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Try out PMC Labs and tell us what you think. Learn More. Anal intercourse is a highly efficient mode of HIV transmission. Nevertheless, there is evidence to suggest that anal intercourse is also widely practiced by women in the US 1 - 4. Given that anal intercourse is associated with higher rates of heterosexual HIV transmission than vaginal intercourse 10 - 13 , women who engage in uduphotos.netotected anal intercourse with sexual partners of unknown or seropositive status may be at greater risk for acquiring HIV than women who do not practice anal intercourse or who use protection while doing so. Additionally, Halperin 1 found that women who engaged in anal intercourse were less likely to use condoms during anal intercourse than during vaginal intercourse.

Women had uduphotos.netotected anal intercourse with a wide variety of partners, ranging from friends to casual partners, short-term and long-term boyfriends, husbands, strangers met on the Internet, and fathers of their children.

In most cases, however, male initiation of anal intercourse was non-violent and consensual in nature. Although male partners initiated anal sex more often, the women in our sample did not necessarily lack control over the practice; in fact, because they were the ones who had to consent to a specific behavior in order for it to take place, at times women felt that they, not their partners, were the ones who determined the course of a sexual encounter.

The following participant, when asked if she had been pressured to have anal sex by her non-exclusive partner, distinguished between male initiative and male pressure:. In other cases, women recognized that permitting or withholding anal intercourse from their male partners allowed them greater power in other areas of their relationships.

For example, engaging in an unusual practice with her casual sexual partner made one participant feel more desirable:. Isabella: I love the attention [from anal intercourse].

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Far from being uncomfortable with anal intercourse, as we might expect of an activity that is so often stigmatized 1this participant took satisfaction in being the object of male desire and, in doing so, reaffirmed her sense of being a beautiful, desirable woman. In acting out this part, she did not so much relinquish her power as assume her scripted role as the pursued. Non-consensual anal intercourse occurred with a range of partners both familiar and unfamiliar, from former husbands and boyfriends to strangers and men met on the Internet.

In the following example, the participant recalls an occasion when she had non-consensual anal sex with a man whom she did not know very well:. Among the seven women who experienced non-consensual anal intercourse, two of them also reported having had anal intercourse during transactional sex on at least one occasion, suggesting, for these women, a history of limited sexual agency.

Among those women who had experienced non-consensual anal intercourse in the past, more than one participant also reported engaging in anal intercourse of her own accord, for non-transactional purposes, on other occasions. Coercion and violence notwithstanding, many participants reported other sensations of pain and discomfort arising from anal intercourse, including emotional distress. Mild intestinal discomfort was also experienced as an aftereffect of anal intercourse, such as in disrupted bowel movements.

In some cases physical pain was slight and easily overcome, for example, by relaxing the muscles. Given the frequent mentions of pain during consensual anal intercourse, we were interested in understanding why and how women engaged in anal sex in spite of these unpleasant sensations.

In cases where women expected anal sex to be painful, they listed various reasons for engaging in the practice anyway: to try something new, to please their partners, or to experience sexual pleasure. Indeed, some participants experienced pain during anal sex as enhancing their sexual pleasure. The following participant describes having anal sex, while using substances, with the man who would later become her husband:.

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Valeria: I let him do it. And we did it in the big recliner chair. It hurt and it felt good at the same time. That some participants experienced anal intercourse as simultaneously pleasurable and painful supports our view that anal intercourse usually occurred as a complex emotional and physiological event for our participants, and cannot be easily categorized as entirely pleasurable or entirely painful, even for the same individual.

For all but one participant, the last occasions of anal intercourse occurred alongside other forms of sexual activity, such as oral sex and vaginal intercourse. Viewed as a complementary form of sexual expression, anal intercourse took on meaning not only as a site of negotiation and pressure, but as a source of sexual pleasure and eroticism for the women in our study.

In considering the motivations for women to engage in high-risk sexual behaviors such as uduphotos.netotected anal intercourse, it is important not to overlook female desire 2431 Among our participants, pleasure-seeking behavior, encompassing both physical arousal and emotional desire, emerged as a factor associated with a greater willingness to both engage in and request anal intercourse from male partners.

Regardless of who initiated it, many women in our study reported enjoying anal intercourse and the physical sensations related to the practice, such as this participant:. Jada: Wanting it. I like it.

If I have anal sex, I have orgasms. My body likes it. It feels like vaginal but almost a little better, it seems like. And it feels good. However, just as the sensation of physical pleasure during anal intercourse varied among participants, so did the importance that participants placed on physical pleasure alone as a motivating factor for engaging in anal intercourse.

Participants often cited the desire for intimacy or closeness to their partners as either the motivation for anal intercourse, or as the necessary preconditions for anal intercourse to occur. Just [for] something different.

And I just found a new part of my body I can enjoy. In the following example, the participant talks about the first time she had anal sex, with a man that she met on the Internet for the purpose of having sex:. In this sense, anal intercourse was sought not only for the physical pleasure that it afforded women, but also valued as a marker for exceptional sex.

By equating exceptional sex with exceptional relationships, women sought to express their love, commitment, and openness towards theirpartners through their willingness to have anal intercourse, as this woman did with her husband:. Sarah: Anal sex? This notion of sexuality does not so much uphold the masculine model of the autonomous sexual actor seeking his own satisfaction, but instead identifies women-and by extension, their male partners-as sexual beings by virtue of their relational stance towards others.

Infrequent condom use during anal activity was to be expected among participants, given the eligibility requirements. Eighty-two percent of the sample indicated that they had not used condoms during the first occasion of anal intercourse and the same proportion though not necessarily the same participants reported no condom use during the last occasion of anal intercourse.

In the following example, the participant was asked if she had used condoms with her boyfriend the last time they had had anal intercourse:. Emma: No, [we did not use condoms]. The reason is that we mostly used the condoms in order not to get pregnant. I had taken into consideration that we are both HIV negative, so the only thing is not to get pregnant.

On the other hand, those participants who had used a condom during anal intercourse listed the following reasons for doing so: a concern regarding hygiene; the erroneous belief that one could get pregnant through anal sex; and the condom that had been used for vaginal sex was kept on during anal sex. When describing discrete occasions of anal intercourse, on eight occasions participants reported that they had used a condom for vaginal sex to prevent pregnancy, but had removed the condom prior to anal sex.

Among those who reported using a condom during anal intercourse, on three occasions participants used the same condom for both vaginal and anal intercourse; on another three occasions participants used separate condoms for vaginal and anal intercourse; and on four occasions participants used condoms for anal intercourse but not vaginal intercourse, citing concern about hygiene or pregnancy as motivations.

Kimberly: Not at all. Alyssa: It was with my significant other. He never had done it before.

By interpreting anal sex as a more intimate form of sexual activity than vaginal or oral sex, women represented themselves not so much as sexual rule-breakers, but as the enforcers of the notion that sex should serve to heighten intimacy and build relationships, rather than satisfy one's own duphotos.net by: 59   In a survey out today 6of teenage girls admit to having sex before the age of Two-thirds of sexually active under year-olds lost their virginity before the age of And 40of the young   Q. Confused About Childhood Sex Games: When I was growing up, I lived in a small cul-de-sac and was really close with some of the other duphotos.net

Alyssa was the only participant who mentioned that she had had uduphotos.netotected anal intercourse with seropositive partner. However, another participant Valeria, 41, Hispanic said that she regularly had anal sex with a man whose other partner was HIV-positive.

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Although nearly all of the participants were aware that uduphotos.netotected anal intercourse might put them at risk for sexually transmitted infections, this knowledge apparently did not translate into behavioral change, as evidenced by the participant who had uduphotos.netotected anal intercourse with her HIV-positive partner. To avoid sounding confrontational, our interviewer did not ask participants why they continued to practice uduphotos.netotected anal intercourse with partners of unknown or positive HIV status, despite the risks involved.

Because our participants tended to follow traditional gender roles when it came to initiating anal intercourse, and because anal intercourse emerged in our interviews as a sexual behavior that complemented vaginal and oral sex, it may be useful to view heterosexual anal intercourse not so much as a deviant behavior, but as an intensified example of how sexual decisions are negotiated between men and women.

  No matter what kind of sex you are or aren't having, it's important that it be safe. That's exactly why Harvard University held an anal sex class as part of its Sex Estimated Reading Time: 2 mins   Girl describes what it was like to have sex with her dad "The sexual intensity was nothing like I'd ever felt before. It was like being loved by a parent you never had, and the partner you always Measures. The survey contained multiple items addressing precoital behavior, sexual intercourse, and demographic characteristics. To mitigate concerns from parents and school personnel regarding exposure of nonsexually experienced seventh-grade students to explicit questions regarding vaginal, oral, and anal sex, 2 precoital items were used to identify and screen for nonsexually experienced duphotos.net by: 65

Following this line of reasoning, at first glance the pattern of male initiative over anal intercourse suggests that women might engage in anal intercourse under pressure, coercion, or persuasion from male partners. Taking sexual scripting theory into account, however, a more complex story emerges from the data.

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In this context, male initiative alone may not necessarily indicate a lack of female agency, but rather serve as a marker for the presence of a strong sexual script that dictates male pursuit and female acquiescence or rejection of male desire. Although researchers have documented the relationship between pleasure-seeking behavior and sexual risk-taking in men who have sex with men 36 - 38it is not yet clear how pleasure-seeking may be related to sexual risk-taking among women.

Nevertheless, as we did not survey a control group of women who engaged in low-risk, protected anal intercourse, it may be difficult to draw conclusions about the relationship between sexual risk-taking and pleasure-seeking behaviors from our sample alone. Future research is needed to elucidate such relationships.

When taken together, uduphotos.netotected anal intercourse seemed to offer women a way to please their partners, to please themselves, and to avoid pregnancy. Unfortunately, missing from this heuristic was a consideration of HIV and STI risk. As long as some women view anal sex as a way to bypass pregnancy concerns while maintaining intimacy and sexual pleasure, the failure to educate this population on HIV and STI prevention may lead to increased infection.

As long as condomless sex is equated with emotional intimacy, argues Blais, MSM may be at increased risk for STIs, including HIV.

A similar dynamic may be at work among women who engage in uduphotos.netotected anal intercourse in order to achieve a greater degree of intimacy with their male partners, as in the case of some of our participants.

Interventions to promote safer anal sex must find a way to increase the use of barrier methods without decreasing perceived intimacy between sexual partners. This may be done by emphasizing the intimate nature of anal intercourse, even when accompanied by condom use. Too often, note Gupta and Weiss 40interventions to address high-risk sexual practices collude with existing hierarchies, rather than challenge the underlying structures that contribute to economic and sexual marginalization.

Therefore, if part of what makes a woman feel like a woman is being desired by her male partner, vaginal and rectal microbicides should be marketed to women as products that will enhance their sexual desirability.

On the other hand, HIV and STI interventions geared towards women who have uduphotos.netotected anal intercourse must not lose sight of societal factors that disadvantage women.

Indeed, even in our small sample, the subgroup of women who had experienced non-consensual anal sex tended to report lower annual incomes than those who had not, though we did not test for statistical significance. Future studies should seek to identify the specific factors that put women at risk for non-consensual, uduphotos.netotected anal intercourse.

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To be successful, interventions must take into account the ways in which violence directed towards women can impact their ability to negotiate safe vaginal and anal sex. Given that the need for female-controlled alternatives to condoms encompasses products that can be used intrarectally as well as vaginally, rectal microbicides should be marketed to women as well as to MSM. Our findings must be interpreted within the limitations of this study. Although the sample was ethnically and racially diverse, participation was limited to English-speaking women, and more low-income women were interviewed than middle- and upper-income women.

Additionally, as the participants included only those women who were willing to be interviewed about a highly-stigmatized practice, we know little about the experiences of women who may feel uncomfortable discussing anal intercourse with a stranger In terms of the generalizability of our discussion on condom use and HIV and STI prevention, we must emphasize that our sample only consisted of women who had recently engaged in uduphotos.netotected anal intercourse with a partner of unknown or seropositive HIV status.

There are undoubtedly numerous women who practice anal intercourse with minimal risk e. Future studies should seek to quantitatively assess HIV and STI risk among a larger and more representative sample of women who engage in anal intercourse.

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Furthermore, notwithstanding that this may have been a highly-motivated group of women who welcomed the opportunity to talk about their anal sex experiences, it is important not to overlook how social constraints or norms about what is socially appropriate situated within the interview itself may have influenced how and what may have been discussed during the course of the interview.

Stadler et al. Despite the limitations of the study, the findings presented here have important implications for HIV interventions aimed at heterosexual women. This research was supported by a grant from the NICHD R01Principal Investigator: Alex Carballo-Dieguez, Ph. National Center for Biotechnology InformationU. National Library of Medicine Rockville PikeBethesda M USA. NCBI Skip to main content Skip to navigation Resources How To About NCBI Accesskeys My NCBI Sign in to NCBI Sign Out.

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Journal List HHS Author Manuscripts PMC Perspect Sex Reprod Health. Author manuscript; available in PMC Sep 7. PMCID: PMC NIHMSID: NIHMS Emily Woodman-Maynar 1 Alex Carballo-Dieguez1 Ana Ventuneac1 Teresa M. Exner1 and Kenneth H. Mayer 2.

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Emily Woodman-Maynard 1 HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, USA, and Fordham University, Department of Psychology, Bronx, New York, USA Find articles by Emily Woodman-Maynard. Alex Carballo-Dieguez 1 HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, USA, and Fordham University, Department of Psychology, Bronx, New York, USA Find articles by Alex Carballo-Dieguez.

Ana Ventuneac 1 HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, USA, and Fordham University, Department of Psychology, Bronx, New York, USA Find articles by Ana Ventuneac. Teresa M. Exner 1 HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, USA, and Fordham University, Department of Psychology, Bronx, New York, USA Find articles by Teresa M.

Kenneth H. Author information Copyright and License information Disclaimer. All correspondence and reprint requests should be sent to Emily Woodman-Maynard, Fordham University, Department of Psychology, Keating HallBronx, New York,or to ude.

mahdrof anyamnamdoow. Copyright notice. The publisher's final edited version of this article is available at Perspect Sex Reprod Health. See other articles in PMC that cite the published article. CONTEXT Anal intercourse is a highly efficient mode of HIV transmission. METHOD The data for our analysis were collected at a community clinic in the Eastern US [clinic name and location to be specified in the final manuscript] as part of a study of rectal microbicide acceptability in Study Procedures Eligible and interested participants reported to the clinic for a one-time, face-to-face meeting with a female interviewer.

Data Analysis The qualitative interviews were tape recorded and transcribed. RESULTS Sample Description Twenty-eight women participated in the study. For example, engaging in an unusual practice with her casual sexual partner made one participant feel more desirable: Isabella: I love the attention [from anal intercourse].

Pain and Discomfort Coercion and violence notwithstanding, many participants reported other sensations of pain and discomfort arising from anal intercourse, including emotional distress.

The following participant describes having anal sex, while using substances, with the man who would later become her husband: Valeria: I let him do it. Physical Pleasure In considering the motivations for women to engage in high-risk sexual behaviors such as uduphotos.netotected anal intercourse, it is important not to overlook female desire 2431 Regardless of who initiated it, many women in our study reported enjoying anal intercourse and the physical sensations related to the practice, such as this participant: Interviewer: What has led you to have anal sex [in general]?

Intimacy and Variety Participants often cited the desire for intimacy or closeness to their partners as either the motivation for anal intercourse, or as the necessary preconditions for anal intercourse to occur. In the following example, the participant talks about the first time she had anal sex, with a man that she met on the Internet for the purpose of having sex: Interviewer: Tell me a little bit about your reasons why you did it the first time.

Nicole: I would have to say to please my partner. That would be just about it. Interviewer: And it sounds like you, like you said [earlier], he pleased you so much. Nicole: Yeah. Like the idea of reciprocity. By equating exceptional sex with exceptional relationships, women sought to express their love, commitment, and openness towards theirpartners through their willingness to have anal intercourse, as this woman did with her husband: Sarah: Anal sex?

Condom Use Infrequent condom use during anal activity was to be expected among participants, given the eligibility requirements. In the following example, the participant was asked if she had used condoms with her boyfriend the last time they had had anal intercourse: Emma: No, [we did not use condoms].

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Pleasure-Seeking and Sexual Risk Although researchers have documented the relationship between pleasure-seeking behavior and sexual risk-taking in men who have sex with men 36 - 38it is not yet clear how pleasure-seeking may be related to sexual risk-taking among women.

Limitations Our findings must be interpreted within the limitations of this study. Acknowledgments This research was supported by a grant from the NICHD R01Principal Investigator: Alex Carballo-Dieguez, Ph. e Associate Professor, ude. htu orelotroT.

nasuSCenter for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, Fannin, 26th Floor, Houston, TX This study examines the prevalence of vaginal, oral, and anal inter-course among a population of urban, public middle school students, the characteristics of early sexual initiators, and the sequence of sexual initiation. Such data are limited for early adolescents.

A total of seventh-grade students Overall, A small percentage of early adolescents are engaging in multiple sexual behaviors. These findings have implications for early adolescent school-based sexual health education.

Although adolescent pregnancy rates have declined steadily in the United States over the past decade, adolescent births and sexually transmitted infections STIs remain serious public health issues. Inbirths to mothers aged years increased for the first time since the early s. Early sexual initiation has been associated with an increased risk of pregnancy and STI. In order to develop effective pregnancy and STI prevention efforts for early adolescents aged yearsit is important to understand the prevalence of vaginal, oral, and anal intercourse in this age-group and the characteristics of early initiators.

However, public sensitivity regarding sexual behavior surveys among early adolescents, particularly in public school settings, has impeded this research. Active parental consent is typically required, and parents and school administrators may be reluctant to expose students to explicit questions regarding sexual behavior, particularly those regarding oral and anal sex. In the Middle School Youth Risk Behavior Surveillance Survey MSYRBS grades and roughly ages6 of 8 states administered items on sexual behavior.

Of those students, between 3. Previous studies among older adolescents report contrasting findings regarding the sequence of sexual initiation. Several studies among 9th- and 10th-grade students indicate earlier initiation of oral sex compared to vaginal sex. Given this lack of detailed information, further epidemiological studies examining sexual behavior among middle school youth are needed to help prioritize effective sexual health education efforts.

The goals of the present study were to 1 examine the prevalence of vaginal, oral, and anal intercourse among a population of urban, public middle school seventh-grade students; 2 to examine the demographic characteristics of those youth who engaged in each type of sexual intercourse, and 3 to examine the sequence of initiation of the 3 types of sexual intercourse.

This information may help to prioritize needs for middle school sexual health education to prevent or mitigate the consequences of early sexual initiation among potentially high-risk youth populations. A total of eighty-nine percent of students were eligible for free or reduced-price lunches, an indicator of low socioeconomic status. Parental consents were returned by Students classified by the school as learning disabled or as having limited English proficiency ie, had their primary instruction in Spanish were excluded from the study sample, leaving youth eligible for participation.

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Reasons for nonparticipation included being absent on survey dates or refusal to participate. Data were collected between November and January ; student consent was obtained at the time of the survey. The survey contained multiple items addressing precoital behavior, sexual intercourse, and demographic characteristics.

To mitigate concerns from parents and school personnel regarding exposure of nonsexually experienced seventh-grade students to explicit questions regarding vaginal, oral, and anal sex, 2 precoital items were used to identify and screen for nonsexually experienced youth. Thus, the precoital items appeared to provide a valid and reliable strategy for avoiding overexposure to sensitive content in this age-group while collecting important information from those youth who were sexually experienced.

Only students who indicated participation in 1 or both of these precoital behaviors received items regarding sexual intercourse.

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For vaginal and anal sex, students who reported being currently sexually active were also asked about the frequency of intercourse without a condom during the past 3 months. Unfortunately, due to the need to limit the number of items, questions regarding condom use during oral sex were not included. Age was dichotomized as 12 years versus years since the majority of students were 12 years old.

Family structure was collapsed into 4 categories: living with 2 biological parents, living with 1 biological parent, living with 1 biological parent and a stepparent or partner, and other which included living with another relative or nonrelative.

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Surveys were administered on laptop computers via audio computer-assisted self-interview ACASI during regular school hours. Surveys were conducted in a quiet location such as an empty classroom or library. The use of ACASI systems has been found to be a valid and reliable method for obtaining sensitive information, including sexual risk-taking behavior, as it appears to increase the honesty of reporting over pencil-paper surveys.

It also allowed for an automatic skipping procedure to limit exposure of nonsexually experienced students to sexually explicit items. Prior to analysis, 5 students were removed from the data set due to missing data regarding lifetime intercourse, and 23 students were removed due to small counts for a specific age ages 11, 15, and 16 leaving a total sample of for analysis. Prevalence estimates of condom use for vaginal and anal sex were computed only for students who were currently sexually active ie, reported having sex in the past 3 months.

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Multivariate logistic regression analysis was used to examine associations between demographic variables and lifetime intercourse experience. Among students who had initiated more than 1 type of intercourse, frequencies were calculated to examine the relative age of initiation for each type of sex ie, whether a specific type of sex was initiated at a younger age, the same age, or an older age relative to the other type of intercourse.

Of seventh graders who participated in the study, Prevalence of sexual intercourse is reported in Table 2. Overall, 1 of 7 students Twelve percent of students reported engaging in vaginal intercourse, 7. Among students who were sexually experienced, approximately one quarter reported having 4 or more lifetime sexual partners and approx-imately two thirds reported being currently sexually active ie, they had sex within the past 3 months.

Among students who were currently sexually active, approximately one third reported having had vaginal or anal sex without a condom at least once during the past 3 months.

Several differences were reported by gender. Significantly higher percentages of males reported initiation of vaginal, oral, and anal sex. Significantly more males reported initiating vaginal and anal sex before age 11 compared to females. No significant gender differences were reported regarding current sexual activity or condom use. In other words, among youth who were sexually experienced, Hispanic youth were more likely to be currently sexually active regardless of type of intercourse.

With regard to condom use, a greater percentage of Hispanic youth reported having vaginal sex without a condom during the past 3 months compared to their peers.

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Age was significantly related to initiation of vaginal sex, with higher percentages of to year-olds reporting lifetime engagement compared to year-olds. No significant differences were reported by age in terms of age of sexual debut, current sexual activity, lifetime number of sexual partners, and condom use. Adjusted odds ratios presented in Table 3 indicate that male and black students were significantly more likely to report having engaged in each type of intercourse compared to female and Hispanic students, respectively.

Older students years indicated increased likelihood of engaging in vaginal intercourse. Students living in nontraditional family structures were almost times more likely to have engaged in vaginal and oral intercourse compared to students living in a 2-biological parent household. Among students who had engaged in more than 1 type of intercourse, vaginal intercourse was the most frequently reported type of sex.

Regarding the sequence of initiation, among students who reported engaging in both vaginal and oral sex, 66 Among students who reported engaging in both vaginal and anal sex, 57 This study was conducted to examine patterns of sexual intercourse among seventh-grade students in an urban public middle school.

One of 7 students This estimate is similar to the median percentage For all types of intercourse, students who were sexually experienced were more likely to be male and black, corroborating findings from previous studies.

Similar findings are observed for youth who experience peer victimization in their schools.

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In this study, vaginal intercourse was the most prevalent type of sexual intercourse reported. Most students who had engaged in both oral and vaginal intercourse, or anal and vaginal intercourse, reported initiating vaginal intercourse either at an earlier age or at the same age.

These results corroborate findings from the NSFG among to year-olds, which indicate that youth who have experienced vaginal sex are more likely to initiate other types of intercourse. Nearly as many students had engaged in anal inter-course 6. Furthermore, Although lifetime experience of anal intercourse was greater among blacks, recent anal activity was greater among Hispanic youth, which contrasts with data from older adolescents.

Approximately two thirds of students who reported being sexually experienced also reported being currently sexually active, that is, they had engaged in sex 1 or more times in the past 3 months. This underscores the need to provide youth with reasons and skills to delay further sexual activity once they become sexually experienced.

Among students who were currently sexually active, approximately one third reported having had vaginal or anal sex without a condom at least once in the past 3 months. This emphasizes the need to provide accurate information about condoms for contraceptive and disease prevention purposes. In addition, students who have been sexually active need to receive information and services related to STI and pregnancy testing, as well as skills training for future abstention or risk reduction if they intend to remain sexually active.

Several cts of the conduct of this study were important for obtaining approval from parents and school district personnel. Use of ACASI for questionnaire delivery was important for maintaining confidentiality of data and inclusion of precoital screening questions limited exposure of sexually inexperienced students to more explicit questions. However, several limitations must be also noted with respect to these findings.

First, the data were self-reported, which may raise concerns regarding reliability and validity. While use of ACASI has been demonstrated to increase reliability over other types of survey administration, 2829 the data may still reflect under- or overreporting.

However, this potential underreporting would result in more conservative prevalence estimates of sexual intercourse than overestimates, and the methodology still provided important information not otherwise available. Active parental consent was required for this study, which led to a lower response rate than desired.

Our response rate is similar, however, to other school-based studies, which have used active parental consent.

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The result is that the prevalence estimates in our study would be underestimated. Finally, all schools were recruited from a single school district, which limits external generalization to other urban middle school youth.

These findings indicate that a small percentage of early adolescents are engaging in multiple sexual risk behaviors. Effective, culturally sensitive school-based HIV, STI, and pregnancy prevention programs are needed at the middle school level to help reduce problems related to early sexual activity.

Furthermore, open discussion of the risks involved in all types of sexual intercourse by school nurses and health educators is recommended with this age group despite sensitivities surrounding sexual health issues.

National Center for Biotechnology InformationU. National Library of Medicine Rockville PikeBethesda M USA. NCBI Skip to main content Skip to navigation Resources How To About NCBI Accesskeys My NCBI Sign in to NCBI Sign Out. PMC US National Library of Medicine National Institutes of Health. Search database PMC All Databases Assembly Biocollections BioProject BioSample BioSystems Books ClinVar Conserved Domains dbGaP dbVar Gene Genome GEO DataSets GEO Profiles GTR HomoloGene Identical Protein Groups MedGen MeSH NCBI Web Site NLM Catalog Nucleotide OMIM PMC PopSet Protein Protein Clusters Protein Family Models PubChem BioAssay PubChem Compound PubChem Substance PubMed SNP SRA Structure Taxonomy ToolKit ToolKitAll ToolKitBookgh Search term.

Journal List HHS Author Manuscripts PMC J Sch Health. Author manuscript; available in PMC Feb PMCID: PMC NIHMSID: NIHMS Christine M. MarkhamPhD, a Melissa Fleschler PeskinPhD, b Robert C. AddyMA, c Elizabeth R. BaumlerPhD, d and Susan R. TortoleroPhD e.

Markham a Assistant Professor, ude. enitsirhcCenter for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, Fannin, 26th Floor, Houston, TX Find articles by Christine M. Melissa Fleschler Peskin b Assistant Professor, ude.

assilemCenter for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, Fannin, 26th Floor, Houston, TX Find articles by Melissa Fleschler Peskin.

Robert C. Addy c Data Analyst, ude. treborCenter for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, Fannin, 26th Floor, Houston, TX Find articles by Robert C. Elizabeth R. Baumler d Assistant Professor, ude. htebazilECenter for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, Fannin, 26th Floor, Houston, TX Find articles by Elizabeth R.

Susan R. Tortolero e Associate Professor, ude. nasuSCenter for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, Fannin, 26th Floor, Houston, TX Find articles by Susan R.

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