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Teen girls: sexual orientation is not always a predictor of sexual behaviour
Apr 8, 2016 by Marion Doull, Postdoctoral Research Fellow, UBC School of Nursing, and Elizabeth Saewyc, Professor, UBC School of Nursing & Executive Director, Stigma and Resilience Among Vulnerable Youth Centre
Previous research has documented that lesbian and bisexual adolescent girls are at higher risk of engaging in a range of sexual behaviours compared to heterosexual girls. Less is known about the behaviours of adolescent girls whose sexual identities fall outside the lesbian, bisexual, and heterosexual categories.
The purpose of this study was to document and compare the sexual behaviours of adolescent girls in the United States who identified as lesbian, bisexual, questioning, unsure or other, and heterosexual.
The study asked about four consensual sexual behaviours: oral sex, sex involving a finger or sex toy going into the vagina or anus, penile-vaginal sex, and penile-anal sex.
The survey also asked about age at first sexual intercourse, the gender of sexual partners, the number of sexual partners (lifetime and past year), consistent condom use and whether barriers were discussed before first sex.
The data for the study were drawn from the Teen and Technology Study, an online survey of girls ages 13-18 years in the United States (N=2,823).
About half of the girls in the study – lesbian, bisexual, straight and questioning/unsure – reported engaging in sex, including oral sex and vaginal or anal sex with a finger or sex toy. Of those who had engaged in sex, one in five lesbians and four in five bisexual girls reported a recent male partner. Thus, sexual orientation does not always predict the type of sex girls are having and who they are having sex with.
Lesbian girls reported a higher lifetime prevalence of sexual behaviours that have lower risk for STIs, such as sex with a sex toy or finger. They were less likely to report penile-anal sex as compared to heterosexual girls. However, lesbian girls were just as likely as heterosexual girls to report engaging in penile-vaginal sex, and importantly, were younger at first sex than heterosexual girls.
Lesbian girls were six times more likely to report inconsistent condom use, and 80% less likely to discuss barriers before sex with their most recent partner, compared to heterosexual girls.
Compared to lesbian girls, bisexual girls were more likely to report a recent male partner, report penile-vaginal and penile-anal sex, were more likely to discuss barrier use before sex with their most recent partner, and were less likely to report inconsistent condom use. Both lesbian and bisexual girls reported more sexual partners than heterosexual girls.
Bisexual girls were three times more likely to report ever engaging in penile-vaginal sex and four times more likely to report engaging penile-anal sex than heterosexual girls.
There were few differences between the reported behaviours of questioning/unsure/other girls and heterosexual girls.
Implications for practice
Health care practitioners should not assume that sexual orientation and sexual behaviours align. These findings reveal that lesbian girls are also having sex with guys, and are less likely to report consistent condom use or communication about barrier use in their sexual encounters.
Higher risk behaviours such as early sex, penile-vaginal and penile-anal sex, were more common among lesbian and bisexual girls (respectively). Health care providers need to ask about sexual orientation when screening adolescent girls for sexual practices.
Sexual health promotion and education needs to be inclusive of all sexual orientations and sexual behaviours. Lesbian and bisexual girls need specific education and health promotion information about girl-to-girl sex behaviours, including awareness about STI transmission between girls, and the need to use barriers, such as condoms on sex toys, or dental dams for oral sex. They also need skills in condom use and negotiation, and information on pregnancy prevention.
The study findings underscore that adolescence is a period of identity development and exploration. Lesbian and bisexual girls may be engaged in other-sex behaviours while exploring their identities, or to manage social pressures or stigma surrounding their identities. Health care providers should question their own assumptions about sexual orientation and sexual behaviours to engage effectively with young people about healthy sexuality.
While the study is based on US data, data from the BC Adolescent Health Survey are very similar, and highlight the higher prevalence of risky sexual behaviours among lesbian and bisexual girls.
For more information
For more information on this study, please contact Elizabeth Saewyc.
Ybarra, M.L., Rosario M., Saewyc E., Goodenow C. (2016). Sexual behaviors and partner characteristics by sexual identity among adolescent girls. Journal of Adolescent Health; 58: 310-316. DOI: http://dx.doi.org/10.1016/j.jadohealth.2015.11.001
Categories: New knowledge