Sexual behaviour of youth and sources of knowledge on such behaviour Sexual behaviour of youth

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1 Sexual behaviour of youth and sources of knowledge on such behaviour Sexual behaviour of youth Agnieszka Maria Bień 1, Sabina Stadnicka 2, Grażyna Jolanta Iwanowicz-Palus 1 1 Samodzielna Pracownia Umiejętności Położniczych, Wydział Nauk o Zdrowiu, Uniwersytet Medyczny w Lublinie 2 Studenckie Koło Naukowe przy Samodzielnej Pracowni Umiejętności Położniczych, Wydział Nauk o Zdrowiu, Uniwersytet Medyczny w Lublinie Author responsible for manuscript preparation Dr n. med. Agnieszka Bień Samodzielna Pracownia Umiejętności Położniczych Wydział Nauk o Zdrowiu Uniwersytet Medyczny w Lublinie Lublin ul. Staszica 4-6 Tel fax mail: agnesmbien@gmail.com PhD Agnieszka Bien Independent Obstetric Skills Unit, Faculty of Health Sciences Medical University of Lublin Staszica 4-6, Lublin, Poland Tel fax agnesmbien@gmail.com

2 Zachowania seksualne młodzieży oraz źródła wiedzy dotyczące takich zachowań Streszczenie Wstęp: Aktywność seksualna młodzieży w okresie adolescencji ma ogromne znaczenie dla ich dalszego rozwoju. W tym okresie rozwijają się potrzeby seksualne i gromadzą doświadczenia w tym zakresie. Celem badań było poznanie zachowań seksualnych młodych ludzi oraz najpopularniejszych źródeł wiedzy dotyczących takich zachowań. Materiał i metoda: Badaniem objęto grupę 258 osób będących uczniami III klas szkól gimnazjalnych oraz szkół ponadgimnazjalnych. Narzędzie badawcze stanowił autorski kwestionariusz ankiety, w którym wykorzystano pytania z wystandaryzowanego kwestionariusza badań nad zachowaniami zdrowotnymi młodzieży szkolnej YRBS (Youth Risk Behavior Survey). Wyniki: W badanej grupie przeżycie stosunku płciowego zadeklarowało 38,4% młodzieży. Średnia wieku rozpoczęcia współżycia seksualnego przez badana młodzież to 17,05 lat. Życie płciowe rozpoczęła ponad jedna trzecia 16-latków (35,4%). Najczęściej stosowanymi przez młodzież formami zachowań seksualnych są: stosunek płciowy (74,4%) oraz stosunek oralny (41,4%). Respondenci najczęściej stosują prezerwatywę (83,8%) jako metodę zapobiegania ciąży. Najczęstszym źródłem z jakiego młodzież czerpie wiedzę na temat seksualności jest internet (69,0%) oraz lekcje z przedmiotu "Wychowanie do życia w rodzinie" (32,9%). Wnioski: Najbardziej popularnymi zachowaniami seksualnymi badanej młodzieży są stosunek płciowy i seks oralny. Najczęściej współżycie płciowe rozpoczynają młodzi ludzie w wieku 16 lat, uczący się w technikum. Najpopularniejszym źródłem z jakiego młodzież czerpie wiedzę na temat seksualności są internet, lekcje z przedmiotu "Wychowanie do życia w rodzinie", rodzice oraz telewizja. Słowa kluczowe: zachowania seksualne, młodzież, wiedza

3 Sexual behaviour of youth and sources of knowledge on such behaviour Abstract Introduction: Sexual activity of adolescents is of great importance to their future development. It is in adolescence that we start to have sexual needs and gain experience in this area. The aim of the research was to learn about the sexual behaviour of young people as well as the most popular sources of knowledge relating to such behaviour. Material and methods: The research was conducted on 258 third-grade students of secondary and upper secondary schools. The tool used in the research was a questionnaire designed by the author, which included questions from the standardized Youth Risk Behaviour Survey YRBS. Results: In the analyzed group, 38.4 per cent of young people declared they had already had a sexual intercourse. The average age at which the respondents became sexually active was Over one-third of sixteen-year-olds (35.4%) stated they had already had their first sexual intercourse. The most common forms of sexual behaviour mentioned by the respondents include sexual intercourse (74.4%) and oral sex (41.4%), and the most frequent method of contraception is condoms (83.8%). The most popular source of knowledge about sexuality is the Internet (69.0%) and Family life education classes (32.9%). Conclusions: The most popular forms of sexual behaviour of the respondents include sexual intercourse and oral sex. The largest group of young people who start their sexual life is sixteen-year-old technical college students. Young people most frequently gain knowledge about sexuality from the Internet, Family life education classes, parents and television. Key words: sexual behaviour, youth, knowledge

4 Introduction The foundation for adult sexuality is the first dozen years of growth. The Interpsychological and behavioural aspect of the development is in the hands of parents and the environment in which young people are growing up. The period of adolescence is a stage of intensive quantitative and qualitative growth, which is under the clear influence of the endocrine system, in which the intensive production and expression of sex hormones take place. Biological changes of this period affect sexual behaviours, which makes those behaviours labile, variable and immature [1].The sexual activity during adolescence period is very important for adolescence's further growth. Forms of this activity lead from less to more mature ones. During this period, the sexual needs are developing and the teenagers gather the sexual experience in this field [2, 3]. The increasing sexual tension is initially reduced by masturbation, then by more mature forms of sexual activity - petting and genital contacts [4]. According to Imieliński "the sexual activity are actions oriented towards achieving the sexual satisfaction or leading to it (preparatory activity) and activities that meet the need for sex or reducing sexual tension (fulfilling activity)" [5]. However, Obuchowski notes that "sexual activity is a result of the sexual characteristics of the person, which forms with them from the beginning of life, and are formed individually. The range of forms is so large that it is making it impossible to obtain sexual satisfaction, whereas for others it might be a condition "[1]. Sexual initiation is one of the most important events in the life of every human being, although usually it has a different meaning for women and for men. In any case, it is a transition from child to adult, a symbol of entry into adulthood [4, 5, 6]. Early growth of children manifest itself by rapid physical maturing, freedom and independence from their parents and the moral changes caused by the so-called "Sexual revolution". All of those factors lead to the conclusion that in next generations we observe a kind of trend that leads to abatement of the age of sexual initiation [7, 8]. The earliest risks associated with teen sexual activity include: increasing prevalence of pregnancies among juveniles and related with them health and social consequences for the young mother, the father of the child and the family, and what is more the prevalence of sexually transmitted diseases [2, 9, 10, 11]. Therefore, there is a need to prevent this type of disadvantageous, both from a medical and socioeconomic point of view,(situations??). The aim of the study was to recognize the sexual behaviour of young people and the most popular sources of knowledge regarding such behaviours.

5 Material and methods The study involved 258 people who are students of classes III junior high schools and high schools. Criterion for inclusion in the study was age between 15 and 19. Sampling was chosen by method of simple random sampling (the class was a unit of selection) with stratification on the type of school. The study was conducted in the period from January to April 2013, using the auditorium questionnaire in selected classes, after obtaining the consent of the school administrators, students and their parents. The study was performed in compliance with the Declaration of Helsinki, and had been approved by the Ethical Committee of the Polish Midwives Association (permission No. V/EC/2012/PMA). Those participating in the study were informed that the surveys were voluntary and anonymous and the results would be used only for scientific purposes. The studies used diagnostic survey method using the questionnaire technique. Author's research instrument was a questionnaire, which used a standardized questionnaire with questions of research on health behaviour of school students - YRBS (Youth Risk Behaviour Survey) [12]. The obtained results of the study were submitted for statistical analysis. Statistical studies were conducted on the basis of computer software STATISTICA 9.0 (StatSoft, Poland). The level of significance is p <0.05. Results Table 1 shows the socio-demographic data of 258 people participating in the study, 135 girls (52.3%) and 123 boys (47.7%), of which the majority of respondents were aged 16 years (34.9), living in rural areas (42,2%), together with their parents (83.3%), learners in secondary school (53.1%). Table 1. Socio-demographic data of the young people Socio-demographic data of the young people N % Sex Female ,3 Male ,7 Age ,0 34,9 27,9 19,0 13,2 Place of residence Type of school Countryside City to 10 thousand residents City of thousand residents City thousand residents Secondary school High school Technical school ,2 5,8 12,4 39, , , ,7

6 Yes ,3 Living with parents Only one parent Not ,6 3,1 In the examined group, the start of sexual intercourse was declared by 38.4% of adolescents. The average age at which the respondent began the sexual intercourse is years. The sexual intercourse had already began more than a third of 16-year-olds (35.4%), two-fifths form of 15-year-olds (20.2%) and 17 year olds (22.2%). The experience of sexual initiation at age 14 or earlier declared one in ten (12.1%) and 10.1% of 18-year-olds. Figure 1. Age of undertaking a sexual initiation Table 2. Type of school and the experience of sexual initiation The experience of sexual initiation Type of school Secondary school High school Technical school TOTAL N % N % N % N % Yes 12 35, , , ,4 Not 22 64, , , ,6 TOTAL , , , ,0 Chi 2 =12,00458 C=0,21 p=0,00247 The research showed a significant association between the type of school, and experience sexual initiation (p <0.05). More than half of students (52.9%) from the technical school and 35.3% of secondary school students had already the first sexual intercourse, while 70.1% of high school students have not yet experienced sexual initiation.

7 Figure 2. Motives for starting the sexual intercourse The most common motive, for starting sexual intercourse, by youth that took part in the research, was love (46.5%). More than one-fifth did it because of curiosity (21.2%) or because of the sense of maturity (19.2%). The answer " this is so exciting that I want to do it " chose 7.1% of the respondents. The least chosen answers were the prospect of forced temporary parting (2%) and pressures of experienced friends (2.0%). 2% of respondents did not grant the answers. Table 3 shows the characteristics of the sexual behaviour of the respondents. The most commonly used forms of sexual behaviour used by youth are: sexual intercourse (74.4%) and oral sex (41.4%). The respondents most frequently use condoms (83.8%) as a method of preventing pregnancy. More than one-fifth of respondents are taking birth control pills (24.2%), and 15.2% use rejected sexual intercourse, natural methods were chosen by 7.1% of respondents, and 4 0% of youth people chose other methods. During a sexual intercourse 8.1% of respondents did not use any method of contraception. More than half of participants (55.5%) declared that they had sexual intercourse with one partner, one-fifth (20.2%) with two partners, one in ten (10.1%) with three partners. Nearly half (49.6%) of the young people do not masturbate and never did, more than two-fifths (41.9%) of respondents stimulates their genitals in order to induce sexual pleasure, while 8.5% did not understand vocabulary used in survey. In the majority of cases, youth perceive sex as a complement to love (65.1%) or pleasure (51.2%).

8 Table 3. Characteristics of sexual behaviour of respondents Characteristics of sexual behaviour of respondents Forms of sexual behaviour N %* sexual intercourse oral sex petting anal sex necking I do not understand the vocabulary ,7 41,4 18,2 14,1 4,0 19,2 Number of sexual partners N %* or more ,5 20,2 10,1 3,0 12,1 Masturbation N % Yes Not I do not understand the vocabulary ,9 49,6 8,5 The methods used to prevent pregnancy N %* Condom Birth control pills Rejected sexual intercourse Natural methods Other methods I do not use any methods ,8 24,2 15,2 7,1 4,0 8,1 ** Values do not sum to 100% due to the possibility to choose multiple answers Table 4. Masturbation and sex of respondents Sex Masturbation Woman Man TOTAL N % N % N % Yes 24 22, , ,0 No 96 75, , ,0 I do not understand the vocabulary 15 68,2 7 31, ,0 TOTAL , , ,0 Chi 2 =67,831 C=0,46 p=0, Respondents who declare masturbation are predominantly boys (77.8%). In the group of people who claim that they do not masturbate are primarily girls (75.0%). More than half

9 of girls (68.2%) and 31.8% of boys do not understand the vocabulary. The observed differences were statistically significant (p <0.05). Figure 3. Sources of knowledge from which young people draw information about sexuality The most common source of knowledge from which young people draw information about sexuality is the Internet (69.0%), for one-third of respondents are lessons "Education for family life" (32.9%), while 31.4% of respondents point their parents and TV (31, 4%). The other answers that young people mention are magazines (24.0%), partner (21.7%), teacher (12.4%), siblings (12.4%). The low percentage of young people gain knowledge from medical personnel (7.0%), another family member (6.6%) or priest (3.5%).

10 Table 5. Lesson "Education for family life" as a source of knowledge about sexuality Knowledge derived from lesson "education for family life" Woman Sex Man TOTAL N % N % N % Yes 55 64, , ,0 No 80 46, , ,0 TOTAL , , ,0 Knowledge derived from lesson "education for family life" Chi 2 =7,7885 Secondary school C=0,17 p=0,00525 Type of school High school Technical school TOTAL N % N % N % N % Yes 6 7, , , ,0 No 28 16, , , ,0 TOTAL 34 13, , , ,0 Chi 2 =6,8964 C=0,16 p=0,0318 Statistical analysis showed that the lesson "Education for family life" is a source of knowledge about sexuality for more than half of girls (64.7%) and more than one-third of boys (35.3%). The observed differences between the groups were statistically significant (p <0.05). The lesson "Education for family life" is treated as a source of knowledge about sexuality by more than half of high school students (63.5%), 29.4% of students in technical school and a small percentage of secondary school students (7.1%). The statistical analysis revealed statistically significant differences (p <0.05). Discussion On the cusp of the last century, social and biological changes significantly accelerated the age of sexual initiation. Sexual intercourse earlier treated as a determinant of the transition to the adult world currently has changed its meaning. There has been a significant reduction for the acceptance of the age of sexual experiments among young people [13, 14]. Teens are part of a population with a high frequency of risky behaviour, often causing problems with sexual and reproductive health [15]. Early sexual initiation has a negative impact on the perception of oneself, and in the later years of life influences state of being and sexual behaviour [16]. Regarding the normative age of first intercourse literature does not provide specific information, it only draws attention to the importance of biological, psychological, sexual and social maturity, which determines the start of erotic life [6, 14]. In the examined group,

11 38.4% of adolescents said they had sexual intercourse. More than a third of 16-year-olds (35.4%) started their sexual life. One in five of 15-year-old (20.2%) and one in five of 17- year-old (22.2%) experienced sexual initiation. Experience of sexual initiation at the age of 14 years or less declares one in ten (12.1%) and 10% of 18-year-olds. The average age of interviewed young people at which they started sexual intercourse is years. Results of our research are similar to the results in the source literature, but they suggest that the average age of sexual initiation of the respondents is slightly higher than in other countries, and what is more, in Poland there is relatively more young people who had not yet started sexual intercourse, than in other countries [17, 18, 19, 20, 21, 22]. This is confirmed by the results of the international report concerning the health behaviour of young people conducted by the HBSC (Health Behaviour in School-aged Children. WHO Collaborative Study) in among 15-year-olds. They show that the Polish youth is in the penultimate place among 15- year-olds who have experienced sexual initiations - respectively 13% girls, 19% boys [23]. Sexual activity of adolescents does not end at sexual initiation. Young people engage themselves in more and more different forms of intimate intercourse with their partners, which include not only petting, but also oral and anal sex [24]. Our research shows that the most common form of sexual behaviour with a partner is an intercourse (74.7%) and oral sex (41.4%). A small percentage of respondents indicated petting (18.2%) and anal sex (14.1%), while 19.2% did not understand the vocabulary used in the question, which indicates a lack of adequate knowledge. You can also presume that young people used some form of behaviour without the knowledge of the nomenclature. Low awareness, limited knowledge and lack of responsibility linked with intercourse is associated with risk factors for both partners [25, 26]. Young people who are have even a little awareness of the potential danger do not relate this to their own. They do not think about the present dangers and future consequences such as: unplanned pregnancy and its health and social consequences, the instability of marriages contracted because of pregnancy, increasing risk of abortion as a result of unwanted pregnancy, psychological problems in the form of low self-esteem, depression, making having sexual relations with many partners, problems and dissatisfaction associated with sexuality in adulthood as a consequence of negative, involuntary and not acceptable intercourse experiences during adolescence, the experience of traumatic sexual experiences asocciated with violence (rape, harassment, various forms of sexual perversion ), adverse impact on female gynaecologic condition due to the lack of prevention of cervical cancer and sexually transmitted diseases [15, 26, 27, 28].

12 More than half of the respondents declare that they had one sexual partner (55.5%), one in five (20.2%) had so far two partners, one in ten had three (10.1%), and 12.1% had five or more partners. The source literature shows that the amount of sexual partners is connected with gender, place of residence and family wealth according to FAS scale. Place of residence twice affects the probability of sexual intercourse among the group of girls living in the city than the ones living in rural areas. Twice often the sexual intercourse is started by boys from wealthy families [15]. The analysis of the studies shows that the experience of sexual initiation is affected by the type of school. Among youth who their first sexual intercourse have behind them, more than half are the pupils from the technical school (52%), more than one-third are secondary school pupils (35.3%), and one third of them are high school students(29.9%). Woynarowski's study also shows that the risk of early initiation is twice as high among specific type of high school students and vocational school students and it is five times higher in vocational schools than in the high schools [15]. Analysis of our research showed that half (49.6%) of the young people do not masturbate, in contrast to 41.9% of the respondents. It has been noticed that gender has an influence on the process of masturbation (p = ). The number of boys (77.8%) who masturbate is much more bigger than the number of girls (22.2%). As it is clear from many studies - the main and sometimes the only form of sexual behaviour which enables to achieve orgasm is masturbation. In their study, Beisert (1991) and Izdebski (2000) report that 60-90% of boys and 1-40% of girls admit that they masturbate. This difference arises from higher sexual arousal of young men, and higher social acceptance [29, 30]. It is believed that masturbation is conditional in its character, it depends on the age, the duration and the circumstances in which a person benefits from it [1]. In their study, Izdebski and Ostrowska (2003) showed that such belief prevails not only among youth, but also adults. Laqueur (2006) reported that masturbation is considered as a "lesser evil", its admissibility is modified by the context in which it occurs [29, 30]. According to Beisert (2006), this form of sexual behaviour is rejected by those less educated,those who live in smaller towns and those more religious [13]. Intercourse with or without ineffective protection increases the risk of unwanted pregnancy, the risk of infection with sexually transmitted diseases and other serious short- and long-term health and social problems connected with them[31]. The Central Statistical Office reported that in 2012 there were 15,704 live births among girls up to 19 years old, and 3756 of which concerned the girls up to 17 years old [32]. The results of our research concerning the use of birth control methods confirm the data of other researchers [15, 33, 34]. From our analysis arise the conclusion that the most common method of contraception among the young people

13 is a condom, it is used by eight out of ten young people (83.8%). More than one-fifth of the respondents use the contraceptive pills (24.2%), 15,2% admit to the pull-out method, 7.1% natural methods of birth control, and 8.1% did not use any methods. Also, Woynarowski's study (2008) shows that 17% of teens have not used any method of contraception or they have not been sure if they used any methods. Two-fifths of respondents (41%) have chosen the method of low effectiveness (pull-out method or natural methods of birth control) [15]. Comparing Woynarowski's(2008) and Wenzel's (1999) studies to our own research, we can assume that the proportion of young people who do not use any method of contraception or they are using methods of very low effectiveness have halved over the last several years [15, 35]. The use of condoms as a method of contraception still stay at a very high level. Presumably, the reason for this phenomenon is the effortlessness of access and usage, a good effectiveness and relatively low price of condoms. The respondents asked about the source of knowledge about sexual behaviour frequently pointed mass media - the internet (69.0%) and television (31.4%). Many authors agree that the knowledge obtained by the majority of young people from the mass media is often unreliable and chaotic. Youth operates language, which they often do not understand what creates a false impression of high education, and information held by them are often full of distortions and understatements [36, 37, 38]. Despite the fact that the subject "Education for family life" has been included to the school's curriculum in 1999, our study shows that those lessons are source of knowledge about sexuality for one-third of respondents (32.9%). This source of knowledge is most commonly used by girls (64.7%) and high school students' (63.5%). 31.4% of respondents indicated their parents as a source of knowledge about sexuality. The results of studies conducted in 2011 by the Group of Sex Educators "Ponton" entitled "How do you know? How does sex education look in Poland "are consistent with the results of our own. The report shows that 44.5% of respondents do not talk with their parents about sexuality, first intercourse, contraception and sexual orientation [37]. Despite the fact that more than half (55%) of young people who had talked with their parents about sexuality, admitted that they had unsatisfactory conversation which took place too late or too early. Parents often transferred their basic, incomplete, sometimes false and even superstitious knowledge to their children [37]. The theories presented above in the available literature, as well as our research, confirms the veracity of the claim that that parents should be a good or a common source of information on methods of preventing pregnancy and sexuality.

14 The paradox seems to be the fact that the vast majority of Polish people claim that the obligation to sex education reside in parents, but every fifth respondent shifts this responsibility to the school [35, 36, 37]. Conclusions 1. The most common sexual behaviour of the young people are sexual intercourse and oral sex. 2. Most of young people, studying in technical college, start their active sexual life at the age of The most common source of knowledge from which young people take information about sexuality are internet, lessons of "Education for family life", parents and the TV.

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