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The effect of sex on American adolescents are the physical and emotional consequences American adolescents experience as a result of their sexual behavior. America has a high level of teenage pregnancy compared to similarly developed nations, and nearly half of all new sexually transmitted diseases are reported in adolescents. Adolescents do not have the mental or emotional maturity to handle sexual behavior, and emotional distress is a frequent consequence of sexual activity. Early sexual activity reflects adolescents confusion about what is normal behavior and will harm their adult relationships. Teens often mistakenly believe that they can have relationships that are merely sexual, but there are invariably emotional consequences.

Physical effects
The American Academy of Pediatrics has identified the sexual behaviors of American adolescents as a major public health problem. The Academy is concerned about the prevalence of sexually transmitted diseases in sexually active teenagers and about the very high rate of teenage pregnancy in the United States compared to other developed countries.

Adolescents and young adults have difficulty predicting the consequences their actions will bring and thus often underestimate their risk for adverse consequences. Research into adolescents' sexual behavior in situations outside traditional dating situations, commonly referred to as hooking up, shows that adolescents underestimate the risk involved in such situations. With all the issues and problems relating to adolescent sex, "ideally, they [adolescents] won’t be having sex", according to LuAnn Moraski, assistant clinical professor of Pediatric Internal Medicine at the Medical College of Wisconsin.

Early sex poses a greater physical threat for girls than for boys. Adolescent girls are especially vulnerable to sexually transmitted infections.

Pregnancy
Teen pregnancies in the United States decreased 28% between 1990 and 2000, from 117 pregnancies per every 1,000 teens to 84 per 1,000. However, a 2007 report showed 3% increase in the teen birth rate from 2005 to 2006, to nearly 42 births per 1,000. Slightly more than half of Hispanic and black teen girls will become pregnant, and overall one in five teen girls will be pregnant at least once before they are 20. Asian-Americans have the lowest rate of teen pregnancy of any ethnic group. Of all girls, 16% will be teen mothers.

International comparisons conducted over the years typically place US teen pregnancy and teen birth rates among the highest in the developed world. For example, a 2001 study by UNICEF found that the US teenage birth rate was the highest among 28 OECD nations in the review; in a 1999 comparison by the Guttmacher Institute, U.S. teen pregnancy and teen birth rates were the second-highest among the 46 developed countries studied. In 2002, the U.S. was rated 84th out of 170 World Health Organization member countries based on teenage fertility rate. According to an international comparison by the Guttmacher Institute, teen pregnancy and childbearing levels are higher in the US largely because of differences in contraceptive use. Sexually active teens in the US are less likely to use any contraceptive method and especially less likely to use highly effective hormonal methods, primarily the pill, than their peers in other countries. The research also found that US teens who become pregnant are less likely to choose abortion, whether due to lack of access, higher levels of antiabortion sentiment, or greater acceptance of teen motherhood.

Sexually transmitted diseases
Each year, between 8 and 10 million American teens contract a sexually transmitted disease. According to the U.S. Centers for Disease Control, almost half of the 19 million sexually transmitted diseases reported in the U.S. occur in young people, ages 15 to 24. Lloyd Kolbe, director of the CDC's Adolescent and School Health program, called the STD problem "a serious epidemic." The younger an adolescent is when they first have intercourse, the more likely they are to get a STD throughout their teenage years.

A 2008 study by the CDC found that one in four teen girls, or an estimated 3 million girls, has an STD. The study of 838 girls who participated in a 2003-04 government health survey found the highest overall prevalence among black girls, nearly half in the study were infected, compared with 20 percent among both whites and Mexican-American teens. The same study found that, among those who were infected, 15% had more than one STD, and 20% of those who said they had only one sexual partner were infected.

Human papillomavirus (HPV) is the most common STI among teens as well as adults. In the CDC study, 18% of teen girls were infected with HPV. Another study found that HPV infections account for about half of STIs detected among 15- to 24-year-olds each year. While most HPV infections cause no disease, HPV does cause genital warts and cervical cancer. An HPV vaccine protects women against two HPV types which cause 70% of cervical cancers as well as two types associated with 90% of genital warts. Ideally the woman should be vaccinated before initial sexual activity, since the vaccine is only effective before exposure to the HPV types.

In the CDC study, 4% were infected with chlamydia, historically the most prevalent of all STDs in the general population. More than a third of all chlamydia cases occur in those aged 15 to 19.

In the CDC study, 2% were infected with herpes simplex. The herpes infection rate fell between 1988 and 2004 among teens as well as the overall population. Overall, the number of Americans aged 14 to 49 who tested positive for herpes 2 infection fell by a relative rate of 19 percent between 1988 and 2004 &mdash; from 21 percent in the late 1980s and early 1990s to 17 percent 10 years later, the researchers reported. The number of people aged 14 to 19 who tested positive for new herpes simplex 2 infections dropped from 5.8 percent in a 1988–1994 survey to just 1.6 percent 10 years later.

Oxytocin
When engaging in sexual acts the body produces oxytocin, a chemical produced in the brain to promote feelings of connection and love. It is known as the "cuddling hormone" because it helps mothers bond with their babies. Production of oxytocin increases during the adolescent years. Research has found that it is released in both men and women after orgasm and it is key to monogamy and long-term attachment. Areas of the brain rich in oxytocin light up when people who have been in love for decades were shown a photo of their beloved.

Some behavioral experts theorize that differences in hormone release explain differences in how girls and boys perceive sex, but there is no scientific consensus on these theories. For girls, who have more oxytocin and may be more sensitive to it, some pscyhologists theorize that oxytocin will make them care about relationships and feel connections with others more intensely than boys.

Boys also get a dose of oxytocin. According to Daniel Amen, author of Sex on the Brain, when a man achieves orgasm his oxytocin levels can rise up to 500% of their normal levels. Michael Gurian, a family therapist and New York Times bestselling author, has written, "when "a man ejaculates, he bonds utterly with" his partner. However, men also get a bigger dose of testosterone which may overpower the oxytocin. According to Laura Sessions Stepp, this is "a logical explanation for why girls are in turmoil after a hook up and boys are not".

Psychological effects
For teens, "having sex changes you. It is emotionally powerful and there are risks involved," Saltz points out. However, adolescent psychiatrist Lynn Ponton writes, "All adolescents have sex lives, whether they are sexually active with others, with themselves, or seemingly not at all ... If more people could view adolescent sexuality as a potentially positive experience, rather than sanctioning it as one fraught with danger, young people would have a better chance of developing healthier patterns and making more positive choices."

In one study conducted by the University of California, San Francisco of 273 sexually active California teens, those studied reported both positive and negative consequences of their sexual activity. Among those who had had both oral and vaginal sex, 60% reported at least one negative effect, such as feeling used, getting pregnant, contracting a sexually transmitted infection, or feeling bad about themselves. According to UCSDF pediatrics Professor Bonnie Halpern-Felsher, "We tend to focus on the health consequences of having sex, like pregnancy and STDs, but we also need to talk to them about all the emotional consequences." Disease and illness related sexual activity is epidemic, but "the psychological outfall isn’t far behind."

According to Harvard Medical School's O'Connell, adolescents "often haven't achieved the emotional, even neurological, maturity necessary for making autonomous and self-aware sexual choices." Emotional, social and cognitive development continues well past adolescence. With their still-developing brains, teens do not yet possess the ability to either fathom the physical and emotional consequences of sex or to deal with them once they happen. "Early sexual activity&mdash;whether in or out of a romantic relationship&mdash;does far more harm than good."

Dr. Drew Pinsky has said teens are "in the dark about the implications of [sexual behavior]. They're in the dark about the emotional reality, they're in the dark about the biological reality, they're in denial about this thing that has become a drug in our culture, rather than an expression about intimate relations."

As the frontal lobe of the brain, which houses complex thinking, understanding cause and effect, controlling impulses, and judgment, is not fully developed until a person is in their 20s, "teens are less prepared to think about 'if I do this today, what will happen to me tomorrow?'" notes psychiatrist Gail Saltz.

Sex for teens is not "without risk. It can take a toll on the soul, dehumanizing unsuspecting students who tumble too soon into the world of hooking up, not knowing enough about sex or themselves to avoid getting hurt," according to educator and psychologist Pat McDonough.

Despite "societal shifts in sexual standards, human development remains pretty much the same. Kids are still emotionally vulnerable and volatile - more so if they are sexually active," McDonough stated in Newsday.

Depression and emotional distress
Longitudinal research has shown "a significant association between teenage sexual abstinence and mental health." In a broad analysis of data from the National Longitudinal Study of Adolescent Health, researchers found that engaging in sex leaves adolescents, and especially girls, with higher levels of stress and depression. "Overall, for either gender, teens who are not sexually active are markedly happier than those who are active." "Depression, anxiety and increased stress accompany the abuse of alcohol and drugs also observed in sexually promiscuous teens."

Research has found "a dramatic relationship" between sexual activity among adolescents and "multiple indicators of adolescent mental health. Compared to abstainers, membership in any of the risk clusters was associated with increased odds of depression, serious thoughts about suicide, and suicide attempts." Sexually active girls are more vulnerable to depression, suicidal ideation, and suicide attempt than sexually active boys, but there is little difference between boys and girls who are not sexually active. Risk for depression is "clearly elevated" for the sexually active of either gender.

Doctor of adolescent medi­cine Meg Meeker writes, “Teenage sexual activity routinely leads to emotional tur­moil and psychological distress. [Sex­ual permissiveness leads] to empty relationships, to feelings of self-contempt and worthlessness. All, of course, precur­sors to depression.”  According to the Heritage Foundation, boys who have had sex are more than 8 times as likely to attempt suicide (6%) as virgins (0.7%), and sexually active girls are almost three times as likely (14.1% versus 5.1%).

Experts recommend that sexually active adolescents be screened for depression and be "provided with anticipatory guidance about the mental health risks of these behaviors." Professors at the University of California recommend that parents and health professionals help teens prepare for and cope with the emotions attached to sex.

Researchers at Brown University have found that cutting is linked to higher levels of risky sex among teenagers. Psychologist Lori G. Plante states that "habitual cutting is a way of managing intense emotional distress. It makes sense that the level of impulsivity and risk taking would also be higher in these teens." Plante believes that cutting, even once, is "a warning sign that they are overwhelmed in some way."

Casual sex
Casual attitudes amongst adolescents toward sex and oral sex in particular "reflect their confusion about what is normal behavior", according to Sabrina Weill, author of The Real Truth About Teens & Sex.

When adolescents engage in casual sexual relationships, they proceed toward adulthood with a lack of understanding about intimacy. James Wagoner, president of Advocates for Youth, worries that "if we are indeed headed as a culture to have a total disconnect between intimate sexual behavior and emotional connection, we're not forming the basis for healthy adult relationships." In US News & World Report, physician Bernadine Healy states, "Both as doctor and mother, I can't help but believe that our anything-goes society, in which impulses are immediately satisfied and sex is divorced from love and bonding, is simply not healthy physically, emotionally, or spiritually."

When taking part in hookups, "the kids don't even look at each other. It's mechanical, dehumanizing", according to psychologist Marsha Levy-Warren. This impersonality is harmful to both girls and boys; however, girls are especially at risk of becoming victims in casual sexual relationships.

Studies show "what many teens come to find out on their own: Even if sexual activity seems casual, it often is not", according to Bill Albert, deputy director of the nonprofit National Campaign to Prevent Teen Pregnancy. "A casual hookup on a Friday night might not feel that way a month down the road." When having causal sex teens are "pretending to say it's just sexual and nothing else. That's an arbitrary slicing up of the intimacy pie. It's not healthy", according to Paul Coleman, psychologist and author of The Complete Idiot's Guide to Intimacy. Depression, alcohol abuse, anorexia, and emotional disturbance can all afflict adolescents as a result.

Mark O'Connell has written that the "explosion of sex without meaning" among American teens "is deeply symptomatic. Emotional deadness, disengagement, and constriction are increasingly the norm. (Oral sex is, after all, 'just something to do.') 'Sexual addiction,' our term for moving from sexual experience to sexual experience without ever being satisfied, is prevalent. Meanwhile, for many kids precocious sexuality represents not freedom and experimentation but is a byproduct frequently seen with sexual trauma: compulsively driven activity that both expresses and aims to manage the effects of chronic intrusion and overstimulation."

Relationships
Even when teens are in a romantic relationship, sexual activities can become the focus of the relationship. Not only are such relationships less sustained, they are often not monogamous and they have lower levels of satisfaction than relationships that do not have sexual activities as their focus, according to W. Andrew Collins, child psychology professor at the University of Minnesota.

The "early initiation into sexual behaviors is taking a toll on teens' mental health" with dependency on boyfriends and girlfriends, serious depression around breakups and cheating, and suffering from a lack of goals as possible results. David Walsh, from the National Institute on Media and the Family, thinks that when adolescents engage in casual sexual relationships they do not develop skills such as trust and communication that are key ingredients in healthy, long-lasting relationships.

In purely sexual relationships, adolescents pick up "a lot of bad habits" and don't learn "to trust or share or know how to disagree and make up", according to Laura Sessions Stepp, author of Unhooked: How Young Women Pursue Sex, Delay Love, and Lose at Both. They become jaded and as a result later in life, they have trouble forming adult relationships, according to Levy-Warren. "They don't learn to build that emotional intimacy before they get physically intimate. In the long term, that develops bad relationship habits," according to adolescent gynecologist Melisa Holmes, author of Girlology: Hang-Ups, Hook-Ups and Holding Out

Males and females experience sex differently, and boys are less likely to see sex as connected to an emotional relationship than girls. Males are more able to shrug off a one-night stand, but "girls are more confused afterward... and in general suffer a loss of self- esteem," according to Carrie Lukas of the Independent Women's Forum. However, by the time a young man has reached his early twenties, his girlfriend or his wife will become his primary emotional caregiver. If he cannot establish an emotional relationship with a woman, who does view sex as connected to intimacy, then he is more likely to become depressed, commit suicide or die from illness.

Experts worry that when teens have sex before they're ready then they undervalue the experience and that leads to a cynical view later on. "I think they can develop a kind of negative attitude about life in general, that things aren't that special and they aren't that wonderful and what's the big deal about a lifelong commitment and a family commitment?" said Linda L. Dunlap, a psychology professor at Marist College. "They're disappointed, probably because they weren't mature enough to understand the meaning of it, and it's kind of made them kind of cold to the idea of commitment in other ways."

Oral sex
Teens believe that oral sex is less risky to their emotional and physical well being than vaginal sex, but experts at the University of California do not believe this conclusion is warranted. They found that oral sex, as well as vaginal sex, was associated with negative consequences.

With regards to oral sex, it is almost always the boys who receive it and the girls who give it. When girls provide oral sex "they do so without pleasure, usually to please their boyfriend or to avoid the possibility of pregnancy." This paradigm has entitled boys and disempowered girls, putting girls at a disadvantage. Adolescents who engage in oral sex but not intercourse report fewer problems with sexually transmitted diseases, guilt, and their parents, but also less resulting pleasure, self-confidence or intimacy with their partners.

Of adolescents engaging in oral sex only, girls were twice as likely as boys to report feeling bad about themselves and nearly three times as likely to feel used. Boys who engaged in oral sex were more than twice as likely as girls to report feeling more popular and confident.