Many teens, young adults unaware of risks tied to unprotected oral sex
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In a recent survey, more than 20% of teenagers and young adults said that a lack of education was the reason why many youths do not use protection when engaging in oral sex.
Before the survey, the most recent data on youths’ knowledge of oral sex were more than 10 years old, according to researchers. As rates of sexually transmitted infections are increasing, “there is a critical need to understand what a contemporary sample of youths know about oral sex and its associated risks, as well as what the barriers are to using protection,” Arianna Strome, a student at the University of Michigan Medical School, and colleagues wrote in Annals of Family Medicine.
The researchers analyzed responses to a text message-based survey from 909 youth aged 14 to 24 years (58.2% aged 18 to 24 years; 58.7% female; 58.1% non-Hispanic white). The survey included four questions that assessed the respondents’ perceptions of oral sex and barriers to protection. The final analysis, depending on the question, included answers from 855 and 893 survey participants.
When asked why few youths use protection during oral sex, most respondents (22.4%) cited a lack of education on the dangers of unprotected oral sex. Other reasons included a lack of perceived risk (19.8%), concerns about decreased sensation or pleasure (19.3%), no pregnancy risk (15.7%) and lack of access or money to buy condoms or dental dams (11.6%).
When asked about the risks, 8.2% of respondents said that unprotected oral sex carried no STI risk and 20.2% reported that unprotected oral sex was “very risky.” Overall, 88% of respondents knew that unprotected oral sex may cause STIs and other diseases, while 5.7% said the behavior was “not risky.” About half (53.7%) said that better education might help more youths use condoms or dental dams during oral sex. Some also suggested normalizing protection in popular culture and making condoms and dental dams “taste and feel better” (19.1%), lowering the cost of protection (15%) and having more protection options (10.5%).
According to the researchers, the findings support previous studies that showed adolescents engage in oral sex for physical pleasure and because it is associated with lower risks compared with vaginal sex.
The new results “suggest a continued need for more comprehensive and inclusive sex education,” Strome and colleagues wrote in Annals of Family Medicine. “Programs and policies developed with the experiences and preferences of youths in mind may be more successful in increasing protection use and subsequently decreasing rates of STI transmission and HPV-related head and neck cancer.”
Perspective
Back to TopThis is useful information about how youths understand the risks of oral STIs, how they weigh these risks in making sexual choices, and what might help them use protection. But while the authors focus on encouraging youth to use protection during oral sex, we would probably have more impact by focusing on decreasing overall youth (and adult) STI incidence and improving STI services.
A major focus should be on implementing the STI National Strategic Plan 2021-2025. This plan highlights the high STI vulnerability of adolescents, particularly Black, Hispanic and Asian Islander/Asian Pacific populations (all underrepresented in this study) and emphasizes a health equity approach that is sexual health positive. The paper did not include analysis of gender identity or sexual orientation, but high STI rates in gay and bisexual men and gender-diverse individuals require a non-stigmatizing approach to STI education and services. Stigma perpetuates STIs.
We must ensure convenient, free and nonjudgmental access to screening and treatment for all STIs, HPV vaccinations and HIV pre-exposure prophylaxis if needed. Home testing, point-of-care testing, school health services and mobile outreach should be expanded. We have done an abysmal job of providing routine chlamydia screening to girls but also of vaccinating our youth against HPV, with 39% receiving two doses and 61% just one dose, while neighboring Canada boasts an 83% rate for two doses. The impact of HPV vaccination far exceeds that of condoms and dental dams — even if we could increase their use. Youths actually want these vaccinations when educated about their benefit, even if some parents have reservations.
Ideally, STI services occur in an integrated one-stop health care shop, but many youths (and adults) lack health insurance or primary care providers, particularly in Medicaid non-expansion states. Additionally, health care providers need training — bolstered by incentives and state-level requirements for training — to assist and encourage them to offer evidence-based, stigma-free sexual health prevention and treatment services to all populations.
The longstanding underfunding of public health systems and our dwindling workforce, worsened by COVID-19, also drastically undercut access to STI services. Cost was noted as a barrier by 15% of this cohort but is likely much higher among minority populations not robustly represented in this sample. We simply will not end the STI epidemic without STI screening, care and treatment without cost to the recipient.
Teacher education and curriculum development for evidence-based, stigma-free, comprehensive sexual health education must be addressed at federal and state levels, but also by local school boards where direct advocacy can be highly impactful — for better or for worse. Direct-to-youth availability of high-quality online and social media sources should also be a priority and could be instituted at the federal level. (Perhaps a Tik-Tok sexual health channel?) Easy access to parental education materials is also important, including nonjudgmental training on how to talk about the taboo subjects of sexual health and sexuality.
Finally, as the authors note, we need better STI prevention methods, requiring more federal, state and private funding for research on STI vaccines, antimicrobial prophylaxis, and novel delivery methods. Youths cannot do this alone, and condoms and dental dams just are not good enough — even for the small numbers of youth who will actually use them.
References:
Bruni L, et al. Prev Med. 2021;doi:10.1016/j.ypmed.2020.106399.
STI strategic plan. https://www.hhs.gov/sites/default/files/STI-National-Strategic-Plan-2021-2025.pdf. Accessed Feb. 14, 2022.
HIV physician, researcher and policy advocate in Atlanta Past chair, HIV Medicine Association
Co-chair, HIV Medicine Association/Infectious Diseases Society of America HIV Primary Care Guidance
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