Teen-Agers Alter Sexual Practices, Thinking Risks Will Be Avoided
By Tamar Lewin
or parents wondering just how much things have changed since the days when they were first experimenting with dating and sex, the answer is right there in the nurse's office at Hunter High School, a New York City public school for gifted students.
On the shelf in the nurse's bathroom is a box of condoms, to help students avoid pregnancy and protect themselves against AIDS and other sexually transmitted diseases.
And right next to it is a box of mint-flavored condoms with no spermicide, labeled 'ONLY for oral sex.'
In part because of the fear of AIDS, and in part because of a basic shift in sexual practices, those who study adolescent sexuality say, oral sex has become a commonplace initiation into sexual activity, widely perceived by many young people as less intimate, and less risky, than intercourse. Many girls also see it as a means of avoiding pregnancy and of preserving their virginity.
'Times change, and the norms of adolescent sexual behavior change with them,' said Dr. Mark Schuster, a Los Angeles pediatrician and lead author of study of adolescent sexual practices. 'Among adults, oral sex was part of the sexual revolution of the 1960's and 1970's. And in an era when vaginal intercourse is seen as dangerous, especially in major cities where AIDS is more prominent, many adolescents view oral sex as an alternative.
This doesn't mean that they don't go on to vaginal intercourse.' Dr. Schuster's study, published in November in the American Journal of Public Health, found that even among Los Angeles high school students who were still virgins, 10 percent had engaged in oral sex -- and that boys and girls were equally likely to be the receiving partner.
Some health experts say the popularity of oral sex is worrisome because many teen-agers incorrectly believe it is so safe that they need not take precautions against AIDS and other sexually transmitted diseases.
A 1994 study conducted by Roper Starch, a national polling organization, found that 26 percent of a nationally representative sample of high school students had had oral sex, and 4 percent had engaged in anal sex. Among those in the survey who had already had intercourse, two-thirds had also had oral sex. There are little comparative data from past decades, but those who teach and counsel adolescents say they have no question that there has been a significant rise in the prevalence of oral sex, and a decline in the age at which it starts -- with little awareness of the health risks.
'It is incredible how casual oral sex has become for some adolescents,' said Dr. Carol Perry, who was a psychologist for 15 years at Riverdale Country School and Trinity School, two private schools in New York City, and who is now in private practice. 'With older people, it was something that usually came further along in a relationship, when two people had been comfortable with each other and intimate for a while. But many of the adolescents see it as safer than intercourse, and not as intimate.'
In part, the change may be due to the awareness of AIDS and other sexually transmitted diseases. In interviews, many young people say that for as long as they can remember, sex education classes have drummed into their heads the idea that intercourse is dangerous, and potentially fatal. And there are signs that that message has gotten through: condom use by younger adolescents is rising.
'This is the first generation for whom AIDS has been part of their life from the moment they were old enough to start school,' said Debra Haffner, president of Siecus, a group promoting sex education. 'Most of them started hearing about sex abuse in preschool, getting told that sex is something a stranger can do to hurt you. Then in third grade, they heard about AIDS, that sex can kill you. In about 10th grade, they started learning about date rape, that even someone you thought was nice can use sex to hurt you. It has to add up to some pretty scary attitudes.'
But if intercourse is widely perceived as dangerous, oral sex is not. 'For the people I know, sexual intercourse is a humongous thing,' said a 15-year-old Manhattan girl who attends a private school. 'It's risky, and it's a big deal. But oral sex doesn't seem like sex. People may see the first time as a rite of passage, but after that, it's nothing much. A friend told me she'd done it to a boy last weekend, and I didn't even think to ask if she'd used a condom. But if she were having intercourse, I'd make her promise me that she would protect herself.'
Boys, too, perceive a fundamental difference between intercourse and oral sex. 'Everybody understands that intercourse is dangerous and that it requires a real commitment,' said a 14-year-old boy, adding that oral sex did not necessarily imply a real relationship.
Many of those interviewed -- teen-agers and sex educators alike -- say that the casual acceptance of oral sex comes in good part from the media, especially movies like 'Pretty Woman,' in which Julia Roberts portrayed a prostitute who would perform oral sex with clients, but would not kiss them, because kissing was too intimate.
And few of them say they know of anyone who has used a condom for oral sex. Counselors and sex-education teachers say that although they make a point of telling adolescents that AIDS and other sexually transmitted diseases can be contracted through oral sex, especially by those with open sores in their mouth or recent dental work, students do not seem to be taking their advice to use condoms or dental dams. For that matter, they say, precautions in oral sex still seem to be unusual among adults, as well.
'When I was at Trinity and I was going to talk about dental dams, I went to the drugstores in the area to see if they were available, and they weren't,' Dr. Perry said. 'Most of them directed me to the toothbrush section. So I took latex condoms and showed how to cut them to make a dental dam. But this is not something I think most kids, or most adults, are really doing.'
It was mostly to prod students to think about the risks of oral sex that the nurse at Hunter began offering the mint condoms in January.
The mint condoms are now being taken at a faster clip than the regular ones. Elaine Sarfati, the school nurse, said she restocks 20 or 30 flavored condoms a day to the box on the shelf in the bathroom off her office -- a shelf high enough to be out of the way of younger children.
'In talking with kids, I found that a lot of them didn't think oral sex was sex,' Ms. Sarfati said. 'They think of it as a safe way of being close.'
And though few young people begin to experiment with it before high school, sex educators say, most urban children know about oral sex by the age of 10 or 11.
'Questions about oral sex start in fifth or sixth grade, not because kids are doing it, but because they've heard about it and they're curious,' said Dr. Cydelle Berlin, the health educator who founded the Adolescent AIDS prevention program at Mount Sinai Medical Center. 'By seventh grade, they want to know if it's really safer sex, and what are the mechanics. For girls, 'Do you spit or do you swallow?' is a typical seventh-grade question. Most parents would be shocked at what their kids know, and what they want to know. I talk to parents' groups sometimes, and they're shocked, surprised, trembling.'
Oral sex has not always been part of most Americans' sexual repertoire. According to a 1994 study of American sexual practices, only a minority of women over 50 had ever performed oral sex. Among women younger than 35, however, more than three-quarters had done so. Most men, whatever their age, had been both givers and receivers of oral sex.
'There are a lot of generational and cultural differences in attitudes to sex,' said Dr. Berlin, whose programs reach thousands of adolescents each year, at Mt. Sinai's adolescent clinic and at public and private schools. 'But especially among white middle-class adolescents, the acceptance of oral sex as a less risky activity is more widespread than it used to be.'
Many educators say that after years of hearing about the perils of AIDS, their students perceive oral sex as a responsible expression of sexuality.
'With all the AIDS education they've had, kids certainly see sex as dangerous,' said Phil Kassen, the middle school principal at the Little Red School House in New York City, and the author of a comprehensive sexuality curriculum. 'And no matter what we tell them, they see oral sex as not as dangerous. Given the issues of adolescence, there are also a lot of adolescents who think the adults who talk to them about AIDS are trying to use it as a club to scare them out of having sex. And of course there probably are some adults using it that way.'
He and others worry that sex-education programs that focus entirely on AIDS and abstinence do little to help young people learn responsible sexual decision-making. Teaching young people the facts about sexually transmitted diseases, they say, does little to change their behavior.
'If you do a program for 40 minutes, it may increase their knowledge about sex, but it's not going to help them negotiate their sexual behavior,' Dr. Perry said. 'Adolescents are having sex earlier, and they know more, but even kids who can rattle off the facts get very awkward when they have to talk about negotiating safe sex or contraception. It's important for them to understand that if you can't really talk to your partner, you're not ready to engage in something that is a very mature act.'
Caption: At the nurse's office at Hunter High School in New York City, a shelf offers lubricated condoms and flavored condoms for oral sex only. (Carolyn Schaefer for The New York Times)
