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Adolescent Brain Development and Sexual Decision Making Freda McKissic Bush, MD, FACOG Clinical Instructor, University of Mississippi Jackson, MS May 14,

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Presentation on theme: "Adolescent Brain Development and Sexual Decision Making Freda McKissic Bush, MD, FACOG Clinical Instructor, University of Mississippi Jackson, MS May 14,"— Presentation transcript:

1 Adolescent Brain Development and Sexual Decision Making Freda McKissic Bush, MD, FACOG Clinical Instructor, University of Mississippi Jackson, MS May 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 Children

4 Teen Pregnancy 1 More than 700,000 teens become pregnant each year. 1 in 3 become pregnant at least once before age 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 children Less 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, 2008

5 Emotional Consequences of Sexual Activity Pain and suffering from broken relationships Fear, confusion about romantic feelings Altered self-esteem Sense of betrayal and abandonment Guilt, depression and emotional rollercoaster Impaired ability to form healthy long- term relationships

6 SPIRIT MINDBODY

7 How Neuroscience Has “Opened” the Brain for Study MRI (Magnetic Resonance Imaging) Utilizes magnets instead of x-ray Can therefore be done repetitively on an individual without brain damage fMRI (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, 2005 Jer-Pogossian, et al. Radiology, 1975

8 The Brain Parietal Lobe Frontal Lobe Occipital Lobe Cerebellum Brain Stem

9 Sagittal View of the Human Brain Brainstem Cerebellum Occipital Lobe Parietal Lobe Frontal Lobe

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)

11 One Fundamental Understanding of Brain Development – 1.Giedd, et al. Nature Neuroscience, Weinberger, et al. The Adolescent Brain, 2005 The prefrontal cortex is not fully mature until the mid-twenties 1

12 The prefrontal cortex is the source of Judgment Seeing into the future Seeing how behavior can affect the future Moral intelligence Abstract thinking Seeing what is not obvious Planning for the future Rational behavior and decision making Understanding rules of social conduct 1.Giedd, et al. Neuroscience, Weinberger, 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 identified Receptors 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: Excitement Pleasure New things Adventure Risk taking Addictive drugs Volkow (referenced in The Primal Teen, p. 94)

21 Strauch. The Primal Teen, Arias-Carrion, et al. Act Neurobiol Exp 2007 Dopamine 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.” Dopamine

22 Dopamine – The Good and the Bad Dopamine 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. or Dopamine can be a reward signal for the excitement of learning, maturing, new relationships, and the possibility of a bright future.

23 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.” 2 1.Dorland. Medical Dictionary 27 th Ed Goleman. Social Intelligence Dopamine and “Addiction”

24 Oxytocin and Vasopressin Sexual intercourse releases large amounts of oxytocin into the female brain and vasopressin into the male brain Both hormones promote bonding with a sexual partner 1 1.Lechman, Brizendine, 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” or strong emotional attachments. (Morse, JR,, 2006.)

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.” Brizendine. “The Female Brain”, 2006

27 1.Lechman. Child Adolescent Psychiatry elin N Am, Brizendine. “The Female Brain” 2007 Men and Vasopressin The male brain has many more receptors for vasopressin. 1 Sexual intercourse releases large amounts of vasopressin into the male brain 1 Vasopressin in the male brain promotes bonding with a sexual partner 1

28 Pheromones Chemicals secreted from the skin and sweat glands of many animals and from human males and females 1 These chemicals are unconsciously detected by the female nose (but not the male) 1 These chemicals can influence a woman’s attraction to a man and her sexual satisfaction with him 2 1. McClintock, et. al. Chem. Senses 30 (Supply 1) 2005

29 Serotonin  Serotonin, 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. Marazziti, D. The National Geographic, 2006

30 Lust, Infatuation and Mature Love Each of these result in dynamic and visible brain activity Each of these produce activity in different areas of the brain Strauch. “The Primal Teen”, 2003 Leckman. Child Adolesc Psychiatry. elin N Am. 1999

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 difference Lust 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 Sex When a person’s body is in intimate contact with another person, the entire person is “connected” with the other 1,2 A 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 prosper 1,2 Sex can greatly benefit this connection or can greatly damage it 1.Light. Biol Psychol, Schore. “Affect Dysregulation and Disorders of the Self”, 2003

33 Sex, Is a Powerful Brain Experience- Two Powerful Brain Events Seem to Always Occur As A Result Attachment (bonding) to the sexual partner Desire for repetition of sex acts (“addiction”) 1.Weinberger, et.al., The Adolescent Brain, 1999.

34 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 J oe Lertola. TIME.com graphic by Garrett Rosso. The Image Bank—Getty Images from the May 10, 2003 issue of TIME MAGAZINE Use It or Lose It Molds the Brain

35 Synapses

36 Brain Molding – The Unexpected Reality A reciprocal pattern of brain function causes physical change (molding) of our brains We initiate an action or thought We repeat the action or thought The experience of the action or thought physically molds our brains to habitually repeat the action or thought Giedd et al 2005

37 What About Bonding And The Sexually Active Adolescent? Bonding always occurs with sexual involvement as far as science can tell 1 The cycle of sexual involvement – break up- sexual involvement – break up is the pattern many young people experience 2 1.Young, et al, Independent Women’s Forum Survey, 2001

38 The Emotional Truths 50% of teen relationship break up within 6 months of beginning Depression and Suicide is higher in sexually active teens

39 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 marriage 1 Couples who cohabit before marriage are more likely to divorce when they do marry than couples who did not cohabit 2 1.Kahnetal. J of Marriage and Fam, Lee, et al. Demography, 1995 Broken Bonding, Repetitively Experienced, Seems to Often Damage the Human Ability to “Bond” (to Connect)

40 Young People are Crying Out for Help 90% of high school students think they all need a strong abstinence message from all society 2/3 of high school students think it is wrong for high schoolers to have sex even if they use condoms and contraceptives National 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 waited Since 2/3 of high school students have had sexual intercourse by graduation, we know many of these students were sexually active National Campaign to Prevent Teen and Unintended Pregnancy – Various Surveys00

42 Healthy Brain Molding The brain learns by trial and error, particularly from the age of 18 on Mistakes are supposed to be made by adolescents The role of parents and caring adults is to provide boundaries within which a young person can make decisions including mistakes, as safely as possible.

43 How can teens successfully handle the challenge for a lifetime of healthy living?

44 Dopamine – The Good and the Bad Dopamine 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. or Dopamine can be a reward signal for the excitement of learning, maturing, new relationships, and the possibility of a bright future.

45 RISK TAKING Clothes: Immodest, Sexy/provocative Make-up: Mature “Girls Gone Wild” Curiosity with Gay & Lesbian lifestyle Drugs Drag racing Dropping out of school

46 Spanning Tree Sexual Network (n=286) Bearman, Moody, & Stovel Diad

47 Delay of Intercourse Reduces Number of Partners Source: The Heritage Foundation Average number of lifetime partners Age at sexual debut

48 The Solution Primary Prevention: Risk Avoidance Secondary Prevention: Risk Reduction Tertiary Prevention: Immunzation

49 Risk Avoidance Abstinence 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.

50 Risk Reduction Condoms Contraception Alternative Behaviors

51 Planned Parenthood “Safer Sex” is about protection and pleasure “Safer Sex” is about protection and pleasure Outercourse Outercourse Mutual Masturbation Mutual Masturbation Body Rubbing Body Rubbing Sex Toys Sex Toys Oral Sex Oral Sex Anal Sex Anal Sex Planned Parenthood: “Sex-Safer and Satisfying”, 9/6/04 Safe “Secure from danger, harm or evil”

52 Condom Effectiveness in STD Prevention Source: National Institute of Health, “Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease Prevention”, July 2001 CONDOM EFFICACY preventing HIV transmission – 85% risk reduction for gonorrhea in men approximately – 50% no evidence for risk reduction for HPV insufficient evidence for prevention of all other STDs

53 New Studies Published After NIH Report 126,220 patients 126,220 patients Only 16% always used a condom Only 16% always used a condom In “Always condom use” – In “Always condom use” – risk reduction for gonorrhea and Chlamydia 34% Shlay, 2004

54 New England Journal of Medicine June 22, virgin women U. of Washington 82 virgin women U. of Washington GYN exams every 4 months GYN exams every 4 months 100 % condom use 100 % condom use Electronic diaries of daily sexual activity Electronic diaries of daily sexual activity Number of instances of vaginal intercourse Number of instances of vaginal intercourse Frequency of male condom use Frequency of male condom use Number of new partners Number of new partners

55 New England Journal of Medicine June 22, 2006  14 virgins had sex with virgins  40 did not know if partners were experienced  Median # of intercourse 48/ year  Median number new partners 1/ year

56 82 virgin women 82 virgin women 54 partners not known to have ever had sex before 54 partners not known to have ever had sex before Conclusion: Among newly sexually active women, consistent condom use by their partners appears to reduce the risk of cervical and vulvovaginal HPV infection Conclusion: Among newly sexually active women, consistent condom use by their partners appears to reduce the risk of cervical and vulvovaginal HPV infection New England Journal of Medicine June 22, 2006

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 18  100% effective against these serotypes  Not effective once seropositive  Proposed indications − Routine - Girls − Catch up  Three doses − 0, 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 decisions We abandon adolescents to the impossibility of mature decision making if we just give them information and then say “do what you think is best”. Giedd, et al 1999

60 Sexual health comes from a positive self- image based on strong characteristics Self control Personal responsibility Honesty Kindness Respect 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 & ROLL State the decision; Write it down Talk about your feelings and needs Options are considered. Pick the best option and evaluate the results DROP the pretence: “Aim to abstain.” Be ready to ROLL. “Run, baby, run!”

63 The Promise of Life & Love

64 Graduation

65

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: 3 B’s Understand The Problem of Sex: 3 D’s Choose The Protection of Sex: 4 H’s

69 Important Points to Communicate Sex within the right kind of relationship i.e. marriage, is healthy and good. Sexual desires are normal and healthy; a decision to act on these desires is controllable behavior Self control is healthy and necessary- for success in all areas of your life.


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