Transitions: The Controversy over Abstinence-Only-Until-Marriage Programs
Volume 12, No. 3, March 2001

This Transitions is also available in [PDF] format.

A special report in Family Planning Perspectives looks at the extent to which adolescent sexual activity consists or does not consist of oral intercourse and how adolescents view oral sex. Much of the 'research' to date has been reported by the popular press. Stories, such as one in TheWashington Post, describe new suburban fads to regularly engage in oral sex at one another's homes, in parks, and at school. Reporters echo similar assertions—that although penile-vaginal (coital) activity among high school students appears to have leveled off or slightly declined, middle-school students (ages 12 to 14) appear to be experimenting with a much wider range of sexual behaviors at progressively younger ages.

The little research performed on this topic occurred in 1982 when a marketing research firm collected data from a national panel of households in 49 states. Roughly one-fifth of 1,067 13- to 18-year-old respondents had ever had oral sex, and 16 percent of young women who had performed fellatio had never had vaginal intercourse.

Many sexually transmitted diseases (STDs) can be transmitted orally, although some are more easily passed than others. According to Penelope Hitchcock, chief of the Sexually Transmitted Diseases Branch of the National Institutes of Health, saliva tends to inactivate HIV, so while HIV transmission through oral intercourse is not impossible, it is relatively rare. Other viral STDs that can be transmitted orally include human papillomavirus (HPV), herpes simplex virus, and hepatits B. Bacterial STDs that can be transmitted orally include gonorrhea, syphilis, chlamydia, and chancroid.

Some clinicians say that they are seeing new types of STD infections and new types of patients —young teens who have not initiated coitus but who come in with fears and anxiety over having acquired an STD orally. Many researchers believe that young teens who have not initiated coitus may be especially reluctant to seek treatment for orally acquired infections. Moreover, adolescents virtually never use condoms or dental dams to protect against orally acquired STD infections.

Experts believe that the oral sex practiced by younger teens is mostly fellatio, not cunnilingus. This also raises questions of exploitation of young teens if the young women are performing oral sex to make boys happy or when alcohol is involved. Deborah Roffman, sexuality educator at The Park School in Baltimore, related the experience of a guidance counselor who, after bringing up the topic of rape in the context of coerced oral sex, was told by female students that the term did not apply since fellatio 'is not really sex.'

Among roughly 600 Midwestern university students surveyed in 1991, 59 percent did not believe that oral sex would qualify as sexual intercourse and 19 percent thought the same about anal sex. Females (62 percent) were more likely than males (56 percent) to assert that cunnilingus and fellatio were not 'sex.' If adolescents perceive oral sex as something different than sexual intercourse, do they view it as abstinence? In one study with 282 12- to 17-year-old respondents in the Midwest, definitions ranged from 'kissing is probably okay' to going only as far sexually as one wanted or felt comfortable with. Most ended a long list of acceptable behaviors with, "To me, the only thing that would take away my virginity is having sex. Everything else is permitted."

The article points out that the few evaluations of abstinence-only programs that exist have never assessed whether adolescents engaged in activities other than sexual intercourse under an assumption that they were being abstinent. Adolescent health professionals believe that the startling information about early initiation into oral intercourse will have a positive effect—forcing educators, health care providers, and parents to have a dialogue with teens about the full meaning of sexual expression, not as a single act, but as a whole range of behaviors. This report concludes with a reminder that comprehensive sexuality education supports giving adolescents the criteria they need to decide when to abstain or to participate across a full continuum of sexual behaviors. By contrast, proponents of abstinence-only education fear that discussing a possible range of behaviors will encourage those behaviors.

Remez L. Oral sex among adolescents: is it sex or is it abstinence? Family Planning Perspectives 2000; 32:298-304.