Alcohol misuse: tackling the UK epidemic - London

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Sexual health
Adolescents and sexual health
This section discusses the current status of adolescent sexual health in the UK, looking specifically at the
issues surrounding sexually transmitted infections(STIs) and teenage pregnancies. It begins by defining
sexual health and outlining sexual activity in adolescence. It then explores the prevalence of STIs and
teenage pregnancies. Finally, interventions in the sexual health of adolescents are outlined and assessed.
Sexual health and sexual activity in adolescence
As a recent review of sexual health in adolescence has noted, 6
it is important to be clear about the scope
of the relevant health issues in order to make a sensible assessment of the sexual health of adolescents.
Sexual health
At its simplest, sexual health is compromised when sex is forced or unwanted and/or it has
undesirable health or reproductive consequences such as the transmission of an STI or the
conception of an unwanted pregnancy. 6
The World Health Organisation’s definition of sexual
health goes further to include a state of physical, emotional, mental and social wellbeing related to
sexuality. 155
Sexual competence is an important concept for understanding adolescent sexual health. The National
Survey of Sexual Attitudes and Lifestyles (NATSAL) 2000 used four variables relating to circumstance:
regret, willingness, autonomy and contraception at first intercourse to construct a measure of sexual
competence. 156
Sexual competence may protect adolescents’ sexual health by ensuring that sexual
intercourse is not coerced and that contraception is used to help prevent unwanted pregnancy or the
transmission of STIs.
Although sexual competence, particularly the use of contraception, can help to protect the sexual health
of adolescents, no sexual intercourse is risk free. Condoms provide the best protection against STIs but
can be an unreliable method of protection, especially among people who lack experience. At least one
survey of pregnant teenagers has found a large proportion (in one survey, 80%) of 13 to 19 year olds
claimed to be using contraception at the time of conception. Many of the condom users knew why the
contraception had failed, attributing conception to the condom splitting, coming off or leaking. 157
In England, Scotland and Wales it is illegal to have sex under the age of 16. In Northern Ireland the age
of consent is 17. This law exists to help protect adolescents from engaging in an activity that they are not
ready for. It is assumed that even if adolescents under the age of consent think that they want to have sex,
they may not be mature enough to understand the consequences of their actions. A cohort study of New
Zealanders in 1993-4 investigated how age at first sexual intercourse is related to the reported
circumstances. It found that, among women, there were increasing rates of coercion with younger age at
first intercourse. Most women (70%) regretted having sexual intercourse before the age of 16. 158
NATSAL provides valuable information about early sexual behaviour in Britain. Over 11,000 participants
aged between 16 and 44 were interviewed about first heterosexual intercourse, communication about sex,
pregnancy and STIs. 156
NATSAL found, among those aged 16 to 19 at interview, the proportion reporting
first intercourse at younger than 16 years was 30 per cent for men and 26 per cent for women.
Among adolescents as a whole there is considerable diversity in sexual experience. Evidence suggests that
for most of those who have had sexual intercourse it has involved enjoyable, protected sex with one
person, often as part of a steady relationship. 6
Peer pressure to have sex has been found to be much more
important among younger adolescents and significantly more important to adolescent boys. 159
British Medical Association Adolescent health