21) And, increasing the number of life-time sexual partners inevitably results in
an increased risk of becoming infected with an STD.(13) Earlier sexual involvement, therefore,
clearly means that the individual will have a much higher chance of catching an STD at some
point in their life.

Teen Trends over the last 35 years (8-23)

Percentage of teens involved in sexual activity has nearly doubled
Average age that teens begin having sex has decreased Physicians are seeing more 12 and
13 year olds who are sexually active
Average number of sexual partners during teen years has increased
Sex with high-risk partners, such as injecting drug users and people with HIV, has
increased
Illegal drug use in teens has escalated Ø Rate of infection with STDs has increased
substantially
Teen pregnancy has increased
While there are many common STDs, none has attracted so much attention in the last ten years
as HIV/ AIDS. This infection is the second leading cause of serious sickness and disability in the
world (24) and is contracted most commonly by young people, aged 15 to 25. (25) With an
estimated 14,000 people infected every single day, an article published in the British Medical
Journal in 2002 stated "despite the impressive advances in medicine since [the 14th century],
HIV/AIDS is likely to surpass the Black Death as the worst pandemic ever." (26) The Black
Death was the most severe plague in history, it ravaged Asia and Europe, and it significantly
impacted both social life and national economies. (26,27)
Just as previous epidemics have affected social and economic life, the current consequences of
teen sex are having a profoundly negative impact both on the lives of individuals as well as on
national health care expenditures. In the United States alone the economic cost for dealing with
problems related to teen sex are tens of billions of dollars annually. (2,28) As health care is a
primary concern for politicians and citizens all over the world, the economics and the
sustainability of public health care is yet another reason that the issue of teen sex needs to be
addressed.

What we know: HIV/AIDS is likely to surpass the Black Death, the most severe plague in
history, and become the worst epidemic ever.
Many well-meaning educators are concerned about burdening teens with the uncomfortable and
even threatening reality of STDs. They are also struggling with the idea that in order to present
non-judgemental information, they should not directly endorse one behavior over another. This
has sometimes resulted in a hesitancy to directly encourage teenagers to make decisions and
choose behaviours that will effectively minimize risk and enhance life-long well-being.
Unfortunately, however, STDs are such a serious problem that they demand attention.
Considering the serious risks, it is crucial that teens begin to learn the comprehensive facts
related to sexual behavior and STDs and that they are encouraged to make health-oriented
decisions.