A new report and study in the current issue of the Alan Guttmacher Institute's journal Family Planning Perspectives examine the assumed increase in "noncoital" sex among teenagers. According to an AGI press release, the findings shed light on the need for more comprehensive study of teen sexual trends, including the development of a broader definition of what constitutes sexual behavior and a reevaluation of STD education initiatives (AGI release, 12/19). "Our anecdotal evidence shows that kids think [oral sex] is considerably safer behavior than vaginal sex," Cory Richards of AGI said, adding, "In some respects it is. The risk of pregnancy is not there. But the risk of STDs is definitely there" (Peterson, USA Today, 12/19).

Oral Sex on the Rise?
According to the report "Oral Sex Among Adolescents: Is It Sex or Is It Abstinence?," written by Lisa Remez, an associate editor of Family Planning Perspectives, an April 1997 article in the New York Times was the "first hint" that oral sex may have become a new "trend" among teenagers. The article proposed that teenagers who had come of age in the time of AIDS considered oral sex "to be a far less dangerous alternative, in both physical and emotional terms," than vaginal intercourse. A July 1999 article in the Washington Post reported that oral sex was becoming more common among middle-school-aged students, and another Times article in April 2000 quoted a Manhattan psychologist as saying that oral sex was "like a good-night kiss to [middle-school students]." But a lack of hard statistics means that the reports "cannot be confirmed or refuted." The "perceived difficulty" of getting parents to let their children be surveyed about their sexual behavior and the fear that asking teenagers about sex will "lead them to choose to have sex" are two obstacles preventing collection of comprehensive data. The federal government's "reluctance" to fund such "controversial" research also stands in the way (Remez, Family Planning Perspectives, November/December/2000).

Tracking Sexual Trends
Results of the Urban Institute's " National Survey of Adolescent Males," reported in Family Planning Perspectives by the institute's Population Studies Center Research Associate Gary Gates and Director Freya Sonenstein, may shed some light on teen sexual trends. Conducted in 1988 and 1995, the survey questioned more than 1,200 males ages 15 to 19, including an "oversampl[ing]" of black and Hispanic teens, about sexual practices ranging from vaginal and oral sex to mutual masturbation and anal sex. While rates of vaginal sexual activity in adolescent males remained relatively stable from 1988 to 1995, experience with "nonvaginal sexual activity" rose. There was a 13% rise in the number of males who said they had been masturbated by a female, and nearly half of all males reported receiving oral sex, up from 44% in 1988. In the largest statistical variance, black teenagers reported a 32% increase in receiving oral sex. Although this was a large change, it brought the group "more in line" with other racial groups. The survey only asked participants if they had "ever" participated in these activities, and did not ask how often or how recently they had engaged in the behaviors (Gates/Sonenstein, Family Planning Perspectives, November/December/2000).

Is it Sex or Abstinence?
Confusion over what exactly constitutes sexual activity is rampant among teenagers, adults and health educators alike. According to Remez, 40% of teens surveyed by Seventeen magazine in the fall of 1999 did not consider oral sex to be "sex," while 18% of girls surveyed by Twist magazine in the summer of 2000 said that oral sex was "something you did with your boyfriend before you are ready to have sex." A midwestern survey of 12- to 17-year-olds found that abstinence was not well defined, with answers ranging from "kissing is probably okay" to "just no intercourse." The Monica Lewinsky scandal also confused national dialogue on the subject, when President Clinton declared that he had not perjured himself when he said he did not have "sexual relations" with Lewinsky because vaginal intercourse was not involved. Educators are just as divided. A 1999 email survey of 72 health educators found that 30% believed oral sex was abstinent behavior, yet 29% said that participating in mutual masturbation would not qualify as abstinence. Title V of the Maternal and Child Health Services Block Grant specifies that programs must teach "abstinence from sexual activity outside of marriage" to receive funding, but does not specify what "sexual activity" entails (Remez, Family Planning Perspectives, November/December/2000).

A Need for Reevaluation
The prevalence of sexual behavior outside of intercourse, and the ambivalent attitudes held by many teens toward it, "suggest that a heightened awareness of oral sex has forced a dialogue with adolescents about the full meaning of sexuality and has underscored the importance of defining sex not as a single act, but as a whole range of behaviors," according to AGI (AGI release, 12/19). Linda Alexander, president of the American Social Health Association, said she wants to see these findings used to support new educational initiatives. "As health educators and parents, we've drilled the kids on the dangers of pregnancy," she said, but "[w]e haven't talked as much about activities that don't result in pregnancy. What concerns me is what kids don't know. They're not protecting themselves; they don't understand the risks of transmitting infection between the genital and oral areas." Ward Cates, president of the Family Health Institute, agreed that more dialogue is needed. "The most important message of these findings is to encourage communication about a whole range of sexual behavior and to get away from the dichotomy we've set up between sex and abstinence, the view that sex is vaginal intercourse and abstinence is nothing beyond holding hands," he said (Lewin, New York Times, 12/19).