Presentation on theme: "Adolescent Brain Development and Sexual Decision Making"— Presentation transcript:
1 Adolescent Brain Development and Sexual Decision Making Freda McKissic Bush, MD, FACOGClinical Instructor, University of MississippiJackson, MSMay 14, 2010
2 The Questions What happens inside the brain when teens have sex? How they can successfully handle the challenge for a lifetime of healthy living?
3 What Is Sex?Sexual activity is defined as any bodily contact meant to derive or give sexual gratification.Horan PF, et al J HIV/AIDS Prev and Educ for Adolescenc and ChildrenSexual activity defined: Any intimate contact between two individuals that involves arousal, stimulation, and/or a response by at least one of the two partners. It also applies to one person if self stimulation is used.
4 Teen Pregnancy 1 More than 700,000 teens become pregnant each year. 1 in 3 become pregnant at least once before age 20.8 out of 10 teen fathers don’t marry the teen mother of their baby.7 out of 10 unwed mothers receive no financial support from the fathers of their childrenLess than 2 out of 3 teen mothers graduate from high school or earn a GED within two years of giving birth.1 McIlhaney and Bush, Hooked, 2008Both teenage mothers and fathers tend to have unrealistic expectations about parenthood and have difficulty adjusting to teen parenthood.Becoming a parent before age 18 significantly reduces the likelihood of graduation from high school for both boys and girls. Teen parents who obtain a GED have even lower lifetime earnings than those who graduate from high school. Teen parents who graduate from high school or earn a GED are less likely than their peers to go to college.2
5 Emotional Consequences of Sexual Activity Pain and suffering from broken relationshipsFear, confusion about romantic feelingsAltered self-esteemSense of betrayal and abandonmentGuilt, depression and emotional rollercoasterImpaired ability to form healthy long-term relationships
6 Sexual activity involves more than just your physical body Sexual activity involves more than just your physical body. It is an integral part of who you are not just what you do. When we separate the physical then sex becomes just a raw animal act. Like dogs: they do it and keep going to the next dog. Humans are not dogs.
7 How Neuroscience Has “Opened” the Brain for Study MRI (Magnetic Resonance Imaging)Utilizes magnets instead of x-rayCan therefore be done repetitively on an individual without brain damagefMRI (Functional MRI)Functioning brain tissue utilizes oxygen. Increased blood flow to an area of the brain that has become active can be detected by fMRI.PET (Positron Emission Tomography)A patient is given a safe dose of a positron emitting radioisotope on a metabolically active molecule.For brain function study FDG (fluorodeoxyglucose), a modified glucose molecule is often used. PET detects active areas of the brain by identifying concentration of isotope in those areas.Fisher, et al. J. Comp Neural, 2005Jer-Pogossian, et al. Radiology, 1975
8 The Brain Parietal Lobe Frontal Lobe Occipital Lobe Cerebellum The brain has been called the largest sex organ in the body. Sexual excitement is actually centered in the brain. It is possible to be stimulated and even achieve orgasm without any physical contact with the sexual organs.CerebellumBrain Stem
9 Sagittal View of the Human Brain Frontal LobeParietal LobeOccipital LobeSLIDE 3:Introduce the parts of the brain:This is a mid-sagittal view or an image of the brain as if it were cut right down the middle of your head.The major parts of the brain (which is part of the central nervous system) are:Brainstem: The brain stem plays a vital role in basic attention, arousal, and consciousness. All information to and from our body passes through the brain stem on the way to or from the brain. (midbrain, pons, medulla oblongata)Cerebellum: Important for coordination, balance, and control of voluntary movements.Cerebrum: The cerebrum includes the cerebral hemispheres and the diencephalon (thalamus and hypothalamus).- Only three of the four lobes of the cerebral cortex are identified here.The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgment, impulse control, and social and sexual behavior. The frontal lobes are extremely vulnerable to injury due to their location at the front of the cranium (plug helmets!).The parietal lobes process sensory information (i.e. touch). They are also involved in spatial processing (i.e. forming mental map).The occipital lobe is involved in visual processing (i.e. color discrimination, movement processing, form processing).The lobe that cannot be viewed from this sagittal image is the temporal lobe (can be viewed on next slide).CerebellumBrainstem
10 The Brain Three pounds 10 billion neurons 100 billion support cells 100 trillion connections(more than all of the internet connections in the world)THE BODY EXHIBIT at the Bellagio, Las VegasGirl’s brains = 2.5% of their body weight; boy’s brains = 2%Dura mater “tough mother”Nervous system_ faster than world’s most powerful computer; regulates all body’s vital functions. Also, processes all thoughts & emotionsCarrying signals over 270 mi/hr.Brain requires 20% of the body’s total blood supply
11 One Fundamental Understanding of Brain Development – The prefrontal cortex is not fully mature until the mid-twenties1EX: Rental car companies will not rent a car to young people under age 25 due to damage potential to their property from risk taking young people do.Giedd, et al. Nature Neuroscience, 1999Weinberger, et al. The Adolescent Brain, 2005
12 The prefrontal cortex is the source of JudgmentSeeing into the futureSeeing how behavior can affect the futureMoral intelligenceAbstract thinkingSeeing what is not obviousPlanning for the futureRational behavior and decision makingUnderstanding rules of social conductFAIR=Forward thinking; Assessing risk and abstract thinking; Impulsive behavior control and decision making; Rules of social conductGiedd, et al. Neuroscience, 1999Weinberger, et al. The Adolescent Brain, 2005.
13 Brain Development – Age 5 Images courtesy of Jay Giedd, MD, National Inst of Mental Health
14 Brain Development – Age 8 Images courtesy of Jay Giedd, MD, National Inst of Mental Health
15 Brain Development – Age 12 Images courtesy of Jay Giedd, MD, National Inst of Mental Health
16 Brain Development – Age 16 Images courtesy of Jay Giedd, MD, National Inst of Mental Health
17 Brain Development – Age 20 Images courtesy of Jay Giedd, MD, National Inst of Mental Health
18 What happens inside the brain when teens have sex?
19 What The Anatomy Doesn’t Show- Neurochemicals More than 100 have been identifiedReceptors must be present in the brain for these substances to be active – the more receptors, the more active.They have a powerful impact on our cognition and behavior and ultimate brain structure
20 Dopamine Dopamine is secreted into the brain in response to: ExcitementPleasureNew thingsAdventureRisk takingAddictive drugsVolkow (referenced in The Primal Teen, p. 94)
21 DopamineDopamine causes a person to feel good by producing intense energy, exhilaration, and focused attention.Dopamine is involved in the feeling of need or desire to repeat pleasurable acts. Therefore, dopamine presence is termed a “reward signal.”Strauch. The Primal Teen, 2003.Arias-Carrion, et al. Act Neurobiol Exp 2007
22 Dopamine – The Good and the Bad Dopamine can be a reward signal for the excitement of learning, maturing, new relationships, and the possibility of a bright future.orDopamine can be a reward signal for the excitement of drugs, sex, violence, and other risky behaviors that threaten the adolescent’s future, including the final structure of their brains.
23 Dopamine and “Addiction” Addiction is defined by Dorland as “ the state of being given up to some habit, especially strong dependence on a drug”1“Then there’s the addictive quality. For men and women alike, dopamine – the chemical that injects intense pleasure in activities as diverse as gambling and drug addictions rockets during sexual encounters.”2Dorland. Medical Dictionary 27th EdGoleman. Social Intelligence
24 Oxytocin and Vasopressin Sexual intercourse releases large amounts of oxytocin into the female brain and vasopressin into the male brainBoth hormones promote bonding with a sexual partner1Lechman, 1999Brizendine, 2007, p. 71
25 Oxytocin and Vasopressin Even if you don’t particularly feel attracted to someone, if you have enough sexual stimulation with them, oxytocin and vasopressin may cause an“involuntary chemical commitment”orstrong emotional attachments.(Morse, JR,, 2006.)“Bonding hormones help explain the remarkable propensity of battered women to return to the very men who abused them. Our hormonal response to touch, to sex, and to proximity is so powerful it can trump our better judgment about what is truly in our interests
26 Oxytocin Engenders Trust Oxytocin is naturally released in the brain after a 20 second hug from a partner – sealing the bond between the huggers and triggering the brains trust circuits.WARNING: “Don’t let a guy hug you unless you plan to trust him.”The “trust” impact of oxytocin is so pronounced that Louann Brizendine, M.D., a neuropsychiatrist at the University of California states “from an experiment on hugging, we also know that oxytocin is naturally released in the brain after a 20 second hug from a partner – sealing the bond between the huggers and triggering the brains trust circuits, so don’t let a guy hug you unless you plan to trust him.”Brizendine. “The Female Brain”, 2006
27 Men and VasopressinThe male brain has many more receptors for vasopressin.1Sexual intercourse releases large amounts of vasopressin into the male brain1Vasopressin in the male brain promotes bonding with a sexual partner1And bonding with their offspring according to studies with prairie voles.Lechman. Child Adolescent Psychiatry elin N Am, 1999Brizendine. “The Female Brain” 2007
28 PheromonesChemicals secreted from the skin and sweat glands of many animals and from human males and females1These chemicals are unconsciously detected by the female nose (but not the male) 1These chemicals can influence a woman’s attraction to a man and her sexual satisfaction with him 21. McClintock, et. al. Chem. Senses 30 (Supply 1) 2005
29 SerotoninSerotonin, among other actions, is a calming neurohormone that has been shown to decrease in people madly in love to levels similar to those found in individuals with obsessive-compulsive disorder.Therefore, people newly in love are less calm and may act somewhat obsessive-compulsive.OCD is characterised by low levels of a chemical called serotonin. Drugs such as Prozac work by keeping serotonin hanging around in the brain for longer than normal, so they might stave off romantic feelings. (This also means that people taking anti-depressants may be jeopardising their ability to fall in love.) But once romantic love begins in earnest, it is one of the strongest drives on Earth. Dr Fisher says it seems to be more powerful than hunger. A little serotonin would be unlikely to stifle it.Marazziti, D. The National Geographic, 2006
30 Lust, Infatuation and Mature Love Each of these result in dynamic and visible brain activityEach of these produce activity in different areas of the brainStrauch. “The Primal Teen”, 2003Leckman. Child Adolesc Psychiatry. elin N Am. 19993030
31 Lust, Infatuation and Mature Love One individual cannot tell if another person’s interest is a result of lust or love – only time and other behaviors can reveal the differenceLust is a powerful emotional state and can cause people to do things that they would not ordinarily do, often for self-gratification.“Early love” is also a powerful emotional state, but, in general, is oriented toward caring for the other person.
32 Connectedness and SexWhen a person’s body is in intimate contact with another person, the entire person is “connected” with the other1,2A person’s inborn need for and ability to connect with another person is a human characteristic that must be nurtured and protected for a person to prosper1,2Sex can greatly benefit this connectionor can greatly damage itBonding occurs even with one act of intercourse. Repeated acts produce even stronger bonds through the neurohormones making impressions on the synapses in the brain.Light. Biol Psychol, 2005Schore. “Affect Dysregulation and Disorders of the Self”, 200332
33 Sex, Is a Powerful Brain Experience- Two Powerful Brain Events Seem to Sex, Is a Powerful Brain Experience- Two Powerful Brain Events Seem to Always Occur As A ResultAttachment (bonding) to the sexual partnerDesire for repetition of sex acts (“addiction”)Both teenage mothers and fathers tend to have unrealistic expectations about parenthood and have difficulty adjusting to teen parenthood.Becoming a parent before age 18 significantly reduces the likelihood of graduation from high school for both boys and girls. Teen parents who obtain a GED have even lower lifetime earnings than those who graduate from high school. Teen parents who graduate from high school or earn a GED are less likely than their peers to go to college.2Young females who marry after becoming teen mothers are more likely to divorce and spend more years as single mothers than females who wait until marriage to become mothers. Teen mothers have more problems with pregnancy and delivery than older females and their babies are less healthy. Pregnant teens, especially unmarried teens, are less likely to receive adequate prenatal care.1Emotional and intellectual development during the teen years, when adolescents should be developing a sense of identity and independence from their parents while growing and developing as individuals through normal teen activities such as peer relationships, dating, school, and career choices, is significantly disrupted by the demands and responsibilities of teen parenthood.1Teens who follow the “ideal” pathway from adolescence to adulthood to parenthood have the best chance of a happy life. The first steps for teens to take in the transition from adolescence to adulthood are completing their education before leaving the family home, developing a career, and finding a permanent job. After achieving emotional and financial independence, a young adult finds a suitable partner, marries, and establishes an emotionally stable relationship and a financially stable household. The birth of the first child and the transition to parenthood is the final step in the transition to adulthood. Yet only a small number of teen parents complete their education before the birth of their first child, and may not ever achieve any of the other steps, such as finding a suitable partner, a permanent job, or establishing a financially stable household.Weinberger, et.al., The Adolescent Brain, 1999.References:Coley RL, Chase-Lansdale PL. Adolescent pregnancy and parenthood: recent evidence and future directions. Am Psychol. 1998;53(2): Available as “in press” publication at: uchicago.edu/About/publications/working-papers/pdf/wpsup_01.pdf. Accessed September 14, 2005.Alan Guttmacher Institute. Facts in Brief: Teen Sex and Pregnancy. New York, NY:Alan Guttmacher Institute; Available at: Accessed September 13, 2005.
34 Use It or Lose It Molds the Brain SOURCES: Dr. Jay Giedd, Chief of Brain Imaging, Child Psychiatric Branch—NIMH; Paul Thompson; Andrew Lee; Kiralee Hayashi;Arthur Toga—UCLA Lab of Neuro Imaging and Nitin Gogtay; Judy Rapoport—NIMH Child Psychiatry Branch. TIME Diagram by Joe Lertola. TIME.com graphic by Garrett Rosso. The Image Bank—Getty Images from the May 10, 2003 issue of TIME MAGAZINE34
36 Brain Molding – The Unexpected Reality A reciprocal pattern of brain function causes physical change (molding) of our brainsWe initiate an action or thoughtWe repeat the action or thoughtThe experience of the action or thought physically molds our brains to habitually repeat the action or thoughtGiedd et al 2005363636
37 What About Bonding And The Sexually Active Adolescent? Bonding always occurs with sexual involvement as far as science can tell1The cycle of sexual involvement – break up- sexual involvement – break up is the pattern many young people experience2Young, et al, 2001Independent Women’s Forum Survey, 2001
38 The Emotional Truths50% of teen relationship break up within 6 months of beginningDepression and Suicide is higher in sexually active teens
39 Broken Bonding, Repetitively Experienced, Seems to Often Damage the Human Ability to “Bond” (to Connect)Individuals who have had multiple sexual partners prior to marriage are more likely to divorce when they do marry than individuals who did not have multiple partners prior to marriage1Couples who cohabit before marriage are more likely to divorce when they do marry than couples who did not cohabit 2Kahnetal. J of Marriage and Fam, 1991Lee, et al. Demography, 1995
40 Young People are Crying Out for Help 90% of high school students think they all need a strong abstinence message from all society2/3 of high school students think it is wrong for high schoolers to have sex even if they use condoms and contraceptivesNational Campaign to Prevent Teen and Unintended Pregnancy – Various Surveys
41 Young People are Crying Out for Help 2/3 of students who have had sex wish they had waitedSince 2/3 of high school students have had sexual intercourse by graduation, we know many of these students were sexually activeNational Campaign to Prevent Teen and Unintended Pregnancy – Various Surveys00
42 Healthy Brain MoldingThe brain learns by trial and error, particularly from the age of 18 onMistakes are supposed to be made by adolescentsThe role of parents and caring adults is to provide boundaries within which a young person can make decisions including mistakes, as safely as possible.The brain is plastic and can be remolded. Parents have a powerful influence on teens. Parents need to understand safe sex is not safe enough.
43 How can teens successfully handle the challengefor a lifetime of healthy living?
44 Dopamine – The Good and the Bad Dopamine can be a reward signal for the excitement of learning, maturing, new relationships, and the possibility of a bright future.orDopamine can be a reward signal for the excitement of drugs, sex, violence, and other risky behaviors that threaten the adolescent’s future, including the final structure of their brains.
45 RISK TAKING Clothes: Immodest, Sexy/provocative Make-up: Mature “Girls Gone Wild”Curiosity with Gay & Lesbian lifestyleDrugsDrag racingDropping out of school
46 Spanning Tree Sexual Network (n=286) In a period of 18 months more than 50% of students at this high school were chained together through romantic and sexual relationships that could have involved exchange of fluids. This is one of the most efficient ways of transmission of disease. There were almost 35% or 189 students who were part of isolated partnerships like the one shown in a box. In this case the partners had no other sex partners before or after the relationship.DiadBearman, Moody, & Stovel. 2004
47 Delay of Intercourse Reduces Number of Partners Average number oflifetime partnersAge at sexual debutSource: The Heritage Foundation
49 Risk AvoidanceAbstinence is the calculated decision and deliberate action to refrain from sexual activity.The only truly effective and practical method to prevent sexually transmitted diseases (STIs) and nonmarital pregnancies.The method that increases the ability to form healthy long term emotional relationships.4949
50 Risk Reduction Condoms Contraception Alternative Behaviors Sexual activity defined: Any intimate contact between two individuals that involves arousal, stimulation, and/or a response by at least one of the two partners. It also applies to one person if self stimulation is used.
51 Planned Parenthood “Safer Sex” is about protection and pleasure Safe “Secure fromdanger, harm or evil”“Safer Sex” is about protection and pleasureOutercourseMutual MasturbationBody RubbingSex ToysOral SexAnal SexPlanned Parenthood: “Sex-Safer and Satisfying”, 9/6/0451
52 Condom Effectiveness in STD Prevention CONDOM EFFICACYpreventing HIV transmission – 85%risk reduction for gonorrhea in men approximately – 50%no evidence for risk reduction for HPVinsufficient evidence for preventionof all other STDsA comprehensive study of all the research available on condom efficacy was conducted by the National Institute of Health (NIH) in The NIH study titled “Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease Prevention”, foundstrong evidence for condom effectiveness in preventing HIV transmission in both men and women with vaginal intercourse with the average efficacy rate being 85% ;risk reduction for gonorrhea in men at approximately 50% efficacy ;no evidence for risk reduction for HPV infection, though perhaps some for warts in men and cervical cancer in women; andinsufficient evidence for syphilis, herpes, and chancroid.CHANGE – Bullet #4 last sentence to “All other STDs”Source: National Institute of Health, “Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease Prevention”, July 2001Source: National Institute of Health, “Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease Prevention”, July 200152
53 New Studies Published After NIH Report 126,220 patientsOnly 16% always used a condomIn “Always condom use” –risk reduction for gonorrhea and Chlamydia 34%Shlay, 200453
54 New England Journal of Medicine June 22, 2006 82 virgin women U. of WashingtonGYN exams every 4 months100 % condom useElectronic diaries of daily sexual activityNumber of instances of vaginal intercourseFrequency of male condom useNumber of new partners54
55 New England Journal of Medicine June 22, 2006 14 virgins had sex with virgins40 did not know if partners were experiencedMedian # of intercourse 48/ yearMedian number new partners 1/ year55
56 New England Journal of Medicine June 22, 2006 82 virgin women54 partners not known to have ever had sex beforeConclusion: Among newly sexually active women, consistent condom use by their partners appears to reduce the risk of cervical and vulvovaginal HPV infection56
57 Contraception and Teen Pregnancy 20% of those aged using birth control pill get pregnant within six months.20% of teens younger than 18 using condoms get pregnant within one year.
58 Immunization Gardasil HPV Vaccine Quadrivalent Vaccine Types 6,11,16 and 18100% effective against these serotypesNot effective once seropositiveProposed indicationsRoutine - Girls 11-12Catch upThree doses0, 2 and 6 months ($360)CDC fact sheet June 2006
59 Adolescents Need Adult Guidance Until the mid-twenties young people do not have the physical brain capacity to make fully mature decisionsWe abandon adolescents to the impossibility of mature decision making if we just give them information and then say “do what you think is best”.(This reality applies through the mid 20s.)Giedd, et al 1999
60 Sexual health comes from a positive self-image based on strong characteristics Self controlPersonal responsibilityHonestyKindnessRespect for yourself and others
61 What do teens say will help? Ask questions.Encourage practical tips:“SET BOUNDARIES””-Don’t go to parties where there is no parent.-Don’t go to private places to “make out”.-Role play helping them to avoid a situation. Come up with phrases that don’t sound cheesy.-Encourage them to hang out with groups.
62 The Planning for Sex The Promise of Sex Decision Making= S T O P; DROP & ROLLState the decision; Write it downTalk about your feelings and needsOptions are considered.Pick the best option and evaluate the resultsDROP the pretence: “Aim to abstain.”Be ready to ROLL. “Run, baby, run!”Make a Decision; Make it plain.
66 Live out your values- model the behavior you desire of her; get rid of your guilty feelings from the past.Reinforce your love and concern “no matter what”.
67 Learn about them…their friends, their interest, what they do when their out. Listen- see if you can learn why they are thinking that way
68 How to Avoid Getting Hooked on Sex Know The Purpose of Sex: B’sUnderstand The Problem of Sex: D’sChoose The Protection of Sex: H’s
69 Important Points to Communicate Sex within the right kind of relationshipi.e. marriage, is healthy and good.Sexual desires are normal and healthy;a decision to act on these desires is controllable behaviorSelf control is healthy and necessary- for success in all areas of your life.