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Try out PMC Labs and tell us what you think. Learn More. A careful examination of young men's sexuality by health professionals in pediatrics, primary care and reproductive health is foundational to adolescent male sexual health and healthy development. Through a review of existing literature, this article provides background and a developmental framework for sexual health services for adolescent boys. This article concludes by examining the implications of these data for sexual health promotion efforts for adolescent males, including HPV vaccination.

Yet, vaccination can provide an important point of contact with health care providers and an opportunity for anticipatory guidance [ 1 ], particularly in the area of sexual health. This lack of attention to adolescent male sexual health is not surprising, and may stem from cultural views of male adolescence.

These images capture common perceptions of adolescent male sexuality—animalistic, adult, and a focus on negative consequences. Sexuality, however, is an intrinsic part of human nature and achieving sexual health has been identified as a key developmental task for all adolescents [ 2 ], boys included. This lack of attention may also be due to the relatively limited amount of research on the topic [ 3 ], as well as the necessarily interdisciplinary nature of that research, which sits at the intersection of medicine, nursing, psychology, social work, sociology, and anthropology.

This article reviews existing health and developmental literature on adolescent male sexual health, and then applies these research findings to the clinical care of adolescent boys. The article concludes by examining the implications of these data for sexual health promotion efforts, including HPV vaccination. Life Behaviors of a Sexually Healthy Adult [ 2 ]. National Guidelines Task Force. General adolescent development occurs within a broad family and social context.

This social ecological perspective has been specifically applied to adolescent sexual development. Sexual health promotion includes policies, programs, and clinical services that support development and optimize sexual health. Although sexual health promotion frequently focuses on the individual, sexual health promotion for adolescents must be situated in the above broader developmental and social context. We first address risk, then shift our focus to development. During adolescence, sexual behavior becomes normative.

Among young men in high school, reports of vaginal-penile intercourse increase from Among high-risk populations of young men, such as those involved with the juvenile justice system or attending STI clinics, the proportion who are sexually active is higher and the age of sexual onset is lower [ 9 — 11 ]. While not all sexual behavior in adolescent males is problematic, a young age of onset represents an increased risk for sexual coercion, STIs, and early fatherhood [ 12 ].

Boys are frequently viewed primarily as perpetrators of interpersonal violence; however, they are also frequently victims of interpersonal violence. Among 9th to 12th grade adolescents, 4. Adolescent pregnancy prevention focuses on girls; however, males frequently adolescent boys are clearly causal participants in pregnancies, and fatherhood has an impact on their lives as well as on the lives of girls. A recent review of adolescent fatherhood highlights the developmental implications of early fatherhood.

Contrary to common belief, most adolescent fathers would like to remain involved with their child; however, these young men face multiple stressors, including the need to provide financially for their child, having limited parenting skills and a limited knowledge of child development, and, frequently, having limited emotional support and resources [ 14 ]. Adolescent and young adult men bear a disproportionate burden of STIs.

In a nationally representative sample of males 18 to 22 years of age, 3. Among high-risk populations such as those in the juvenile justice system, STI clinic attendees, and homeless adolescents, the prevalence of Chlamydia can be 2 to 3 times as high [ 17 — 19 ]. The CDC also documented a continuous increase in new HIV cases among individuals 15 to 19 years of age both male and female across 34 states, from in to in [ 21 ].

Longitudinal data show that young men may often move into and out of high-risk groups as they move from adolescence into young adulthood. Across the 3 waves, participants moved in and out of high-risk groups. It is for this reason that we need universal prevention strategies e. Across adolescence, boys progress from same-gender peer groups, move to mixed-gender peer groups, and then to dyadic friendships and romantic relationships [ 29 ].

Collins has identified five dimensions of relationships that evolve across adolescence: romantic involvement in a relationship ; partner identity characteristics of people they date ; relationship content what partners do together ; relationship quality positive, supportive, or beneficial experiences of relationships ; and cognitive and emotional processes in the relationship [ 31 ].

While a growing body of literature exists on romantic involvement, partner identity and relationship content, less is understood about relationship quality or cognitive and emotional processes related to relationships. Our work and that of others describe early relationships as short-lived, usually arranged through intermediaries, characterized as having limited physical interaction and emotional investment, and occurring in school, on the phone, or in groups [ 29 , 32 , 33 ].

Across adolescence, relationships lengthen, with increased time spent together, increased closeness, increased likelihood of sexual behaviors vaginal, oral, or anal sex , and increased emotional investment [ 30 , 34 — 36 ]. Relationship power is an important aspect of relationship quality. However, data on early and middle adolescents paint a different picture.

From the perspective of relationship power, a school-based study of adolescents in the 7th to 11th grades with recent dating experience found that boys had less relationship power than girls. Specifically, the study describes: 1 adolescent girls were more confident than boys in navigating relationships; 2 adolescent boys were perceived by both girls and boys to have less relationship power; and 3 adolescent boys were more likely to report that their dating partner attempted to or actually influenced them [ 38 ].

Boys expressed levels of love and emotional attachment similar to girls in this study. Differences in the ages of partners were frequently cited as one source of the power differential in adolescent relationships; however, Add Health data show that while adolescent girls reported romantic partners 1 to 3 years older, adolescent boys reported romantic partners that were the same, or close to the same, age. In Wave I of Add Health, the mean difference in age between and year-old boys and their partners was less than 2 months. Relationship oriented motivations tap into relationship quality, and are commonly expressed in studies of early to middle adolescent boys.

In Add Health, males and females reported a similar unfolding of social, romantic, and sexual events within romantic relationships. Both reported, in sequential order, of first spending time with their partner in a group, then holding hands, thinking of themselves as a couple, and telling others they were a couple.

Later events included declaring love, touching under clothes, talking about birth control or STIs, touching genitals, and engaging in sexual intercourse [ 40 ]. Some racial and ethnic variation existed in the sequence of events. Readiness, curiosity, and anticipation of sex are characteristics closely tied to adolescent development. It has become clear that categorizations of adolescents in a binary way e.

Anticipation also plays a role in sexual decision making. Delayers did not expect to initiate sex in the next year; anticipators did. A variety of contextual variables were associated with being an anticipator or a delayer; these included subsequent sexual behavior, maternal education, age of mother at her first birth, parenting practices, and church attendance [ 43 ].

The preparation for, and contextual associations with, sexual experiences reported in this and studies suggest that for many adolescent boys sex requires more than opportunity. It requires curiosity, interest, preparation, and planning, facilitated by relationships and social contexts. For example, a study of positive motivations for sex in a multiethnic sample of ninth graders found that male participants ranked intimacy above sexual pleasure and social status as an important relationship goal [ 44 ].

In this study, sexually experienced participants expected that sex was just as likely to lead to intimacy as to sexual pleasure [ 44 ]. A qualitative study that interviewed ninth grade boys about relationships further developed our understanding about intimacy. In a study of reasons for sex among college-aged young adults, males and females differed in physical reasons for sex e.

Masculinity is comprised of a culturally defined set of beliefs that men should, or should not, behave in certain ways. Examples include beliefs that men should be independent and self-reliant, be physically tough, not show emotion, be dominant and sure of themselves, and be ready for sex [ 47 , 48 , 49 ].

Various research activities with young men have described the enactment of masculinity within relationships. Among early to middle adolescent males, these beliefs about masculinity appear with the ly described relationship-oriented motivations. Interviews with high school freshmen have demonstrated a tension between the enactment of masculinity beliefs and relationship desires.

For example, a need to maintain emotional distance and a desire for sex compete with an underlying desire for closeness and intimacy [ 45 ]. Among ninth grade boys, both intimacy and sexual pleasure were endorsed as goals for relationships as well as expectations that sex would meet these goals [ 44 ]. The 10 th graders in this study had only limited endorsement of masculine ideology [ 39 ]. Endorsement of conventional beliefs about masculinity has been associated with both poor sexual health outcomes and lower levels of engagement with health services among older adolescent and young adult males.

In NSAM, adolescent males 15 to 19 years of age with stronger endorsement of traditional beliefs about masculinity reported more sexual partners, less intimate relationships with those partners at last intercourse, less consistent condom use, and less belief in male responsibility to prevent pregnancy [ 54 ].

Controlling for potential confounders, baseline masculinity beliefs in this cohort also were associated with less use of primary care [ 55 ]. All 3 types of communication were associated with increased use of dual contraceptive methods [ 56 ]. Other studies of young men have shown similar associations between adolescent-partner communication and condom use, and have additionally demonstrated that adolescent-partner communication is related to contextual factors such as adolescent-parent communication and parenting styles [ 57 ].

While the positive associations between sexual behavior and measures of communication about sexual protective behaviors are encouraging, little is known about the actual content of these communications. This is due in part to limitations in measurement. Complex concepts such as communication about sexual topics are often measured with just a single item e. Romantic and sexual behaviors arise from, and occur in, a broader peer context [ 29 , 58 ]. In a qualitative study with middle adolescent boys, participants experienced high levels of intimacy only with very close friends.

This intimacy included sharing secrets, sharing money, and protecting one another physically and emotionally [ 59 ]. Boys without close friends described a sense of loss and a desire for the intimacy of friendship. Trust was a key issue, with most participants describing distrust of all but their closest friends.

Compared with girls, adolescent boys started high school with a much lower quality of close friendships, but the quality then increased steeply during the high school years [ 60 ]. These gender differences in close relationships are supported by data from other populations and have implications for both content and type of communication with peers about sex. Another school-based study found that, compared with girls, adolescent boys had lower self-efficacy to communicate with peers about sex [ 61 ].

These associations have been shown in both small studies and nationally representative samples.

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