1. Toward a science of adolescent sexual health as an HIV/STI prevention strategy
J. Dennis Fortenberry MD MS
Indiana University School of Medicine
Indianapolis IN USA

2. A definition of sexual health
Sexual health encompasses sexual development and reproductive health, as well as such characteristics as the ability to develop and maintain meaningful interpersonal relationships; appreciate one’s own body; interact with both genders in respectful and appropriate ways; and express affection, love, and intimacy in ways consistent with one’s own values.”
… “responsible adolescent intimate relationships” should be “consensual, non-exploitative, honest, pleasurable, and protected against unintended pregnancy and STD’s if any type of intercourse occurs.”

3. Why is a science of adolescent sexual health potentially useful?
Definitions are difficult to operationalize
Enduring belief in the value of empiricism
Data as an anodyne to deception
The nagging feeling that we’re talking about the wrong things

4. Adolescent sexual health as an oxymoron
“Nearly exclusive focus on risk has created a limited research paradigm with uneasy correspondences to a social and political agenda that excludes sex from adolescent sexual health.”
Adolescent Sex and the Rhetoric of Risk, 2003

5. Taboo words and adolescent sexual health
Sexual rights
Sexual choice
Pleasure

6. Differences of adolescent and adult sexual health
Sexual freedoms and rights typically restricted for people under age 18
Restricted access to sexual health information and sexual health services
Restricted access to sexual health research, including clinical trials
Developmental changes in organization and meaning of sexuality and sex

7. A contemporary public health model of adolescent sexual health
Adolescent Sexual Un-Health
What’s wrong with this picture?
Abstinence
Partnered Sexual Behaviors
Masturbation

8. Adolescent Sexual Behaviors, Past 90 days - Men, by Age
Fortenberry et al., J Sex Med, 2010

9. Adolescent Sexual Behaviors, Past 90 days - women, by Age
Fortenberry et al., J Sex Med, 2010

10. A 21st century model of adolescent sexual health
Abstinence
Partnered Sexual Behaviors
Masturbation

11. Abstinence as an adolescent sexual behavior
Emergence of sexual thoughts and feelings associated with adrenarche/pubarche
Cognitions about abstinence develop in concert with cognitions about sexual behavior
Ability to frame abstinence as a choice
Choice connects sexual health to sexual rights

12. Sexual desire is harder than most temptations
Sexual desire is harder than most temptations yo (abstinent) adolescent women
Abbot & Dalla, It’s a choice, simple as that: youth reasoning for sexual abstinence or activity. J. Youth Studies 2008.

13. Masturbation as a distinct expression of sexuality
Masturbation as an adolescent sexual behavior why bother if there is no risk?
Masturbation as a distinct expression of sexuality
Masturbation as a prevalent sexual behavior
Masturbation as a correlate of partnered sexual activity
Why bother if

14. Masturbation and partnered sexual activity (past year), 14-17 year olds
Robbins et al, Arch Pediatr Adolesc Med, 2011

15. Masturbation (past year) and condom use at last penile-vaginal sex, by genderNS
Robbins et al, Arch Pediatr Adolesc Med, 2011

16. Pleasure and sexual function are the next frontiers of adolescent sexual health

17. Subjective Sexual Experience at last Penile-Vaginal Intercourse, by Condom Use – Men
*Most recent event “extremely”
** Most recent event “any”
Unpublished Data

18. Subjective Sexual Experience at last Penile-Vaginal Intercourse, by Condom Use – Women
*Most recent event “extremely”
** Most recent event “any”
Unpublished Data

19. A 21st century model of adolescent sexual health
Adult Sexual Health
Adolescent Sexual Health
Abstinence
Partnered Sexual Behaviors
Masturbation

20. Measurement of sexual health – Adolescent Women
Unpublished Data

21. Association of Sexual Health and Condom Use – Adolescent Women
Unpublished Data

22. Association of Sexual Health and Lifetime Partners – Adolescent Women
Unpublished Data

23. Sexual Health and STI – Adolescent Women
Unpublished Data

24. A Research Framework for Health Sexual Development International Journal of Sexual Health, 2010
Freedom from unwanted sex
Relationship skills
Agency
Competence in sexual media
Understand of consent
Understand boundaries
Healthy Sexual Development
Understand biology
Understand parental values
Lifelong learning
Resilience
Open Communi-cation
Awareness of Pleasure
Self-acceptance

25. A model for sexual health in adolescent men
Partner Characteristics
.14
Social Embededdness
.31
.15
Physical Attraction
.31
Relationship Quality
.49
Male Sexual Health
Relationship Feel
.50
Satisfaction
Desire
.12
Condom Self-efficacy
Sexual Communication
.24
.27
.16

26. Principle of evolving capacity combines respect for children, their dignity and entitlement to protection
Acknowledges the value of their own contribution towards their protection. Societies must create environments in which children can achieve their optimal capacities and where greater respect is given to their potential for participation in, and responsibility for, decision-making in their own lives.