Understanding Teenagers

1. Understanding Teenagers Adolescent Sexuality Datin Dr Sheila Marimuthu Adolescent Medicine Consultant & Paediatrician HKL,KKM

2. Adolescents = Healthy Aging ?

3. Understanding adolescence • A distinct and significant period of life, unique and different from all others • A struggle between inner drives and outside expectations • “A time of cosmic yearnings and private passions, of social concern and private agony” Haim Ginott, Between Parent and Teenager, 1969

4. Sexuality Sexuality comprises everything the individual thinks, feels or does during the entire life span related to being male or female.

5. Overview • An historical perspective • A developmental perspective • A clinical perspective • A social perspective

6. Historical perspective • 1960’s- advent of the pill, the women’s movement and gay liberation • 1970’s - crumbling of censorship and the rise of casual sex

7. Influences on adolescent sexuality • Changes in family structure • Differing expectations in the peer group • Greater diversity in cultural and sexual norms • Confusing and conflicting values in the family and the community Tolstoshev, 1994

8. A developmental perspective • Gender identity and sex roles • Anxious pubertal preoccupations • Early stirrings and infatuations • Self discovery and its advantages Bennett, 1995

9. Developmental perspective

10. A developmental perspective • Exploratory sexual behaviour • Falling in love • Going ‘all the way’ • Not everybody’s heterosexual Bennett, 1995

12. TEEN BRAIN • The part of the teen brain not yet fully developed is the frontal lobe, • which is the part of the brain that manages impulse control, judgment, insight, and emotional control. • So when teens engage in risky and/or foolish behaviour, their brains have difficulty assessing consequences. • Basically, teens have less myelin (the fatty coating that surrounds nerve cells). Nerve cells need myelin to send signals throughout the brain. • So in teen brains, the synapses that are supposed to connect the frontal lobe to the rest of the brain are not working as well as they should. As a result, teens can't access those skills based in the frontal lobe easily

14. Infuriatingly normal behaviour “Teenagers dominate the telephone, play unbearably loud music, never tidy their rooms, are incredibly moody, and push their parents to the limit.” David Bennett, 1987

15. First sexual intercourse “For teenage boys with racing hormones, the process of intercourse is quick and explosive, an awesome out-of-control rush to orgasm. It will never be as quick and driven at any other time in their lives. For many young girls, this rip-roaring intercourse is a terrible disappointment.” Horin, 1981

16. Often unprotected • It can’t happen to me • It’s not my responsibility • Sex should be ‘spur of the moment’ • I shouldn’t look as if I’m expecting it • Condoms are too embarrassing to buy “If you don’t premeditate sex, you’re not ready for it.” McCarthy & Gordon, 1984

17. Failure to use condoms • Trust in partner • Use of contraceptive pill • Perceived low risk or ‘clean’ partner Dunne et al, 1993

18. Sexual orientation • Sexual fantasy • Emotional attraction • Sexual behaviour • Cultural affiliation

19. Same-sex attraction • Survey of 3,500 students in Years10 to 12 in 118 schools throughout Australia • 6.3% attracted to people of their own sex or people of both sexes; another 2.3% not sure • For girls, increases from Year 10 (5.4%) to Year 12 (8.4%); no change for boys (5.3% for both) Smith, Lindsay & Rosenthal, 1999

20. Reassuring facts • Many adolescents worry about their sexual identity • 25 - 50% of adolescents have a homosexual experience • Occasional attraction to the same sex does not equal homosexuality • Sexual orientation is determined early in life

21. Psychosocial stressors & concerns • Parental disapproval • Loss of friendships; verbal and physical abuse from peers • School problems: dropout, truancy, deteriorating performance • Substance abuse & mental health problems Remafedi, 1987

22. Sexually vulnerable Young people: • Have more partners • Have sex more often • Are less likely to use condoms • Are more vulnerable to STDs

23. Sexual behaviour - risk factors Factors associated with early sexual initiation, poor contraception, early pregnancy & STDs: • Poverty • School failure • Risk-taking behaviour • Mental health disorders

24. Mental health disorders & risky sex • A disproportionate burden of sexual risk is borne by young people with psychiatric problems • Depression, substance dependence, antisocial disorders, mania and schizophrenia are associated with early sex, risky sexual behaviour and STDs • Psychiatric co-morbidity elevates the likelihood of sexual risk taking Ramrakha et al, 2000

25. A clinical perspective • Adolescents are sexually vulnerable, particularly girls • Sexual/ reproductive health history • Some things are special: vaginal examination • Anticipatory guidance and sexual counselling

27. History • In patient Adolescent services- 2003 • 2003-2010 – 2700 patients • Sexual and reproductive- 900pts (30%)

28. SRH • Commonest presentation at AMU , HKL • Statutory rape- under 16 in Child Act 2001 • Majority – Consensual (SUKA SAMA SUKA)

39. The hormones

42. Sex education in schools • A subject shrouded in embarrassment, secrecy and shame… • An emphasis on the importance of chastity, morality, respect for religious teachings, family and societal values… • A fear of promoting promiscuous and irresponsible behaviour… Friedman, 1993

43. Sex education and sexual activity • Sex education does not increase the likelihood of initiating sexual activity • Sex education increases short term knowledge but has minimal effect on whether or not adolescents take precautions • Abstinence-only prevention programs have not been shown to reduce sexual activity

44. Parental misconceptions • That adolescents are knowledgeable about sex • That if you tell them, they will want to do it • That you have to be all knowing • That you have to be liberal in your attitudes • That you have to be always comfortable about sex Bennett, 1995

45. Safer sex messages for young people • Abstinence works • Think ahead about your limits • Talk about your feelings • Keep a clear mind • Protect your self respect • Always use condoms during sex

46. THANK YOU