1. HOOKED, New Science on Teen Brain and Sex Freda McKissic Bush, M.D.,FACOG Board of Directors, Medical Institute for Sexual Health Clinical Instructor, University of Mississippi Medical Center Jackson, MS

2. Present the new science on brain development and the interaction of sex and the brain. Present the new science on brain development and the interaction of sex and the brain. Identify the physical and emotional consequences of adolescent sex. Identify the physical and emotional consequences of adolescent sex. Discuss risk reduction and risk avoidance strategies. Discuss risk reduction and risk avoidance strategies.

4. What Is Sex? Sexual activity is defined as Sexual activity is defined as any bodily contact meant any bodily contact meant to derive or give to derive or give sexual gratification. sexual gratification.

5. SPIRIT MINDBODY

6. Physical Consequences of Sexual Activity Sexually Transmitted Infection Sexually Transmitted Diseases Infertility Cancer Death Nonmarital Pregnancy

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

8. One Fundamental Understanding of Sexual Involvement ─ “Science is increasingly demonstrating that the human person is hardwired to connect” 1 “We are hardwired for close attachments to other people, beginning with our mothers, fathers and extended family, then moving out to the broader community” 1 If babies are left in their cribs untouched they often fail to thrive and can even die 2 1.Commission on Children at Risk, “Hardwired to Connect”, 2003 2.Johnson, et. Al. Trauma, Violence, Abuse, 2006.

9. How Neuroscience Has “Opened” the Brain for Study MRI (Magnetic Resonance Imaging) MRI (Magnetic Resonance Imaging) Utilizes magnets instead of x-ray Utilizes magnets instead of x-ray Can therefore be done repetitively on an individual without brain damage Can therefore be done repetitively on an individual without brain damage fMRI (Functional MRI) 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. 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) PET (Positron Emission Tomography) A patient is given a safe dose of a positron emitting radioisotope on a metabolically active molecule. 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. 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

10. The Brain Parietal Lobe Frontal Lobe Occipital Lobe Cerebellum Brain Stem

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

12. The Brain Three pounds Three pounds 10 billion neurons 10 billion neurons 100 billion support cells 100 billion support cells 100 trillion connections 100 trillion connections (more than all of the internet connections in the world)

13. One Fundamental Understanding of Brain Development – 1.Giedd, et al. Nature Neuroscience, 1999 2.Weinberger, et al. The Adolescent Brain, 2005 The prefrontal cortex is not fully mature until the mid-twenties 1

14. 1.Weinberger, et al. The Adolescent Brain, 2005 The prefrontal cortex is the source of: Judgment Judgment Seeing into the future Seeing into the future Seeing how behavior can affect the future Seeing how behavior can affect the future Moral intelligence Moral intelligence Abstract thinking Abstract thinking Planning for the future Planning for the future Rational behavior and decision making Rational behavior and decision making Understanding rules of social conduct 1 Understanding rules of social conduct 1

15. Brain Development – Age 5 Images courtesy of Jay Giedd, MD, National Inst of Mental Health

16. Brain Development – Age 8 Images courtesy of Jay Giedd, MD, National Inst of Mental Health

17. Brain Development – Age 12 Images courtesy of Jay Giedd, MD, National Inst of Mental Health

18. Brain Development – Age 16 Images courtesy of Jay Giedd, MD, National Inst of Mental Health

19. Brain Development – Age 20 Images courtesy of Jay Giedd, MD, National Inst of Mental Health

20. What The Anatomy Doesn’t Show- Neurochemicals More than 100 have been identified 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. 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 They have a powerful impact on our cognition and behavior and ultimate brain structure

21. Dopamine Dopamine activation of the pleasure circuits of the brain: Dopamine activation of the pleasure circuits of the brain: –Result in a feeling of “well being” –Produce a desire to repeat an experience (1) Volkow (referenced in The Primal Teen, p. 94)

22. Dopamine Arias-Carrion, et al. Act Neurobiol Exp 2007 Dopamine is secreted into the brain in response to: Dopamine is secreted into the brain in response to: –excitement –pleasure –new things –adventure –risk taking –addictive drugs

23. 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.

24. Oxytocin and Vasopressin -- Their Vital Role Oxytocin in females and a male hypothalamic hormone, vasopressin, are both released during intimate male-female contact, resulting in pair-bonding. (Young, LJ et al., 2002.) 14 “The very process of spending time together, touching each other, having sex, and sleeping next to each other night after night, creates a powerful bond, partly biochemical, between partners.” (Morse, JR, 2006.) 19

25. Oxytocin and Vasopressin Impact Even if you don’t particularly feel attracted to someone, if you have enough orgasms with them oxytocin and vasopressin may cause an “involuntary chemical commitment” or strong emotional attachments. (Morse, JR,, 2006.)

26. Oxytocin Impact on the Body and Brain  During labor -- causes uterine contractions  During suckling -- causes milk letdown  Promotes bonding between mother and baby 1  Promotes bonding of a woman to another person with whom she has physical contact -- ranging from touching, to caressing, to intercourse 1 1. Uvuas-Moberg. Psychoneuro-endocrinology, 1998.

27. 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. 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.” WARNING: “Don’t let a guy hug you unless you plan to trust him.” Brizendine. “The Female Brain”, 2006

28. Pheromones Chemicals secreted from the skin and sweat glands of many animals and from human males and females 1 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 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 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. Sex, Therefore, Is a Powerful Brain Experience- Two Powerful Brain Events Seem to Always Occur As A Result Attachment (bonding) to the sexual partner Attachment (bonding) to the sexual partner Desire for repetition of sex acts (“addiction”) Desire for repetition of sex acts (“addiction”) 1.Weinberger, et.al., The Adolescent Brain, 1999.

31. Weinberger, et al. The Adolescent Brain, 2005. What is happening during these– Brain “Molding” years? Life experience causes synapses to live and strengthen or wither and die Life experience causes synapses to live and strengthen or wither and die This process “molds” the brain until the brain “sets” in its adult form This process “molds” the brain until the brain “sets” in its adult form This final brain structure then guides our thoughts and behavior in the future This final brain structure then guides our thoughts and behavior in the future We now know that adolescent brains are exquisitely responsive to experiences they are having. We now know that adolescent brains are exquisitely responsive to experiences they are having.

32. 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

33. Synapses

34. 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 initiate an action or thought We repeat the 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 The experience of the action or thought physically molds our brains to habitually repeat the action or thought Giedd et al 2005

35. Brain Molding The brains final structure is formed as a result of experiences repeated over and over again. The patterns of behavior become part of “who we are” and “what we do” because that is what our brain structure has become We are generally unaware that our brain actually “make us do things” – either choices that are helpful or choices that are harmful Weinberger, et al. The Adolescent Brain, 1999

36. 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, 2001 2.Independent Women’s Forum Survey, 2001

37. Protecting the Molding of The Brain To Form Bonds (Attachment) is Vital For Human Beings “Science is increasingly demonstrating that the human person is hardwired to connect” 1 “Science is increasingly demonstrating that the human person is hardwired to connect” 1 “ beginning with our mothers, fathers, and extended family, and then moving out to the broader community” 1 “ beginning with our mothers, fathers, and extended family, and then moving out to the broader community” 1 Marriage is the ultimate connectedness Marriage is the ultimate connectedness 1. Hardwired to Connect 2003 p. 14

38. Married Sex Long Term Relationships ( A Characteristic of “Bonding” It is rare in America for a spouse in an intact marriage to have sex with anyone but their own spouse Desire for Pleasure (A Characteristic of “Addiction”) “The group that has the most sex is not the young and the footloose but the married” “Married women had much higher rates of ‘usually’ or ‘always’ having orgasms as compared to women who were never married and not cohabitating” Laumann, et. Al. Sex in America. 1995

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 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 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, 1991 2.Lee, et al. Demography, 1995 Broken Bonding, Repetitively Experienced, Seems to Often Damage the Human Ability to “Bond” (to Connect)

40. Compromised Monogamy - Cohabitation Less likely than marrieds to view their sexual union as permanently exclusive 1 Less likely than marrieds to view their sexual union as permanently exclusive 1 People who cohabit did not know their partners as long before they had sex as did couples who married 2 People who cohabit did not know their partners as long before they had sex as did couples who married 2 Women who are cohabitating are more likely to have been forced to do something sexually they did not want by a man 2 Women who are cohabitating are more likely to have been forced to do something sexually they did not want by a man 2 Cohabiters are much more violent than marrieds 3 Cohabiters are much more violent than marrieds 3 Compared to married couples, cohabiting couples have less healthy relationships 3 Compared to married couples, cohabiting couples have less healthy relationships 3 1.Write and Gallagher. The Case For Marriage. 2000 2.Laumann, et. al. Sex in America, 1995 3.Hahn, et. al. J Marriage and Fam, 1991

41. No Commitment to Monogamy Multiple Partners – –The risk of STI/STD infection is directly related to the number of lifetime sexual partners 1 – –1 in 4 sexually active adolescents is infected with an STI 2 Nonmarital Pregnancy -1 out of 3 American babies are born out of wedlock - 7 out of 10 African American babies are born out of wedlock. 2 1.The Hidden Epidemic 2.The Medical Institute. Optimal Sexual Health. 2006.

42. Lust, Infatuation and Mature Love One individual cannot tell if another person’s interest is a result of lust or love –. Lust is often for self-gratification. “Early love” is, in general, oriented toward caring for the other person.

45. What Can We Do Understand that there is a problem Understand that the problem particularly affects young women but can significantly affect young men too Understand that they do want our help Understand the incredible importance of dopamine for an adolescent and help young people “feed” on it Understand that adults can help young people have the best chance of achieving their potential - -

46. The “Dopamine High” “We as a society are doing a remarkably poor job at addressing our adolescents partly hardwired needs for risk, novelty, excitement and peer affiliation” 1 We adults can help provide that as we encourage achievement in academics, sports, spiritual growth, adventures and relationship building We can encourage the older young person to experience the thrill of gradually becoming independent and self sufficient Commission on Children at Risk. “Hardwired to Connect” 2003

47. With adult help, young people can trump the negative messages of peers, media and society With adult help, young people can trump the negative messages of peers, media and society As young people learn to make good decisions with help, this healthy pattern becomes a part of their brain structure As young people learn to make good decisions with help, this healthy pattern becomes a part of their brain structure As adults they will then more likely continue to make wise, thoughtful, healthy decisions As adults they will then more likely continue to make wise, thoughtful, healthy decisions They will then have a greater chance of achieving their dreams They will then have a greater chance of achieving their dreams Achieving Their Dreams

49. What is Abstinence? Abstinence is the calculated decision and deliberate action to refrain from sexual activity. 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 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. The method that increases the ability to form healthy long term emotional relationships.

50. Delay of Intercourse Reduces Number of Partners Source: The Heritage Foundation. 2003. 1 Average number of lifetime partners Age at sexual debut

51. The Planning for Sex The Promise of Sex Decision Making= S T O P; DROP & ROLL State the decision; Write it down State the decision; Write it down Talk about your feelings and needs Talk about your feelings and needs Options are considered. Options are considered. Pick the best option and evaluate the results Pick the best option and evaluate the results DROP the pretence: “Aim to abstain.” DROP the pretence: “Aim to abstain.” Be ready to ROLL. “Run, baby, run!” Be ready to ROLL. “Run, baby, run!”

52. It wasn’t really sex– …just oral sex …just anal sex …just outercourse It wasn’t really sex– …just oral sex …just anal sex …just outercourse SEXLIES

53. So What is Sex? Hooking Up Simon & Schuster © 2005

54. Spanning Tree Sexual Network (n=286) Bearman, Moody, & Stovel. 2004 Diad

55. 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% evidence for risk reduction for HPV approximately – 30% insufficient evidence for prevention of all other STDs

56. There Is a Problem: Dopamine “Addiction” Seems to Be Working Well 1/4 of college students have had sexual intercourse with six or more partners in their lifetime 1 47% of college students have had oral sex in the past 30 days 2 More than 2/3 of college students had had sexual intercourse during the three months preceding the National College Health Risk Behavior Survey 1 The annual sexual victimization rate (completed and attempted rapes) is 35.3 per 1000 female students (eq. 350 annually on a campus of 10,000) 3 1.CDC, YRBS: National College Health Risk Behavior Survey, 1995. 2.National College Health Assessment: Reference Group Executive Summary.2005 3.National Institute of Justice. 2000.

57. Sex and Depression – College Students 45% of students during the past year have felt so depressed that it was sometimes hard for them to function 1 45% of students during the past year have felt so depressed that it was sometimes hard for them to function 1 10.3% of students reported seriously considering attempting suicide at least once during the past year and 1.4% had actually attempted suicide in the past year. 1 10.3% of students reported seriously considering attempting suicide at least once during the past year and 1.4% had actually attempted suicide in the past year. 1 “A growing body of research suggests that sex- particularly sex with more than one partner-puts young women but not necessarily men at risk of depression, suicide, and a loss of respect in the eyes of their partners. “ 2 “A growing body of research suggests that sex- particularly sex with more than one partner-puts young women but not necessarily men at risk of depression, suicide, and a loss of respect in the eyes of their partners. “ 2 1.American College Health Association Survey 2004 2.Wilcox (as referenced by Sahner). The Way Street Journal, 2007