Sexual behaviour of youth and sources of knowledge about such behaviour

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1 JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE No. 4/2015 (31-37) 31 Sexual behaviour of youth and sources of knowledge about such behaviour (Zachowania seksualne młodzieży oraz źródła wiedzy dotyczące takich zachowań) A Bień 1,A,C,D, S Stadnicka 2,B, G Iwanowicz-Palus 1,E,F 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 thirdgrade students of lower-secondary and upper-secondary s. 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 analysed group, 38.4 per cent of young people declared that they had already had sexual intercourse. The average age at which the respondents became sexually active was Over one-third of 16-year-olds (35.4%) stated that they had already had their first sexual intercourse. More than half (52.9%) of secondary technical students and 35.3 per cent of lower-secondary students had already had their first sexual intercourse, and 70.0 per cent of the young people that had not yet become sexually active were upper-secondary students. The most common forms of sexual behaviour mentioned by the respondents included sexual intercourse (74.4%) and oral sex (41.4%). The respondents usually use condoms (83.8%) as a method of contraception. 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 are 16-year-old secondary technical 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. 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%). Ponad połowa (52,9%) uczniów z technikum odbyła już pierwszy stosunek płciowy oraz 35,3% gimnazjalistów, natomiast 70,0% uczniów, którzy nie przeżyli jeszcze inicjacji seksualnej to licealiści. 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. Author Affiliations: 1. Independent Workshop of Midwifery Skills, Faculty of Nursing and Health Sciences at the Medical University of Lublin 2. Student s Research Club at the Independent Workshop of Midwifery Skills, Faculty of Nursing and Health Sciences at the Medical University of Lublin Authors contributions to the article: A. The idea and the planning of the study B. Gathering and listing data

2 32 C. The data analysis and interpretation D. Writing the article E. Critical review of the article F. Final approval of the article Correspondence to: Agnieszka Bień MD PhD, Independent Workshop of Midwifery Skills, Faculty of Nursing and Health Sciences at the Medical University of Lublin, Staszica 4-6 Str.,PL Lublin, Poland, Accepted for publication: October 9, The risks related to the early sexual activity of teenagers are above all: increased occurrence of teen pregnancies and the resulting health and social consequences for the young mother, father and family as well as contracting sexually transmitted disease [4, 11-13]. Therefore, it is necessary to prevent such situations which are unfavourable both from the medical and socio-economic point of view. 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. II. MATERIALS AND METHODS T I. INTRODUCTION he first ten-odd years are the foundation of adult sexuality. The intrapsychic and behavioural aspects of development depend on the parents and environment in which young people are raised. Adolescence is a stage of intense quantitative and qualitative development significantly influenced by the endocrine system, in which an intense production and expression of sex hormones takes place. The biological processes of that period have an impact on sexual behaviour rendering it labile, changeable and immature [1-3]. Sexual activity of adolescents is of great importance to their future development. The forms of such activity may be more or less mature. It is in adolescence that we start to have sexual needs and gain experience in this area [4,5]. The increasing sexual tension is initially reduced by masturbation and later by more mature forms of sexual behaviour petting and intercourse [6]. According to Imieliński sexual activity consists of actions aimed at obtaining sexual satisfaction or leading to it (preparatory activity) as well as actions satisfying sexual needs or reducing sexual tension (satisfying activity) [7]. Obuchowski, in turn, notes that: sexual activity is the result of sexual characteristics of a person, which have been forming in that person since the beginning of their life. They shape individually and their scope of forms is so large that what prevents sexual satisfaction for one person may be a necessary condition for another [1]. Sexual initiation is one of the most important events in everybody s life, although it is usually of different meaning to women and men. In each case, however, it means crossing a border and symbolises entering into adulthood [6,7,8]. The ever-earlier development of children manifesting itself in rapid physical growth, freedom and independence from their parents as well as a change in customs caused by the so-called sexual revolution contribute to the fact that sexual initiation tends to occur at an earlier age in subsequent generations [9,10]. The research was conducted on 258 third-grade students of lower-secondary and upper-secondary s. The inclusion criterion was age between 15 and 19. The sample was selected using the cluster sampling method (a class being a sampling unit) with stratification according to type. The research was conducted from January to April 2013 using the auditorium questionnaire method in selected classes after receiving the informed consent of head teachers, students, and their parents. People taking part in the study were informed about its voluntary and anonymous character as well as the use of results for scientific purposes only. The diagnostic survey method was used in the research with the questionnaire technique. The tool used in the research was a questionnaire designed by the author, which included questions from the standardized Youth Risk Behaviour Survey YRBS The results of the author s research were subjected to statistical analysis. Statistical research was based on STATISTICA 9.0 computer software (StatSoft, Poland). The adopted level of statistical significance was p<0.05. III. RESULTS Table 1 presents the socio-demographic data of the 258 respondents: 135 girls (52.3%) and 123 boys (47.7%), most of whom were aged 16 (34.9%), and who predominantly lived in the country (42.2%), with their parents (83.3%), and went to a general upper-secondary (53.1%).

3 33 Table 1. Socio-demographic data of the adolescent respondents Sex Age Place of residence School type Living with parents Socio-demographic data N % female male country town of up to 10,000 inhabitants town of 10,000 to 100,000 inhabitants city of 100,000 to 500,000 inhabitants lower-secondary general upper-secondary secondary technical yes with one parent only no In the analysed group, 38.4 per cent of young people declared that they had already had sexual intercourse. The average age at which the respondents became sexually active was Sex life had been initiated by over one-third of 16-year-olds (35.4%). The remaining two-fifths are comprised of 15-year-olds (20.2%) and 17-year-olds (22.2%) respectively. Sexual initiation at the age of 14 or earlier was declared by every tenth respondent (12.1%) and at the age of 18, by 10.1%. Sexual initiation Table 2. School type and sexual initiation Lowersecondary School type General uppersecondary Secondary technical N % N % N % N % Yes No TOTAL Chi 2 = C=0.21 p= The research has demonstrated a significant correlation between the type of and sexual initiation (p<0.05). More than half (52.9%) of secondary technical students and 35.3% of lower-secondary students had already had their first sexual intercourse, and 70.0% of young people who had not yet become sexually active were upper-secondary students. The most frequent motive for initiating sex life by the respondents was falling in love (46.5%); over one-fifth had done it out of curiosity (21.2%) or due to the fact that they felt mature enough (19.2%); the answer it s so much fun that you just have to try it was selected by 7.1% of the respondents, whereas the least frequent groups pointed to the prospect of a temporary separation (2%) and the pressure exerted by experienced friends (2.0%). 2 per cent of the respondents did not give any answer. Table 3 presents the characteristics of the respondents sexual behaviour. The most common forms of sexual behaviour mentioned by the respondents included sexual intercourse (74.4%) and oral sex (41.4%). The respondents usually use condoms (83.8%) as a method of contraception. Over one-fifth take contraceptive pills (24.2%), 15.2% practise coitus interruptus, whereas natural methods are chosen by 7.1% and other methods by 4.0% of youth. 8.1% of the respondents do not use any method of contraception during sex. More than half of the respondents (55.5%) declared that they had had one sex partner so far, one-fifth (20.2%) had had two, and every tenth respondent (10.1%) had had three partners. Almost half (49.6%) of the youth surveyed do not masturbate and they have never done it, over two-fifths (41.9%) stimulate their sex organs to obtain sexual pleasure, while 8.5% did not understand the vocabulary used in the questionnaire. Most frequently, the adolescent respondents considered sex as complementary to love (65.1%) or as pleasure (51.2%). Table 3. Characteristics of the respondents sexual behaviour Characteristics of the respondents sexual behaviour Forms of sexual behaviour N %* sexual intercourse oral sex petting anal sex necking I don t understand the vocabulary Number of sex partners N %* or more Masturbation N % yes no I don t understand the vocabulary Methods of contraception used N %* condom contraceptive pills coitus interruptus natural methods other methods I don t use any methods *The values do not add up to 100% because it was possible to select several answers

4 34 Masturbation Table 4. Masturbation and respondent s sex female Sex male TOTAL N % N % N % Yes No I don t understand the vocabulary TOTAL Statistical analysis has revealed that Family Life Education lessons are a source of knowledge about sexuality for over half of the girls surveyed (64.7%) and one-third of the boys (35.3%). The differences found between the groups studied were statistically significant (p<0.05). Family Life Education is treated as a source of knowledge about sexuality by over half of upper-secondary students (63.5%), 29.4% of secondary technical students and an insignificant percentage of lower-secondary students (7.1%). Statistical analysis has revealed significant differences (p<0.05). Chi 2 = C=0.46 p= The respondents who admit to masturbating are predominantly men (77.8%). The group of respondents who claim that they do not masturbate are mostly girls (75.0%), while over a half of girls (68.2%) and 31.8% of boys do not understand the relevant vocabulary. The differences found were statistically significant (p<0.05). The most popular source of knowledge about sexuality for youth is the Internet (69.0%). One-third of respondents pointed to Family Life Education classes (32.9%), whereas 31.4% mentioned parents and television. Other answers included magazines (24.0%), partner (21.7%), teacher (12.4%), and siblings (12.4%). A low percentage of young people benefited from the knowledge of medical personnel (7.0%), another family member (6.6%) or a priest (3.5%). Table 5. Family Life Education classes as a source of knowledge about sexuality Knowledge obtained during Family Life Education classes female Sex male TOTAL N % N % N % Yes No TOTAL Knowledge obtained during Family Life Education classes Chi 2 = C=0.17 p= Lowersecondary School type General uppersecondary Secondary technical TOTAL N % N % N % N % Yes No TOTAL Chi 2 = C=0.16 p= IV. DISCUSSION Over the last century, social and biological changes have significantly accelerated sexual initiation. Sexual intercourse, earlier treated as a symbol of transition into the adult world, is not treated in such a manner anymore. A significant reduction in the age of sexual experimentation among young people has occurred [15, 16]. Teenagers are a part of population with a very high likelihood of risky behaviours, often leading to sexual and reproductive health problems [17]. Early sexual initiation has a negative influence on self-perception, subsequent well-being and sexual behaviour in further life [18]. As far as a normative age of the first sexual intercourse is concerned, literature does not provide specific data however, emphasis is placed on the meaning of biological, psychological, sexual and social maturity, which determines erotic initiation [8, 16]. In the analysed group, 38.4% of young people declared that they had already had sexual intercourse. Sex life had been initiated by over one-third of 16-year-olds (35.4%), every fifth person aged 15 (20.2%), and every fifth person aged 17 (22.2%). Sexual initiation at the age of 14 or earlier was declared by every tenth respondent (12.1%), and at the age of 18, by 10.1%. The average age at which the respondents became sexually active was The results of the author s own study are similar to the results found in literature of the subject, although a conclusion may be drawn that the average age at which the respondents began their sex life is somewhat higher than in other countries, and there are relatively more young people in Poland who have not had sexual intercourse compared to other countries [19-24]. This is also confirmed by the results of an international report on the health behaviour of youth conducted by HBSC (Health Behaviour in School-aged Children WHO Collaborative Study) in the years among 15-year-olds. According to the study, Polish youth occupy the penultimate

5 35 place among 15-year-olds who have initiated sex life 13% of girls and 19% of boys [25]. The sexual activity of teenagers is not limited to sexual initiation. Youth engage in various forms of intimate activities with their partners which do not only consist of petting but also oral and anal sex [26]. The author s own study demonstrates that the most frequent forms of sexual behaviour engaged in by the respondents with their partners are sexual intercourse (74.7%) and oral sex (41.4%). A small percentage of the surveyed pointed to petting (18.2%) and anal sex (14.1%), whereas 19.2% did not understand the vocabulary used in the question, which points to a lack of relevant knowledge. It may also be presumed that teenagers engage in some forms of behaviour without knowledge of the relevant nomenclature. Low awareness, inadequate knowledge and a lack of responsibility associated with sexual intercourse contribute to risk factors for both partners [27, 28]. Youth who are aware of the potential risk to a small degree at least do not relate it to themselves. They do not consider the present risks and future consequences such as unplanned pregnancy and the associated health and social effects, the instability of marriage entered into due to pregnancy, the increased risk of abortion as a result of unwanted pregnancy, psychological issues in the form of low self-esteem, depression, sexual intercourse with multiple partners, lack of satisfaction with sex life in adulthood as a result of negative experiences such as forced and unaccepted intercourse in adolescence, traumatic experiences related to violent sexual acts (rape, sexual harassment, and various forms of sexual deviations), and finally the adverse impact on the gynaecological health of girls due to the lack of cervical cancer and STD prevention [17, 28-29]. More than half of the respondents admit to having had at least one sex partner (55.5%), every fifth person (20.2%) has had two partners so far, every tenth teenager has had three (10.1%), and 12.1% mentioned five or more sex partners. Literature of the subject demonstrates that the number of sex partners depends on the respondent s gender, place of residence and his or her family s financial status according to the FAS scale. The effect of place of residence is such that girls living in urban areas are twice as likely to engage in sexual intercourse as girls living in rural areas. Boys from wealthy families are twice more likely to have sex [17]. The author s own study indicates that the type of has an influence of sexual initiation. From adolescents who have already had their first sexual intercourse, more than half are secondary technical students (52%), over one-third are lower-secondary students (35.3%), and every third person is an upper-secondary student (29.9%). It also results from the research by Woynarowska that the risk of early initiation is twice higher for specialised and vocational secondary students and five times higher for vocational students in comparison to general secondary students [17]. The analysis of the author s own material has demonstrated that half (49.6%) of the teenage respondents do not masturbate, whereas 41.9% do. It has been noticed that gender has an influence on engaging in masturbation (p= ). Boys masturbate much more often than girls 77.8% and 22.2% respectively. As various studies demonstrate, the main, and often only form of sexual behaviour leading to orgasm is masturbation. Beisert and Izdebski provide data in their research according to which 60-90% of boys and 1-40% of girls admit to masturbating. Such a discrepancy results from the higher sexual arousal of young men and a higher degree of social acceptance in that respect [31, 32]. Masturbation is believed to be of a conditional character, and it depends on age, duration and circumstances in which the person masturbating is [1]. Izdebski and Ostrowska have proved in their research that this belief is not only popular among teenagers, but also among adults. Laquer states that masturbation is considered as the lesser evil, and its admissibility is modified by the context [31, 32]. According to Beisert (2006), this form of sexual behaviour is rejected by people with less education, inhabitants of small towns, and religious people [15]. Sexual intercourse with contraceptives or without effective contraceptives increases the risk of unwanted pregnancy and contracting sexually transmitted disease, which entails serious short-term and long-term health and social problems [31]. According to the data of the Central Statistical Office of Poland from 2012, there were 15,704 live births given by girls aged up to 19, from which 3,756 were given by girls aged up to 17 [34]. The results of the author s own study concerning the methods of contraception confirm the data provided by other researchers [17, 35, 36]. The author s own study demonstrates that the most frequent method of contraception among the teenage respondents is the condom which is used by eight in ten young people (83.8%). Over one-fifth of respondents use contraceptive pills (24.2%), 15.2% practise coitus interruptus, 7.1% apply natural birth control methods, and 8.1% do not use any methods whatsoever. The research by Woynarowska has also revealed that 17% of teenage respondents did not use any method of contraception or they were not sure whether they did or not, while less effective methods (coitus interruptus and the natural method) were selected by two-fifths of the respondents (41%) [17]. When the author s own research is compared to that of Woynarowska and Wenzel, it may be concluded that the percentage of youth not using any method of contraception or using methods which lack effectiveness has

6 36 decreased by half over the last ten-odd years [17, 37]. The use of condoms as a means of contraception still remains at a very high level. It may be presumed that the reasons for that are the wide availability, considerable effectiveness, and a relatively low price of condoms. When asked about the source of knowledge about sexual behaviour, the respondents usually indicated the mass media the Internet (69.0%) and television (31.4%). Many authors unanimously agree that the knowledge obtained by teenagers from the mass media is frequently unreliable and chaotic. Adolescent use language that they often do not understand, which produces the misleading impression that they posses a high degree of knowledge about sexuality, whereas in fact, the information is often largely false and understated [38-40] Although Family Life Education classes were incorporated into syllabuses in 1999, this subject is mentioned as a source of knowledge about sexuality by one-third (32.9%) of respondents in the author s own study. This source of knowledge is used most often by girls (64.7%) and general upper-secondary students (63.5%). Parents as a source of knowledge about sexuality were indicated by 31.4% of the respondents. The results of research conducted in 2011 by the Ponton Group of Sexual Educators entitled How do you know? What sexual education looks like in Polish homes are in line with the results of the author s own study. The report indicates that 44.5% of the respondents do not talk to their parents about sexuality, first intercourse, contraception, and sexual orientation [39]. Even though over a half (55%) of teenagers surveyed talked to their parents about sexuality, they admitted that the conversations were unsatisfactory and they took place too late or too early. Parents often share basic, incomplete, sometimes false or even superstitious knowledge with their children [39]. The literature available confirms the theories of the above-mentioned research and the author s own study that parents are not, although they ought to be, a reliable and frequent source of knowledge about methods of contraception and sexuality. It seems to be a paradox that even though a vast majority of Poles claim that it is the parents duty to educate their children about sexuality, every fifth respondent shifts the responsibility to [37, 38, 39]. V. 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