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While sexual behavior during adolescence includes the entire continuum of sexual expression, national data is sparse for any sexual behaviors other than heterosexual intercourse, which has decreased over the past 20 years. Currently, 79% of adolescents report using some form of contraception at first intercourse and 86% used a method to prevent pregnancy at last intercourse. These trends and the availability of long-acting reversible contraceptive methods and emergency contraception have resulted in substantial declines in rates of teenage pregnancy, births, and abortion.

A 2015 survey on sexual behavior of youth between the ages of 15 and 19 showed that 41.2% of high school students had experienced coitus at least once (43.2% of males and 39.2% of females). National data sets in the United States do not correlate socioeconomic status (SES) and coital activity in adolescents; thus, we are left only with data by race and ethnicity, an imperfect surrogate marker for SES and community characteristics. The percentages of youth reporting sexual intercourse vary by race and ethnicity: for blacks, 37.4% for female and 58.8% for male teenagers; for Hispanics, 39.8% for females and 45.1% for males; and for whites, 40.3% for females and 39.5% for males. Predictably, the higher the grade in school, the higher the percentage of students reporting sexual intercourse, with 9th graders at 24.1%, 10th graders at 35.7%, 11th graders at 49.6%, and 12th graders at 58.1%.

Data on other forms of partnered sexual behavior are limited. Data on oral sex from the 2013 National Survey on Family Growth showed that 49% of males and 45% of females ages 15 to 19 years old reported they had received oral sex. Smaller percentages (38% of males and 39% of females) reported having given oral sex. Again, reported engagement in these sexual behaviors increases with age and sexual experience, with higher percentages reporting both oral and vaginal sex than reporting solely oral sex. Reports of anal sex were equally common among males (10.2%) and females (10.5%) 15 to 19 years of age. Rates were much higher among 18- to 19-year-olds as compared to 15- to 17-year-olds for both genders (14.9% versus 7.0% among females and 16.6% versus 6.2% among males, respectively).

Among middle school students, rates of reported sexual intercourse are much lower, with 5.2% to 10.5% of students reporting ever having had intercourse (3.7% to 7.3% of girls and 5.6% to 13.5% of boys). Of note is the significant increase between 8th and 9th grades, which should encourage pediatricians to discuss sexual activity and risk reduction with their early adolescent patients.

Not all states include questions about sexual identity or same-sex sexual activity in the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey (YRBS), but data based on the 9 YRBS sites that do assess sexual identity show that high school youth who identified as gay or lesbian ranged from 1.0% to 2.6% (median, 1.3%), ...

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