Healthy Adolescent
Sexual Development
October 2010
Richard E. Kreipe, MD, FAAP
Division of Adolescent Medicine
Golisano Children’s Hospital
University of Rochester Medical Center
ACT for Youth Center of Excellence
Cornell University Family Life Development Center
Cornell University Cooperative Extension of New York City
New York State Center for School Safety
University of Rochester Medical Center Div. of Adolescent Medicine
Text Copyright © 2010 by ACT for Youth Center of Excellence
Outline

Define terms and concepts

Key biological, psychological and social
features of normal adolescent sexual
development

Markers of healthy—and unhealthy—behaviors
and relationships in adolescent development

Resources
Healthy Adolescent Sexual Development

Adolescent 1: phase between childhood and
adulthood; physical changes of puberty

Sexual Health 2: “state of physical, emotional,
mental and social well-being in relation to
sexuality…not merely the absence of disease,
dysfunction or infirmity…requires a positive and
respectful approach to sexuality and sexual
relationships...free of coercion, discrimination, and
violence…sexual rights of all persons must be
respected protected, and fulfilled”

Development: change over time; ecological view
1.
2.
Steinberg L. Adolescence 9th ed, 2010
Nat’l Strategy to Improve Sexual Health. JAMA 2010;304(9):1006-6
Adolescent Sexual Development: Biology

Puberty
 Girl→Woman; Boy→Man
 Reproduction
 Internal and external changes

Central parts of the brain
 Gonads make sex hormones
 Ovaries: estrogen
 Testicles: testosterone

Hormones cause changes of puberty
Adolescent Sexual Development: Biology

Estrogen: breast development; height;
widening of the hips; body fat; menstrual
cycles (balance of estrogen and progesterone).

Testosterone: growth of the penis, height,
widening of the shoulders, deepening of the
voice and facial hair.
Adolescent Sexual Development: Biology
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Adolescent Sexual Development: Biology


Normal puberty

Begins: breast age 7-13; testicles age 11-15

Ends: girls age 12-16; boys age 14-20s
Females

Menstruation: 11-13 years of age

Irregular periods normal

Ovulation ► Pregnancy possible
 Males

Nocturnal emissions (“wet dreams”)

Ejaculation ► Release of sperm
Adolescent Sexual Development: Psychological

Thinking: rational decision making, abstractions,
consequences of behavior

Brain maturation1


Behavior Risk/Benefit Analysis2




Disconnect between capacity and behavior
Alcohol and substances may further impair
Potential risk may be overestimated
Potential benefits may be overestimated even
more, especially in peer relationships
Social situations: realize influence of brain
maturation and analyze benefits more closely
1.
2.
Steinberg L. Adolescent Brain Development….IOM/NAS
www.bocyf.org/Steinberg_presentation.pdf
Reyna V. Psych Science Pub Int 2006;7:1-44
Adolescent Sexual Development:
Psychological

Identity: sense of self, role in society to prepare for
adult intimacy; experimentation and role play1

Gender identity


Male or Female
Transgender: “trapped in the wrong body”
Sexual orientation (not a “preference”)






Heterosexual
Gay/Lesbian
Bisexual
Questioning
LGBTQ
“Sexual minority”
1. McNeely and Blanchard. The Teen Years Explained.
Johns Hopkins Center for Adolescent Health, 2010
Adolescent Sexual Development:
Socio-Cultural

Family, peers, social networks

Traditions

Neighborhood/neighbors

School

Faith Community

Youth-serving agencies
Adolescent Intimate/Romantic Relationships

Much time, emotional energy devoted to intimacy,
romantic relationships; preparing for adulthood

10-14 year olds: preoccupied with romantic
issues; mixed-gender groups

15-19 year olds: romantic relationships central to
social life; vast majority have had at least one
relationship, half “serious”; spend more time with
partner than with family and friends

Open communication, high levels of trust, partner
relatively close in age, emotional support
 Sexual minority youth
1. McNeely and Blanchard. The Teen Years Explained. Johns Hopkins Center for Adolescent Health, 2010
2. www.actforyouth.net/documents/AdolescentRomanticRelationships_July07.pdf
Adolescent Sexual Development:
Adult Communication

Parent-Adolescent: What, How, When, How
Often ALL matter1, 2; verbal and non-verbal

“Actions speak louder than words”
 “Do as I say, not as I do”


1.
2.
Sexuality normal part of development
Openness, authenticity, mutual respect, trust
and emotional support in context of human
relationships (with self and with others)
Parent-Adolescent Communication about Sex in Latino Families: A Guide for Practitioners.
(wwwthenationalcampaign.org)
The Teen Years Explained. Johns Hopkins Center for Adolescent Health 2010
Adolescent Sexual Development:
Common Behaviors

Masturbation1
 Alone

in privacy, or in group (“circle jerk”)
Early same-sex exploratory behavior
 Does
not predict sexual orientation
 “Practice…to see what it’s like…”

Genital touching1

Sexual intercourse
onset delayed and more condom use1, earlier
more like to be forced2
 Oral, Anal: avoid pregnancy, maintain “virgin status”1
 Vaginal:
1. Short MB, et al. Adolescent Sexual Development.
In Textbook
of Adolescent Health Care, American Academy of Pediatrics 2011
2. www.cdc.gov/nchs/data/series/sr_23/sr23_025.pdf
Average Age of Initiation of
Sexual Intercourse in U.S.
Facts on American Teens' Sexual and Reproductive Health January 2010
http://www.guttmacher.org/pubs/FB-ATSRH.html
Healthy Adolescent Sexual Development

Biological (puberty, reproduction)
 Psychological (thinking and identity)
 Socio-Cultural (multiple influences)
 Positive Youth Development1




Problem-free is not fully-prepared.
Shift the focus away from helping individual children
and youth “beat the odds” toward a full-fledged
commitment to change those odds.
Thinking differently is hard, acting differently is
harder, acting together is harder still.
Strategy of risk reduction and promotion of
protective factors
1. Ferber T & Pittman K. State Youth Policy: Helping All Youth to Grow Up Fully
Prepared and Fully Engaged. (www.ForumFYI.org/Files/StateYouthPolicy.pdf)
Advocates for Youth:
Rights, Respect, Responsibility® Campaign

Youth have the right to accurate and complete
sexual health information, confidential
reproductive and sexual health services, and a
secure stake in the future.

Youth deserve respect.

Society has the responsibility to provide young
people with the tools they need to safeguard their
sexual health…

Young people have the responsibility to protect their
own emotional and physical health as well as that
of their partners.
Advocates for Youth. The Vision: Rights. Respect. Responsibility.
www.advocatesforyouth.org/index.php?option=com_content&task=view&id=22&Itemid=51
Resources 1 of 4

Sexuality Information and Education Council of
the United States (SIECUS www.siecus.org )

SexEd Library: www.sexedlibrary.org

Advocates for Youth: www.advocatesforyouth.org

American Academy of Pediatrics, Promoting
Healthy Sexual Development:
http://BrightFutures.AAP.org/pdfs/Guidelines_PDF/9
-Promoting-Healthy-Sexual-Development.pdf
Resources 2 of 4

The Teen Years Explained
 Webinar:
http://www.jhsph.edu/adolescenthealth/_includes/
JHU%20Webinar%20April%202010.wmv

A Guide to Healthy Adolescent Development.
Johns Hopkins University Press 2010:
http://www.jhsph.edu/adolescenthealth/_includes/
Interactive%20Guide.pdf

Global Lessons on Healthy Adolescent Sexual
Development (2009):
www.ncbi.nlm.nih.gov/pubmed/19502984
Resources 3 of 4
Presentations
ACT for Youth On-Line Training:
http://www.actforyouth.net/?training
Adolescent Identity Development:
http://breeze.cce.cornell.edu/identity
Adolescent Ethnic and Racial Identity Development:
http://breeze.cce.cornell.edu/ethnicracialid
Family Planning 101:
http://breeze.cce.cornell.edu/p16061884/
Five Promises: Addressing School Completion and
Teen Pregnancy:
http://breeze.cce.cornell.edu/fivepromises_rev3/
Resources 4 of 4
Publications
ACT for Youth Publications
http://www.actforyouth.net/?publications
New Vision for Adolescent Sexual and Reproductive Health
http://www.actforyouth.net/documents/NewVision_Nov09.pdf
Growing Up Transgender: Research and Theory
http://www.actforyouth.net/documents/GrowingUpTransPt1.pdf
Growing Up Transgender: Safety and Resilience
http://www.actforyouth.net/documents/GrowingUpTransPt1.pdf
ACT for Youth Center of Excellence
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