Historically, children have been thought of as innocent or incapable of sexual arousal (Aries, 1962). A more modern approach to sexuality suggests that the physical dimension of sexual arousal is present from birth. That said, it seems to be the case that the elements of seduction, power, love, or lust that are part of the adult meanings of sexuality are not present in sexual arousal at this stage. In contrast, sexuality begins in childhood as a response to physical states and sensation and cannot be interpreted as similar to that of adults in any way (Carroll, 2007).

Video 4.3.1. “What Happens When?” Child and Adolescent Sexual Development explains major milestones in sexual development throughout childhood and adolescence, as well as how to support kids during these stages.

Infancy

Boys and girls are capable of erections and vaginal lubrication even before birth (Martinson, 1981). Arousal can signal overall physical contentment and stimulation that accompanies feeding or warmth. Infants begin to explore their bodies and touch their genitals as soon as they have sufficient motor skills. This stimulation is for comfort or to relieve tension rather than to reach orgasm (Carroll, 2007).

Early Childhood

Self-stimulation is common in early childhood for both boys and girls. Curiosity about the body and about others’ bodies is a natural part of early childhood as well. Consider this example. A mother is asked by her young daughter: “So it’s okay to see a boy’s privates as long as it’s the boy’s mother or a doctor?” The mother hesitates a bit and then responds, “Yes. I think that’s alright.” “Hmmm,” the girl begins, “When I grow up, I want to be a doctor!” Hopefully, this subject is approached in a way that teaches children to be safe and know what is appropriate without frightening them or causing shame.

As children grow, they are more likely to show their genitals to siblings or peers, and to take off their clothes and touch each other (Okami et al., 1997). Masturbation is common for both boys and girls. Boys are often shown by other boys how to masturbate, but girls tend to find out accidentally. Boys masturbate more often and touch themselves more openly than do girls (Schwartz, 1999).

Hopefully, parents respond to this without undue alarm and without making the children feel guilty about their bodies. Instead, messages about what is going on and the appropriate time and place for such activities help the child learn what is appropriate.

Parents should take the time to speak with their children about when it is appropriate for other people to see or touch them. Many experts suggest that this should occur as early as age 3, and of course the discussion should be appropriate for the child’s age.  One way to help a young child understand inappropriate touching is to discuss “bathing suit areas.” Kids First, Inc. suggests discussing the following: “No one should touch you anywhere your bathing suit covers. No one should ask you to touch them somewhere that their bathing suit covers. No one should show you a part of their or someone else’s bodies that their bathing suit covers.” Further, instead of talking about good or bad touching, talk about safe and unsafe touching. This way children will not feel guilty later on when that sort of touching is appropriate in a relationship.

Adolescence

Developing sexually is an expected and natural part of growing into adulthood. Healthy sexual development involves more than sexual behavior. It is the combination of physical sexual maturation (puberty, age-appropriate sexual behaviors), the formation of a positive sexual identity, and a sense of sexual well-being (discussed more in-depth later in this module). During adolescence, teens strive to become comfortable with their changing bodies and to make healthy, safe decisions about which sexual activities, if any, they wish to engage in.

Earlier in the physical development section, we discussed primary and secondary sex characteristics. During puberty, every primary sex organ (the ovaries, uterus, penis, and testes) increases dramatically in size and matures in function. During puberty, reproduction becomes possible. Simultaneously, secondary sex characteristics develop. These characteristics are not required for reproduction, but they do signify masculinity and femininity. At birth, boys and girls have similar body shapes, but during puberty, males widen at the shoulders and females widen at the hips and develop breasts (examples of secondary sex characteristics). Sexual development is impacted by a dynamic mixture of physical and cognitive change coupled with social expectations. With physical maturation, adolescents may become alternately fascinated with and chagrined by their changing bodies, and often compare themselves to the development they notice in their peers or see in the media. For example, many adolescent girls focus on their breast development, hoping their breasts will conform to an ideal body image.

As sex hormones cause biological changes, they also affect the brain and trigger sexual thoughts. Culture, however, shapes actual sexual behaviors. Emotions regarding sexual experience, like the rest of puberty, are strongly influenced by cultural norms regarding what is expected at what age, with peers being the most influential. Simply put, the most important influence on adolescents’ sexual activity is not their bodies, but their close friends, who have more influence than do sex or ethnic group norms (van de Bongardt et al., 2015).

Sexual interest and interaction are a natural part of adolescence. Sexual fantasy and masturbation episodes increase between the ages of 10 and 13. Masturbation is very ordinary—even young children have been known to engage in this behavior. As the bodies of children mature, powerful sexual feelings begin to develop, and masturbation helps release sexual tension. For adolescents, masturbation is a common way to explore their erotic potential, and this behavior can continue throughout adult life.

Sexual Interactions

Many early social interactions tend to be nonsexual—text messaging, phone calls, email—but by the age of 12 or 13, some young people may pair off and begin dating and experimenting with kissing, touching, and other physical contact, such as oral sex. The vast majority of young adolescents are not prepared emotionally or physically for oral sex and sexual intercourse. If adolescents this young do have sex, they are highly vulnerable to sexual and emotional abuse, sexually transmitted infections (STIs), HIV, and early pregnancy. For STI’s in particular, adolescents are slower to recognize symptoms, tell partners, and get medical treatment, which puts them at risk of infertility and even death.

Adolescents ages 14 to 16 understand the consequences of unprotected sex and teen parenthood, if properly taught, but cognitively they may lack the skills to integrate this knowledge into everyday situations or consistently to act responsibly in the heat of the moment. By the age of 17, many adolescents have willingly experienced sexual intercourse. Teens who have early sexual intercourse report strong peer pressure as a reason behind their decision. Some adolescents are just curious about sex and want to experience it.

Becoming a sexually healthy adult is a developmental task of adolescence that requires integrating psychological, physical, cultural, spiritual, societal, and educational factors. It is particularly important to understand the adolescent in terms of his or her physical, emotional, and cognitive stage. Additionally, healthy adult relationships are more likely to develop when adolescent impulses are not shamed or feared. Guidance is certainly needed, but acknowledging that adolescent sexuality development is both normal and positive would allow for more open communication so adolescents can be more receptive to education concerning the risks (Tolman & McClelland, 2011).

Adolescents are receptive to their culture, to the models they see at home, in school, and in the mass media. These observations influence moral reasoning and moral behavior, which we discuss in more detail later in this module. Decisions regarding sexual behavior are influenced by teens’ ability to think and reason, their values, and their educational experience. Helping adolescents recognize all aspects of sexual development encourages them to make informed and healthy decisions about sexual matters.

Teenagers are much more sexually active today than they were before the sexual revolution of the 1960s and 70s. About 43 percent of never-married teens ages 15–19 of both sexes have had sexual intercourse (Martinez et al., 2011); this percentage represents a drop from its highest point, in 1988, of 51 percent for females and of 60 percent for males. About three-fourths of girls in today’s sexually experienced group and 85 percent of boys in this group use contraception, most often a condom, the first time they ever have sex. In their most recent act of sexual intercourse, almost 86 percent of girls and 93 percent of boys used contraception, again most often a condom.

If 43 percent of teens have had sexual intercourse, that means the majority of teens, 57 percent, have never had intercourse. It is interesting to examine their reasons. The table below identifies the main reason given for never having sexual intercourse. The top reason for both sexes is religion and morals, followed by concern about a possible pregnancy and not having found the right person with whom to have sex (Martinez et al., 2011).

Table 1. Main Reason Given for Never Having Sexual Intercourse, Ages 15–19 (%)

	Females	Males
Against religion or morals	38	31
Don’t want to get (a female) pregnant	19	25
Haven’t found the right person yet	17	21
Don’t want to get an STI	7	10
In a relationship, but waiting for the right time	7	5
Other reason	12	8

Most teenage pregnancies and births are unplanned and are part of a more general problem for all women in their childbearing years. Almost 700,000 unplanned teenage pregnancies occur annually; another 50,000 teenage pregnancies are planned. These 750,000 teenage pregnancies annually result in some 400,000 births (Kost, Henshaw, & Carlin, 2010). Altogether, about 18 percent of women, or one of every six females, become teen mothers, and in several southern and southwestern states, this percentage is as high as 25–30 percent (Perper & Manlove, 2009).

The birth rate for females aged 15–19 in 2009 was 39.1 births per 1,000 females. This rate represented a substantial decline from the early 1990s when the rate reached a peak of almost 60. However, it was still twice as high as Canada’s rate and much higher yet than other Western democracies (Figure 1).

Figure 1. Teenage Birth Rates in Selected Western Democracies

 

Although teenaged pregnancies (and births from these pregnancies) are far from the majority of all pregnancies, unplanned or planned, they pose special problems (American College of Obstetricians and Gynecologists, 2011; Anderson, 2011). On the individual level, pregnant teenagers are more at risk than older pregnant women for high blood pressure and anemia, and they are also more likely to experience early labor, premature birth, and low birth weight. In addition, because teenagers are more likely than adults to have STIs, pregnant teenagers are more likely than older pregnant women to have an STI while they are pregnant, either because they already had an STI when they conceived or because they contract an STI from having sex during pregnancy.

Many pregnant teenagers decide to drop out of school. If they stay in school, they often must deal with the embarrassment of being pregnant, and the physical and emotional difficulties accompanying their teenage pregnancy can affect their school performance. Once the baby is born, child care typically becomes an enormous problem, whether or not the new mother is in school. Because pregnant teenagers disproportionately come from families that are poor or near-poor, they have few financial resources and often have weak social support networks, either before or after the baby is born (Andrews & Moore, 2011).

At the societal level, teenage pregnancy and motherhood are very costly in at least two important respects. First, because pregnancy and childbirth complications are more common among teenagers, their health-care expenses during and after pregnancy and childbirth are often higher than the expenses incurred by older women. Medicaid, the federal government’s national health plan for poor families, often covers much of these expenses, and the premiums that private health insurance companies charge are higher than otherwise because of their expenses when they insure the families of pregnant teenagers.

Second, the children of teenage mothers are at risk for several kinds of behavioral and developmental problems. Teenage parents may be unprepared emotionally or practically to raise a child. Children of teen parents may receive less cognitive stimulation and proper emotional support. In addition, the stress they experience as young parents put them at risk of neglecting or abusing their children. Teenage parents also tend to come from low-income families and continue to live in poverty or near poverty after they become mothers compounds all these problems. For all these reasons, the children of teenage mothers are at greater risk for several kinds of issues. These problems include impaired neurological development, behavioral problems, poor school performance, and chronic health problems.

In an effort to reduce teenage pregnancies, two approaches have been used: (1) Emphasize abstinence, convincing teens to hold off on having sex until adulthood or marriage, and (2) comprehensive sex education, including teaching the effective use of contraception if they do have sex. Most sexual behavior researchers believe that pleas for abstinence, as well as sex education programs that focus solely or almost entirely on abstinence, do not help to reduce teen sex and pregnancy (Ball & Moore, 2008).

Comprehensive sex education is based on the strategy of harm reduction. A harm reduction approach recognizes that because certain types of harmful behavior are inevitable, our society should do its best to minimize the various kinds of harm that these various behaviors generate. In regard to teenage sex and pregnancy, a harm reduction approach has two goals: (1) to help reduce the risk for pregnancy among sexually active teens and (2) to help teenage parents and their children.

To achieve the first goal, parents, sex education classes, family planning clinics, youth development programs, and other parties must continue to emphasize the importance of waiting to have sex but also the need for teenagers to use contraception if they are sexually active. In addition, effective contraception (birth control pills, other hormonal control, and even condoms, which protect against STIs) must be made available for teenagers at little or no cost. Studies indicate that these two contraception strategies do not lead to more teenage sex, and they also indicate that consistent contraceptive use dramatically reduces the risk of teenage pregnancy. As one writer has summarized these studies’ conclusions, “Contraceptives no more cause sex than umbrellas cause rain…When contraception is unavailable, the likely consequences is not less sex, but more pregnancy” (Kristof, 2011, p. A31).

In this regard, a recent report of the Guttmacher Institute called contraception a “proven, cost-effective strategy” (Gold, 2011, p. 7). It added, “Contraception is almost universally accepted as a way to reduce the risk of unintended pregnancy…Contraceptive use reduces the risk of unintended pregnancy significantly, and consistent contraceptive use virtually eliminates it.” The report noted that government-funded family planning agencies prevent 2 million unintended pregnancies annually by providing contraception to 9 million young and low-income women each year. Because most of the women who would have these prevented pregnancies would be eligible for Medicaid, the Medicaid savings from these prevented pregnancies amount to about $7 billion annually. An expansion of family planning services would almost certainly be an effective strategy for reducing teenage pregnancies as well as unplanned pregnancies among older women.

Another strategy to prevent teenage pregnancy involves the use of early childhood intervention (ECI) programs. Many such programs exist, but they generally include visits by social workers, nurses, and other professionals to the homes of children who are at risk for neurological, emotional, and/or behavioral problems during their first several years and also as they grow into adolescents and young adults (Kahn & Moore, 2010). It might sound like a stereotype, but these children are disproportionately born to single, teenage mothers and/or to slightly older parents who live in poverty or near poverty. Long-term evaluation studies show that the best of these programs reduce the likelihood that the very young children they help will become pregnant or have children of their own after they become teenagers (Ball & Moore, 2008). In effect, assisting young children to today helps prevent teenage pregnancy tomorrow.

The second prong to this harm reduction strategy targets teenage parents and their children. Because teen pregnancies occur despite the best prevention efforts, the second goal of a harm reduction approach is to help teens during their pregnancy and after childbirth. This strategy has the immediate aim of providing practical and emotional support for these very young mothers; it also has the longer-term goals of reducing repeat pregnancies and births and of preventing developmental and behavior problems among their children.

To achieve these aims, Early Childhood Intervention programs have again been shown to be helpful (Ball & Moore, 2008). Another type of program to help teen mothers involves the use of second-chance homes, which are maternity group homes for unmarried teen mothers (Andrews & Moore, 2011). One of the many sad facts of teenage motherhood is that teen mothers often have nowhere to live. A teen mother’s parent(s) may refuse to let her and her infant live with them, either because they are angry at her pregnancy or because they simply do not have the room or financial means to house and take care of a baby. Or a pregnant teen may decide to leave her parents’ home because of the parents’ anger or because they refuse to let her continue seeing the child’s father. In another possibility, a teen mother may begin living with the father, but these unions are typically unstable and often end, again leaving her and her child without a home. As well, many teen mothers were runaways from home before they became pregnant or were living in foster care. Because of all these situations, many teen mothers find themselves without a place to live.

In second-chance homes (which, depending on the program, are in reality one large house, a set of apartments, or a network of houses), mothers and children (as well as pregnant teens) receive shelter and food, but they also receive essential services, such as childrearing help, educational and vocational counseling and training, family planning counseling, and parenting classes. Although rigorous evaluation studies do not yet exist on the effectiveness of second-chance homes, they do seem to offer a valuable resource for teen mothers and their children (Andrews & Moore, 2011).

A final strategy for addressing the problem of teenage sex and pregnancy is to address a more general societal condition that helps produce teenage sex and pregnancy. This condition is poverty. As noted earlier, children who grow up in poor families and in disadvantaged neighborhoods—those with high rates of poverty, unemployment, high school dropouts, and so forth—are more likely to have sex earlier as teens and to become pregnant (Harding, 2003; Scott, Steward-Streng, Barry, & Manlove, 2011).

In addition to pregnancy and birth, another problem associated with teenage sexual activity is the transmission of sexually transmitted infections (STIs). This is a problem during the teenage years, but it is even more of a problem during young adulthood, when sexual activity is higher than during adolescence (Wildsmith, Schelar, Peterson, & Manlove, 2010). The STI rate in the United States is higher than in most other Western democracies. Almost 19 million new cases of STIs are diagnosed annually, and more than 65 million Americans have an incurable STI, such as herpes. Although teens and young adults ages 15–24 compose only one-fourth of sexually active people, they account for one-half of all new STIs. Despite this fact, most young adults who test positive for an STI did not believe they were at risk of getting an STI (Wildsmith et al., 2010).

In any one year, 15 percent of young adults ages 18 and 26 have an STI. This figure masks a significant gender difference: 20 percent of young women have had an STI in the past year, compared to 10 percent of young men. It also masks important racial/ethnic differences: 34 percent of young African Americans have had an STI in the past year, compared to 10 percent of Asians, 15 percent of Hispanics, and 10 percent of whites.

Three types of sexual behaviors increase the risk of transmitting or contracting an STI: having sex with at least three partners during the past year, having a sex partner with a known STI, and not using a condom regularly. About 17 percent of sexually active young adults have had at least three partners during the past year, and 8 percent have had a partner with a known STI. Three-fourths of unmarried sexually active young adults do not use a condom regularly. Combining all these risk factors, 39 percent have engaged in one risk factor in the past year, 14 percent have engaged in at least two risk factors, and the remainder, 48 percent, have engaged in no risk factors (Wildsmith et al., 2010).